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The Role of 5G for Digital Healthcare against COVID-19 Pandemic: Opportunities
and Challenges
Yushan Siriwardhanaa,* Gürkan Gürb, Mika Ylianttilaa, Madhusanka Liyanagea,c
aCentre for Wireless Communications, University of Oulu, Pentti Kaiteran katu 1, 90570, Oulu, Finland
bZurich University of Applied Sciences (ZHAW), Gertrudstrasse 15, 8400 Winterthur, Switzerland
cSchool of Computer Science, University College Dublin, Belfield, Dublin 4, Ireland
Abstract
COVID-19 pandemic caused a massive impact on healthcare, social life, and economies on a global scale. Apparently,
technology has a vital role to enable ubiquitous and accessible digital health services in pandemic conditions as well as
against “re-emergence” of COVID-19 disease in a post-pandemic era. Accordingly, 5G systems and 5G-enabled e-health
solutions are paramount. This paper highlights methodologies to effectively utilize 5G for e-health use cases and its role to
enable relevant digital services. It also provides a comprehensive discussion of the implementation issues, possible
remedies and future research directions for 5G to alleviate the health challenges related to COVID-19.
Keywords:
COVID-19, Pandemic, 5G, IoT, E-Health
1. Introduction
The recent spread of Coronavirus Disease (COVID-19)
due to Severe Acute Respiratory Syndrome Coronavirus 2
(SARS-CoV-2) [1] has caused substantial changes in the
lifestyle of communities all over the world. By the end of
June 2020 at the time of this writing, over eleven million
positive cases of COVID-19 were recorded, causing over
500,000 deaths. Countries have been facing a number of
healthcare, financial, and societal challenges due to the
COVID-19 pandemic. Overwhelmed healthcare facilities due
to rapid growth of new COVID-19 patients, are experiencing
interruptions in provision of regular health services.
Moreover, healthcare personnel are also becoming
vulnerable to COVID-19 and this is taxing the healthcare
resources even more. To cease the wide spread of the virus,
governments impose strict restrictions and control on travel
within and between countries, negatively affecting the
economies. While the remote work was considered as an
alternative with limitations, certain jobs became obsolete.
The increased unemployment is a burgeoning problem even
for strong economies. Apart from that, government
expenditure on unemployed workforce, losing income from
sectors associated with tourism such as airlines, hotels, local
transport, and entertainment were major challenges for the
economies. Governments had to introduce new guidelines
on social distancing to prevent the spread of the virus. This
resulted in closing schools, isolating cities and even
restricting public interactions, affecting the regular lifestyle
of people. Such disruption could lead to unprecedented
_______________________
*Corresponding author
Email addresses: yushan.siriwardhana@oulu.fi (Yushan Siriwardhana),
gueu@zhaw.ch (Gürkan Gür), mika.ylianttila@oulu.fi (Mika Ylianttila),
madhusanka.liyanage@oulu.fi, madhusanka@ucd.ie (Madhusanka
Liyanage)
consequences such as losing physical and mental well-being.
Maintaining the societal well-being during the COVID-19 era
is therefore a daunting task.
The technological advancement is one of the key
strengths in the current era to overcome the challenging
circumstances of COVID-19 outbreak. The timely
application of relevant technologies will be imperative to
not only to safeguard, but also to manage the post-COVID-
19 world. The novel ICT technologies such as Internet of
Things (IoT) [2], Artificial Intelligence (AI) [3], Big Data, 5G
communications, cloud computing and blockchain [4] can
play a vital role to facilitate the environment fostering
protection and improvement of people and economies. The
capabilities they provide for pervasive and accessible
health services are crucial to alleviate the pandemic related
problems.
5G communications present a paradigm shift from the
present mobile networks to provide universal high-rate
connectivity and a seamless user experience [5]. 5G
networks target delivering 1000x higher mobile data
volume per area, 100x higher number of connected devices,
100x higher user data rate, 10x longer battery life for low
power massive machine communications, and 5x reduced
End-toEnd (E2E) latency [6]. These objectives will be
realized by the key technologies such as mmWaves, small
cell networks, massive Multiple Input Multiple Output
(MIMO) and beamforming [7]. By utilizing these
technologies, 5G will mainly support three service classes
i.e. enhanced Mobile BroadBand (eMBB), Ultra Reliable and
Low Latency Communication (URLLC) and massive Machine
Type Communication (mMTC). The novel 5G networks will
be built alongside fundamental technologies such as
Software Defined Networking (SDN), Network Function
Virtualization (NFV), Multi-access Edge Computing (MEC)
Preprint submitted to Elsevier July 14,
2020
2
and Network Slicing (NS). SDN and NFV enable
programmable 5G networks to support the fast deployment
and flexible management of 5G services. MEC extends the
intelligence to the edge of the radio network along with
higher processing and storage capabilities. NS creates
logical networks on a common infrastructure to enable
different types of services with 5G networks.
These 5G technologies will enable ubiquitous digital
health services combating COVID-19, described in the
following section as 5G based healthcare use cases.
