Ghersi et al.

BMC Medical Informatics and Decision Making (2018) 18:63

https://doi.org/10.1186/s12911-018-0643-5

RESEARCH ARTICLE Open Access

Smart medical beds in patient-care

environments of the twenty-first century: a
state-of-art survey
Ignacio Ghersi1,2* , Mario Mariño1 and Mónica Teresita Miralles1,2

Abstract
Background: Recent scientific achievements and technological advances have brought forward a massive display
of new or updated medical devices, enabled with highly-developed embedded-control functions and interactivity.
From the final decade of the twentieth century, medical beds have particularly been affected by this surge, taking
on new forms and functions, while accommodating to established properties that have become well-known for
these devices. The past fifteen years have also brought forward changes to conceptual frameworks, concerning the
product design and manufacturing processes (standards), as well as the patient (perspectives on patient-care environments
and accessibility). This work presents a state-of-art survey on electric medical beds, representing what is defined as the time
of “smart beds”, as part of an increasingly comprehensive patient-care environment.
Methods: A survey and assessment of market trends, research efforts and standards related to smart medical beds was
performed, covering a wide range of public records of intellectual property, models and related healthcare solutions, as well
as relevant research efforts in the field between 2000 and 2016. Contextual topics, necessary for the understanding of this
subject, on novel technologies, disability and the reach of healthcare systems, were also researched and interpreted.
Results: The new generation of electric medical beds is defined, with the final stage of the proposed timeline for these
devices being covered. Functional, aesthetic and interactive features are presented, and the current global market for
medical beds and related standards are also assessed. Finally, discussions concerning rising challenges and opportunities
for these systems are explored, with the potential for adding further monitoring and assistive implementations into
medical devices and environments being highlighted.
Conclusions: Smart medical beds are integrated solutions for patient care, assistance and monitoring, based on a
comprehensive, multidisciplinary design approach. Research in this field is critical in a context of global ageing, and
powered by a surge in opportunities for accessibility solutions. Smart beds, seamlessly integrated into the healthcare
system, have a unique opportunity in enabling more efficient efforts for caregivers, and more responsive environments
for patients.
Keywords: Electric bed, Smart medical bed, Patient-centered, Technology, Accessibility

* Correspondence: igghersi@gmail.com
1
Centro de Investigación en Diseño Industrial de Productos Complejos
(CIDI-FADU-UBA), Facultad de Arquitectura, Diseño y Urbanismo, Universidad
de Buenos Aires, 2160 Intendente Güiraldes Ave, Buenos Aires, Argentina
2
Laboratorio de Biomecánica e Ingeniería para la Salud (LaBIS-FI-UCA),
Facultad de Ingeniería y Ciencias Agrarias, Pontificia Universidad Católica
Argentina, 1600 Alicia Moreau de Justo Ave, Buenos Aires, Argentina

