ETSI TR 103 509 V1.1.1 (2019-10)

TECHNICAL REPORT
SmartM2M;
SAREF extension investigation;
Requirements for eHealth/Ageing-well

2 ETSI TR 103 509 V1.1.1 (2019-10)

Reference
DTR/SmartM2M-103509
Keywords
ageing, eHealth, IoT, oneM2M, ontology, SAREF,
semantic
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3 ETSI TR 103 509 V1.1.1 (2019-10)
Contents
Intellectual Property Rights . 5
Foreword . 5
Modal verbs terminology . 5
1 Scope . 6
2 References . 6
2.1 Normative references . 6
2.2 Informative references . 6
3 Definition of terms, symbols and abbreviations . 8
3.1 Terms . 8
3.2 Symbols . 8
3.3 Abbreviations . 8
4 SAREF extension for eHealth/Ageing-well domain . 10
5 Related initiatives . 10
5.0 Introduction . 10
5.1 Standardization bodies . 10
5.1.1 IEEE . 10
5.1.2 ETSI . 11
5.1.3 SNOMED International . 11
5.1.4 oneM2M . 11
5.2 Alliances . 12
5.2.1 Personal Connected Health Alliance (PCHAlliance) - Continua . 12
5.2.2 Health Level Seven International (HL7) . 12
5.3 Associations . 12
5.3.1 Alliance for Internet of Things Innovation (AIOTI) . 12
5.4 IoT Platforms . 12
5.4.0 Introduction. 12
5.4.1 HL7 FHIR (Fast Healthcare Interoperability Resources) . 12
5.4.2 ETSI SmartBAN global IoT Reference Architecture . 13
5.4.3 universAAL IoT . 13
5.4.4 Sofia2 . 13
5.5 European projects and initiat i ves . 13
5.5.1 ACTIVAGE LSP . 13
5.5.2 CareWare ITEA3 project . 14
5.5.3 MobiGuide . 14
5.5.4 European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) . 14
5.5.5 FIESTA-IoT Ontology . 15
5.6 Industrial/medical world initiatives . 15
5.6.0 Introduction. 15 ®
5.6.1 Philips HealthSuite . 15
6 Initial data models/ontologies to considered . 16
6.1 WSNs/measurement world main ontologies . 16
6.2 eHealth/Ageing-well domain main ontologies . 16
6.3 Base Ontologies to consider for SAREF4EHAW extension . 16
6.3.1 SAREF . 16
6.3.2 oneM2M . 16
6.3.3 SSN . 16
6.3.4 SmartBAN Reference Model . 17
6.3.5 SEMIOTICS project SAREF4health first try . 17
7 Use cases . 18
7.1 Use case 1: elderly at home monitoring and support . 18
7.2 Use case 2: monitoring and support of healthy lifestyles for citizens . 19
7.3 Use case 3: Early Warning System (EWS) and Cardiovascular Accidents detection . 20
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4 ETSI TR 103 509 V1.1.1 (2019-10)
7.4 Other relevant Use Cases . 21
7.4.1 Daily activity monitoring . 21
7.4.2 Integrated care for older adults under chronic conditions . 21
7.4.3 Monitoring assisted persons outside home and controlling risky situations . 21
7.4.4 Emergency trigger. 22
7.4.5 Exercise promotion for fall prevention and physical activeness . 22
7.4.6 Cognitive stimulation for mental decline prevention . 22
7.4.7 Prevention of social isolation . 22
7.4.8 Comfort and safety at home . 22
7.4.9 Support for transportation and mobility . 22
8 eHealth/Ageing-well ontological requirements . 22
9 Conclusions . 24
Annex A: eHealth/Ageing-well domain service level assumptions . 25
A.1 eHealth/Ageing-well domain general service level assumptions . 25
A.2 eHealth/Ageing-well domain additional service level assumptions . 26
History . 29

ETSI
5 ETSI TR 103 509 V1.1.1 (2019-10)
Intellectual Property Rights
Essential patents
IPRs essential or potentially essential to normative deliverables may have been declared to ETSI. The information
pertaining to these essential IPRs, if any, is publicly available for ETSI members and non-members, and can be found
in ETSI SR 000 314: "Intellectual Property Rights (IPRs); Essential, or potentially Essential, IPRs notified to ETSI in
respect of ETSI standards", which is available from the ETSI Secretariat. Latest updates are available on the ETSI Web
server (https://ipr.etsi.org/).