However, there are also implementation challenges which
need to mitigated for efficient and high-performance
solutions with wide availability and user acceptance as
discussed in Section 3. In this work, we elaborate on these
aspects and provide an analysis of 5G for healthcare to fight
against the COVID-19 pandemic and its consequences.
2. 5G based Healthcare Use Cases for COVID-19
Capabilities of 5G technologies can be effectively utilized
to address the challenges associated with COVID-19
presently and in the post COVID-19 era. Existing healthcare
services should be tailored to fit the needs of COVID19 era
while developing novel solutions to address the specific
issues originated with the pandemic. In this section, the
paper discusses several use cases where 5G is envisaged to
play a significant role. These use cases are depicted in Figure
1 and the technical requirements of use cases are outlined in
Table 1.
Telehealth for Patients
Telehealth is the provision of healthcare services in a
remote manner with the use of telecommunication
technologies [8]. These services include remote clinical
healthcare, health related education, public health and
health administration, defining broader scope of services.
Telemedicine [9] refers to remote clinical services such as
healthcare delivery, diagnosis, consultation, treatment
where a healthcare professional utilizes communication
infrastructure to deliver care to a patient at a remote site.
Telenursing refers to the use of telecommunication
technologies to deliver nursing care and conduct nursing
practice. Telepharmacy is defined as a service which
delivers remote pharmaceutical care via
telecommunications to patients who do not have direct
contact with a pharmacist. (e.g. remote delivery of
prescription drugs). Telesurgery [10] allows surgeons to
perform surgical procedures over a remote distance. All
these healthcare related teleservices are highly encouraged
in post-COVID-19 period due to multiple reasons. Lack of
resources (i.e., hospital capacity, human resources,
protective equipment) in healthcare facilities due to existing
COVID-19 patients, social distancing guidelines imposed by
authorities, requirements of maintaining the regular
healthcare services adhering to the new guidelines imposed
by the healthcare administrations and the need to minimize
the risk of healthcare professionals getting exposed to
COVID-19 are factors motivating teleservices related to
healthcare.
These teleservices sometimes have strict requirements
and call for sophisticated underlying technologies for
proper functionality. As an example, a telemedicine follow-
up visit between the patient and the doctor, would require
4K/8K video streaming with low-latency and low jitter.
Telehealth based remote health education programs should
be accessible to the students from anywhere via an Internet
connection having a proper bandwidth. Monitoring the
patients via telenursing also requires uninterrupted HD/4K
video stream between the patient and the nurse. Remote
delivery of drugs is possible via Unmanned Ariel Vehicles
(UAV), which requires assured connectivity with the base
station to send/receive control instructions without delays.
Extreme use cases like telesurgery requires ultra-low
latency communication (less than 20 ms E2E latency)
between the surgeon and the patient, connectivity between
number of devices such as cameras, sensors, robots,
Augmented Reality (AR) devices, wearables, and haptic
feedback devices [11].
Role of 5G
The future 5G networks will use the mmWave spectrum,
which leads to the deployment of ultra-dense small cell
networks, including the network connectivity for indoor
environments. Technologies like massive MIMO combined
with beamforming will contribute for providing extremely
high data rates for large number of intended users. These
technologies together provide a better localization for
indoor environments [12]. These 5G technologies realize
the eMBB service class which facilitates the transmission of
4K/8K videos between the healthcare professional and the
patient, irrespective of the location of access. The new radio
access technology developed by the 5G networks, also
known as 5G New Radio (NR) supports URLLC. The URLLC
service class helps to realize the ultra-low latency
requirements of telesurgery applications. A Local 5G
Operator (L5GO) has its core and access network deployed
locally on premises, serves the healthcare facility with
multiple base stations deployed both outdoors and indoors
to provide connectivity for case specific needs. This
deployment is beneficial for telesurgery use case to achieve
ultra-low latency, given that there is a requirement of
surgeon and patient being in separate rooms due to the
pandemic situation. MEC servers deployed at the 5G base
stations can be utilized to deploy the control functions for
UAVs for proper payload deliveries. The fundamental design
changes in 5G networks will enable the communication of
large number of IoT devices, which usually transfer less data
compared to human activities such as streaming. These
mMTC services provide the support to 5G enabled Medical
IoTs (MIoTs) that can be used to monitor and treat remote
patients. mMTC will connect and enable communication
3
between heterogeneous devices into the 5G network so
that they can operate in synchronicity. A sensor in a
wearable device of the patient can immediately sends a
signal to the remote nurse via 5G network so that the nurse
can activate a special equipment in the patient’s room
using the mobile device. The use of 5G technologies in a
hospital environment for telehealth use cases is illustrated
in Figure 2.