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 2 of 12

Background function, like real-time monitoring, caregiver and patient

Electric medical beds have accumulated almost one assistance, automated functions and positions (chair,
hundred years of history. An essential part of the assisted bed exit), and data logging, as well as more
healthcare environment, the medical bed is also used advanced means of communication.
as a measure of its reach [1], its efficiency (for This work presents a survey on medical beds in the
occupancy and bed-management strategisation [2]), healthcare environments between the years 2000 and
development (representing funding and investment in 2016, leading to an analysis on their current product and
healthcare systems, see [3]) and diversity. For the case research state-of-art, as well as on their potential for de-
of automated, electric devices such as these, techno- velopment and market perspectives. Focused on the final
logical and contextual factors have resulted in signifi- stage of the product timeline, it proposes a study of wide
cant changes to their appearance and their expected scope on the many factors affecting medical beds over
functionality over this period, while retaining original this reduced time range, through a deeper assessment of
features that have guided the first exponents of this current technologies, challenges and views that are set
medical device. It is, however, in the twenty-first to shape the healthcare environment and delivery
century, that an unprecedented, innovative stage in methods in the near future.
the development of these devices has peaked, taking
advantage of all technological means at the disposal Methods
of developers, and resulting in new vectors of added This work presents the results of a survey on electric
value for these products: this stage can be referred to medical beds from the year 2000, and up to 2016. Three
as the time of smart medical beds. different topics were assessed:
Previous work [4] has detailed the evolution of medical
beds form initial, push-button models, to the year 2000, a) Trends and changes found in medical beds over this
dividing such period into two stages: electric beds (1940’s period (section “Twenty-first century medical beds:
to 1980’s) and mechatronic1 beds (1990’s). Highlights Trends and changes (2000–2016)”).
from this diachronic study over a sixty-year period were: b) Current market-reach and features of smart beds
(section “Twenty-first century medical beds:
a) Spreading of these devices outside the hospital Current market-reach and features”).
environment from the 60’s, towards institutional or c) Research efforts with an impact on the experience
residential facilities. or capabilities of the medical bed, as part of more
b) Development of particular regulatory frameworks comprehensive healthcare environments (section
c) Growing invention and commercialization of “Research shaping the future of smart healthcare
dedicated accessories environments”).
d) Incipient incorporation of new technologies into the
devices (second stage) As a characterization of the current state of a specific
medical device, sources for this article have been the re-
Mechatronic beds became a reality in the 90’s, when in- sult of a thorough literature survey on its core subject
ventions, commercial products (i.e. Hill-Rom TotalCare (medical, long-term care beds, patients and operators).
-1998), and dedicated research work [5] accumulated In order to form a comprehensive view on the matter
ergonomics, functions and accessories (alternative actua- and its perspectives, however, other relevant sources
tors, pressure mattresses, weighing scales), incorporating representing economic, social/political and cultural
informatics and communications into these devices. implications to such a relevant medical device were also
In the past decades, the medical-bed market has fur- involved in this study:
ther changed, responding to also-changing structural,
functional, and social-economic demands concerning – Current models of medical beds (significant brands,
the performance of medical beds. From the year 2000 to models of medical beds, and products found
the present, these highly elaborate mechatronic devices through dedicated catalogs [6]).
have consolidated into what can be called the segment – Relevant research findings and publications
of smart mechatronic beds or smart beds, a term that (IEEExplore, JSTOR, PubMed, SpringerLink,
describes a comprehensive synthesis between new mate- EBSCOhost, ScienceDirect), concerning
rials, design and higher functionality and autonomy for mechatronics, patient/bed monitoring, advances in
these systems, all under advanced user interfaces. Smart user interfaces, accessibility and sensors. Terms
beds implement new technologies (graphical interfaces, (with combinations): Hospital Bed/s, Control,
novel environment-aware sensors and actuating solu- Bedridden, Stretcher, MEMS, Face (for face control
tions, etc.), to provide a higher level of service and in accessibility), BCI, Ergonomics, Motor Impairment,
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 3 of 12

South America (for local research and product state- Results

of-art), Trends, Long term, Technology, Cost Nursing A total 85 distributors and manufacturers of medical
Beds, Design. beds from America, Europe and Asia were found and
– Public records of intellectual property (hospital/ evaluated. A wide range of beds covering home-care,
electric bed control interfaces, accessibility-enabled institutional-care, emergency, surgical and therapeutic
beds, networking and communication): United beds (bariatric, elderly, long-term) have been detected.
States Patent and Trademark Office, German Patent Given the inclusion criteria of this work, emergency,
and Trademark Office, The Lens database, INPI psychiatric, obstetric and surgical beds were not
(Argentina). assessed. Nine companies were found to be distributors
– Standards relevant to the implementation of new from other brands. Out of the rest, two manufacturers
technologies into these devices, based on reports were discarded for lack of data concerning the specifics
from regulatory agencies and certifications declared of the manufactured beds, resulting in a group of 74
by medical-bed models. manufacturers of medical beds.
– Commercial solutions and technological news at a Figure 1 is an illustration of a smart medical bed
global scale on these topics (IEEE Spectrum, summarizing the changes that were found to be most
Scientific American, Wired Magazine, Popular significant to these medical devices in the twenty-first
Mechanics). Terms: BCI, Bedridden, Hospital, Bed, century: innovative interfaces, increased functionality
Control, Face Control, MEMS. and dedicated accessories, with customization and
finishing options.
Inclusion criteria restricted models between 2000 and Integration of features like those in Fig. 1 into medical
2016, and to those designed for medium to long-term beds has been a result of technological advances of the
care scenarios, for which patient/caregiver/environment past decades. Table 1 is a list of records of intellectual
interactions become most relevant. Scientific publica- property, found to be associated to smart features compa-
tions included research on novel sensors and assistive tible with medical beds and patient-care environments of
technologies, implemented or believed to be compatible this period (see Section “Smart features”). Accessibility,
with the use or improvement of the experience of the networking and environmental control from the bed, as
medical bed (motion sensors, brain-computer interfaces, well as improved function and design features are exem-
image processing, speech recognition, and adapted plified in these patents, with many of these concepts or
push-buttons). Changes to regulations covering medical variations currently available in smart beds.
beds in this period were also assessed. Unlike commer- Table 2 lists 20 models from 13 manufacturers that
cial models of medical beds, patents were not restricted have been selected as representative of the different cri-
to the period 2000–2016 because the priority or issue teria that were chosen for the evaluation of smart beds
date may not be indicative of when the invention is (user-interfaces, accessories, aesthetics/design, func-
actually implemented or distributed. Criteria for the tions). Highlights of these models are further explored in
evaluation of innovations and changes to medical beds sections “Twenty-first century medical beds: Trends and
in this period were a) user interfaces, b) accessories, c) changes (2000–2016), Twenty-first century medical beds:
aesthetic-morphological properties, and d) embedded Current market-reach and features and Research shaping
functions. the future of smart healthcare environments”, with each

