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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Selecting Cloud Service for Healthcare Applications: From Hardware to Cloud Across Machine Learning</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Ivan Kuzlo</string-name>
          <email>i.kuzlo@student.csn.khai.edu</email>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Anastasiia Strielkina</string-name>
          <email>a.strielkina@csn.khai.edu</email>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Artem Tetskyi</string-name>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Dmytro Uzun</string-name>
          <email>d.uzun@csn.khai.edu</email>
        </contrib>
      </contrib-group>
      <fpage>26</fpage>
      <lpage>34</lpage>
      <abstract>
        <p>The paper describes the process of creating the Internet of Things (IoT) healthcare applications and selecting an environment to deploy it. Based on research of healthcare application architecture was proposed selecting of cloud service. It draws our attention to complex architecture with using different sources of medical data like external medical databases, medical equipment and wearable medical and non-medical devices. Much attention is given to using machine learning in the process in the detection of health problems. In addition, the paper describes two levels of machine learning: one for detecting single problems with heals and second for predictions complex reports and providing treatment plan based on data from the first level. The main emphasis in choosing of cloud service is made on scalability and the ability to create multiple neural networks for processing data.</p>
      </abstract>
      <kwd-group>
        <kwd>Internet of Things</kwd>
        <kwd>Cloud</kwd>
        <kwd>Healthcare</kwd>
        <kwd>Machine Learning</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>1.1</p>
    </sec>
    <sec id="sec-2">
      <title>Introduction</title>
      <sec id="sec-2-1">
        <title>Motivation</title>
        <p>
          Machine learning has come a long way from its early roots in classical mathematic and
statistics. Today’s machine learning uses analytic models and algorithms that learn
from data, finding hidden insights without being explicitly programmed where to look.
Using algorithms that learn by looking at thousands or millions of data samples,
computers can make predictions based on these learned experiences to solve the same
problem in new situations. And they are doing it with a level of accuracy that is
beginning to mimic human intelligence [
          <xref ref-type="bibr" rid="ref1">1</xref>
          ].
        </p>
        <p>
          Due to the statistical data[
          <xref ref-type="bibr" rid="ref2">2</xref>
          ], the number of devices connected to the Internet
extremely grows. Industrial giants report that by 2020 we will have from 21 billion [
          <xref ref-type="bibr" rid="ref3">3</xref>
          ]
to 30 billion [
          <xref ref-type="bibr" rid="ref4">4</xref>
          ] devices connected to the Internet (e.g., car, bicycle, smartphone, watch,
fitness tracker or some personal medical devices like tonometer or thermometer). All
these smart devices form an Internet of Things (IoT). Many of these devices already
targeted to medical usage [
          <xref ref-type="bibr" rid="ref5">5</xref>
          ], some of them on first look targeted to other purposes but
also can get some medical parameters. In future to make full outpatient study it will be
enough to wear special fitness tracker for a day, and all information from it will be
automatically sent to doctor or healthcare cloud application where neural network will
perform as a doctor.
        </p>
        <p>
          Machine learning (ML) provides many advantages for healthcare application and
IoT. It can help to find hidden pathologies during the medical survey and to add an
additional level to avoid mistakes of a doctor. And the biggest advantage is that such
systems are able to join medical data from different sources like medical database from
few places (like different hospitals), home medical kit (tonometers) and IoT devices
(smartwatch, glucose monitors, Holter monitor [
          <xref ref-type="bibr" rid="ref6">6</xref>
          ]).
1.2
        </p>
      </sec>
      <sec id="sec-2-2">
        <title>State-of-the-Art</title>
        <p>The idea of creating healthcare systems with machine learning is not new. Such ideas
can be separated into two big categories: healthcare research support systems and
healthcare decision support systems.</p>
        <p>
          The first type targeted to supporting different types of research centres and help them
to store and process big amounts of data. Customers of such solutions types typically
make researches in genomic/cancer where they have petabytes of data from research
and they need a system to process them. One of the examples of such type of system is
Google Healthcare &amp; Life Sciences Solutions [
          <xref ref-type="bibr" rid="ref7">7</xref>
          ]. It provides powerful solutions to
process huge data sets on different types of data processors from statistical analysis to
machine and deep learning. The disadvantages of such systems
        </p>
        <p>
          The second type targeted to personificated medicine. This solution presented a list
of tools for collecting and systematization patient data. It can help in relative process
medical data of a patient and notify therapist about changes in health state of the patient.
