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

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

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

AN EXAMPLE

SALT, THE #1 KILLER

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

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

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

Vital Sensor

Data management PCUrine proteinUrine glucose

Urine analyzer

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

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

Passive Wireless Sensor Systems

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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

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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,

Overall Cost of Care Comparison$67,757.88

$17,407.02

0

10000

20000

30000

40000

50000

60000

70000

80000

Dol

lars

$

Unm

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red

Monitored

FUTURE WELLNESS TECHNOLOGIES

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

The Wellness Health Paradigm 

EvaluationandReporting

Predictive Diagnostics

ContinuousMonitoring

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