Rapid Deployment of New Healthcare Applications and
Services
The spread of COVID-19 disease demands the rapid
launching of new healthcare services/applications, change
the way present healthcare services are provided [13],
integrate modern tools such as AI and Machine Learning
(ML) in the data analysis process [14]. A new application can
collect the data of COVID-19 patients from different
healthcare centers, upload the data to a cloud server and
make the information available to public so that others can
rely on the information for different purposes. A live video
conferencing based interactive applications which enable
healthcare professionals to discuss with patients and help
them is another example [15]. Other applications would
perform regular health monitoring of patients such as
followup visits, provide instructions on medical services,
and spread knowledge on present COVID-19 situation and
upto date precautions. The difficulty during the pandemic
was that there was a need to automate most of the regular
work to minimize the interaction between people and new
application development needs were also sudden. This calls
for a flexible network infrastructure which supports the
development of such applications within a short period of
time.
Role of 5G
In contrast to the present 4G networks, 5G supports the
creation of new network services as softwarized Network
Functions (NFs) by utilizing SDN and NFV technologies.
These NFs can be hosted at the cloud servers, operator
premises, or in the edge of the network based on the
application demands. MEC servers equipped with storage
and computing power and reside at the edge of the radio
network, will be a suitable platform to host these
applications. The deployment of such applications will be
more flexible in 5G networks because of the SDN and NFV.
Bringing the NFs towards the edge eliminates the
dependency of the infrastructure beyond the edge, making
the applications more reliable. Increasing the capacity of
the 5G network is much easier because the network itself
is programmable. 5G networks are capable of deploying
network slices which create logical networks to cater the
services with similar type of requirements such as IoT slice
and low latency slice, thereby serving applications with
guaranteed service levels.
Figure 1: 5G Health Use cases for the Fight Against COVID-19
4
Supply Chain Management for Healthcare
A surge in demand for Personal Protective Equipment
(PPE), ventilators and certain drugs was observed at the
beginning of the COVID-19 spread, causing an imbalance of
the regular supply chains [16]. Manufacturing plants were
unable to maintain the regular production due to the
shortage of raw materials and labor force, therefore they
were not capable of responding to the increased demand for
the goods. The supplies of finished products were also
delayed due to transport restrictions and there were no
proper alternative distribution mechanisms so that the
people who are really in need would receive them. N95
masks, hand sanitizers, and regular medicine are some of the
goods where this imbalance of supply was often seen. Those
who reacted quickly could stock items in surplus while
others who are in need did not receive them. Donations to
the victims were not always distributed in a fair manner
because of the absence of centralized management systems.
Delivery of the items to the final consumer was a concern
due to the risk of COVID-19 spread and the restrictions
imposed by the authorities to limit the physical contact. It is
a challenge for the governments, healthcare authorities,
distributors to implement proper mechanisms to manage
the supply chains of healthcare items in the COVID-19
period. To address the issues in healthcare related supply
chains, industries can adopt smart manufacturing
techniques equipped with IoT sensor networks, automated
production lines which dynamically adapt to the variations
in demand, and sophisticated monitoring systems. IoT
based supply chains could be used to properly track the
products from the manufacturing plant to the end
consumer, i.e. connected goods. UAV based automated
delivery mechanisms are specially suited in the COVID-19
situation to deliver medicine, vaccines, masks to the end
consumer minimizing the physical contact.
Figure 2: An Overview of 5G Deployment for Telehealth in a Hospital
5
Role of 5G
5G supports direct connectivity for IoT and mMTC
between IoT devices. This will fuel the possibility to use
large amount of IoT devices to increase the efficiency of
supply chains. Deployment L5GOs to serve the needs of
industries is a better way to integrate IoT sensors, actuators,
robots directly into 5G network enabling a 5G based smart
manufacturing system. The proper network connectivity for
the sensors, actuators, robots in the manufacturing plants
will be enabled by the mmWave 5G small cells deployed
indoors. Massive MIMO will provide connectivity for a large
number of devices and beamforming technique ensures a
better quality of the network connection. The direct
connectivity of goods into the 5G systems makes the supply
chains more transparent. MEC integrated with 5G, can be
used to process the data locally to improve the scalability of
the systems as well as security and privacy of collected data.
Moreover, MEC integrated with 5G can easily be used to
implement decentralized solutions via Blockchain [17], [18].
The delivery of items to the final destination can be
performed via Beyond LineOf-Sight (BLOS) UAV guided by
the 5G network. This could minimize unnecessary
interactions in COVID-19 period and reduce human efforts.
Real-time data is available for the authorized users for
monitoring and tracking, which increases the transparency
of the operation.
Self-Isolation and Contact Tracing
COVID-19 positive patients with mild conditions are
usually advised for self-isolation to prevent further spread.
While self-isolation is a better alternative to manage the
capacity of healthcare facilities, the self-isolating individuals
should be properly monitored to make sure that they follow
the self-isolation guidelines. The challenge is to track every
movement of the patient, which is currently impossible. In
an event of a violation of self-isolation guidelines, control
instructions should be sent. Mobile device based self-
isolation monitoring is possible via an application which
sends random GPS data of patient’s mobile phone to a cloud
server. Wearable devices attached to the patient’s body use
their sensors to measure the conditions of the patient and
upload the data via the mobile phone. UAV based solutions
can monitor the conditions of the patients from a distance.