Pursuant to the ETSI IPR Policy, no investigation, including IPR searches, has been carried out by ETSI. No guarantee
can be given as to the existence of other IPRs not referenced in ETSI SR 000 314 (or the updates on the ETSI Web
server) which are, or may be, or may become, essential to the present document.
Trademarks
The present document may include trademarks and/or tradenames which are asserted and/or registered by their owners.
ETSI claims no ownership of these except for any which are indicated as being the property of ETSI, and conveys no
right to use or reproduce any trademark and/or tradename. Mention of those trademarks in the present document does
not constitute an endorsement by ETSI of products, services or organizations associated with those trademarks.
Foreword
This Technical Report (TR) has been produced by ETSI Technical Committee Smart Machine-to-Machine
communications (SmartM2M).
Modal verbs terminology
In the present document "should", "should not", "may", "need not", "will", "will not", "can" and "cannot" are to be
interpreted as described in clause 3.2 of the ETSI Drafting Rules (Verbal forms for the expression of provisions).
"must" and "must not" are NOT allowed in ETSI deliverables except when used in direct citation.

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6 ETSI TR 103 509 V1.1.1 (2019-10)
1 Scope
The present document provides requirements for an initial semantic model extending SAREF for eHealth/Ageing-well.
This initial SAREF extension is based on a limited set of use cases and existing data models identified within available
initiatives that are summarized in dedicated clauses of the present document. The conducted work is expected to be
developed in close collaboration with in particular ETSI (in particular EP eHealth and TC SmartBAN), oneM2M,
AIOTI (in particular WG 05 "Smart Living Environment for Ageing Well"), and the H2020 Large Scale Pilots
(ACTIVAGE project). Other initiatives coming from eHealth/Ageing-well industrial/medical world and alliances (e.g.
HL7, PCHAlliance) will also be investigated. Further extensions are envisaged in the future for entirely covering the
eHealth/Ageing-well domain.
2 References
2.1 Normative references
Normative references are not applicable in the present document.
2.2 Informative references
References are either specific (identified by date of publication and/or edition number or version number) or
non-specific. For specific references, only the cited version applies. For non-specific references, the latest version of the
referenced document (including any amendments) applies.
NOTE: While any hyperlinks included in this clause were valid at the time of publication, ETSI cannot guarantee
their long term validity.
The following referenced documents are not necessary for the application of the present document but they assist the user
with regard to a particular subject area.
[i.1] European Commission and TNO: "Smart Appliances REFerence ontology (SAREF)", April 2015.
NOTE: Available at http://ontology.tno.nl/saref, SAREF is now extended to Smart Applications REFerence
ontology.
[i.2] European Commission and TNO: "D-S4 Final Report - SMART 2013-0077 - Study on Semantic
Assets for Smart Appliances Interoperability", March 2015.
NOTE: Available at https://sites.google.com/site/smartappliancesproject/documents.
[i.3] ETSI TS 103 264 (V2.1.1): "SmartM2M; Smart Appliances; Reference Ontology and oneM2M
Mapping".
NOTE: Available at
https://www.etsi.org/deliver/etsi_ts/103200_103299/103264/02.01.01_60/ts_103264v020101p.pdf.
[i.4] ETSI TR 103 411 (V1.1.1): "SmartM2M; Smart Appliances; SAREF extension investigation".
[i.5] IEEE 802.15.6 "Standard in wireless Body Area Networks (BAN) from a healthcare point of
view".
NOTE: Available at https://ieeexplore.ieee.org/document/7581523.
[i.6] ETSI TR 103 477: "eHEALTH; Standardization use cases for eHealth".
NOTE: Available at https://portal.etsi.org/webapp/WorkProgram/Report_WorkItem.asp?WKI_ID=46025.
