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Future Trends in Remote Patient Monitoring

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Title: Future Trends in Remote Patient Monitoring


1
Future Trends in Remote Patient Monitoring
  • Tony Tam
  • Candidate MHSc. Clinical Engineering
  • University of Toronto

2
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)

5
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

6
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
7
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
8
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
9
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
10
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/
11
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
12
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
13
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
14
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

15
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
16
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
17
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
18
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
19
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
20
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.

21
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

22
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.

23
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

24
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

25
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

26
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

27
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
28
Bionic Nano Implants
AAMI 2004 Presentation Latest Wireless
Technologies for Medical Applications such as SDR
and UWB Ryuji Kohno, Yokohama National
University, Japan
29
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
30
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