On middleware for emerging health services

Healthcare concerns have become diverse, ranging from acute and chronic conditions to lifestyle, wellbeing and the prevention of illness. Increasingly, individuals are taking responsibility for monitoring their own conditions. Healthcare technologies are increasingly used not only for administration, but also in specialist treatments and many forms of monitoring, including when a person is mobile. As well as formal interactions with professional carers and results from specialist procedures, care may involve ad hoc interactions with an individual’s community. Together, these yield a wealth of data relevant in different contexts. Unfortunately, many existing healthcare systems are inflexible, single-purpose, and self-contained, so that we cannot fully realise their potential. We believe that a framework for flexible interoperability of healthcare-relevant components is crucial, in a time of increasing need from an ageing population.We present a vision of pervasive, preventative and personalised healthcare. To achieve this we believe that the application logic embodied in components should be separated from the policy that specifies where and how they should be used—which may be in ways not contemplated by their original designers. Middleware should therefore provide a framework that supports not only traditional communication among components but also dynamic reconfiguration of components in response to circumstances that arise, with the management and enforcement of high-level policy integrated with the middleware. By this means, functionality for patients, carers and health administrators can be customised and provided as, when and where required.This paper explores middleware requirements and challenges arising from technology- and population-driven developments in healthcare provision. We describe the specific requirements that middleware must address, and present some practical steps towards addressing these from the initial stages of a middleware (SBUS).