UNIVERSITY OF
CAMBRIDGE 4th FUTURE OF WIRELESS INTERNATIONAL CONFERENCE
THE MØLLER CENTRE, CHURCHILL COLLEGE, CAMBRIDGE
mHEALTHCARE OPPORTUNITIES,CHALLENGES
AND
PROSPECTS
PROFESSOR C R LOWE
UNIVERSITY OF
CAMBRIDGE
WHY DO WE NEED mHEALTHCARE? THE
WORLD IS CHANGING
TRADITIONAL RISKS
MODERN RISKS
LIFESTYLE / WELLBEING
OBESITY
CANCER
PSYCHIATRIC DISORDERS/
NEURODEGENERATIVE
CEREBROVASCULAR DISEASE
DIABETES
FOOD/WATER QUALITY
URBAN AIR QUALITY
OCCUPATIONAL RISKS
SECURITY / TERRORISM
RISK
SIZE
TIME
UNDERNUTRITION
INFECTIOUS DISEASES
WATER
SANITATION
HYGIENE
HUMAN ENVIRONMENT
LIFESTYLE
HEALTH & WELFARE
CLINICAL DISORDERS
CHEMICAL
INTELLIGENCE
WHY DO WE NEED mHEALTHCARE? THE WORLD IS
CHANGING
UNIVERSITY OF
CAMBRIDGE
MOTIVATION FOR mHEALTH
MOTIVATION FOR mHEALTH
CONSTRAINTS FELT BY HEALTHCARE SYSTEMS
POPULATION GROWTH AND DEMOGRAPHICS
HIGH BURDEN OF DISEASE PREVALENCE
LOW HEALTHCARE WORKFORCE
LARGE NUMBERS OF RURAL INHABITANTS
LIMITED FINANCIAL RESOURCES TO SUPPORT
HEALTHCARE INFRASTRUCTURE AND HEALTH
INFORMATION SYSTEMS
RAPID RISE IN MOBILE PHONE PENETRATION IN
DEVELOPING NATIONS
UNIVERSITY OF
CAMBRIDGE
mHEALTH MARKET SEGMENTATION
mHEALTH MARKET SEGMENTATION
TeleHEALTH
mCARE mHEALTH
WELLNESS/
FITNESS
HOSPITAL
DISCHARGE
HOME CARE
MEDICAL
HOME
PRACTICE
RETAIL
CLINIC
CHRONIC
DM
HOME
DIAGNOSTICS
mVISIT
EMR
ONLINE
DM
mEXPERT
OPINION CONSUMER
WIKI
CORPORATE
FITNESS
SENIOR
FITNESS
FITNESS
TRACKING
DIET
CONTROL
MEDICATION
REMINDER
FALL
MONITORING
WANDER-OFF
MONITORING AT-HOME
ACTIVITY
MONITORING
INSURANCE
COVERAGE
PROFESSIONAL
CARE SELF-CARE
SELF-PAY
mPERSONAL
HEALTH
RECORDS
MEDICATION
MONITORING
UNIVERSITY OF
CAMBRIDGE
FACTORS SHAPING THE FUTURE OF mHEALTHCARE LIFETIME DIAGNOSTIC MANAGEMENT
FOOD/WATER/AIR QUALITY
LIFESTYLE
ALCOHOL/DRUGS OF ABUSE
STRESS
SLEEP DISORDERS
MIGRAINE
PREGNANCY
FERTILITY
DIABETES
CANCER
ISCHAEMIC HEART DISEASE
COPD
NEURODEGENERATIVE/
NEUROPSYCHIATRIC DISORDERS
CEREBROVASCULAR DISEASE
HIV/AIDS
EARLY
SYMPTOMS DISEASE
HOME
PHYSICIAN’S OFFICE
CLINICAL CENTRE
HOME
WORKPLACE
A&E
BEDSIDE
ITU
CENTRAL
LABORATORY
HEALTHY ACUTELY
SICK
CHRONICALLY
ILL
WORRIED
WELL BLOOD ANALYTES
LIVER/KIDNEY DYSFUNCTION
FAECAL OCCULT BLOOD
GLUCOSE
HAEMOGLOBIN A1C
ASTHMA
MENOPAUSE
COAGULATION/PLATELET FUNCTION
INFECTIOUS DISEASES
STI
CONCERN
FACTORS SHAPING THE FUTURE OF mHEALTHCARE LIFETIME DIAGNOSTIC MANAGEMENT
UNIVERSITY OF
CAMBRIDGE
RISK
PREDICTION
COMPLIANCE TESTING
PATIENT
STRATIFICATION
DIAGNOSIS
TREATMENT REGIME
(THERAPEUTIC
STRATIFICATION)
MONITOR PATIENT
RESPONSE
SUSCEPTIBILITY
ADR
FACTORS SHAPING THE FUTURE OF mHEALTHCARE EMERGING THERANOSTIC INTERVENTIONS
PROGNOSIS
DISEASE EVOLUTION