UAVs can monitor body temperature via infrared
thermography and identify the person via face recognition
algorithms. Moreover, contact tracing of identified positive
cases is extremely important [19]. However, present contact
tracing mechanisms involve significant human engagement
and consist of a lot of manual work. This prevents the
identification of all the possible close contacts and hinders
the effectiveness of the contact tracing. Manual tracing does
not guarantee that all the possible close contacts are
identified. Bluetooth Low Energy (BLE) based contact
tracing applications use BLE wearable devices, which
advertise its ID periodically so that other compatible devices
in close proximity can capture the ID and store with the
important details such as timestamp, GPS location data
(optionally). Once an infected COVID-19 patient is detected,
the BLE solution provides the IDs of the close contacts over
a defined period. BLE based solutions identify the contacts
in the range of few meters, whereas pure GPS based
solutions do not have that accuracy.
Role of 5G
mMTC in 5G is responsible for massive
connectivity of heterogeneous IoT devices such as sensors,
wearables, and robots. The small cell networks equipped
with MIMO and beamforming in 5G will ensure better
connectivity and positioning including indoor
environments. Hence, IoT devices directly connected to 5G
network can be effectively used to monitor the compliance
of self-isolation. Instead of using general mobile device
data, the patients can be attached with a low power
wearable devices which transfer data via BLE technology.
Those sensory data can be updated to the cloud via the 5G
network and the authorized parties can monitor the
behavior of the patient. A similar concept can be applied to
contact tracing where the wearable BLE devices collect
data of nearby devices and upload to the cloud via 5G
network. Once a patient is tested positive, all the close
contact details are already in the cloud and they are
notified for proper safety measures such as self-isolation.
MEC servers deployed at the 5G base stations are useful to
increase the scalability of the operation as the resource
demand increases. Allocating a separate network slice for
contact tracing data transfer is a better approach to assure
the Quality of Service (QoS) and strengthen the privacy and
security of the data.
3. Implementation Challenges
Despite the use-cases for 5G concerning healthcare and
the fight against COVID-19, there are also imminent
challenges ranging from technical ones such as scalability
to socio-economic ones including technology acceptance.
The impact of pertinent deployment challenges on each use
case is depicted in Table 2.
6
3.1. Privacy Protection Issues
A video recording of a telemedicine session may contain
personal information which the patient would like to
disclose only to the doctor. In addition, automated contact
tracing applications aggregate sensitive location data
without the owners’ knowledge. Sharing such sensitive
user data with unauthorized parties such as third-party
advertisers is a serious privacy violation [27]. In addition,
privacy protection is a legal requirement, which is posed
by various legal frameworks such as GDPR [28] and Health
Insurance Portability and Accountability Act (HIPAA) [29].
Possible Solutions
To address the privacy challenge, solutions like Privacy
by-Design[30], software defined privacy [31] have to be
deployed with 5G health applications already at the design
phase. Privacy-by-Design relies on the notion that that data
controllers and processors should be proactive in
addressing the privacy implications of any new or upgraded
system, procedure, policy or data-sharing initiative, not at
the later stages of its life-cycle, but starting from its planning
phase [32]. The developed e-health solutions in 5G should
consider the entire life-cycle of health data when protecting
Table 1: Technical Requirements of Digital Healthcare related Use Cases [20, 21, 22, 23, 24, 25, 26]
Use
Case
Application
Expected
Capacity
Expected
Latency
Number of
Devices
Other Requirements
Telemedicine
>
500 million
visits per year
<
1-100 ms
1-10 per
appointment
Real-time backhaul connectivity
Streaming data type
Telenursing
<
50 Mbps
<
1-100 ms
1-10 per
appointment
Real-time backhaul connectivity
Streaming data type
Telesurgery
30-50 Mbps
>
1
Gbps for
holographic
rendering
<
1 ms
10-100 per
surgery
Real-time backhaul connectivity
Streaming data type
>
99.999% availability required
>
99.999% reliability required
Telehealth
Telepharmacy
<
50 Mbps
<
1000 ms
1-10 per
appointment
Real-time backhaul connectivity
Streaming data type
Connected
Goods
small-data
(
<
1 Kbps) per
device,
>
1-10
Gbps of data
per supply
chain
<
10000 ms
up to
millions
per supply
chain
Intermittent backhaul
connectivity
Streaming/historical data
>
95% availability required
Supply
Chain
Manufacturing
>
1-10 Gbps of
data per plant
wide range:
<
1 ms for
time-critical
(e.g.robotics),
<
10000 ms for
non-time-critical
optimizations
(e.g.
as
set localization)
1000-one
million per
plant
Real-time backhaul connectivity
Streaming data
Indoor connectivity and high
availability
Using sensor
data for
contact
tracing
>
10-100 GB of
data per city
per day
<
1 ms
1000-one
million per
city
Real-time backhaul connectivity
Streaming data type
Low power consumption
Contact
Tracing
Self Isolation
<
1 GB of data
per isolated
person per day
<
1000 ms
1-10 per
isolated
person
Real-time/intermittent backhaul
connectivity
Streaming data type
7
them. To protect privacy, access control methods managing
how different parties access information are necessary.