Fig. 1 Illustration of a smart medical bed for clinical use: directed at multiple settings, smart medical beds integrate an array of innovative
interfaces, functions and accessories, with distinct design features and customizations
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 4 of 12

Table 1 Selected records of intellectual property concerning smart functions, design features and connected patient-care
environments
Priority Year Ref Patent Title Highlight
1991 [35] US5335313A Voice-actuated (…) control system for Speech Recognition
hospital bed
1992 [17] US6481688 Hospital bed communication and Accessibility Accessory for Beds
control device
1994 [48] US5831221A Caster mounted weighing system Integrated Scale
[49] US5454126A Foot egress chair bed Chair Position
1995 [50] US5542138 Bedside control unit for a hospital Environmental Control through bed
bed Adjustable interface
[51] US7017208B2 Hospital Bed Graphical Interface
1998 [52] US6781517B2 Communication and Bed Function Multiple Integrated Controls
Control Apparatus
2001 [53] US8334779 Touch Screen Control of a Hospital Touchscreen
Bed
2004 [8] US7852208B2 Wireless Bed Connectivity Networking Functionality
2005 [10] US20080172789A1 Patient Support with Improved Integrated Front Panel, Side-rail Controls (patient and caregiver).
Control Touchscreen, Graphical Interface. Environmental Control
2007 [54] EP2027844A1 Proximity Activation of Voice Different Operation for Caregiver and Patient, Voice control
Operation of Hospital Bed
2010 [11] US20110214234A1 Multifunctional Display for Hospital Touchscreen for Patient and Caregiver. Environmental control
Bed
2010 [55] EP2438897A2 Hospital bed with graphical user Graphical User Interface, Networking, Communication
interface having advanced functionality
2010 [56] EP2460503A2 Biometric Bed Configuration Biometrics, Conditional Control

section detailing findings on the three areas of interest medical beds became the most significant in this period,
that were listed in section “Methods”. resulting in examples with multi-language speech
synthesis for patient-caregiver communication (Stryker
Twenty-first century medical beds: Trends and changes InTouch), and recommending [10], and even imple-
(2000–2016) menting speech-recognition functions for their control
Market expansion and technological availability (Vallitech-2015). With significant embedded capabilities
In accordance with the aforementioned results, a and autonomy, user interfaces (detailed in section “User
growing number and variety of medical beds has been interfaces”) continue to stand out as relevant weighting
found in this period, with increased mechanical and au- factors in the evaluation of these products. A patent of
tonomous functions, reaching up to novel devices, like a 2005 shows multiple potential configurations for
continuous-use bed that turns into a wheelchair for side-rail integrated controls [10], and a subsequent pa-
disabled patients [7], and models with embedded net- tent of 2010 updates these alternatives with touchscreen
working, communication, monitoring and integrated functions, for both patient and caregiver use [11]. In
alarms [8] (i.e. Stryker iBed Awareness). The global mar- 2004, a patent displaying a bed with wireless connecti-
ket for medical beds has become, as a result, vastly more vity, high-complexity user interfaces, and incorporating
competitive in the past decades [9], and the continuing patient-blocking functions, foot pedals, and automated
trend of specialization into different sub-groups of pa- functions was presented [8]. The TotalCare SpO2RT
tients and environments is evident: apart from bariatric bed, from Hill-Rom, as well as Stryker’s InTouch Care
(i.e. Joerns Bari10A and Hill-Rom Excel Care ES) and bed and SizeWise’s Navigator models, show integrated
domiciliary beds, new product lines, aimed at the aid of touchscreens and dedicated graphical user interfaces as
the elderly (Japan’s Paramount Bed Co. Ltd. Rakusho part of their developments. Upgraded, comprehensive
Series) or pediatric patients appear more prominently, front panels and alternate controls continued to prolife-
while other models (for instance Merivaara Carena) dis- rate in this period, and the redundancy of controls be-
play features directed at many of these populations came a standard feature (for instance, visible in Haelvoet
under a single model. Olympia Hospital and Linet Eleganza Smart models).
Following the trend of all medical devices, the integra- Improved ergonomics and risk-reducing articulations
tion of more-developed technologies into electric have also been included into new devices, modifying the
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 5 of 12