EMERGING THERANOSTIC
INTERVENTIONS
UNIVERSITY OF
CAMBRIDGE
FACTORS SHAPING THE FUTURE OF mHEALTHCARE DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE
MEDIUM METABOLITES/BIOMARKERS
UREA
CREATININE
BILIRUBIN
TRIGLYCERIDES
LONG IRON
ALBUMIN
HAEMOGLOBIN A1c
IMMUNOGLOBULINS
CHOLESTEROL
CONCENTRATION RANGE [C] = 10-1-10-18M
RAPID
REAL-TIME
BLOOD GASES (pO2, pCO2)
GLUCOSE
IONS (Na+, K+, Cl-
HORMONES (CORTISOL)
NEUROTRANSMITTERS
FACTORS SHAPING THE FUTURE OF mHEALTHCARE
DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE
UNIVERSITY OF
CAMBRIDGE
PATIENT SENSOR RECORDING FORMATS NON-INVASIVE
INVASIVE
MINIMALLY
INVASIVE INTELLIGENT
CLOTHES/
ACCESSORIES/
JEWELLRY
NON-INVASIVE
(SPECTROSCOPIC)
INDWELLING
CATHETERS
SUBCUTANEOUS
IMPLANTS
BREATH
ANALYSIS
SMART TATTOO
SKIN E-PATCH
DIGITAL PLASTER
COSMETICS
CONTACT LENS
WATCH
FINGERSTICK
PATIENT SENSOR RECORDING FORMATS
BREATH
TEARS
SALIVA
SWEAT
BLOOD
URINE
FAECES
SEMEN
BLOOD
ISF
CSF
UNIVERSITY OF
CAMBRIDGE
BIOSENSOR PRINCIPLES AND
TRANSDUCERS
ANALYTE
(BIO)RECOGNITION
SYSTEM
TRANSDUCER
ELECTRICAL
OPTICAL
ACOUSTIC
MAGNETIC
THERMAL
MICROENGINEERED
INSTRUMENTATION
BIOSENSOR PRINCIPLES AND
TRANSDUCERS
UNIVERSITY OF
CAMBRIDGE
QUICK TIME-TO-ANSWER
SIMPLE READOUT
LOW COST
EASILY/INEXPENSIVELY MANUFACTURED
MINIATURE AND LOW (OR NO) POWER BURDEN
GOOD SENSITIVITY AND SPECIFICITY
USED BY MINIMALLY TRAINED PERSONNEL
FUNCTION >30 °C AND AT HIGH HUMIDITY
LONG STORAGE TIMES WITHOUT REFRIGERATION
NO LOCAL REAGENTS/WATER AND/OR SPECIALIZED
EQUIPMENT
DETECT MULTIPLE PATHOGENS
KEY ATTRIBUTES OF MOBILE/WEARABLE
SENSORS
KEY ATTRIBUTES OF MOBILE/WEARABLE SENSORS
UNIVERSITY OF
CAMBRIDGE
0
10
20
30
40
0
0.5 1 1.5 2 2.5
LACTATE
GLUCOSE
[SUBSTRATE] (mM)
MICROAMPEROMETRIC BIOSENSORS
MICROAMPEROMETRIC BIOSENSORS
UNIVERSITY OF
CAMBRIDGE
MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)
RF COIL
NdFeB MAGNET
LIQUID SAMPLE
N
S AIR GAP
ACOUSTIC WAVE
RF COIL
PIEZOELECTRIC
QUARTZ DISC
(AT-cut, 0.25mm
thick, 12mm dia)
ALUMINISED
GLASS DISC
MAGNETIC ACOUSTIC RESONATOR SENSOR
(MARS)
UNIVERSITY OF
CAMBRIDGE
MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)
MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)
-400
-300
-200
-100
0
100
200
300
400
0 50 100 150 200 250 300 350 A (
mV
)
f (MHz)
Signal Generator
Lock-in Amplifier
AM Detector Copper Coil
Output
16th HARMONIC
SIGNAL GENERATOR
AM DETECTOR
LOCK-IN AMPLIFIER
COIL/DEVICE
OUTPUT
UNIVERSITY OF
CAMBRIDGE
REMOTE ACOUSTIC MEASUREMENTS WITH A TOROIDAL
ELECTRIC FLUX
TOROIDAL ANTENNA
(TRANSCEIVER)
SUBCUTANEOUSLY IMPLANTED
e-PATCH
CONTACT LENS
MRAS QUARTZ DISC
-30
-20
-10
0
10
20
30
20.1 20.12 20.14 20.16 20.18 20.2
f (MHz)
