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Content for  TR 22.826  Word version:  17.1.0

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1  ScopeWord‑p. 6
The present document focuses on 5G communication services targeting the critical medical applications and enabling wireless connectivity between those applications and medical devices.
Those communication services are often submitted to (but not limited to) very low latency, high reliability, and high availability requirements and may be operated on a shared network infrastructure that also provides resources to other less demanding communication services.

2  References

The following documents contain provisions which, through reference in this text, constitute provisions of the present document.
  • References are either specific (identified by date of publication, edition number, version number, etc.) or non specific.
  • For a specific reference, subsequent revisions do not apply.
  • For a non-specific reference, the latest version applies. In the case of a reference to a 3GPP document (including a GSM document), a non-specific reference implicitly refers to the latest version of that document in the same Release as the present document.
[1]
TR 21.905: "Vocabulary for 3GPP Specifications".
[2]
Digital Imaging and Communications in Medicine (DICOM): supplement 202 (Real Time Video)
[3]
TS 22.104: Service requirements for cyber-physical control applications in vertical domains
[4]
ANSI/AAMI/IEC TIR80001-2-2:2012: Application of risk management for IT- networks incorporating medical devices - Part 2-2: Guidance for the disclosure and communication of medical device security needs, risks and controls
[5]
IEC TR 80001-2-3: Application of risk management for IT-networks incorporating medical devices -- Part 2-3: Guidance for wireless networks
[6]
Allied Market Research. Operating Room Integration Market by Device Type: (Audio & Video Management System, Display System, Documentation & Recording System, and Others), Application (Urology, Surgery, Neuro, and Others), and End User (Hospital and Clinic) - Global Opportunity Analysis and Industry Forecast, 2017-2025.
[7]
J. White. The connected hospital: Wireless technology shapes the future of healthcare - healthcare-information-technology/the-connected-hospital-wireless-technology-shapes-the-future-of-healthcare.html
[8]
Markets and Markets. Wireless Health Market by Technology, Component, Application, & by End Users - Analysis: Available at: http://www.marketsandmarkets.com/Market-Reports/wireless-healthcare-market-551.html. Accessed Jun. 16, 2016.
[9]
M. Perez, F.Quiaios, P. Andrivon, D. Husson, M. Dufaut, J. Felblinger. Paradigms and experimental set-up for the determination of the acceptable delay in Telesurgery: Conference of the IEEE EMBS. August 23-26, 2007.
[10]
Emergency Medicine Journal: The relationship between distance to hospital and patient mortality in emergencies: an observational study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464671/
[11]
TS 22.261: "Service requirements for the 5G system".
[12]
World Health Organization "Global Health Observatory (GHO) data": https://www.who.int/gho/health_financing/en/
[13]
Goldman Sachs Global Investment Research, "Healthcare's Holy Grail: Better Outcomes at Lower Costs," February 2017
[14]
Transparency Market Research: "Wireless Communications/Technologies in Healthcare Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2015 - 2023"
[15]
Giulianotti P, Gorodner V, Sbrana F, Tzvetanov I, Jeon H, Bianco F, et al. Robotic transabdominal kidney transplantation in a morbidly obese patient: Am J Transplant. 2010;10:1478-82.
[16]
Oberholzer J, Giulianotti P, Danielson KK, Spaggiari M, Bejarano-Pineda L, Bianco F, et al. Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation: Am J Transplant. 2013;13:721-8.
[17]
Christopher N, Brian M, Rajni PW L, Christopher M. Pre-clinical remote telesurgery trial of a da Vinci telesurgery prototype: Int J Med Robotics Comput Assist Surg 2008; 4: 304-309.
[18]
Joseph L Dieleman PhD et al, National spending on health by source for 184 countries between 2013 and 2040: The Lancet, 2016
[19]
Karen Taylor, Worldwide: 2017 Global Healthcare Outlook: Making Progress Against Persistent Challenges, 2017
[20]
https://www.statista.com/statistics/671374/global-telemedicine-market-size/
[21]
http://www.bbc.com/future/story/20140516-i-operate-on-people-400km-away
[22]
Towards 5G Enabled Tactile Robotic Telesurgery: Qi Zhang, Jianhui Liu and Guodong Zhao
[23]
https://www.omicsonline.org/open-access/telesurgery-and-robotic-surgery-ethical-and-legal-aspect-2376-0214-1000355.php?aid=54752
[24]
Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016: on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (Text with EEA relevance)
[25]
U.S. Department of Health and Human Services Office for Civil Rights: Health Information Patient Accountability Act (HIPAA) Privacy Rule
[26]
111th Congress of United States of America: Health Information Technology for Economic and Clinical Health (HITECH) Act
[27]
Pre-Hospital Ultrasound: Current Indications and Future Perspectives, Zanatta et al., International Journal of Critical Care and Emergency Medicine 2016, 2:019, Volume 2 | Issue 2, ISSN: 474-3674
[28]
https://www.fourcc.org/yuv.php
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3  Definitions, symbols and abbreviationsWord‑p. 7