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7 ETSI TR 103 509 V1.1.1 (2019-10)
[i.7] ETSI TS 103 378 (V1.1.1): "Smart Body Area Networks (SmartBAN) Unified data representation
formats, semantic and open data model".
NOTE: Available at
https://www.etsi.org/deliver/etsi_ts/103300_103399/103378/01.01.01_60/ts_103378v010101p.pdf.
[i.8] ETSI TS 103 327 (V1.1.1): "Smart Body Area Networks (SmartBAN); Service and application
standardized enablers and interfaces, APIs and infrastructure for interoperability management".
NOTE: Available at
https://www.etsi.org/deliver/etsi_ts/103300_103399/103327/01.01.01_60/ts_103327v010101p.pdf.
[i.9] SNOMED International.
NOTE: Available at http://www.snomed.org/.
[i.10] ETSI TS 118 112 (V2.0.0): "oneM2M; Base Ontology (oneM2M TS-0012 version 2.0.0
Release 2)".
NOTE: Available at
https://www.etsi.org/deliver/etsi_ts/118100_118199/118112/02.00.00_60/ts_118112v020000p.pdf.
[i.11] Continua Design Guideline description.
NOTE: Available at https://www.pchalliance.org/continua-design-guidelines. ®
[i.12] HL7 FHIR Specification 3 document.
NOTE 1: Available at http://hl7.org/fhir/index.html.
NOTE 2: FHIR® is an example of an existing eHealth standard. This information is given for the convenience of
users of the present document and does not constitute an endorsement by ETSI of this standard.
[i.13] CareWare ITEA3 project, CareWare deliverable: D1.1. Use cases manual. 2016.
NOTE: See https://itea3.org/project/careware.html. ®
[i.14] Philips HealthSuite.
NOTE: Available at https://www.usa.philips.com/healthcare/innovation/about-health-suite. ®
NOTE 2: Philips HealthSuite is an example of a suitable product available commercially. This information is
given for the convenience of users of the present document and does not constitute an endorsement by
ETSI of this product.
[i.15] A. Haller, K. Janowicz, S. Cox, D. Le Phuoc, K. Taylor, M. Lefrançois, R. Atkinson, R. García-
Castro, J. Lieberman, C. Stadler: "Semantic Sensor Network Ontology". W3C Recommendation,
19 October 2017.
NOTE: Available at https://www.w3.org/TR/vocab-ssn/.
[i.16] J. L. R. Moreira, L. Ferreira Pires, M. van Sinderen, L. Daniele: "SAREF4health: IoT Standard-
Based Ontology-Driven Healthcare Systems". FOIS 2018: 239-252.
[i.17] L. Nachabé Ismail, M. Girod-Genet, B. El-Hassan, J. Khawaja: "Ontology based Tele-health
Smart Home Care System: OntoSmart to monitor elderly". In Proceedings of CoNeCo 2016,
Zurich, Switzerland, pp. 43-59, June 2016.
[i.18] INTER-IoT, INTER-IoT deliverable: "D2.4. Use cases manual", 2016.
NOTE: Available at https://files.inter-iot.eu/deliverables/accepted/D2.4%20-%20Use%20cases%20manual.zip.
[i.19] INTER-IoT, INTER-IoT deliverable: "D2.3. Use cases manual", 2016.
NOTE: Available at https://files.inter-iot.eu/deliverables/accepted/D2.3%20-%20INTER-
IoT%20Requirements%20and%20Business%20Analysis.pdf.
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8 ETSI TR 103 509 V1.1.1 (2019-10)
[i.20] Abbott, T.E.F., et al., Pre-hospital National Early Warning Score (NEWS) is associated with
in-hospital mortality and critical care unit admission: "A cohort study". Annals of Medicine and
Surgery, 2018. 27: p. 17-21.
[i.21] ETSI TS 103 410-8: "SmartM2M; Extension to SAREF; Part 8: eHealth/Ageing-well Domain".
NOTE: Available at https://portal.etsi.org/webapp/WorkProgram/Report_WorkItem.asp?WKI_ID=51404.