-250
-200
-150
-100
-50
0
50
100
6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73
Frequency MHz
Am
plit
ud
e m
V
pH 2
pH 3.5
pH 4
pH 5
pH 5.1
pH 5.2
pH 5.25
pH 5.5
pH 6
pH 7
pH 8
100
50
0
-50
-100
-150
-200
-250
Am
pli
tud
e (
mV
)
6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73
Frequency (MHz)
REMOTE ACOUSTIC MEASUREMENTS WITH
A TOROIDAL ELECTRIC FLUX
UNIVERSITY OF
CAMBRIDGE
Poly (acrylamide-co-3-APB)(78.5mol% acrylamide; 1.5mol% MBA; 20mol% 3-APB)
PBS Buffer pH 7.4
ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS
O
HO
HOH 2 C
O
HO
O
B
HO
- 6MHz
20MHz
33MHz
47MHz
60MHz
73MHz
0 5 10 15 20
0.2
0.4
0.6
0.8
1.0
[Glucose](mM)
No
rmalised
Am
pli
tud
e
0
ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS
UNIVERSITY OF
CAMBRIDGE
PC Lock-in
Amplifier
Signal
Generator
AM Detector
MARS Jig
Gilson minipuls 2
Pump y = 1.0434x - 19.187
R² = 0.9969
0
50
100
150
200
250
50 100 150 200 250
Am
pli
tud
e o
f th
e e
xp
eri
me
nta
l fl
ud
ic s
ys
tem
(m
V)
Amplitude of the static system (mV)
DYNAMIC GLUCOSE
MEASUREMENT SYSTEM
DYNAMIC GLUCOSE
MEASUREMENT SYSTEM
UNIVERSITY OF
CAMBRIDGE FABRICATION OF HOLOGRAPHIC SENSORS
MIRROR
EMULSION
GLASS TANK
ACHROMAT
LASER SPATIAL
FILTER
MIRROR
4°
UNIVERSITY OF
CAMBRIDGE
ΣRi
PRINCIPLE OF HOLOGRAPHIC SENSORS
wavelength (nm)
refle
cta
nc
e (%
)
0
5
10
15
20
25
30
35
600 610 620 630 640 650 660
lpk
R pk
n
“Smart” Polymer
θ
d
λmax = 2ndcosθ
COLOUR
BRIGHTNESS
IMAGE/ALPHANUMERIC
MESSAGE
POSITION
OPTICAL ELEMENTS
MICRO-HOLOGRAMS
UNIVERSITY OF
CAMBRIDGE
DIABETIC MONITORING WITH GLUCOSE
HOLOGRAMS
-20
0
20
40
60
80
100
120
140
160
180
2 4 6 8 10
[GLUCOSE] (mM)
25
15
12
10
8 5
mol% 3-APB
max(n
m)
O
HO
HOH 2 C
O
HO
O
B
HO
-
WHOLE BLOOD
INDWELLING CATHETER
SUBCUTANEOUS NEAR-IR
CONTACT LENS
SKIN PATCH/TATTOO
DIABETIC MONITORING WITH GLUCOSE
HOLOGRAMS
UNIVERSITY OF
CAMBRIDGE
CONTACT LENS HOLOGRAPHIC GLUCOSE
SENSOR
TOXICITY
TEAR [GLUCOSE]<BLOOD [GLUCOSE]
pH VARIABILITY (5.8-7.8)
TIME LAG (~MIN)
SELECTIVITY (LACTATE/FRUCTOSE)
OPTICAL PHYSICS
COMFORT/COSMETIC APPEARANCE
INSTRUMENTATION
CONTACT LENS HOLOGRAPHIC GLUCOSE SENSOR
UNIVERSITY OF
CAMBRIDGE
80
100
120
140
160
0 12 16 19 23 26
Time [minutes]
Blo
od
-Glu
co
se
[m
g%
]
680
700
720
740
Wa
ve
len
gth
[n
m]
TRACKING OF BLOOD GLUCOSE IN TEAR
FLUID IN VIVO
TRACKING OF BLOOD GLUCOSE IN TEAR FLUID
IN VIVO
UNIVERSITY OF
CAMBRIDGE
HUMAN BREATH ANALYSIS
DIABETIC KETOACIDOSIS
RENAL FAILURE
LIVER DYSFUNCTION
ALCOHOL INTOXICATION
CANCER
CYSTIC FIBROSIS
ASTHMA
GIT DISORDERS (H pylori)
HALITOSIS
STRESS
H2
ETHANE
n-PENTANE
BUTANE
NO
CO
NH3
ETHANOL
ACETONE
THIOLS
HUMAN BREATH ANALYSIS
UNIVERSITY OF
CAMBRIDGE
90
80
70
60
50
