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Future Trends in Remote Patient Monitoring

Tony TamCandidate MHSc. Clinical EngineeringUniversity of Toronto

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Presentation Outline

Challenges in Healthcare Objectives of Remote Patient Monitoring Innovations in Patient Monitoring Future work Q&A

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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.

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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_lifeguard_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://www.tensiomed.com/tensiomobile.html

http://aerotel.com/Products/ShowDetails.asp?iProductsID=23

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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?iProductsFamilyID=2http://www.hommed.com/products/peripherals/medicaldevices.html

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•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

Telemetric EMG Systems

http://www.noraxon.com/applications/clinical/applications.php3

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Implantable Heart Monitor

http://www.medtronic.com/reveal/

•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

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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_Issues/2003May/Korhonen.pdfhttp://www.hightechfinland.com/2004/healthcarelife/ist.html

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Digital Angel

http://www.skyaid.org/Skyaid%20Org/Medical/digital_angel.htm

•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 Alzheimer’s patients, autistic children, lost pets.

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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/mmci-v-101104.phphttp://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_lifeguard_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_lifeguard_paper_FINAL.pdf

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Lifeshirt

http://www.vivometrics.com/site/system_howitworks.html

•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

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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/deliverables/pdf/new/MobiHealth_WP2_TMSI_D2.1_v0.2_31.07.03.pdf

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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 patient’s 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_wireless.pdfhttp://www.healthcare-informatics.com/issues/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?