Table 2 Smart medical beds: models exhibiting state-of-art – They are highly and increasingly user-oriented (insti-
functional, design and interactive features tutions, operators and patients), which is
Brand Model Year (where available) expressed in their form, function, interactivity and
ArjoHuntleigh Enterprise 9000 2010 ergonomics.
Haelvoet Olympia Hospital 2013 – They strongly express the ideas of hygiene, safety,
durability, comfort, ease of use (both for patients
Hill-Rom TotalCare SpO2RT 2004
and caregivers), reliance on technology and
TotalCare Bariatric 2007
caregivers, with panels and side-rails as main diffe-
Excel Care ES 2013 rentiating factors (full/split rails, integrated
Joerns Bari10A 2012 controls).
UltraCare XT 2013 – They emphasize embedded functions and high-end
Linet Eleganza Smart 2009 technologies, displaying the power embedded into
these products, and in line with a growing techno-
Eleganza 3XC 2013
logical awareness. However, they also allude to the
Merivaara Carena 2012
invisibility of this elaborate technology with simple,
Paramount Bed Co. Ltd. Rakusho Series – intuitive controls.
METIS VIP Series –
KA6600 Series – In sum, the following trends, exemplified in Fig. 2,
Pro Bed Freedom Bed – have been associated to the design of smart beds:
Rotec Versatech 600 2013
– While these devices highlight their advanced
SizeWise Navigator 2013
functionality, they maintain simplified control
Stryker InTouch II 2008/2011 interfaces, relying on known structures and signals,
S3 Med/Surg Bed 2015 to ease their use by patients or caregivers.
Vallitech VLT-931 2015 – For residential or residential-inspired beds, they
Völker LTC Beds 2016 assimilate into these daily environments (Haelvoet
Olympia Hospital, Völker LTC Beds, Paramount Bed
Co. Ltd. METIS VIP).
– Oppositely, critical-care beds highlight robustness,
hip-section articulation when the backrest is lifted embedded technologies, and their reliability for
(TotalCare SpO2RT model), and/or compensating the medical use through their design (Stryker InTouch,
position of the patient in its environment (Stryker S3 Hill-Rom TotalCare Bariatric, Linet Eleganza 3XC,
Med/Surg Bed). Paramount Bed Co. Ltd. KA6600 series). Other
models can be customized for both scenarios (i.e.
Changing (and keeping) the face of the medical bed Rotec Versatech 600).
Over the past years, trends and most relevant innova-
tions to medical beds have been notably related to Regulatory consolidation
design aspects, referred to materials (more hygienic and Regulatory frameworks have an impact on the
resistant), population-specific models, ergonomic ma- design-process and requisites expected of different
nual commands, and morphological changes associated families of devices in order to reach their potential
to updated mobility-options (elevation, front-back and la- users. In the sector of medical beds, there have been
teral inclination, etc.), updated side-rails, patient-support advances in this field between 2000 and 2016. After
structures, castors (fifth castor for enhanced transport), the development of particular standards for electric
while embedded with the aforementioned new medical beds in the late 90’s [4], the first decades of
technologies. the twenty-first century have seen the convergence of
In the competitive scenario presented in previous these standards into a unified reference. ISO/IEC
sections, aesthetic and comprehensive design features standard 60,601–2-52:2009 (basic safety and essential
stand out as a differentiating factor between products. performance of medical beds) [12] was issued in 2009 as a
These features, prominently represented by the side-rails combination of previous standards IEC 60601–2-38:1996
and panels, also serve in adapting the beds to different (requirements for the safety of electrically operated hos-
environments and populations. An analysis of these pital beds) [13], and EN 1970:2000 (adjustable beds for
products, and their means of diffusion, allowed inferring disabled persons: requirements and test methods). This
a set of values and responses that this new generation of document, which covers issues like safe working loads,
smart beds aims to provoke: mechanical and electrical safety, ergonomic requisites and
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 6 of 12