3 Definition of terms, symbols and abbreviations
3.1 Terms
For the purposes of the present document, the following terms apply:
metadata: data about data
ontology: formal specification of a conceptualization
NOTE1: It can be viewed as the extension of metadata with the data environment view.
NOTE 2: It is used to explicitly capture the semantics of a certain reality.
semantic: meaning of data
3.2 Symbols
Void.
3.3 Abbreviations
For the purposes of the present document, the following abbreviations apply:
AAL Ambient Assisted Living
AHA Active and Healthy Ageing
AIOTES ACTIVAGE IoT Ecosystem Suite
AIOTI Alliance for the Internet of Things Innovation
API Application Programming Interface
ARIB Association of Radio Industries and Businesses
ATIS Alliance for Telecommunications Industry Solutions
AVPU Alert, Verbal, Pain, Unresponsive
BAN Body Area Network
BP Blood Pressure
bpm beats per minute
BSN Body Sensor Network
CCSA China Communications Standards Association
CPS Cyber-Physical System
DAM Daily Activity Monitoring
DICOM Digital Imaging and COmmunications in Medicine
DUL DOLCE+DnS UltraLite
ECG ElectroCardioGram
EHAW eHealth/Ageing-Well
EHPAD Etablissement d'Hébergement pour Personnes Agées Dépendantes
EHR Electronic Health Record
EIP European Innovation Partnership
EMT EMergency Trigger
EP ETSI Project
ETSI European Telecommunications Standards Institute
EU European Union
EWS Early Warning System
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9 ETSI TR 103 509 V1.1.1 (2019-10)
EXP EXercise Promotion
FHIR Fast Healthcare Interoperability Resources
GDPR General Data Protection Regulation
GEN GENeral
HL7 Health Level Seven international
HR Heart Rate
HTTP HyperText Transfer Protocol
ICT Information and Communication Technology
IHE Integrating the Healthcare Enterprise
IoT Internet of Things
JSON JavaScript Object Notation
LE Low Energy
LSP Large Scale Pilot
MAC Medium Access Control
MDP Mental Decline Prevention
MOH Monitoring Outside Home
NASA National Aeronautics and Space Administration
OGC Open Geospatial Consortium
OHS Office d'Hygiène Sociale
ONT ONTological category
OWL Ontology Web Language
PCHAlliance Personal Connected Health Alliance
PHD Personal Health Device
PSI Prevention of Social Isolation
QoL Quality of Life
QUDT Quantities, Units, Dimensions and Types
RDF Resource Description Framework
REST Representational State Transfer
SAO Stream Annotation Ontology
SAREF Smart Appliances REFerence ontology
SAREF4EHAW SAREF extension for eHealth/Ageing-Well
SDO Standards Development Organization
SEMIOTICS Smart End-to-end Massive IoT Interoperability, Connectivity and Security
ShEx Shape Expressions
SIL Semantic Interoperability Layer ®
SNOMED CT SNOMED Clinical Terms
SOSA Sensing, Observation, Sampling and Actuation
SPARQL SPARQL Protocol and RDF Query Language
SSN Semantic Sensor Network
STF Special Task Force
STM Support for Transportation and Mobility
SWE Sensor Web Enablement
TC Technical Committee
TIA Telecommunications Industry Association
TR Technical Report
TS Technical Specification
TSDSI Telecommunications Standards Development Society India
TTA Telecommunications Technology Association
TTC Telecommunication Technology Committee
TV TeleVision
UCC Under Chronic Conditions
USA United State of America
VoID Vocabulary of Interlinked Datasets
W3C World Wide Web Consortium
WG Working Group
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4 SAREF extension for eHealth/Ageing-well domain
SAREF [i.1] is a reference ontology for IoT created in close interaction with the industry during a study requested by
the European Commission in 2015 [i.2] and subsequently transferred into an ETSI Technical Specification [i.3].
SAREF contains core concepts that are common to several IoT domains and, to be able to handle specific data elements
for a certain domain, dedicated extensions of SAREF can be created. Each domain can have one or more extensions,
depending on the complexity of the domain. As a reference ontology, SAREF serves as the means to connect the
extensions in different domains. The earlier document ETSI TR 103 411 [i.4] specifies the rationale and methodology
used to create, publish and maintain the SAREF extensions.