Edge computing is beneficial to minimize data transmissions
through different network elements and enable local
processing, improving privacy aspects [33]. Furthermore,
users of e-health technology should be made fully aware of
what they are consenting to regarding data sharing and
processing when they are using such digital solutions.
Similarly, transparency in the form of informing users of
potential privacy risks are effective to improve the adoption
of e-health solutions [34].
3.2. Security Challenges
Attempts by adversaries to attack the databases
containing sensitive information pose security risks. The
importance of e-health systems exacerbates the impact of
attacks on the availability requirement. The integration of
MIoT increases security risks of healthcare systems. Such
low-end devices are comparably easy to hack and
vulnerable to Denial-of-Service (DoS) attacks. Massive
amount of connected devices increases the number of
entry points for attackers to perform unauthorized
operations, i.e. increases the attack surface, on the
healthcare system [35].
Possible Solutions
Lightweight and scalable security mechanisms must be
designed to secure MIoTs. Adequate security mechanisms
are crucial to address the limited capabilities of constrained
sensors, as well as the additional vulnerabilities if part of the
security functions are offloaded to the cloud. For the digital
health services, widespread automation, data analytics and
smart control requires ML and AI techniques in 5G systems.
Encrypted data transmission and distributed security
solutions such as blockchain can prevent attackers gain
access to the network and protect the collected user data of
different premises. The employed security mechanisms and
algorithms should support continuous updates with
minimal effort to adapt to discovered vulnerabilities and
emerging security threats.
3.3. Scalability and QoS Provisioning in Massive
Connectivity Regime
A rapid deployment of new healthcare applications will
add extra traffic as well as increase the number of 5G users
who access such services. This will lead to increased
network congestion. As an example, AR based applications
used in telemedicine require high bandwidth and low
latency. However, a congested network fails to satisfy the
service levels for such applications. Moreover, it is
challenging to manage billions of MIoTs. When a large
number of IoT devices generate ad-hoc data transfers, the
network should be scalable to cope with the increased
number of traffic events. The small data characteristics and
intermittent connectivity of IoT encumber the medium
access and physical layers of access networks serving e-
health applications.
Possible Solutions
NS in 5G with dynamic scalability is a possible solution
to address this problem. The slices serve similar type of
services and they can be made adaptive based on the various
parameters such as priority of the service, present network
traffic, available network resources, QoS requirement,
number of IoT devices presently connected [36].
Deployment of virtual NF based on demand at the MEC
servers will provide a solution to the congestion due to
sudden increase of localized demands. For improving
scalability, edge computing systems and distributed clouds
can perform visual processing on large computational
capabilities like GPUs and transmit the audiovisual outputs
enriched with analytics results to mobile e-health devices. In
this way, the impact from device limitations is elastically
minimized while congestion towards core network is also
mitigated. Regarding the physical layer, PHY techniques
such as full beamforming technologies using a large number
of antenna elements increase scalability, high frequency
utilization efficiency and high-speed communication.
3.4. 5G Deployment and Limited Connectivity Challenges
Network operators need to deploy these 5G based
solutions as soon as possible. The limited deployment of 5G
networks and limited availability of 5G devices will be an
immediate problem for many countries. Undoubtedly, the
5G proliferation is expected to be gradual in terms of
network connectivity and capacity. The complexity and
implementation issues of 5G devices including power
consumption due to high frequency transmissions as well
as multi-band support of upper and lower frequency bands
complicate the device cost and production challenges.
Possible Solutions
Governments and networks operators should push
forward their deployment plans. Moreover, small scale 5G
deployments such as L5GO networks [37] should be
encouraged to use in hospitals, manufacturing plants [38].
Purpose-built IoT devices with a smaller but targeted
capabilities for e-health use-cases can alleviate the
complexity and cost issues regarding the deployment and
commissioning of 5G systems. From the business
perspective, offering a discount to mobile operators
bidding in spectrum auctions in exchange for an improved
coverage commitment can expedite the 5G deployment.
For improving coverage in poorly served areas, some
spectrum bands can be shared by different network
providers. From the cost minimization perspective, RAN
sharing allows multiple operators to use the same radio
access infrastructure and enables an easier coverage
expansion for 5G.
3.5. Societal Issues and the Human Factor
Incidents such as destroying the cellular base stations
[39, 40] due to conspiracy theories linking new 5G mobile
networks and the COVID-19 pandemic [41], disrupts
connectivity affecting the applications. However, network
8
connectivity and service continuity are critical for
connected e-health solutions. 5G solutions may require the
user to possess sophisticated level of technical literacy.
However, many people lack such level of technical literacy.
