Future Trends in Remote Patient Monitoring

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Future Trends in Remote Patient Monitoring

• Tony Tam
• Candidate MHSc. Clinical Engineering
• University of Toronto

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Presentation Outline

• Challenges in Healthcare
• Objectives of Remote Patient Monitoring
• Innovations in Patient Monitoring
• Future work
• QA

3
Challenges of Healthcare

• Growing number of chronic disease patients
  (hypertension, diabetes, asthma, cardiovascular
  problems etc)
• Costs of health care delivery are increasing

First Ministers'. Ottawa New Release from the
First Ministers Meeting New Federal Investments
on Health Commitments on 10-Year Action Plan on
Health. September 2004.
4
Remote Patient Monitoring

• The application of technology to assess patient
  health within and beyond health care facilities
• Two major types
• Long term trending - management of chronic
  disorders or health problems (periodic data dump)
• Detection of emergency events of at-risk patients
  (real-time alert)

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Objectives of Remote Patient Monitoring

• Continue monitoring the health status of patients
  outside of the health facility reducing need for
  checkups/ hospitalization
• Measurement of treatment effectiveness more
  objective and better characterization of patient
  response to treatment
• Postpone hospitalization / Discharge patients
  earlier
• Extend independent living for the elderly
• Reduce demand on caregivers, allowing caregivers
  to provide services for a greater number of
  patients

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Applications for Non-Invasive and Continuous
Monitoring

• Remote telemedicine
• In-home care
• Patient transport (ambulance, aircraft) send
  patient data prior to arrival (e.g. in transit),
  physician consultation in remote situations
• Military assessment of battlefield conditions
• Emergency worker monitoring (first responders,
  firefighters)
• Inpatient and outpatient clinical monitoring
• Cardiac monitoring
• Sleep studies
• Clinical trials

http//lifeguard.stanford.edu/presentations/embc_l
ifeguard_paper_FINAL.pdf
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Asynchronous home monitors

• TensioMobile can store up to 600 blood pressure
  measurements
• Transfers the stored data via mobile phone to a
  central monitoring center
• Physician receives periodic report

http//aerotel.com/Products/ShowDetails.asp?iProdu
ctsID23
http//www.tensiomed.com/tensiomobile.html
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Physiological parameters

• Blood Pressure (Hypertension)
• Weight scale (diabetes)
• Respiratory Flow Meter (asthma, pulmonary
  function)
• Glucose meter
• Blood Oxygen Saturation Level (SpO2)
• ECG
• Temperature
• Blood clotting time and INR ( Coumadin therapy
  effectiveness)

http//aerotel.com/Products/ProductsFamily.asp?iPr
oductsFamilyID2 http//www.hommed.com/products/pe
ripherals/medicaldevices.html
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Telemetric EMG Systems

• Electromyographs (EMGs) provide information about
  muscle fatigue and recovery time to determine
  whether treatments are focused on the appropriate
  muscles, sufficient, and effective.
• Incontinence - Retraining the pelvic floor
  muscles to eliminate or reduce incontinence.
• Rehabilitation - Establish baseline data, measure
  progress, project duration of rehabilitation,
  project associated costs, document progress

http//www.noraxon.com/applications/clinical/appli
cations.php3
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Implantable Heart Monitor

• Continuously records heart rate and heart rhythm
  for 14 months (works like a black box in an
  airplane)
• 15-20 minute operation to insert Medtronic
  monitor under skin
• After waking from a fainting episode, place
  Activator over monitor
• Doctor for analyzes Activator data to determine
  whether fainting is due to irregular heart rhythm

http//www.medtronic.com/reveal/
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Vivago WristCare

• Back plate and straps measure micro- and
  macro-movement, as well as skin temperature and
  skin conductivity.
• When it detects a significant change from normal
  activity pattern (e.g. heart attack,
  unconsciousness), the system automatically sends
  an alarm to a designated recipient.
• Monitoring sleep patterns and the impact of
  changes in medication on activity levels
• Manual alarm button

http//emb-magazine.bme.uconn.edu/EMB_Main/Past_Is
sues/2003May/Korhonen.pdf http//www.hightechfinla
nd.com/2004/healthcarelife/ist.html
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Digital Angel

• Patient wears a wristwatch containing biosensors,
  a GPS receiver and a wireless transmitter.
• Periodic transmission of health status to a
  central station
• Sends help in emergencies
• Locate wandering Alzheimers patients, autistic
  children, lost pets.

http//www.skyaid.org/Skyaid20Org/Medical/digital
_angel.htm
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VitalSense

• Measures core body temperature (pill 1.6 g) and
  skin temperature (patch).
• 2 modes
• continuous data log
• monitor multiple pills (e.g. group of fire
  fighters)
• Each pill is coded for simultaneous monitoring
• Average 1.5 day use, 45

http//www.eurekalert.org/pub_releases/2004-10/mmc
i-v-101104.php http//www.minimitter.com/Products/
Brochures/900-0138-00_VS.pdf
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Clinical Applications

• Monitor heat stress in firefighters
• Battlefield monitoring of soldiers
• Perioperative monitoring of patients
• Telemonitoring
• Clinical studies underway
• Menopausal hot flash monitoring
• Ovulation detection
• Sepsis detection in hospitals