The present document specifies the requirements for an initial SAREF extension for eHealth/Ageing-well. This initial
SAREF extension will be based on a limited set of use cases and existing data models identified within available
initiatives that will be summarized in dedicated clauses of the present document. The work conducted in the present
document has been developed in the context of the STF 566, which was established with the goal of creating SAREF
extensions for the following domains: Automotive, eHealth/Ageing-well, Wearables and Water. This work is expected
to be developed in close collaboration with ETSI, oneM2M, AIOTI, eHealth/Ageing-well related H2020 Large Scale
Pilots and EU projects. However, other initiatives coming from eHealth/Ageing-well industrial/medical world and
alliances will also be investigated.
STF 566 consists of the following two main tasks:
1) Gather requirements, collect use cases and identify existing sources (e.g. standards, data models, ontologies,
etc.) from the domains of interest (Automotive, eHealth/Ageing-well, Wearables and Water) in order to
determine the requirements for an initial semantic model for each of the aforementioned domains, based on at
least 2 use cases and existing data models (STF 566 Task 2).
2) Specify and produce the extensions of SAREF for each of the aforementioned domain based on the
requirements resulting of STF 566 Task 2 (STF 566 Task 3).
The present document focuses on STF 566 Task 2 and the extension of SAREF for eHealth/Ageing-well domain. The
present document sets the requirements of an initial semantic model that will result in a new SAREF ontology extension
for eHealth/Ageing-well, called SAREF4EHAW and to be published in ETSI TS 103 410-8 [i.21] as part of STF 566
Task 3 SAREF extensions series.
5 Related initiatives
5.0 Introduction
Within clause 5 of the present document, some of the main related initiatives in term of modelling and standardization
in the eHealth/Ageing-well domain are reviewed. Existing efforts range from national or international standards to
rather specific models used in certain software solutions provided by industrial/medical world actors. Therefore, the
potential stakeholders identified for this SAREF extension might be classified as: public administrations, associations
related to the Internet of Things and eHealth/Ageing-well, European projects and Large Scale Pilots, standardization
bodies and alliances related to the Internet of Things and eHealth/Ageing-well domain, as well as industrial/medical
world and alliances initiatives of the eHealth/Ageing-well domain. For each type of stakeholder, the initiatives that have
been taken into account are described next.
5.1 Standardization bodies
5.1.1 IEEE
IEEE 802.15.6 Working Group on Body Area Network [i.5]: "A communication standard optimized for low power
devices and operation on, in or around the human body (but not limited to humans) to serve a variety of applications
including medical, consumer electronics/personal entertainment and other." However, only aspects related to radio
technologies and Physical and MAC layers are addressed.
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11 ETSI TR 103 509 V1.1.1 (2019-10)
5.1.2 ETSI
ETSI Project (EP) eHealth should form the 'horizontal' nucleus for the co-ordination of ETSI' activities in the Health
ICT domain. EP eHealth works in close co-operation with all relevant TCs, EPs and SCs within ETSI, 3GPP, and
others. It has in particular the following responsibilities:
• Collect and define the Health ICT related requirements gaps from relevant stakeholders.
• Identify gaps and suggest further standardization activities to fill those gaps.
• Input the requirements, identified gaps and suggested new activities to the concerned ETSI Technical Bodies.
• Develop Health ICT related deliverables in all areas not covered by existing system specific and horizontal
Technical Bodies or other SDO.
• Co-ordinate ETSI positions on Health ICT related issues and represent ETSI externally.
EP eHealth in particular is developing ETSI TR 103 477 [i.6] presenting typical eHealth domain use cases, from their
analysis (actors and their roles included; from FP7/H2020 projects to current Health/eHealth industry practices), to
identify gaps in standardization. This document in particular covers aspects related to network interconnectivity and
semantic interoperability.
