Aerospace and Electronic Systems Magazine May 2018 - 6

Feature Article:

DOI. No. 10.1109/MAES.2018.170114

Evolution of ICT for the Improvement of Quality of Life
Giulia Cisotto, Silvano Pupolin, University of Padua, Padova, Italy

INTRODUCTION
In today's society, chronic diseases are a well-known issue related
to the average increasing age of a population, especially in the most
developed countries. The elderly, who are often the most impaired
individuals, experience a significant reduction of independence
in their daily life. This, consequently, affects their psychological
conditions as well as their social attitudes and relationships. Therefore, industry, academia, and government health organizations are
actively investigating and testing large-scale affordable solutions
to improve the overall Quality of Life (QoL) in this population.

QOL DEFINITION
QoL can be defined as an "individual's perception of their position
in life in the context of the culture and value systems in which
they live and in relation to their goals, expectations, standards, and
concerns" [1]. In other words, "QoL is a subjective, multidimensional concept, which places emphasis on the self-perception of an
individual's current state" [2].
Surveying among a large and heterogeneous population all
over the world, the World Health Organization (WHO) identified
several domains that generally determine satisfaction about healthrelated QoL (HRQoL). Not only physical conditions are included,
but also psychological, social (independence and relationships),
and environmental (climate, crime rate, landscape) ones seem to
be important [3], [4].
As suggested by Frow and colleagues [5], it is possible to create a Health-Related Ecosystem that could be characterized by four
levels: the Micro level includes the individual patient, the clinical
staff, as well as his/her family and friends; the Meso level includes
clinics, hospitals, and also other health agencies; the Macro level
includes State health authorities, professional associations, Unions
in health care sectors, and Health insurers; finally, the Mega level
accounts for Government agencies, health funding bodies, regulatory bodies, and even media.
Based on a framework such as this one, a Health Care Business
Model Ecosystem (HCBMEs) can be developed to optimize the
cost-benefit tradepff in terms of HRQoL. Specifically, HCBMEs
Authors' address: University of Padova, Information Engineering, Via Tartaglia, 11, Padova, PD-PADOVA 35136 Italy, E-mail:
(giulia.cisotto@gmail.com).
Manuscript received June 6, 2017, revised November 16, 2017,
and ready for publication January 3, 2018.
Review handled by L. Ligthart.
0885/8985/18/$26.00 © 2018 IEEE
6

typically account for vertical and horizontal markets, including all
possible stakeholders and operating within the healthcare framework. HCBME evaluates telecare-related HRQoL both in terms of
its economic burden, i.e. financial resources for specialized personnel, infrastructures, spaces in the public institutes, and social
inclusion (avoiding problematic situations, e.g., elderly isolation).
Optimization through HCBMEs could mitigate issues like long
waiting lists, suboptimal admission criteria, bed-blocking, multiple diagnoses, all delays experienced in current clinical practice
(impact on the Micro and Meso levels), while minimizing costs
for hospitals and State health agencies (impact on the Meso and
Macro levels).
It has to be noted that healthcare in different countries is supported by different organizations, either the national health system
(such as in Greece, Italy, Nordic Countries, and United Kingdom)
or national social insurance system (such as in Austria, France, Germany, and The Netherlands). At the same time, the social welfare
system is usually regional or locally-based. Therefore, the modalities of how healthcare can be accessed in different places are subject
to different rules and constraints. Availability of services can differ
as well. The HCBME concept also give insights and suggestions
about how to coordinate different healthcare providers in order to
overcome inefficiencies, ensure interoperability between different
countries, and reduce overall costs for health, ensuring at the same
time a high quality and uniform level of health-related service.
The recent concept of Internet-of-Things (IoT) can be applied
to the healthcare ecosystem (IoT-health) to provide a framework
where everyone is connected and connections and communications can be achieved both within-levels and between-levels of the
HCBME [6], [7]. This futuristic ecosystem scenario is made possible by the technological developments across disciplines within a multidisciplinary area involving all actors of the healthcare
ecosystem [8], including the patients and medical doctors (micro
and meso levels) and the communication providers and insurance
companies (macro and mega levels) that provide different kinds
of services to the core actors. IoT-health is expected to optimize
resources within the HCBME and the HRQoL.
Specifically, IoT-health needs to focus on the diseases that impact the most people in the HRQoL. The abovementioned survey
by the WHO classified the most impacting diseases in our current
society as in Five Big Chronic diseases: diabetes mellitus, cardiovascular disease, chronic respiratory disease, cancer, and stroke. It
may also be useful to include Alzheimer's (AD) disease and Parkinson's disease (PD), as well, because of their long-term effects
on patients and the need for continuous monitoring. That said, we
can then label them as the Seven Big Chronic diseases (7BCD) of
our society.

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