Im3 04 Technologische Uitdagingen Voor Cardiale Telemonitoring Peter De Cleyn

Technologische uitdagingen voor cardiale telemonitoring

Peter De CleynIBBT-PATS-UA

Outline

Introduction Future technologies Future measurements Conclusions Demo scenarios Demo

Introduction - IM3 Future Technologies

Goal: study the usability of emerging technologies to create an end-to-end interactive medical mobile monitoring solution

Approach: Theoretical studies and simulations Proof of Concept

End-to-End System

Secure communication

End-to-End System

Sensor

Capture Measurement Data


End-to-End System

Sensor ProcessingNetworking


Process Data and TransmitOver BAN


End-to-End System


ProcessingNetworking



Process Data and Transmit Over BAN(n-steps)


End-to-End System


ProcessingGateway

(UI)





Process Data and TransmitOver WAN


End-to-End System


ProcessingGateway

(UI)






(Re)ConfigureGateway

Add/Remove processing algorithmsStart/Stop processingConfigure parametersRemotely over WAN


End-to-End System


ProcessingGateway

(UI)


ProcessingStoring

Multiple UI





Process Data, StoreNotifyPresent (multi-user)


Add/Remove processing algorithmsStart/Stop processingConfigure parametersRemotely over WAN


WBAN

SensorProcessingGateway

(UI)

ProcessingStoring

Multiple UI



On body transport of measurements



WBAN

WBANs are wireless, short range, low power, multihop networks, to transport collected medical data from the sensor to a central device

Its application in healthcare requires these networks to be reliable, having long lifetime and for all be secure.

A hardware and routing software combination achieves these goals: NXP CoolFlux Technology:

Ultra Low Power DSP (10MHz, 9kB SRAM, 6kWord flash)

Magnetic Radio CPFSK 7-15 MHz, ~ 20cm distance (optimum)

Cidada: Tree based scheduling protocol to efficiently and reliable collect data within a WBAN

Medical hub

SensorProcessing

StoringMultiple UI




Medical hub

ProcessingGateway

(UI)


Medical hub

The Medical hub collects data from the WBAN, performs a first processing and analysis and transmits the data to the back end.

The Medical hub is a collection of software components, algorithms and device drivers.

All these components can be remotely managed: Transparent to the patient: no interaction or contact with

technician needed Patient does not need to come in

Software is platform independent: Same software runs on wide variety of smartphone, PDA or PC systems: applicable to existing devices

Software is lightweight: it must run smoothly on smallest platform

Medical hub – Web Services

Back end interaction using Web services Goal: perfect interoperability between several service

providers, by the use of distributed middleware Web service =

Software application Identified by a URI Interfaces are defined, described, and discovered by XML

artefacts (WSDL, UDDI) Interactions with other software applications using XML-based

messages via Internet-based protocols (SOAP)

Signal processing

Sensor




Processing of measurements


ProcessingStoring

Multiple UI

ProcessingGateway

(UI)

Signal processing

Huge amount of available information due to continuous monitoring

Automatic processing and event detection gives medical staff indication of problems No need to review all date when no events are detected

Simplified algorithm at medical hub False positives possible

Event processing at backend False positives get removed

Signal processing

Performance of Atrium Fibrilation detector Comparison of detections (blue) and scoring of cardiologist (green)

Security



End-to-End security


ProcessingStoring

Multiple UI

ProcessingGateway

(UI)


Security Wireless communication medium Appropriate security and privacy protection is

necessary Threat analysis: identification of security issues Security requirements:

Confidentiality of medical data Integrity of medical data Source authentication of medical data Mutual device authentication (Location) privacy End-to-end security

CICADA-S: secure version of WBAN protocol Asymetric cryptography has interesting advantages but is energy

consuming Feasability study of elliptic curve cryptography on WBAN sensor

Data representation

Sensor




Data storage and representation


ProcessingGateway

(UI)

ProcessingStoring

Multiple UI

Data representation

Website : Visualisation of the measurements Download data file for further processing and analysis Patient information and history Event notification

Future measurements




Actual needed measurements


ProcessingGateway

(UI)

ProcessingStoring

Multiple UISensor

Future measurements

Objective: Determine what measurements are important and

economically feasible to include in Remote Patient Monitoring solutions for Congestive Heart Failure Atrial Fibrillation

Consolidation CHF

More types of measurements could provide more information, but: Weight (mainly to determine increase in fluids) Respiration (correlated to motion)

Both rhythm and volume Heart beat and heart rate variability (with coupled motion/accelerometer)are sufficient to measure in telemonitoring. Additional

Blood pressure ECG Lungimpedance

Note: Other measurements will take place in the hospital Full ECG not required, but HB and HRV can be derived from it Measure fluids in lungs can be a measurement in telemonitoring

Should be automatic – no patient action. Can be impedance or sound. BP and Weight will be done by the patient

ECG (HB/HRT) can be automatic and without patient interference if subcutaneous Continuous measurement next to the daily BP and weight measurement

Consolidation AF

More types of measurements could provide more information, but: ECG (with coupled motion/accelerometer) is sufficient to measure

in telemonitoring.

Note: ECG (HB/HRT) can be automatic and without patient interference

if subcutaneous

Key: Weight (fluids), Respiration and Heart Beat (correlated to motion) However

Measurements involve patient action which is not desired

Errors, discipline, patient stress Sound/Impedance could replace weight measurements

For both fluids and respiration For automatic measurement without patient action,

ECG Sound and/or impedance Motion

can replace these – preferably subcutaneous – in the longer term

Observations

Conclusions

Technological factors which influence acceptance for an end-to-end telemonitoring system

ease of use for the patient ease of (re)configuration and installation accurate automatic data processing and filtering data representation overall security

Technology is currently available to tackle these needs!

Actual measurement needs should be defined for each pathology

Demo Scenario

Demo Scenario WBAN

ECG transport multihop routing

Medical HUB remote configuration signal processing event detection

Backend data retrieval advanced signal processing

Demo Architecture

Im3 04 Technologische Uitdagingen Voor Cardiale Telemonitoring Peter De Cleyn

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