One of the disadvantages such system that it works only with patient medical card or
manual entered by patient information. One of the examples of this system is IBM
Watson Care Manager [
          <xref ref-type="bibr" rid="ref8">8</xref>
          ].
        </p>
        <p>The disadvantages of the first type of systems that they can not be used for
personification medicine. They can be only a part of it with help to increase the speed
of research and creating top level of prediction and decision system in healthcare. The
second type looks more like user data aggregator to help the personal doctor better
understand changes in patient health and real-time monitoring it. We think that
combination of both types can fully show the potential of using IoT and Machine
Learning in personificated medicine.
1.3</p>
      </sec>
      <sec id="sec-2-3">
        <title>Objectives, Approach and Structure</title>
        <p>One of the biggest question in creating big decision support system for healthcare is
selecting environment for its rollout. Best and more secure way it set up all system by
yourself. But on design stage better is focus on the application, then on preparing
hardware, setting the private cloud, thinking about server stability and specific
hardware for running ML. The best way is using cloud services for it. To better
understanding of cloud service system requirements was proposed to create a small
prototype of all system to understand, how we can connect medical devices to the cloud,
how much data they can generate, what type of hardware we need to run ML for data
processing.</p>
        <p>As an example, we use ECG-device for generating data and real-time transferring
data to the cloud. All collected medical data is storing in the database. Then data is
processing with ML and results are storing on the next level of the database. This
example helps to understand the amount of data what system can receive, and what
computing power needed to process it.</p>
        <p>The remainder of the paper is structured as follows. Section 2 presents a brief
description of application architecture. Section 3 describes simple medical sensor and
type of data generated by sensor and type. Section 5 presents a comparison of cloud
services followed by concluding remarks.
2</p>
      </sec>
    </sec>
    <sec id="sec-3">
      <title>Application Architecture</title>
      <p>The application should contain few different levels each of them must produce, store
or process different types of medical data. All levels are separated from each other to
satisfy single responsibility principle.</p>
      <p>Level 1. Hardware. This level includes all devices (sensors) that provide medical data
about the patient. It can be EKG sensors, thermal sensors, physical activity sensors,
tonometers, blood glucose monitoring devices and etc.</p>
      <p>
        They collect data and send it to the first database level, in the cloud. These do not do
any preprocessing data. They can send data directly to the cloud with WI-FI or GSM,
or use some Gateway [
        <xref ref-type="bibr" rid="ref9">9</xref>
        ]. To Gateway they can connect with Bluetooth, ZigBee or
wired connection. Example of such architecture is depicted in Fig 4.
      </p>
      <p>Level 2. Database. This is the first level that store all raw data from sensors. Al-so, on
this level, it is possible to connect external medical databases. The external medical
database may provide raw data of medical survey form different medical insti-tutions.
Also, on this level can be connected free databases with datasets of medical survey for
training artificial intelligence (AI).</p>
      <p>Level 3. First Level of Machine Learning. On this level, different AI for pro-cessing
medical datasets are kept. AI on this level is very simple and can detect only one type
of heels problem. As an example, it can be few AI for processing ECG, EEG data,
ultrasound survey, fluorography and magnetic resonance imaging (MRI image
processing). All processed data are stored on the second level of the database.