ETSI SmartBAN TC is a vertical technical committee responsible for development and maintenance of ETSI
standards, specifications, reports, guides and other deliverables to support the development and implementation of
Smart Body Area Network technologies (Wireless BAN, Personal BAN, Personal Networks, etc.) in health, wellness,
leisure, sport and other relevant domains. It is addressing all the aspects from Physical layer up to service and
application layers, as well as from the patient's vital data collection/control devices (sensors, actuators, hub/coordinator)
up to the monitoring/control and decision support applications on the patients/caregivers/followers side (i.e. the global
end-to-end system). Aspects related to heterogeneity/interoperability management are also addressed (including
informational and semantic interoperability). ETSI SmartBAN TC has in particular standardized:
• A BAN - data, device, service/application - unified semantic and open reference model, with corresponding
modular ontology [i.7].
• A BAN dedicated global and more integrated IoT Reference Architecture, with semantic interoperability
management and embedded semantic-based data analytics, for generic secure interaction and access to BAN
data & entities [i.8].
5.1.3 SNOMED International
SNOMED International [i.9] determines global standards for a comprehensive, multilingual clinical healthcare ®
terminology and health terms in the world health terms (SNOMED CT , see http://www.snomed.org/snomed-ct/get-
snomed. ®
NOTE: SNOMED CT is an example of a suitable terminology available and this information is given for the
convenience of users of the present document and does not constitute an endorsement by ETSI of this
terminology, thus enabling consistent representation of clinical content in electronic health records.
5.1.4 oneM2M
Referring to https://www.etsi.org/committee/1419-onem2m and http://www.onem2m.org/about-onem2m/partners,
oneM2M is the global standards initiative that covers requirements, architecture, API specifications, security solutions
and interoperability for Machine-to-Machine and IoT technologies. Formed in 2012 oneM2M consists of eight of the
world's preeminent standards development organizations (partners type 1): ARIB (Japan), ATIS (USA), CCSA (China),
ETSI (Europe), TIA (USA), TSDSI (India), TTA (Korea), and TTC (Japan), together with (partner type 2)
GlobalPlatform and over 200-member organizations. oneM2M specifications provide a framework to support
applications and services such as the smart grid, connected car, home automation, public safety, and health. oneM2M
actively encourage industry associations and forums with specific application requirements to participate, in order to
ensure that the solutions developed support their specific needs.
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12 ETSI TR 103 509 V1.1.1 (2019-10)
oneM2M is devoted to the development of technical specifications for M2M solutions related to the service layer which
can be combined with existing hardware and software solutions. The main goal of the organization is to attract and
involve organizations in domains such as telematics and intelligent transportation, healthcare, utilities, industrial
automation, or smart homes, among others. oneM2M prepares, approves and maintains technical specifications and
reports for use cases, service layer aspects, protocols, APIs, interoperability, data collection, and many other aspects of
the M2M domain. The oneM2M base ontology ETSI TS 118 112 [i.10] is the minimal ontology that enables achieving
interoperability among organizations.
5.2 Alliances
5.2.1 Personal Connected Health Alliance (PCHAlliance) - Continua
PCHAlliance is a non-profit organization, mobilizing a coalition of stakeholders and aiming to make health and
wellness an effortless part of daily life through personal connected health techniques. The Alliance also publishes and
promotes adoption of the Continua Design Guidelines [i.11], an open implementation framework for end-to-end
interoperability of personal connected health devices and systems.
5.2.2 Health Level Seven International (HL7)
Health Level Seven International (HL7) is a not-for-profit standard organization with the objective to develop and
standardize a framework for exchanging healthcare information electronically: Fast Healthcare Interoperability
Resources (FHIR) [i.12]. It addresses digital healthcare records and EHRs unified semantic modeling specification and
standardization for their common understanding and processing (automated clinical decision support; via common set
of metadata and resources definition/specification).
