transforming healthcare through innovation

TRANSFORMING HEALTHCARE THROUGH INNOVATION

Robin A. Felder, PhDThe University of VirginiaDepartment of Pathology

Disclosures

University of Virginia Department of

Pathology

Medical Robotics Medical Automation Hypogen WellAWARE Systems MeyeChem Proteus Bio Global Cell Solutions Monte Piccolo Farm

Pursuit of 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

© Felder, 2011

Social Physical

Cognitive

8.0

6.2 9.1

Wellness Balance

Wellness Support

Growing need for new sources of data, and data interpretation

Integration of multiple diagnostic sources (lifestyle, self testing)

Integrated wellness and health record

Ongoing information support for maintaining healthy lifestyles

Wellness Technologies Monitor

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

Wellness Support

Food coaching Rewards

Exercise Nutrition Therapeutic compliance

Consequence reporting Consequence forecasting

Overcome vicarious goal fulfillment or, “exhaustion of self-control”

Home Health IT

New revenue sources: Medical Cloud coaching and Interpretations

Cloud Interpretations

Proliferation of Wellness Tools

Accelerometer based

Various models for data delivery

Basic physiologic measurements

Information Week BodyMedia

FitBit

Nike Feulband

Zephyr

Basis

Striiv

BodyMedia

Scanadu Tricorder

Shine Misfit

SENSINGLocal content

& services discovery

SEEINGAugmented reality UI:Map, 3D, in building

navigation

INTERACTINGConnection manager

(WAN, Wi-Fi)

KNOWSYou and what is

around you

LEARNSWhat you like

DISCOVERSThings relevant

to you

FILTERSOut the irrelevant

Source: Jarrin (Qualcomm)

SENSINGLocal content

& services discovery

SEEINGAugmented reality UI:Map, 3D, in building

navigation

INTERACTINGConnection manager

(WAN, Wi-Fi)

KNOWSYou and what is

around you

LEARNSWhat you like

DISCOVERSThings relevant

to you

FILTERSOut the irrelevant

Source: Jarrin (Qualcomm)

new ipad mini

Lifewatch AG

Portable Diagnostics

iPhone based portable ultrasound

EKG Otoscope Dermatoscope Microscope

Cell Scope ™

Dermatoscope – iPhone clip-on Transmits high quality magified

pictures of skin blemishes

“Smart Otoscope” – iPhone ear drum microscope Transmits pictures of videos of

the ear canal and ear drum Looks at progression or

regression of disease

Otoscope Images

Normal Ear Drum Ear Infection Ruptured ear drum

Cloud Based Diagnosis of Parkinsons Non-invasive phone

based Accurate (98%) Remote, non-expert

Low Cost Rapid diagnosis Scalable to large

populations

Max Little - Parkinson’s Voice InitiativeTED Conference 2012

iPhone Body Fluid Diagnostics

Biosense Technologies uCheck

ToucHb

Continuous Glucose Monitoring

Dexcom

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 individual

尿糖

尿蛋

白

· Body temperature· Pulse· Blood Pressure· Body fat

percentage

Vital Sensor

Data management PC Urine protein Urine glucose

Urine analyzer

Home network

Healthcare providers

Passive Wellness Monitoring

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

Passive Remote Sensing 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

Passive Gait Sensors

Vibration sensors placed in the house detect occupant gait

Passive Physiologic Sensors

Physiologic sensors embedded in common household furniture and fixtures

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

30

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

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red

Monitored

FUTURE WELLNESS TECHNOLOGIES

3D Manufacturing

36

4cm1cm0.2cm

First Warning Systems™ heat distribution sensing sports bra

Wearable Cancer Detection

Underwear That Measures Blood Pressure Pulse wave velocity

correlates with 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

UCSD

Medical Robotics

Preventive Science Inc.

MeyeChem, LLC

Real time glucose monitoring

Alerts for low or high glucose concentrations

Trending analysis Food coaching via

telenutritionalmentoring

Virtual Reality Image enhancement,

correction, zoom Correction currently

limited to 0.2 logMAR, 20/32

Full view software modulated images

Superimposed augmented reality

Gas-permeable nanopolarizer (iOptik contact lens)

Off axis projection with transflective diffuser 90° field eyewear iOptik

Zoom lens (3X) UCSD

Diopter adjustable mini-scleral lens and wearable computer (iOptik)

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

Receptivity

Presenting health vs wellness to a patient

Determining what information is TMI

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

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

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http://medicalautomation.org

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Robotic Reality

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