Level 4. Second Level of Database. This level stores all processed data of pa-tients
from different sources and after AI algorithms. Also, on this level more infor-mation
about patients like patient history and patient circumstances is kept. This level collects
all related to patient data for next step of processing.</p>
      <p>Level 5. Prediction of AI. There is a big and complex AI for prediction the pa-tient
health state on this level. This is the most complex AI in whole system because it works
with a big amount of different data. As an example, on this level for predic-tion heart
disease can be used not only ECG of the patient. Age, gender, information about similar
problems from parents and grandparents, information about physical activity on time
getting ECG are taking into account on this level. Even it can take into account
information about the ecological situation in place where the patient is living.</p>
      <p>All levels of healthcare IoT application are shown in Fig. 2.</p>
    </sec>
    <sec id="sec-4">
      <title>Collecting and Processing Medical Data</title>
      <p>
        As an example, to calculate how many data system can receive, Heart Rate Monitor
based on chip AD8232 [
        <xref ref-type="bibr" rid="ref10">10</xref>
        ] was used. It produces eighty states electrical activity of the
heart over one second. All produced data collecting during some period (from 15 sec.
to 48 hours [
        <xref ref-type="bibr" rid="ref11">11</xref>
        ]). All this information is stored in a special file. A full timeline of
measurement, short patient information (id of the patient, id of the survey, type of
measurement, time, duration) are stored in the small blocks of data and then sent to the
cloud.
      </p>
      <p>
        To automate the process of classification of medical data was proposed to use
neural networks (NN). The simplest NN for ECG signals classification is based on the
statistical algorithm called KernelFisher Discriminant analysis [
        <xref ref-type="bibr" rid="ref12">12</xref>
        ]. In a NN, the
operation is organized into a multi-layered feed-forward neural network [
        <xref ref-type="bibr" rid="ref13">13</xref>
        ] with three
layers namely Input layer, hidden layer and Decision layer. Such neural network can
process raw data from seasons and make classification of them with mostly human
accuracy.
4
      </p>
    </sec>
    <sec id="sec-5">
      <title>Comparison of Cloud Services</title>
      <p>Nowadays there is a wide specter of the cloud services that can be used for any type of
projects. Selected cloud service should satisfy a few basic demands in case of deploying
AI application:
• support last types of NVidia GPUs;
• big amount of memory (more than 64GB RAM and 16 GB video RAM);
• native support of different types of machine learning engines;
• interactive tools for data exploration, analysis, visualization and machine learning.
Creating Healthcare AI application imposes few additional demands as:
• reliability;
• support HIPAA;
• safety of patient data
Based on requirements above three cloud services was compared: Google, IBM,
Amazon.</p>
      <p>
        IBM. IBM Watson Machine Learning [
        <xref ref-type="bibr" rid="ref14">14</xref>
        ] is a full-service Bluemix offering that
makes it easy for developers and data scientists to work together to integrate predictive
capabilities with their applications. The Machine Learning service is a set of REST
APIs that make integration with programming language to develop applications that
make smarter decisions, solve tough problems, and improve user outcomes.
      </p>
      <p>Watson Machine Learning allows to create different models and compare the results.
Create automated experiments and self-learning models. Also, Watson Machine
Learning allows easy visualize created models. It allows creating machine learning
models using visual modeling tools and quickly identify patterns, gain insights, and
making decisions faster. That is important on the first steps since it allows to involve
doctors without programming knowledge in the first stage of creating predictions
models.</p>
      <p>Also deploying application on IBM Bluemix bring availability to connect IBM
Watson Health. It brings access to medical databases for training models and improve
machine learning models.</p>
      <p>
        Google AI. Google Cloud Machine Learning Engine [
        <xref ref-type="bibr" rid="ref15">15</xref>
        ] is a managed service that
enables to easily build machine learning models that work on any type of data of any
size. The service is integrated with Google Cloud Dataflow for pre-processing,
allowing to access data from Google Cloud Storage, Google BigQuery, and others.
      </p>
      <p>One of the advantage and disadvantage of using Google Cloud AI is supported only
TensorFlow SDK for machine learning. TensorFlow one is the most popular now
frameworks for machine learning which allow works with different types of data such
as simple data (sets of some calculations or datasets), processing images, video, and
audio.</p>
      <p>
        Working with TensorFlow give us the ability to create Portable Models. It can be
used the open source TensorFlow SDK to train models locally on sample data sets and
use the Google Cloud Platform for training at scale. Models trained using Cloud
Machine Learning Engine can be downloaded for local execution or mobile integration.