3.1  Definitions

For the purposes of the present document, the terms and definitions given in TR 21.905 and the following apply. A term defined in the present document takes precedence over the definition of the same term, if any, in TR 21.905.
Biometric data:
personal data resulting from specific technical processing relating to the physical, physiological or behavioural characteristics of a natural person, which allow or confirm the unique identification of that natural person, such as facial images or dactyloscopic data.
Clock synchronicity:
the maximum allowed time offset within a synchronisation domain between the master clock and any individual UE clock.
Clock synchronisation service:
the service to align otherwise independent user-specific UE clocks.
Communication service availability:
percentage value of the amount of time the end-to-end communication service is delivered according to an agreed QoS, divided by the amount of time the system is expected to deliver the end-to-end service according to the specification in a specific area.
Communication service reliability:
ability of the communication service to perform as required for a given time interval, under given conditions.
Controller:
means the natural or legal person, public authority, agency or other body which, alone or jointly with others, determines the purposes and means of the processing of personal data; where the purposes and means of such processing are determined by Union or Member State law, the controller or the specific criteria for its nomination may be provided for by Union or Member State law
Data Subject:
an individual, of any nationality and age, who is the subject of the personal data
End-to-end latency:
the time that takes to transfer a given piece of information from a source to a destination, measured at the communication service interface, from the moment it is transmitted by the source to the moment it is successfully received at the destination.
Genetic data:
personal data relating to inherited or acquired genetic characteristics of a natural person which give unique information about the physiology or the health of that natural person and which result, in particular, from an analysis of a biological sample from the natural person in question.
Imaging system latency:
the time that takes to generate an image from a source, to apply a certain amount of processing, to transfer it to a destination and then to render the resulting image on a suitable display device, as measured from the moment a specific event happens in the operating field to the moment that very same event is displayed on a screen.
Medical data:
personal data related to the physical or mental health of a natural person, including the provision of health care services, which reveal information about his or her health status.
Non-public network:
a network that is intended for non-public use.
Personal data:
information relating to an identified or identifiable natural person; an identifiable natural person is one who can be identified, directly or indirectly, in particular by reference to an identity such as a name, an identification, location data, an online identifier or to one or more factors specific to the physical, physiological, genetic, mental, economic, cultural or social identity of that natural person
Private slice:
a dedicated network slice deployment for the sole use by a specific 3rd party.
Processing:
obtaining, recording, holding, or carrying out any operation on personal data. It includes organisation or alteration; retrieval or use; disclosure and anonymization, blocking or destruction. Most operations in relation to personal data will constitute processing.
Processor:
a natural or legal person, public authority, agency or other body which processes personal data on behalf of the controller
Survival time:
the time that an application consuming a communication service may continue without an anticipated message.
Teleoperation system latency:
the round trip time that takes to generate control commands at a robotic control console, send those commands over a communication service to a target robot, execute the robot's actuators processes accordingly, sample the new robot system status, transmit that status back over the same communication service and render it to the operator through the control console equipment, measured from the moment the operator performs an action to the moment he can sense the result of that same action.
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3.2  AbbreviationsWord‑p. 9
For the purposes of the present document, the abbreviations given in TR 21.905 and the following apply. An abbreviation defined in the present document takes precedence over the definition of the same abbreviation, if any, in TR 21.905.
BMI
Body Mass Index
CABG
Coronary Artery Bypass Graft
CAGR
Compound Annual Growth Rate
CT
Computed Tomography
DICOM
Digital Imaging and COMmunications
ECG
ElectroCardioGraphy
EHR
Electronic Health Records
ER
Emergency Room
ERC
Emergency Room Center