40
30
20
10
0
0 2 4 6 8 10 100 200 300
Time (s) Time (s)
(nm)
A B 1-Butyne Butane 1-Butene Iso-butane Propane Propyne/propadione Propene Ethane Ethyne
RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES
590 580
570
560
550 540
530
520
510
(
nm
)
0 100 200 300 400 500 600 700
Time (s)
Butane
80
60
40
20
0
0 20 40 60 80 100
Concentration (%v/v)
(n
m)
1-Butyne
Butane
1-Butene
isoButane
Propene Propane
Ethyne Ethane
Temperature (°C)
10 20 30 40
1
10
100
(nm)
RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES
UNIVERSITY OF
CAMBRIDGE
0 20
40 60
80
Weight
Blood sugar
Vital signs (Blood pressure/heart
rate/respiratory rate)
Exercise/physical activity
Calories/fat content taken in
Pain level
Sleep patterns
Cardiac rhythm
Bladder control
Acid reflux/indigestion
Digestive health
%
Yes (88%)
No (12%)
PHYSICIAN’S WANTING PATIENTS TO TRACK/MONITOR
HEALTH AT HOME
PHYSICIAN’S WANTING PATIENTS TO
TRACK/MONITOR HEALTH AT HOME
Source: PriceWaterhouseCoopers HRI Physician Survey (2010)
UNIVERSITY OF
CAMBRIDGE
IMPACT OF mHEALTH ACCORDING TO
PHYSICIANS
IMPACT OF mHEALTH ACCORDING TO PHYSICIANS
EXPEDITE DECISION
MAKING (56%)
DECREASE TIME IT
TAKES FOR
ADMINISTRATIVE TASKS
(39%)
INCREASE COLLABORATION
AMONG PHYSICIANS
(36%)
ALLOW MORE
TIME WITH
PATIENTS (26%)
HAVE NOT AFFECTED
MY DAY-TO-DAY WORK
(24%)
UNIVERSITY OF
CAMBRIDGE mHEALTH AND HEALTHCARE OUTCOMES
mHEALTH AND HEALTHCARE OUTCOMES
IMPROVED HEALTH OUTCOMES AND COST SAVINGS
INCREASED ACCESS TO HEALTHCARE AND HEALTH-
RELATED INFORMATION
ACCESS TO HARD-TO-REACH POPULATIONS
REGIONS OF POOR LITERACY RATES AND LIMITED LOCAL
LANGUAGE-ENABLED PHONES
IMPROVED ABILITY TO DIAGNOSE AND TRACK DISEASES
TIMELIER, MORE ACTIONABLE, PUBLIC HEALTH
INFORMATION
EXPANDED ACCESS TO ONGOING MEDICAL EDUCATION
AND TRAINING FOR HEALTH WORKERS
IMPROVED HEALTHY LIFESTYLES
UNIVERSITY OF
CAMBRIDGE EMERGING TRENDS IN mHEALTHCARE
EMERGENCY RESPONSE SYSTEMS (ROAD
TRAFFIC ACCIDENTS, OBSTETRIC CARE)
MOBILE VOICE AND SMS SUPPORT TO REMOTE
CLINICIANS
REMOTE PATIENT MONITORING
MONITORING OUTBREAKS AND EPIDEMICS
HEALTH-RELATED mLEARNING FOR PUBLIC
TRAINING AND CONTINUED PROFESSIONAL
DEVELOPMENT FOR HEALTHCARE WORKERS
HEALTH PROMOTION AND COMMUNITY
MOBILIZATION
SUPPORT OF LONG-TERM CHRONIC CONDITIONS
(DIABETES,NEUROPSYCHIATRIC DISORDERS)
EMERGING TRENDS IN mHEALTHCARE
UNIVERSITY OF
CAMBRIDGE
SENSOR/
TRANSMITTER
WIRELESS
MONITOR
CLOUD
SERVER
Intelligent
algorithms
Messaging
PATIENT
HEALTHCARE
PROVIDER
MOBILE HEALTH TOOL
REAL-TIME MONITORING
PHYSICIAN TRACKING
FEEDBACK
CARER ALERTS
DRUG AUTOMAT
PHYSICIAN
DRUG
AUTOMAT
mHEALTH
WATCH
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