Fig. 2 Aesthetic and design customizations stand out in state-of-art medical beds, serving a purpose of adaptation to different environments.
Left: residential-inspired, long-term care (Völker LTC Vis-à-vis bed) [43]; Right: cardiac and progressive-care for hospital ward (Malvestio Sigma PCU
Electric Bed Scale System) [44]. Permission for use of images granted by Völker and Malvestio

risk-management strategies as a consolidated reference Hill-Rom, Linet, ArjoHuntleigh, Stryker, Paramount Bed
among five scenarios for medical beds (from hospital to Co. Ltd. and Invacare.
nursing and home environments) [12], was first amended The global market of electric and smart medical beds,
in 2015 [14], and falls within the updated scope of IEC both for healthcare facilities and residential use, reaches
60601 [15]. its highest degree of development in the United States and
Europe, with the Asian market showing great potential for
Twenty-first century medical beds: Current market-reach growth in the following years, and within this market,
and features pressure-relief surfaces and beds are among the most
Current market reach prominent sub-groups [9]. Figure 3 shows the global dis-
The current number of developers and manufacturers of tribution of the reviewed companies (accessed 04/2018).
medical beds, their associated products and accessories,
as well as healthcare-management technologies, falls Smart features
easily within the hundreds. Significant market actors, as Table 3 shows a set of stand-out curent medical-bed
described by medical-bed market surveys [9, 16], include properties found on the reviewed systems, ranging from

Fig. 3 Global distribution of the reviewed electric and smart-bed manufacturers. World map adapted from [45]
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 7 of 12

Table 3 Standout features of current medical beds

Related to the device Related to the patient/caregiver Related to the environment
Description • Ergonomic • Universal • Hospital
• Low: controllable frame height, • Bariatric • Intensive Care
significantly lowering the frame to • Critical • Long-Term
mitigate consequences of bed falls • Acute • Residential
• Early Mobility • Medical-Surgical
• Multiple
Aesthetic/design features • 5th castor for eased bed • Frame extension (length-width) • Optional panels, side-rails, colors
transportation • Ergonomics for patient, caregiver and materials for environmental
• Robustness, removable panels • Movable, adaptable side-rail controls adaptation
for hygiene • Autoregression: the back section is • Under-Bed Lighting
• Controllable height (including moved • Chair position
low-frame models) towards the headboard when lifted, • Concealable controls
• Side-rail shock absorbers reducing applied pressure to the • Customizable for medical or
• Advanced mechanics lower back residential scenarios
Standout functions • Backup power • Lit Controls • Patient exit alarm
• Accessory support • Integrated scale • Remote-local alarms
• Mechanical/Digital head of bed • Braden Scale Calculation • Obstacle detection
angle indicators • Nursing staff reminders • Communication functions
• Predefined, programmable positions • Patient blocking functions
(cardiac chair, Trendelenburg, etc.) • Translation for basic questions
• Usage History (positions, etc.) • Monitoring (i.e. bed-exit)
• Integrated accessories • Eased CPR control
(i.e. active mattress) • Motion Support
• Motion Programs • Treatment/Preventive therapies/systems

homecare to intensive-care solutions, detailing aesthe- largely visible. For instance, 85% of the models highlighted
tic-morphological properties (section “Changing (and in Table 2 include positions like cardiac chair and auto-
keeping) the face of the medical bed”) and special func- matic CPR (cardiopulmonary resuscitation), and 95% have
tions that are available in these devices, stemming from dedicated accessories like specialty mattresses, IV-holders
the integration of multiple technological solutions into and options for a fifth castor. From the perspective of
one device (section “Market expansion and technological robustness and safety, battery backup and eased CPR
availability”). As a group, these devices directly highlight release, mentioned in Table 3, provide for fast responses
the different specific purposes that medical beds can be to emergencies under power-failure conditions, another
intended for (see “description”), as well as the increased functionality mentioned in the current standard.
level of technology embedded into them over time. Supplementing design features, customization of fini-
These features are divided in the table, according to shings, materials, colors and side-rail styles for a single
their relation to the device itself, the user (caregiver or model are also distinct, but present to a lesser extent
patient), or the healthcare environment. (corresponding to a 60% of the models in Table 2), while
Features mentioned in the table (i.e. bed-exit alarms, proving a meaningful addition to the design of dedicated,
obstacle detection, advanced motion options, therapy more patient-conscious environments. Finally, adjustable
routines, patient and bed history logging, integrated bed sections (frame width and length), particularly useful
scale, head-of-bed angle monitoring and measurements, for bariatric patients, have become a widespread feature,
patient-blocking, local and remote information on pa- found in the form of integrated mechanics, or as optional
tient conditions, integrated accessory-controls), are all additions, across all models from Table 2.
relevant in their own right, but most impactful when
controlled under a single patient-care interface. Most of User interfaces
these features are shared among models, and not only As a result of this analysis, it has become evident how
isolated cases, representing the increased expectations user interfaces in medical beds have progressively diver-
that their users have developed. sified in this period. Starting with wired hand-held con-
As indicated in section “Changing (and keeping) the face trols (which persist in most models, for instance Joerns
of the medical bed”, design highlights, including patient UltraCare XT), interfaces have advanced up to solutions
and caregiver ergonomics and environmental adaptations with redundant side-rail integrated controls (exterior
for clinical and/or residential settings, are most significant and interior, i.e. ArjoHuntleigh Enterprise 9000), remote
and prominently present across the growing family of controls, foot-pedals, integrated numeric displays and
smart beds. Similarly, access to pre-programmed posi- touchscreens (mostly directed to caregiver control), and
tions, dedicated accessories and optional features are also variants like hanging controls reachable by the patient
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 8 of 12