5.3 Associations
5.3.1 Alliance for Internet of Things Innovation (AIOTI)
AIOTI is an inclusive body of IoT industrial players - large companies, successful SMEs and dynamic start-ups - as
well as well-known European research centres, universities, associations and public bodies. AIOTI was founded by the
European Commission in 2015, consists of working groups (https://aioti.eu/working-groups/) covering a broad array of
IoT sectors, among which one is dedicated to eHealth/Ageing-well: WG 05 "Smart Living Environment for Ageing
Well". This group focuses on smart homes and smart living environments that can support vulnerable people, such as
(but not limited to) elderly or disabled people. Its deliverables (available at https://aioti.eu/aioti-wg05-report-on-smart-
living-environment-for-ageing-well/) include white papers, recommendation reports, as well as innovative use cases, for
improving the quality of life of elderly using IoT technologies.
5.4 IoT Platforms
5.4.0 Introduction
Clause 5.4 of the present document focuses on open platforms mainly related to eHealth.
5.4.1 HL7 FHIR (Fast Healthcare Interoperability Resources)
HL7 Fast Healthcare Interoperability Resources (FHIR) [i.12] is an emerging open platform and standard that is
considered as the evolution of the HL7 standards for the new generation of health data exchange. HL7 FHIR defines a
collection of "resources" (data model elements) that can be mixed and adapted for particular clinical contexts through
the "profiling" process. Along with W3C semantic web community, HL7 developed an RDF representation of the FHIR
data model, which can be described and validated with Shape Expressions (ShEx) [i.12].
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13 ETSI TR 103 509 V1.1.1 (2019-10)
The central FHIR element is the Observation resource [i.12], which is used to support diagnosis and monitor progress,
and is recommended for monitoring vital signs and device measurements. In particular, the "ECG (electrocardiogram)
example using Sampled Data" [i.12] demonstrates how to serialize ECG data using the Observation resource, which
offers the property valueSampledData, responsible to represent the ECG sample sequence as a series of measurements
of the heart electrical activity through the SampledData element, similarly to HL7 ECG. A SampledData provides a
concise way to handle the data produced by devices that sample a particular physical state at a high frequency. A typical
use for this is to represent the output of an ECG device. The data type includes a series of raw decimal values, which are
mostly simple integers, along with adjustments for scale and factor.
Current issue of FHIR RDF is that it presents poor quality because it is a (semi) automatic serialization of FHIR lexicon
standard, and thus a straightforward serialization of the FHIR standard data model. This causes both an overload of
object properties, since more than ten properties represent the "description" concept, and a lack of reuse of common
terms (e.g. instead of having more than ten "description" terms, dc:description term could be reused). Although HL7
FHIR lexicon standard is widely adopted and used in industry, its semantic model is still in early stages.
5.4.2 ETSI SmartBAN global IoT Reference Architecture
ETSI SmartBAN global IoT Reference Architecture is a standardized global and more integrated IoT reference
architecture, with semantic interoperability management and embedded semantic-based data analytics, for generic
secure interaction and access to BAN data and entities [i.7]. This global IoT reference architecture is in particular
specified on top of the SmartBAN Reference Model and is oneM2M based. It has also been clinically tested for elderly
at home monitoring and control purposes in the context of the CareWare ITEA3 project (see clause 5.5.2 of the present
document).
5.4.3 universAAL IoT
universAAL IoT (see https://www.universaal.info/) is an IoT solution and platform developed for smart environments
and Ambient Assisted Living (AAL) applications. It is provided with dedicated data models and ontologies for handling
data heterogeneity at application level.
5.4.4 Sofia2
Sofia2 is a semantics-based IoT platform that makes use of ontology-like models for providing connection management
between low-level device information and applications. It is one of the platforms used in ACTIVAGE LSP (see
clause 5.5.1 of the present document).
5.5 European projects and initiatives
5.5.1 ACTIVAGE LSP
ACTIVAGE LSP (see http://www.activageproject.eu) is a European Large Scale Pilot (9 deployment sites in seven
European countries) on Smart Living Environments. Its main objective is to build the first European IoT ecosystem for
enabling the deployment and operation of Active and Healthy Ageing (AHA) IoT based solutions and services,
supporting and extending the elderly's independent living in their living environments, as well as for responding to
caregivers, service providers and public authorities needs. The proposed IoT environment is built upon existing open
and proprietary IoT platforms, technologies and standards that will be scaled up and interoperated through the
integration new interfaces that will provide the mandatory interoperability management middleware functionality. For
that purpose ACTIVAGE will mainly deliver:
• ACTIVAGE IoT Ecosystem Suite (AIOTES). AIOTES comprises both a set of techniques, tools and
methodologies for interoperability management between heterogeneous IoT Platforms (at different IoT layers),
and an open framework for providing semantic interoperability management for AHA purposes. It will
obviously address security, privacy and trust.