The provided ease of use is an important factor that
supports or inhibits the implementation of e-health
systems. Health personnel is deterred from or resistant to
using such new systems with additional complexity to their
workflows, or requiring additional effort/time [42].
Furthermore, 5G devices are significantly more expensive,
leading to a cost burden on users.
Possible Solutions
Experts and media have responsibility to clear out these
inaccurate social beliefs with the support of civil society and
governments. The applications can be made easier to use
and to execute on average hardware and devices so that
everyone can afford it and use the services. For e-health
solutions supporting physician-patient interaction, an
effective clinical decision support system must minimise the
effort required by clinicians to receive and act on system
recommendations. This requirement is extended to include
ease of use for patients and their family members and other
service users, or even health professionals be-sides
clinicians, such as nurses [42].
3.6. Legal and Regulatory Dimension
Solutions for remote monitoring, contact tracing will
result in legal issues unless the sensitive personal data is
not properly handled. Examples are contact tracing after
the patient is recovered from COVID-19, collecting and
storing unnecessary data from the personal devices. Since
access to healthcare is a right, if the technical solutions
prevent people from obtaining timely healthcare or cause
wrong diagnosis/treatment, that is an issue concerning
fundamental rights. 5G-enabled smart devices for e-health
will have a far reaching impact on manufacturers, service
companies, insurers and consumers. Such a situation could
also lead to legal issues.
Possible Solutions
Adhering to the policies defined by standardization
bodies such as EU statement on contact tracing [43]
prevents legal issues. Standardisation and regulation must
cover the whole range of healthcare technology chain from
medical device technologies to software technologies,
including sensors. Obtaining legal advice before the
deployment of different applications would also prevent
the future legal issues. The traditional product liability
limited to the form of tangible personal property should be
extended to the correct functioning of network and
services in e-health solutions. This is more challenging due
to the complex environment of 5G. Therefore, root-cause
analysis techniques and pervasive monitoring functions
are important [35].
4. Conclusions
Healthcare sectors of the countries were the first to affect
due to the spread of COVID-19 disease, facing numerous
challenges. As the countries now have control mechanisms
in place to minimize the spread of COVID19, they are re-
opening the economies so that the public can resume their
regular lifestyle. To prevent any “re-emergence” of the
disease, healthcare sectors of each country must be
equipped with novel solutions to address any emerging
Table 2: Pertinent Deployment Challenges on Use Cases and their Impacts [20, 21, 22, 23, 24, 25, 26]
Deployment Challenges
Use Case
Application
Privacy Issues
Security
Challenges
Scalability Issues
QoS Provisioning
Limited
Connectivity
Societal Impact
Legal Issues
Regulatory
Restrictions
Telemedicine
H
H
H
M
H
H
M
H
Telenursing
M
M
M
L
L
H
M
M
Telesurgery
M
H
L
H
L
H
H
H
Telehealth
Telepharmacy
L
H
H
L
H
L
L
M
Connected Goods
M
H
H
L
L
M
L
Supply Chain
Manufacturing
L
M
H
H
L
L
L
L
L
Contact Tracing
H
M
H
L
H
H
H
Containment
Self Isolation
H
M
H
L
H
H
H
H
H
L = Low Impact, M = Medium Impact, H = High Impact
9
challenges effectively. To this end, 5G technologies are
crucial. 5G utilizes mmWave frequencies of the radio
spectrum with small cell base stations which will provide
better connectivity including indoor environments via its
NR. Massive MIMO combined with beamforming will serve a
large number of 5G devices/users with guaranteed data
rates. These technologies deliver eMBB, URLLC and mMTC
service classes which enable the development of different
types of services using 5G networks such as AR, UAV
communication, and collaborative robots. Together with 5G,
MEC and NS will improve flexibility, scalability, guaranteed
service levels and security for the applications. Hence,
solutions developed using 5G technologies serve various
health related use cases such as telehealth, supply chain
management, self-isolation and contact tracing, and rapid
health services deployments. However, a wide range of
implementation challenges such as privacy/security,
scalability, and societal issues should be addressed before
deploying such applications with full functionality.
Acknowledgments
This work is partly supported by the European Union in
RESPONSE 5G (Grant No: 789658) and the Academy of
Finland in 6Genesis (grant no. 318927)
References
[1] C.-C. Lai, T.-P. Shih, W.-C. Ko, H.-J. Tang, P.-R. Hsueh, Severe Acute
Respiratory Syndrome Coronavirus 2 (SARSCoV-2) and Corona
Virus Disease-2019 (COVID-19): The Epidemic and the Challenges,
International journal of antimicrobial agents (2020) 105924.
[2] M. Talal, A. Zaidan, B. Zaidan, A. Albahri, A. Alamoodi, O. Albahri, M.
Alsalem, C. Lim, K. L. Tan, W. Shir, et al., Smart Home-based IoT for
Real-time and Secure Remote Health Monitoring of Triage and
Priority System using Body Sensors: Multidriven Systematic Review,
Journal of Medical Systems 43 (3) (2019) 42.