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Lifeguard

• Transmit vital signs wirelessly and logs data for
  up to 8 hours
• Physiological sensors (ECG/respiration, pulse
  oximetry, blood pressure)
• Small wearable computer with internal sensors
  (activity sensor via 3-axis accelerometers and
  skin temperature) acquires, logs, and transmits
  data
• A display station (Tablet PC). Analysis routines
  combine all parameters to one basic status
  indicator of "general health"

http//lifeguard.stanford.edu/presentations/embc_l
ifeguard_paper_FINAL.pdf
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Lifeguard

• Developed for extreme environments (Under-sea
  habitat, mountain climbing centrifuge
  experiments, microgravity).
• Real-time transmission of vital signs from
  Licancabur volcano in Chile at 19,700ft,
  reflected off an Inmarsat satellite, downlinked
  via France Telecom, sent across the Internet to
  Standford University demonstrated the feasibility
  of global telemedicine.

http//lifeguard.stanford.edu/presentations/embc_l
ifeguard_paper_FINAL.pdf
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Lifeshirt

• Sensors are woven into the shirt around the
  subject's chest and abdomen. Measures 30
  cardiopulmonary signs, subject posture and
  physical activity
• Blood pressure, blood oxygen saturation, EEG,
  EOG, periodic leg movement core body temperature,
  skin temperature, end tidal CO2 and cough
• Lightweight (8 oz.),machine-washable

http//www.vivometrics.com/site/system_howitworks.
html
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Body Sensor Platform

• Center for the Integration of Medicine and
  Innovative Technologies (CIMIT)
• On-body sensor array patch that transmits
  information through a radio transmitter to a cell
  phone or PDA (can send alerts)
• Measures Temperature, Respiration rate, Motion,
  Heart rate
• Military application
• Physiologic state of soldiers
• Aid medics in triaging wounded.
• Sleep study measure respiration rate

http//www.cimit.org/utmon.html
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European Commission MobiHealth Body Area Network
(BAN)

• Sensors
• Front-end
• Mobile Base Unit (MBU).

http//www.mobihealth.org/html/details/deliverable
s/pdf/new/MobiHealth_WP2_TMSI_D2.1_v0.2_31.07.03.p
df
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MobiHealth Body Area Network (BAN) Components
(cont.)

• Sensors
• Front End amplify, digitize, and synchronize
  signals, send the data to the MBU using Bluetooth
  
• Mobile Base Unit (HP iPAQ) transmits the
  received data through the GPRS or UMTS (wireless
  broadband) network over the Internet.

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MobiHealth Inputs

• Shielded ECG electrode leads with snap-connector
  (for 2-lead, 3-lead or 12-lead ECG)
• Respiration sensor
• Activity/movement/position sensor
• Pulse-oximeter (gives saturation value,
  plethysmographic waveform and heart rate),
• Marker/alarm button

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MobiHealth Features

• Infrastructure built on industry standards
• Customize sensor array for individual needs
• Real-time collection of data over the Internet
• Front end serial number, type of front end,
  signal names, signal resolution etc. This
  information is transmitted to the Backend-Server
  as part of the data header.
• Multiple front-ends can be simultaneously
  connected to the Mobile Base Unit.

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MobiHealth Trials - Netherlands

• Integrated homecare in women with high-risk
  pregnancies
• Intensive monitoring of both mother and child
  postponing hospitalization
• Tele Trauma Team
• Paramedics wear trauma team BANs (video camera,
  audio system, and a wireless communications link
  to the hospital).
• Patient BAN measures vital signs.
• Goal decrease lag-time between the accident and
  the intervention. Increase survival rates and
  decrease morbidity

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MobiHealth Trials - Germany

• Telemonitoring of patients with cardiac
  arrhythmias
• ECG measurements have to be taken regularly to
  monitor efficacy of drug therapy.
• Patients transmit ECG and blood pressure to the
  health call centre where the vital signs are
  monitored by cardiologists.
• Irregular patterns in these vital signs will be
  quickly detected for appropriate intervention

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MobiHealth Trials - Sweden

• Alarm and Locator Trial Room based alarm
  replaced with mobile alarm and locator.
• Monitoring of vital parameters in patients with
  respiratory insufficiency early detection of
  disease progression and detection of emergencies
• Home care and remote consultation for recently
  released patients in rural areas

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MobiHealth Trials - Spain

• Outdoors patient's rehabilitation Patient
  rehabilitation in their own environment.
• Physiotherapist receives on-line information on
  patients exercise performance (e.g. walking
  speed) and provides feedback and advice.
• Measure Pulse oximetry, ECG and mobility with
  audio communication between patient and remote
  supervising physiotherapist

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Future Work

• Greater use of home-based monitoring and
  treatment
• Intelligent control of medication delivery (e.g.
  insulin delivery based directly on blood glucose
  levels)
• Greater use of nanotechnology and microfluidics
  (lab on a chip)

http//www.ece.uah.edu/jovanov/papers/rmbs01_wire
less.pdf http//www.healthcare-informatics.com/iss
ues/2004/01_04/cover.htm
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Bionic Nano Implants
AAMI 2004 Presentation Latest Wireless
Technologies for Medical Applications such as SDR
and UWB Ryuji Kohno, Yokohama National
University, Japan
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Bionic Nano Implants

• Yokohama National University, Japan
• Communication and positioning between bionic nano
  implant systems
• Coordination and access of multiple systems based
  on Spread-Spectrum or UWB (ultra wide band)
  techniques
• Remote diagnostic monitoring and system update of
  bionic nano implant system from outside the body
• Battery charge by power transmission using UWB

AAMI 2004 Presentation Latest Wireless
Technologies for Medical Applications such as SDR
and UWB Ryuji Kohno, Yokohama National
University, Japan
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Questions?