Passive Home-based Monitoring in an Era of Telemedicine

http://medicalautomation.org

Robin A. Felder, Ph.D.The University of VirginiaProfessor of PathologyAssociate Director Clinical Chemistry

Market Opportunity

� Mobile health APPs market will grow 400% from $150 M in 2011 to $400M in 2016

� Initial market will be sports, fitness, and wellness

� Stimulated by wide availability of sensors, wireless transmission protocols, and ubiqitous mobile cellular infrastructure

ΑΒΙ Research, London, UK

Wellness

� State of complete physical, mental and social well-being

� Health results from primarily positive perspectives and choices by which to live

� Technology can provide information that facilitates positive choices

SocialPhysical

Cognitive

8.0

6.2 9.1

© Felder, 2011

Wellness

� Feeling well

� Achieving wellness

� Wellness strategies

� Denial or retraining

Wellness Support

� Growing need for new sources of data, and data interpretation

� Integration of multiple diagnostic sources (clinical, radiology, molecular biology, pharmacy, lifestyle)

� Integrated wellness and health record

� Ongoing information support for maintaining healthy lifestyles

Wellness Support

� Food coaching

� Exercise rewards

� Consequence reporting

� Consequence forecasting Overcome vicarious

goal fulfillment or, “exhaustion of self-control”

Home Health IT

� Integration of multiple information sources (wellness, socialization, medical)

� New revenue source: Medical Cloud coaching and Interpretations

Cloud Interpretations

Vogue 4-10

Example of Medical Cloud Interpretation� Hypogen-DX

(Hypertension/Salt Sensitivity Genomic Interpretation)

� 3 SNP test ($300)� Proprietary algorithms

� Determines probability of developing HT or SS

� 1st Example of Molecular Diagnostics for Chronic Disease

Wellness Technologies

� Nutrition� Exercise� Biometrics� Stress reduction� Mood enhancement� Pain reduction� Sleep improvement� Health and wellness monitoring

Social

Physical

Cognitive 8.0

6.2 9.1

New Communication Paradigms

Embedded Wellness Sensors� Instrument common

fixtures

� Wireless transmission of data

� Web based aggregation and interpretation

Action Inspired Instruction

� Real time coaching

� Medically approved content

� Tailored for the individual

尿糖尿蛋白

·Body temperature·Pulse·Blood Pressure·Body fat percentage

Vital Sensor

Data management PCUrine proteinUrine glucose

Urine analyzer

Home network

Healthcare providers

Passive Wellness Monitoring

Toilet Technology

� Wireless - low power

� Automatically activated

� Biometric identification

� Self calibrating and cleaning

The M.A.R.C. In-Home Health Monitoring Project

� Create a model where the impact of chronic disease is delayed or avoided

� Provide opportunity for medical intervention before a crisis occurs

� Minimize impact of chronic disease on the healthcare system

� Potentially delay admittance to a nursing home and reduce the cost of healthcare

Passive Wireless Sensor Systems

17

� WellAWARE™, provides unobtrusive, highly accurate wellness monitoring services to allow individuals to age with options.

Passive Remote Sensing� The WellAWARE™ solution has three primary

elements that work together to provide passive, yet informative, monitoring of seniors:

� Wireless Sensor Array (WSA) – gathers data on daily activities

� Data Manager (DM) –transmits data to data analysis servers

� Capture Analysis & Reporting Engine (CARE) – captures potential problems and alerts caregiver

Sleep Monitoring� Sleep apnea affects more

than 40 million people in the United States alone of which 85% are currently undiagnosed

� sleep apnea testing and therapy market that is expected to reach more that $4 billion by 2012

Passive Vital Sign Bed Monitor

Mattress pad to measure:• Sleep quality• Pulse (and HRV)• Breathing

• Movement/ restlessness

• Bed exit

• Subject position/ turning

• Body temperature• Blood Pressure

Polysomnography

Passive Sensing

Restless Resident

Restful Resident

Sleep Quality Graphs

Remote Automated Triage

� Real time assessment of participant health status/well being

� Ability to drill down to specifics� Built in automated optimized dispatching� Manual override of dispatch event or

downstream processes

23

One Click Trending

� Health

� Socialization

� System utilization

Telehome Monitoring Decreases Costs by 74%

N=21 in each group, P<0.05;Telemed J E Health, 2007 13(3):279−85

Overall Cost of Care Comparison

$67,757.88

$17,407.02

0

10000

20000

30000

40000

50000

60000

70000

80000

Do

llars

$

Unm

onito

red

Monitored

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Underwear That Measures Blood Pressure� Pulse wave velocity

correlates with blood pressure

� Tissue impedance shows passing pulses

� Pulse timing correlated with relative pressure

� Continuous blood pressure monitoring

Automated Pharmaceuticals� Automated Pill – iPill (Philips)

� Magnatrace™ System looks for pill ingestion

� Networked pills (Proteus Biomedical)� Instrumented Pills� Cost < $0.01

� Measure and send physiologic signals through body electrically

� Receiver is a patch worn on the body that also logs respiration, heart rate and body movement, sleep patterns

Automated Intestinal Biopsies

� Intestinal diagnostic imaging coupled with miniaturized biopsies

� Pillcams with intestinal “Velcro” to arrest the camera at a selective location

� Continuous monitoring

MIT Technology Lab

The Eye as the Window to Health

Univ. of MD, Baltimore

UCSC

Medical Robotics

Medical Robotics, LLC

� Real time glucose monitoring

� Alerts for low or high glucose concentrations

� Trending analysis

� Food coaching via telenutritionalmentoring

Receptivity

� Presenting health vs wellness to a patient

� Determining what information is TMI

� Optimizing the time for the presentation of wellness strategies “Wellformation”

Augmented Reality

� Projection of underlying anatomy on living tissue

� Relies on superimposition of reality and previously scanned animated image/data

Not for the Faint Hearted

Robotic Reality

HRP-4C National Institute of Advanced Industrial Science and Technology

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The Wellness Health Paradigm

EvaluationandReporting

Predictive Diagnostics

ContinuousMonitoring

A non-profit educational organization improving healthcare quality and efficiency through teaching automation principles and their application in health systems

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