Overview

This figure shows the various stakeholder roles that the system currently supports: patients, researchers, physicians, sensor operators, policy makers, and cyber operators.

Study participants, most of which are cancer patients, use sensors in their homes or while out in the community. These sensors transmit their data to the Sensor Hub, which is a small plug-in home computer that transmits data to the back-end CI. We used so far a custom built Home Health Hub (HHH), but we are currently integrating QualcommLife's 2net hub. Participants also use a smart phone to answer assessments or record videos, which are automatically sent to CYCORE’s Cyber-Infrastructure (CI). Once data is uploaded to CI, according to the policies in place the CI relays the data to the user — either the research or clinical team. CYCORE provides researchers capabilities to define and run studies, perform observations based on acquired data, and define algorithms, filters, and visualizations on data. In addition, sensor operators register new sensors and assign sensors to participants, while CYCORE’s CI correctly maps the data to participants, and tracks sensor malfunctions. Policy makers perform system audit, and cyber operators manage user accounts and maintain the CI. All stakeholders access the system via a user interface that is tailored to the role that the stakeholder has, such that only the relevant subset of capabilities is accessed.

As an example, consider the scenario of a head and neck cancer patient who has just completed the first of 35 daily radiation therapy sessions she will have over the next 7 weeks. As her therapy proceeds, her symptoms will rapidly worsen: at week 2-3, she can expect a sore throat, irritated skin, and decreased taste; by weeks 4-5, she will face pain at rest and when swallowing resulting in decreased eating; by week 6 through 2-3 weeks post-treatment, she will experience intense pain, mouth sores, and peeling of the skin. Although this patient will see her radiation oncology physician on a weekly basis, her greatly diminished swallowing capability places her at high risk for dehydration while she is at home, which can—and frequently does—lead to an emergency room visit or hospitalization. With CYCORE, the patient takes daily measurements related to dehydration risk (blood pressure, pulse, and weight), and uses a smart phone to self-report dehydration-related symptoms, urine color, and dietary and fluid intake. CYCORE’s data acquisition services collect data from all devices and send them to the storage services from where they can be further queried, analyzed, and visualized as needed. The patient’s physician monitors these diverse data that same day, and is able to determine if changes in her treatment should be made.

All people, devices, or outside systems connect to CYCORE securely. Furthermore, these stakeholders have diverse concerns such as privacy and dependability. For example, the patient wants to make sure her privacy is respected and she doesn’t want to send any data unencrypted. The physician and researcher do not want any of the data collected from patients to be lost, so the data should be buffered on devices when connectivity cannot be established. Moreover, the physician wants timely delivery of data, at least on a daily basis, whereas the researcher typically analyzes data at the end of a study.

To meet the needs of a diverse stakeholder population, we have designed and implemented the CYCORE CI as a Rich Services architecture, which is a type of Service-Oriented Architecture for organizing complex systems. The CI manages crosscutting concerns such as security, policy, failure management within the infrastructure, allowing for such services to be plugged into the architecture without modifying core system functionality. This feature ensures decoupling and scalability, so CYCORE can grow as new needs are identified without changes to the existing services.