(see Linet Eleganza Smart and Haelvoet Olympia). of developing pressure ulcers [20]. Based on acquired
Figure 4 shows examples of these alternatives, supple- data concerning the state of the patient or device, these
menting handheld and side-rail controls, which are also monitoring proposals can either show the detected state
visible in Fig. 2. Additionally, current inventions contem- [21], emit alarms [18], or act autonomously against
plate new integrations between these technologies for detected hazards [22, 23]. Patient-motion sensors, in
future devices [10, 17]. contact with the subject, can perform similar tasks con-
Smart medical-bed interfaces count on the aforemen- cerning the detection and alert of lack of mobility (Leaf
tioned, now-standard features like patient blocking, Healthcare Inc. developed one such device), as isolated
nurse-call functions, networking and interaction with additions.
other devices and accessories (i.e. air-pressure mat- Integrated, non-invasive vital-sign acquisition from the
tresses), and redundancy through multiple controls is bed has also been a matter of research over the past years.
available for most options, favoring robust and reliable A consumer-ready device [24] can be placed under the
operation. Based on years of interdisciplinary experience, mattress, and acquire heart and breathing rates, as well as
currently-enforced standards have regulated requisites estimate patient motion and register caregiver-response
for these interfaces (indicators, size, means of operation) time. Outside the medical bed, entertainment systems
[12]. The addition of advanced graphical means and with infrared sensors have been valued and are being
touchscreens with dedicated user interfaces is currently studied for non-invasive heart rate detection [25].
present in a select number of beds, however (20% of the Head-of-bed angle indication and logging is impor-
highlighted cases in this article), while it provides eased tant for the prevention of secondary conditions asso-
access to features like alarm setup and monitoring, and ciated to immobility, and requisites concerning its
is essential to the control of a growing number of states state vary depending on the condition of the patient
and functions in smart beds, like bed-history functions. (prevention of pressure ulcers requires low angles,
For this reason, their presence is expected to increase in and risk of aspiration in intubated patients requires
the future. head-rest angles of over 30 degrees, according to the
experience of nursing and medical staff ) [26]. While
Research shaping the future of smart healthcare incorporated into high-end current devices, the
environments addition of this functionality to manual devices
Monitoring and assistive solutions through MEMS [27] sensors is a low-cost addition
Available as integrated functions for commercial beds with great positive potential [28]. Many current tech-
and research proposals, patient monitoring is the most nologies are, likewise, sufficiently developed to allow
extended group among comprehensive proposals for the for low-cost derived solutions, integrating these into
care of high-risk or long-term patients. Varied systems less-developed healthcare environments.
for fall [18] and agitation detection, around the bed, can Finally, patient-motion assistance is another field of
be valuable additions to the medical bed, allowing for research that is valued for the care of the older and
patient-aware care environments and active sensor-net- disabled patients, with research solutions [29], as well as
works [19]. Similarly, pressure-distribution matrices over consumer-ready devices incorporating such features, so
the support surface of the bed allow a comprehensive that the device supports patient motion, instead of
analysis on patient position, and may reduce the risk replacing it.