[3] A. Albahri, R. A. Hamid, et al., Role of Biological Data Mining and
Machine Learning Techniques in Detecting and Diagnosing the
Novel Coronavirus (COVID-19): A Systematic Review, Journal of
Medical Systems 44 (7) (2020).
[4] H. Kaur, M. A. Alam, R. Jameel, A. K. Mourya, V. Chang, A Proposed
Solution and Future Direction for Blockchain-based Heterogeneous
Medicare Data in Cloud Environment, Journal of Medical Systems 42
(8) (2018) 156.
[5] F. Boccardi, R. W. Heath, A. Lozano, T. L. Marzetta, P. Popovski, Five
Disruptive Technology Directions for 5G, IEEE communications
magazine 52 (2) (2014) 74–80.
[6] A. Osseiran, F. Boccardi, V. Braun, K. Kusume, P. Marsch,
M. Maternia, O. Queseth, M. Schellmann, H. Schotten, H. Taoka, et al.,
Scenarios for 5G Mobile and Wireless Communications: The Vision of
the METIS Project, IEEE Communications Magazine 52 (5) (2014) 26–
35.
[7] J. G. Andrews, S. Buzzi, W. Choi, S. V. Hanly, A. Lozano, A. C. Soong, J.
C. Zhang, What will 5G be?, IEEE Journal on selected areas in
communications 32 (6) (2014) 1065–1082. [8] E. R. Dorsey, E. J.
Topol, State of Telehealth, New England Journal of Medicine 375 (2)
(2016) 154–161.
[9] Y. S. Hau, J. K. Kim, J. Hur, M. C. Chang, How about Actively using
Telemedicine during the COVID-19 Pandemic?, Journal of Medical
Systems 44 (2020) 1–2.
[10] W. D. de Mattos, P. R. Gondim, M-health Solutions using 5G Networks
and M2M Communications, IT Professional 18 (3) (2016) 24–29.
[11] A. Mahajan, G. Pottie, W. Kaiser, Transformation in Healthcare by
Wearable Devices for Diagnostics and Guidance of Treatment, ACM
Transactions on Computing for Healthcare 1 (1) (2020) 1–12.
[12] J. Palacios, G. Bielsa, P. Casari, J. Widmer, Single-and Multiple-access
Point Indoor Localization for Millimeter-wave Networks, IEEE
Transactions on Wireless Communications 18 (3) (2019) 1927–1942.
[13] B. N. Naik, R. Gupta, A. Singh, S. L. Soni, G. Puri, RealTime Smart Patient
Monitoring and Assessment Amid COVID19 Pandemic–an Alternative
Approach to Remote Monitoring, Journal of Medical Systems 44 (7)
(2020) 1–2.
[14] K. Santosh, AI-driven Tools for Coronavirus Outbreak: Need of Active
Learning and Cross-population Train/test Models on
Multitudinal/multimodal Data, Journal of Medical Systems 44 (5)
(2020) 1–5.
[15] M. M. Kiah, S. Al-Bakri, A. Zaidan, B. Zaidan, M. Hussain, Design and
Develop a Video Conferencing Framework for Realtime Telemedicine
Applications using Secure Group-based Communication Architecture,
Journal of Medical Systems 38 (10) (2014) 133.
[16] J. R. Patrinley, S. T. Berkowitz, D. Zakria, D. J. Totten, M. Kurtulus, B. C.
Drolet, Lessons from Operations Management to Combat the COVID-
19 Pandemic, Journal of Medical Systems 44 (7) (2020) 1–2.
[17] T. Hewa, G. Gu¨r, A. Kalla, M. Ylianttila, A. Bracken, M. Liyanage, The
Role of Blockchain in 6G: Challenges, Opportunities and Research
Directions, in: 2020 2nd 6G Wireless Summit (6G SUMMIT), 2020, pp.
1–5.
[18] M. C. Chang, D. Park, How Can Blockchain Help People in the Event of
Pandemics Such as the COVID-19?, Journal of Medical Systems 44
(2020) 1–2.
[19] P. O’Neill, T. Ryan-Mosley, B. Johnson, A Flood of Coronavirus Apps are
Tracking us. Now It’s Time to keep Track of Them, mIT Technology
Review (2020).
[20] R. Gupta, S. Tanwar, S. Tyagi, N. Kumar, Tactile-InternetBased
Telesurgery System for Healthcare 4.0: An Architecture, Research
Challenges, and Future Directions, IEEE Network 33 (6) (2019) 22–
29.
[21] A. Osseiran, J. F. Monserrat, P. Marsch, 5G Mobile and Wireless
Communications Technology, 1st Edition, Cambridge University
Press, USA, 2016.
[22] P. Porambage, J. Okwuibe, M. Liyanage, M. Ylianttila, T. Taleb, Survey
on Multi-Access Edge Computing for Internet of Things Realization,
IEEE Communications Surveys Tutorials 20 (4) (2018) 2961–2991.