• User-demand driven interoperable IoT-enabled AHA solutions that will be deployed on top of AIOTES in
each of the 9 European deployment/pilot sites of ACTIVAGE LSP, provided with a common Reference
Evaluation Framework and a co-design framework, for the promotion of independent living and the
preservation of quality of life and autonomy.
ETSI
14 ETSI TR 103 509 V1.1.1 (2019-10)
• Semantic Interoperability Layer tools facilitating access to ACTIVAGE ontologies (i.e. ontology explorer,
query translator, device semantics editor, service semantics editor, semantic Device/service auto-discovery;
REST-based methods). For that purposes, SIL is also based on semantic-related standards like e.g. RDF and
OWL description languages for data representation and modelling, data as well as SPARQL for data access
and semantic search/query (SPARQL) and standard data serialization format like JSON for data exchange.
However and even if an ACTIVAGE ontology is mentioned, it is mainly addressing devices, services and
collected data semantic (see Table 1), and no dedicated eHealth, Ageing Well, AHA data model and associated
ontology(ies) are provided.
Table 1: ACTIVAGE ontology concepts
Type Description
Sensor Data Sensory data provided by a service, i.e. real-time information provided by a sensor Smart Object
measuring physical quantities.
Action Service functionality, i.e. mostly an actuation on the physical environment through an actuator Smart
Object. It can also be a request to do a virtual action (e.g. play a multimedia on a TV).
State Variable Variable for information representing a Smart Object (sensor/actuator) state variable of the service. It
is most likely to be modified by an action.

5.5.2 CareWare ITEA3 project
CareWare ITEA3 project (see https://itea3.org/project/careware.html), a three years EU project ended October 2018 and
involving partners from France/Belgium/Lithuania, aims at developing and leveraging novel unobtrusive cyber physical
systems for monitoring and advancing personal health and wellbeing [i.13]. CareWare draws on the results from
previous researches in body area networks (BAN), wearable sensors, care technologies, electronic textiles,
physiological measurements and personal health service development, and utilizes the state of the practice to produce
innovative and easy to use wearable cyber-physical system (CPS) solutions. One of the two considered use cases is
related to home care for the elderly and elderly remote monitoring and control. The provided technical solutions are
mainly based on:
• HL7 FHIR for the Belgium consortium demonstrator.
• ETSI SmartBAN Reference Model (for semantic interoperability management, embedded semantic based data
analytics and decision making support purposes) and ETSI SmartBAN global IoT Reference Architecture (for
real time remote monitoring/control and alarm management purposes) for the French consortium
demonstrator.
IoT applications have mainly been developed, on top of the CareWare IoT framework and in co-conception with
elderly/caregivers/followers, for: elderly daily support and life quality improvement (wellbeing on patient's side),
elderly remote monitoring and control, as well decision making support (on caregivers' side). CareWare technical
solutions/applications have been validated and clinically tested in partnership with OHS (Office d'Hygiène Sociale)
Nancy within both OHS premises (i.e. one of its EHPAD - an housing for dependent elderly peoples - and one of its
daily hospitals) and few elderly homes.
5.5.3 MobiGuide
MobiGuide (see https://www.cvast.tuwien.ac.at/projects/mobiguide) is a European project with the objectives of
developing a framework for intelligent decision-support of patients with chronic illnesses. This framework will in
particular provide guidance and support of patients anytime and anywhere, as well as care management facilities to
caregivers, thus reducing both patient risk and healthcare cots.
5.5.4 European Innovation Partnership on Active and Healthy Ageing (EIP
on AHA)
European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) is a European Commission initiative
launched for enhancin
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