by Emmanouil G. Spanakis and Vangelis Sakkalis (FORTH-ICS)
DAPHNE is aiming to develop a resilient networking service for critical related applications, as a novel approach for next generation mHealth information exchange. Our goal is to provide in-transit persistent information storage, allowing the uninterruptible provision of crucial services. Our system will overcome network instabilities, capacity efficiency problems, incompatibilities, or even absence of end-to-end homogeneous connectivity, with an emphasis on future networks and services (i.e. 5G). We aim to provide a set of tools for the appropriate management of communication networks during their design time and avoid the “build it first, manage later” paradigm.
Future mHealth informatics rely on innovative technologies and systems for transparent and continuous collection of evidence-based medical information at anytime, anywhere, regardless of coverage and availability of communication means. Such an emerging critical infrastructure is influenced by factors such as biomedical and clinical incentives, advances in mobile telecommunications, information technology developments, and the socioeconomic environment. This cross dependency has led to concerns about reliability and resilience of current network deployments, hence it is imperative that communication networks be designed to adequately respond to failures, especially in cloud, mobile and Internet Of Things (IoT) / Web Of Things (WoT) environments that have traditional boundaries.
New community-based arrangements and novel technologies can empower individuals to be active participants in their health maintenance by enabling them to self-regulate and control their wellness and make better lifestyle decisions using community-based resources and services. Mobile sensing technology and health systems, responsive to individual profiles, supported by intelligent networking infrastructures and combined with cloud/IoT computing can expand innovation for new types of interoperable services that are consumer oriented and community based. This could fuel a paradigm shift in the way health care can be, or should be, provided and received, while reducing the burden on exhausted health and social care systems .
Crucial innovation is needed to make and deploy large scale ICT that facilitates end-user services that are usable, trusted, accepted and enjoyed. This will require multi-domain, multilevel, trans-disciplinary work that is grounded in theory and matched by business ability to bring innovation to the market. Importantly, it must be driven by the needs, expectations and capabilities of individuals and healthcare professionals. Communication networks are one of the most important critical infrastructures underpinning this system, since many other critical infrastructures depend on them in order to function. The heavy reliance on communication networks has led to concerns about reliability and resilience; hence, it is imperative that such networks are designed to adequately respond to failures and attacks, especially in environments that have traditional boundaries. The goal is to form services at scale, establishing a layer of trust among entities in order to share/collaborate/communicate while minimising the likelihood of failure.
The fifth generation of mobile technology (5G) is positioned to address the demands and business context of 2020 and beyond. It is expected to enable a fully mobile and connected society and to empower socio-economic transformations in countless ways, many of which are unimagined today, such as facilitating productivity, sustainability and well-being. The meaning of 5G, and the ways it will affect electronic health services, is still a subject of discussion in the industry. However, the softwarisation of networks is expected to shape its design, operation and management. Right now there is a growing density/volume of traffic and a rapidly growing need for connectivity. To facilitate this, a multi-layer densification is required, as well as a broad range of use cases and business models, in order for vendors to avoid the “build it first, manage it later” paradigm. In this project our goal is to extend the performance envelope of 5G networks including embedded flexibility, a high level of convergence and access in a highly heterogeneous environment (characterised by the existence of multiple types of access technologies, multi-layer networks, multiple types of devices, multiple types of user interactions, etc).
DAPHNE is implemented around a bundle protocol (BP) (IETF RFC 4838 and RFC 5050) adapted to 5G network stack implemented around a convergence layer (CL). Data packets are encapsulated in the BP and can transparently travel across regions with different network protocol stacks. Our convergence layer implementations may include HTTP, TCP, UDP, Ethernet, BT & BLE, AX.25, RS232, IEEE 802.11x, 802.15.4, LR-WPAN, 5G and other. In our reference implementation, we created a “dtntunnel proxy” forming a DTN tunnel over a heterogeneous 5G network that can sustain any delay or disruption, thanks to the in-network storage of our designed architecture.
Daphne [L1], implements a resilient service for critical to support mHealth services enabling personalisation, patient inclusion and empowerment with the expectation that such systems will enhance traditional care in a crisis and provide provision in a variety of situations, where remote consultation and monitoring can be implemented despite the lack of end-to-end connectivity (Figure 1) . In this scenario we envision next generation personal health systems and pervasive mobile monitoring to empower individuals in well-being and disease prevention, and chronic disease management. IoMT and Personal Health Systems covering well-being, prevention of specific diseases or follow-up and management of existing chronic diseases can enhance patient empowerment and self-care management.
Figure 1: Daphne mHealth service network.
DAPHNE is focusing on the underline cyber-physical ecosystem of interconnected sensors and actuators to regulate this networking ecosystem, formed by a collection of biomedical sensors, wearable medical devices, control/sink nodes (mobile phones) and gateways supporting underline critical healthcare service and enable intelligent decision making. These proposed technologies for the underlying architecture, embrace remote monitoring, sensor data collection, remote patient monitoring, extraction of health related features for detection of risks/ alarming and/or alerting, personalized feedback and recommendation services for the patient or informal caregiver. The growing developments in the IoMT, including smart connected technology, can be used for smart and uninterrupted data collection in order to benefit healthcare and its data-processing abilities, timely decision-making and the overall goal for better patient outcomes (i.e. remote healthcare and monitoring, better drug management through smart devices and actuators, adjustment of therapies and treatment plans, medical device monitoring and control, management of devices within critical healthcare infrastructures).The ability to resiliently provide in-transit persistent information storage will allow the uninterruptible provision of crucial e-Health services, overcoming network instabilities, incompatibilities, or even absence, for a long duration. In our implementation we support application scenarios for: Heterogeneous networks, Harsh intermittent connectivity, Extremely large delays and, Severe disruptions. Our focus is on the integration of a prototype proxy implementation adapted for mHealth requirements and future internet services through emerging telecommunication converging networks (i.e. 5G) . We analyze the vulnerabilities from a fault tolerant perspective, while taking into account the autonomic principles and we propose a self-healing based framework for 5G networks to ensure availability of services and resources. We will emphasise the problem of reliable system operation with extremely low power consumption and discontinuous connectivity, which are typical for continuous monitoring of people. The goal is to study network failures making them imperceptible by providing service continuity and by minimising congestion.
This project has received funding from the Hellenic Foundation for Research and Innovation (HFRI) and the General Secretariat for Research and Technology (GSRT), under grant agreement No 1337.
 E.G.Spanakis et al.: “Technology-Based Innovations to Foster Personalized Healthy Lifestyles and Well-Being: A Targeted Review”, J Med Internet Res 2016;18(6):e128, DOI: 10.2196/jmir.4863, PMID: 27342137.
 E.G. Spanakis, A.G. Voyiatzis: “DAPHNE: A Disruption-Tolerant Application Proxy for e-Health Network Environments”, 3rd International Conference on Wireless Mobile Communication and Healthcare, Paris, France, November 21-23, 2012.
 E.G. Spanakis: “Internet of Medical Things for Healthcare in Smart Monitoring and Diverse Networking Environments”, EMBC 2018.
Emmanouil G. Spanakis,