[23] D. Soldani, F. Fadini, H. Rasanen, J. Duran, T. Niemela,
D. Chandramouli, T. Hoglund, K. Doppler, T. Himanen, J. Laiho, N.
Nanavaty, 5G Mobile Systems for Healthcare, in: 2017 IEEE 85th
Vehicular Technology Conference (VTC Spring), 2017, pp. 1–5.
[24] M. J. Keeling, T. D. Hollingsworth, J. M. Read, The Efficacy of Contact
Tracing for the Containment of the 2019 Novel Coronavirus (COVID-
19), medRxiv (2020).
[25] A. Barat`e, G. Haus, L. A. Ludovico, E. Pagani, N. Scarabottolo, 5G
Technology for Augmented and Virtual Reality in Education, in:
Proceedings of the International Conference on Education and New
Developments 2019 (END 2019), 2019, pp. 512–516.
[26] S. Baldoni, F. Amenta, G. Ricci, Telepharmacy services: Present status
and future perspectives: A review, Medicina 55 (7) (2019).
doi:10.3390/medicina55070327.
URL https://www.mdpi.com/1010-660X/55/7/327
[27] J. L. Hall, D. McGraw, For Telehealth to Succeed, Privacy and Security
Risks must be Identified and Addressed, Health Affairs 33 (2) (2014)
216–221.
[28] European Commission, EU data protection rules (2016).
URL https://ec.europa.eu/info/law/law-topic/ data-
protection/eu-data-protection-rules\_en
[29] U.S. Department of Health & Human Services, Health insurance
portability and accountability act of 1996 (HIPAA) (1996).
URL https://www.hhs.gov/hipaa/index.html
[30] F. H. Semantha, S. Azam, K. C. Yeo, B. Shanmugam, A systematic
literature review on privacy by design in the healthcare sector,
Electronics 9 (3) (2020) 452.
[31] F. Kemmer, C. Reich, M. Knahl, N. Clarke, Software defined privacy, in:
10
2016 IEEE International Conference on Cloud Engineering Workshop
(IC2EW), 2016, pp. 25–29.
[32] Y. O’Connor, W. Rowan, L. Lynch, C. Heavin, Privacy by design:
Informed consent and internet of things for smart health, Procedia
Computer Science 113 (2017) 653 – 658.
[33] F. Rao, E. Bertino, Privacy techniques for edge computing systems,
Proceedings of the IEEE 107 (8) (2019) 1632–1654.
[34] J. Wilbanks, S. H. Friend, First, design for data sharing, Nature
biotechnology 34 (4) (2016) 377–379.
[35] Jordi Ortiz et al., INSPIRE-5Gplus: Intelligent security and pervasive
trust for 5G and Beyond networks, in: accepted to Proceedings of the
13th International Conference on Availability, Reliability and Security
- Workshop on 5G Networks Security (5G-NS 2020), 2020, pp. 1–10.
[36] Y. L. Lee, J. Loo, T. C. Chuah, L.-C. Wang, Dynamic Network Slicing for
Multitenant Heterogeneous Cloud Radio Access Networks, IEEE
Transactions on Wireless Communications 17 (4) (2018) 2146–2161.
[37] M. Matinmikko, M. Latva-Aho, P. Ahokangas, S. Yrj¨ola¨, T. Koivuma¨ki,
Micro Operators to boost Local Service Delivery in 5G, Wireless
Personal Communications 95 (1) (2017) 69–82.
[38] Y. Siriwardhana, P. Porambage, M. Liyanage, J. S. Walia, M.
Matinmikko-Blue, M. Ylianttila, Micro-operator driven Local 5G
Network Architecture for Industrial Internet, in: 2019 IEEE Wireless
Communications and Networking Conference (WCNC), IEEE, 2019,
pp. 1–8.
[39] BBC News, Mast Fire Probe amid 5G Coronavirus Claims (Apr 2020).
URL https://www.bbc.com/news/uk-england-52164358\#
[40] The Guardian, At Least 20 UK Phone Masts Vandalised over False 5G
Coronavirus Claims (Apr 2020).
URL https://www.theguardian.com/technology/2020/apr/
06/at-least-20-uk-phone-masts-vandalised-over-false-5g-coronavirus-
claims
[41] W. Ahmed, J. Vidal-Alaball, J. Downing, F. L. Segu´ı, COVID19 and the
5G Conspiracy Theory: Social Network Analysis of Twitter Data,
Journal of Medical Internet Research 22 (5) (2020) e19458.
[42] 5G Infrastructure Association, 5G-PPP white paper on ehealth
vertical sector, Technical Report (2015).
URL https://5g-ppp.eu/wp-content/uploads/2016/02/
5G-PPP-White-Paper-on-eHealth-Vertical-Sector.pdf
[43] Europe Technology Policy Committee, Statement On Essential
Principles and Practices for Covid-19 Contact Tracing Applications
(May 2020).
URL https://www.acm.org/binaries/content/assets/ public-
policy/europe-tpc-contact-tracing-statement.pdf