Amazon. Amazon like previous companies provides similar scope of services for
machine learning. AWS Machine Learning [
        <xref ref-type="bibr" rid="ref16">16</xref>
        ] allow creating big scalable machine
learning system based on all the major frameworks, including TensorFlow, Caffe2, and
Apache MXNe. One of the advantages is not only CPU and GPU for data processing.
      </p>
      <p>AWS allows to create optimized instances based on combination CPU, GPU and
even FPGAs with allow get same performance with less cost.</p>
      <p>It can be noticed that all giants of internet commerce provide mostly similar tools
for creating machine learning systems.</p>
      <p>Many of they provide only special type of cloud which allows to create scalable ML
systems. All 'containers' have access to powerful CPU and GPU, so selecting of cloud
depends on used framework for machine learning, price, and infrastructure of whole
project.</p>
      <p>All information about supported frameworks is shown in Table 1.</p>
      <p>Google Cloud AI
AWS Machine Learning</p>
      <p>IBM Watson</p>
      <p>Google Cloud AI
AWS Machine Learning</p>
      <p>IBM Watson</p>
      <p>CPUs
1-64
cores</p>
      <p>1-64
cores</p>
      <p>
        12
cores
x
x
Processing of data with machine learning require huge computation powers. Using
specialised systems decrease cost of all system and increase it speed. GPUs in this case
one of the better decision because they have more computational units and having a
higher bandwidth to retrieve from memory. Now the most popular GPU for machine
learning is NVIDIA TESLA P100 and NVIDIA TESLA K80. All configurations of
instances displayed in Table 2 and Table 3.
After comparing of the cloud services, it can be finally analyzed which service is better
for deploying healthcare IoT application. Google is one of the best decision for
TensorFlow. It provides powerful instances for running machine learning, easy
integration to others Google services like Big Query and others. Also, for the
lightweight solution on small IoT devices like Raspberry-Pi or android smartphone, it
provides tools for porting trained models to TensorFlow-Lite. In its turn, IBM is the
best solution for integration with other IBM Bluemix services and IBM Watson Health.
It supports many different frameworks for ML and powerful hardware for it. Also, the
big plus is access to medical datasets of American hospitals for training [
        <xref ref-type="bibr" rid="ref17">17</xref>
        ]. Amazon
is the best solution to deploying AI application. It provides most powerful and scalable
hardware for ML including CPU, GPU and FPGA [
        <xref ref-type="bibr" rid="ref18">18</xref>
        ], supports the widest set of ML
libraries and services for storing and processing data. Also, there are many libraries and
integrations of hardware (sensors and gateways) directly to Amazon services.
      </p>
    </sec>
    <sec id="sec-6">
      <title>Conclusions and Future Work</title>
      <p>This paper describes the first step in creating IoT Healthcare cloud service. The first
prototype of application architecture and data flow from hardware to predictions and
its results were described. According to the application architecture and data sources
was made comparing cloud services and selected better variant for prototype deploy.</p>
      <p>Next step will be dedicated to increasing count and types of medical sensors. Add
additional sources of data like meteorological reports. Move from Prototype to first
MVP project where we can start to test this solutions on real peoples. In addition, it is
planned to focus the solution to collecting and processing data from handheld devices
and smartphones and smartwatches.</p>
    </sec>
    <sec id="sec-7">
      <title>Acknowledgements</title>
      <p>This paper results from the Erasmus+ programme educational project ALIOT «Internet
of Things: Emerging Curriculum for Industry and Human Applications» (reference
number 573818-EPP-1-2016-1-UK-EPPKA2-CBHE-JP, web-site http://aliot.eu.org)
in which the appropriate course is developed (ITM4 - IoT for health systems) within its
framework, we have developed modules related to IoT systems modelling. The authors
would like to thank colleagues on this project, within the framework of which the results
of this paper were discussed. The authors also would like to show their deep gratitude
to colleagues from Computer systems, networks and cybersecurity, National Aerospace
University «KhAI» for their patient guidance, enthusiastic encouragement and useful
critiques of this paper.</p>
    </sec>
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