Fig. 4 User interfaces in smart beds are multiple, robust and dedicated to the patient and/or caregiver. Integration of new technologies,
ergonomics and graphical interfaces allows for improved control over a broader range of functions. Left: Olympia Hospital bed, developed and
manufactured by Haelvoet [46]. Right: example of a graphical-user interface designed for the control of a new generation of medical beds [47].
Permission for use of images granted by Haelvoet
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 9 of 12

Accessibility interfaces for smart beds resources (tutorials [38], etc.) concerning different
Directed to the treatment of subjects with temporary or conditions. Even when not including control over the
permanently-restricted mobility, medical beds benefit bed itself, these “Interactive Patient-Care Systems” [39]
from past and current accessibility inventions and deve- may integrate a touchscreen through adjustable stands
lopments, both in terms of their actuation-means, as (e.g. Siemens HiMed Cockpit, visible in Fig. 5).
well as in terms of their user-interfaces. The development of personalized healthcare and medical
Among these solutions, environmental control units devices for injuries and chronic diseases has been deemed
(ECU, see [30] for a review on incipient models of the as one of the most impactful and feasible challenges to be
late 90’s) currently stand out as available additions to the tackled by biomedical engineers in the near future [40], and
medical bed environment, controlling some medical the evolution of medical beds and devices in the immediate
beds. These systems are among the most used surroundings of the patient is instrumental to these ad-
accessibility-technologies by patients with spinal cord in- vances. The core of these projects stems from a thorough
jury [31]. Basic inputs to ECUs include accessibility vision concerning the patient’s experience of this environ-
switches, sip-puff controls and pressure sensors (see [32]), ment, valuing the possibility of empowering patients on
and their impact on the quality of life of patients is a mat- their own care, through a more fluid interaction with their
ter of research [33]. Over the past decades, this concept surroundings.
has been considered by research solutions for healthcare
facilities, with inventions aiming at supplementing bed Discussion
control [17]. Speech control, for instance, is considered Medical beds have changed, in the past decades, from
and implemented on a limited number of cases, as an technological, aesthetic, and functional perspectives.
accessory ECU (as the one developed for the Pro Bed Smart medical beds are a comprehensive synthesis of
Medical Technologies Freedom Bed) or incorporated into these three: integrated solutions for patient care, as-
some devices [34]. The promise of speech control for sistance and monitoring. Powered by a surge in user
these devices is not new, with a patent from 1991 describ- technological-awareness, the acceptance of new tech-
ing an ECU for a hospital bed and its environment [35]. nologies into smart beds and accessories will likely
The effectiveness of speech recognition, however, was continue to grow in developed regions, reaching more
more limited at that time, as compared to current models complex, upgraded, and even bold iterations in the
and consumer-ready systems. near future.
Another example is the development of Brain-Computer The future of medical beds will be shaped by the
Interfaces [36], powerful technologies for the aid of critic- continued, conscious supplement of technologies into
ally impaired patients, which are seen as possible inputs for the healthcare environment. A prospective analysis on
ECUs and medical beds with basic actuating functions. This the evolution of healthcare systems will be necessary for
promising technology, however, presents specific difficulties the definition of proper strategies, in order to provide
[37] and is under development, limiting its current reach. better, adapted services (expectations concerning num-
ber of beds and resources needed [41]). As for patients
Technology-assisted healthcare environments and environments, research is heading in the way of pro-
Surrounding the medical bed, the integration of viding even further functionality and integration with
information-technologies into the patient-care environ- the medical bed. Embedded monitoring, autonomous re-
ment has changed the way patient-information and sponses and accessibility-enabled systems can take full
treatments are handled. Updated user interfaces, dedi- advantage of the potential of these devices, while also
cated to patients and caregivers, have emerged over the posing future challenges in the development of reliable
past decade, both as consumer-ready solutions [38] and solutions for the severely-disabled.
research projects [34], covering the management of pa- Technologies implemented into smart medical beds
tient records, and control over the near environment may, at this point, result in derived, low-cost upgrades
(like TV, lights, etc.). As medical beds become smarter, to other devices, like manually-operated beds, which
interaction with these smart environments becomes a less-developed regions can benefit from.
possibility [8]. While features like autonomy and embedded function-
A growing trend looks to change the experience of the ality may hint at an apparent detachment form the work
healthcare environment for patients, providing new of health specialists at this point in time, the need for
means of communication and entertainment at their multidisciplinary insight will, actually, become more
reach, particularly aimed at patients with restricted urgent in the development of successful healthcare
mobility (acute, recovering, and long-term patients). solutions. Research and study on healthcare-environment
These proposals integrate connectivity and a higher con- related solutions is of great need in a context of a
trol over the environment, while including informative globally-ageing population [42], where disability will have
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 10 of 12