ESRD
End Stage Renal Disease
GDP
Gross Domestic Product
GDPR
General Data Protection Regulation
HDR
High Dynamic Range
HFR
High Frame Rate
HIPAA
Health Information Patient Accountability Act
HITECH
Health Information Technology for Economic and Clinical Health
LAD coronary
Left Anterior Descending coronary
MRI
Magnetic Resonance Imaging
MSP
Mobile Specialist Practise
MTA
Medical Technical Assistant
OR
Operating Room
RAKT
Robotic Aided Kidney Transplant
RTV
Real Time Video
SDI
Serial Digital Interface
SMPTE
Society of Motion Picture and Television Engineers
SSI
Surgical Site Infection
US
Ultra Sound
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4  OverviewWord‑p. 10
The current average spending in the healthcare sector is around 10% of GDP worldwide, with a $7,200 billion market in 2105 according to the World Health Organization [12]. According to Goldman Sachs [13], $650 billion in savings can be expected by 2025 through a shift in focus from volume-based healthcare to value-based healthcare.
This means that the traditional value chain for the medical device industry, which historically has been driven by innovation and research and development, is currently witnessing a shift in the landscape. As governments and health insurers worldwide implement measures to control costs, public hospitals are operating on tighter budgets, while private facilities are receiving lower reimbursements. In the developed world, decisions that used to be the sole preserve of doctors are now also made by regulators, hospital administrators, and other non-clinicians. This broader set of influencers comes with different objectives, e.g. the prioritization of cost effectiveness or even just costs.
As an example, the US medical device industry has been working on traditional business models based on innovation where physicians have been the target audience willing to pay for products with incremental improvements. The efficacy and safety of the products have been the most important criteria for their commercial success. But lately, the shift to value-based healthcare has led medical devices companies to move to business models based on providing clinical value with cost efficiency.
Technological progress and better infrastructures, in particular high-quality wireless networks, have fed this business model transformation, allowing coordinated therapies, services, and health analytics and enabling efficient outcome measurement solutions. In addition, as depicted in [14], the healthcare industry has moved from the traditional paper-record keeping method to electronic or e-records that has bolstered the demand for wireless communications.
On this matter, 5G can have an important impact by enabling personalization of healthcare through wirelessly and continuously collecting patient's monitoring data for processing and centralized storage. In fact, this superior monitoring capability means that 5G can substantially improve the effectiveness of preventive care:
  • As 5G facilitates information collection, information transmission and big data analytics, this is one of the essential ingredients helping healthcare provision to change from a "volume-based" model in which providers of health care are compensated for quantity, not quality, to a "value-based" model in which compensation is linked to the value delivered.
  • Additionally, improvements in well-being and quality of life, which are not always captured in conventional economic measurements such as the GDP, play a key role in work force productivity.
Also, 5G enables shifting care location from hospitals to homes and others lower cost facilities which mechanically translates into additional savings. Additionally, another example showing that 5G can enable cost savings required by the medical industry can be found inside hospitals where wireless transmission of low latency data streams improves operating room planning, enable streamlining equipment usage and simplifies operating theater implementation.
Healthcare systems dictate the means by which people and institutions pay for and receive health services. Interactions between industry's players, driven by who actually pay for healthcare services through which mechanisms, depends on the model that is used. The picture below shows how telco's can integrate the medical ecosystem in case of the National Health Insurance Model (one of the most widely adopted worldwide):
Reproduction of 3GPP TS 22.826, Figure 4-1: National Health Insurance Model
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In this technical report we specifically focus on critical medical applications, which is a generic term covering medical devices and applications involved in the delivery of care for patient's survival. In this context 5G can help healthcare providers that face revenue pressures both to adopt new and more efficient care delivery models and to shift to outpatient services in order to reduce administrative and supply costs.

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