Fig. 5 Interactive patient-care systems integrate technology, information and communications into the healthcare environment [38]. Permission
for use of images granted by Siemens

an even greater impact. Accessibility-enabled smart med- Abbreviations

ical beds have the potential of becoming the center of CPR: Cardiopulmonary Resuscitation; ECU: Environmental Control Units;
IEC: International Electrotechnical Commission; ISO: International
new, comprehensive and patient-conscious healthcare Organization for Standardization; MEMS: Micro-ElectroMechanical System
environments.
Funding
This work was supported in part by Universidad de Buenos Aires,
Conclusions Programación Científica 2013–2016, Proyecto Interdisciplinario PIUBAMAS
Smart medical beds have emerged in the past decades as 2062120100011BA: “Evaluación del riesgo de caídas en adultos mayores y en
integrated solutions for patient care, assistance and moni- pacientes geriátricos”.
This work was supported in part by Facultad de Ingeniería y Ciencias
toring, based on a comprehensive, multidisciplinary design Agrarias, Pontificia Universidad Católica Argentina: “Modelos biomecánicos y
process. The global market of medical beds is currently desarrollos de dispositivos para la cuantificación del movimiento humano en
broad, competitive, and still has potential to spread. Dedi- individuos normales y/o disfuncionales”.
cated devices for different demographics are developed, Availability of data and materials
and high-end functionality under customizable solutions All data generated or analysed during this study are included in this
have become common features, expected of these devices. published article.
Research is also continuously promoting novel or updated Authors’ contributions
integrations of technology into this family of devices. It is IG, MM and MTM contributed to the design of the research and to the
expected that these changes will continue to spread into analysis of its results. MM and MTM directed the project. IG took the lead in
writing the manuscript with input from all authors. All authors read and
further automation and design adaptations, with the smart approved the manuscript, provided critical feedback and helped shape the
bed becoming the heart of the smart patient-care environ- state-of-art survey, analysis and figures.
ment of the future. The full potential of smart beds will
not only be achieved with isolated technological or mor- Author’s information
IG: PhD in Design (UBA). Eng. in Electronics and Communications (UCA).
phological advances, but when they are seamlessly inte- Researcher in Biomechanics and Health Engineering at LaBIS-UCA. PhD work
grated into the healthcare system, enabling more efficient on updated mechatronics and interfaces for a novel medical bed design
efforts for caregivers, and more responsive environments (CIDI-UBA & LaBIS-UCA).
MM: Emeritus Professor (FADU-UBA). PhD in Industrial Design (UBA).
for patients. Founding member of the Center for Research in Industrial Design CIDI-
FADU-UBA, with patented work and extensive research on mechatronic beds
Endnotes and products.
1 MTM: PhD in Physics (UBA). Academic, researcher, and director of the
Mechatronics refers to a multi-disciplinary field, com- Biomechanics and Health Engineering Laboratory LaBIS-UCA. Member of
bining knowledge from mechanics, electronics, informat- CIDI-FADU-UBA, with research on biomechanics, medical technology and hu-
ics and communications engineering, as well as control man balance.

theory, into the design of a broad range of products [57], Ethics approval and consent to participate
among which are medical devices. Not applicable.
Ghersi et al. BMC Medical Informatics and Decision Making (2018) 18:63 Page 11 of 12

Consent for publication Computing in cardiology conference (CinC), 22–25 Sept, vol. 2013; 2013. p.
Not applicable. 671–4.
25. Zeng W, Zhang Q, Zhou Y, Xu G et al. (2015) Infrared video based non-
Competing interests invasive heart rate measurement. In: 2015 IEEE International Conference on
The authors declare that they have no competing interests. Robotics and Biomimetics (ROBIO), 6–9 Dec 2015. pp 1041–1046. doi:
https://doi.org/10.1109/ROBIO.2015.7418909.
26. Bachman T. Patient positioning: more than just “turn every 2h”. BNI. 2006;22:3.
Publisher’s Note 27. Crone WC. A brief introduction to MEMS and NEMS, Chapter 9. In: Springer
Springer Nature remains neutral with regard to jurisdictional claims in handbook of experimental solid mechanics. USA: Springer-Verlag; 2008. p.
published maps and institutional affiliations.
203–6. ISBN: 978–0–387-26883-5.
28. Staub M. Senior design team helps hospital staff regulate bed angle.
Received: 9 November 2017 Accepted: 26 June 2018
2013. Department of Mechanical Science and Enginering, University of
Illinois at Urbana-Champaign. (online) https://mechanical.illinois.edu/
news/senior-design-team-helps-hospital-staff-regulate-bed-angle.
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