The Next Generation of Wireless Healthcare

MT5009: Analyzing High-Tech Opportunities

Chen Weiming

Alec Liu

Asger Thomsen

Eugene Wang

Zhang Jianliang

Overview

• Introduction

– Future Trends

– Enabling Technologies

• Illustrations

– Capsule Endoscopy

– Smart Drug Delivery

– Digital Pill System

– M-Health

• Conclusion

Healthcare Future Trends

• Paradigm shifts

• Greater participation of one’s health matters

– Doctor’s office → home

• Mobile devices will play a greater part in welfare

– Desktops → mobile devices

• Greater human-device interaction

– Accuracy: inside body >> outside body

• Medical records → electronic

Some Stats

Have access to in the world:

4.2 b 4.8 b

140% greater survival rate for patients with pacemaker with

high remote monitoring

Patient Remote Monitoring almost

doubles from 2012 to 2014

US will be short of 90,000 doctors next 4 years

30 million wearable health devices shipped

in 2012

What if we could harness the potential of IT for the betterment of healthcare?

Enabling Technologies – Processing CapabilitiesAdvances in integrated circuits drive the reduction of computing devices, and increase their functionality

Enabling Technologies – MEMs

Enabling Technologies – Power Consumption

Computations per kWh have been increasing by a factor of 1.5 per year

0

100

200

300

400

500

600

700

800

1990 1995 2000 2005 2010 2015 2020

Ener

gy D

ensi

ty (

Wh

/l)

Year

Li-ion Energy Density

Enabling Technologies – Batteries

New materials continue to help elongate Li ion battery life

Enabling Technologies – Biomarkers

Biomarkers have become more important indicators in recent years• Proteins, DNA, hormonesIncreasing number of approved biomarkers• 400%, 2003 - 2012

Presentation Theme

• Next gen of wireless healthcare is for

– Diagnosis

– Effective regimen

– Healthier lifestyle

– Monitoring

• In corpore, ex corpore, and corpus-silico

Capsule EndoscopyDiagnosis

Effective regimenHealthier lifestyle

Monitoring

What is Capsule Endoscopy

Why Capsule Endoscopy - explore the unexplored

5m

0.5m

1.5m

Lower endoscopy

Upper endoscopy

Capsule endoscopy

• Photographic capsule

• Collect 2 images per second

• Moves by peristalsis

• Images are collected and stored for later download

• Capsule “working life” ranges 8-10hrs

• Capsule passes from body naturally

• Specific to examination of the Small bowel but other wireless device that exam remainder of GI tract

1) Precheck up to see patient are eligible to take capsule endoscopy 2) Patient are required to fast for 12 hours before taking the capsule3) Patient are mounted with antenna on the abdomen4) Patient swallow the capsule5) Patient bring back the data recorder to workstation for review the images/video

Procedure

Technology for Improvement

• Lens

• LEDS

• Camera

• Batteries

• RF transmitter

• Antenna

27mm

11mm

Current limitations

• Unable to control the speed of the capsule movement

• Unable to perform biopsy

• Risk of capsule retention

• Time consuming to review thousands of photos download at the end of the inspection

Smart Drug Delivery

DiagnosisEffective regimenHealthier lifestyle

Monitoring

Future drug delivery• Imagine you automatically will get what you need

• Monitors your body and gives you drug when needed

Biosensor

Drug reservoirs

wireless

Heart rate Hormones temperature

Many different drugs

Implant

Drug delivery today

• Syringes

• External pumps

• Pens

• Inhalers

• Pills

• Patches

• Labor-intensive!

New drug delivery - Benefits

• Lower cost of care

• More data

• Automatic release

– Minimizing patient’s efforts

– No human errors

• Drug doses spread out in time

• Constant monitoring

How close are we?

• Not a single device that can do everything

• However, devices are moving in that direction

Biosensor

Drug reservoirs

wireless

Omnipod

Microchip

Apple Watch

Example of a device – MicroCHIP (1)

• Implanted by doctor with local anesthesia

• 20 reservoirs, each containing 600 nanolitre

• Seal made of thin layer platinum and titanium

– Melts when current are applied

• Timer or wireless command (execute only)

• Not yet any biosensors, no data<- 3 cm ->

<-5

cm ->

Example of a device – MicroCHIP (2)

• Successfully tested with drug to treat osteoporosis patient

– Needs daily injections

• Price still to high

– Same as delivered with injections

• $10,000-12,000 per year<- 3 cm ->

<-5

cm ->

Example of a device - Omnipod• Insulin pump

• Attach to skin (lasts three days)

• Manage dose wirelessly

– Intelligent system

• Not an implant, separate controller

Example of a device – Apple Watch

• Biosensor and data

– Monitors pulse

– Steps taken

• Connected to smartphone

• Not an implant and no drug

Infrared sensor

Barriers

• Reliability

– Complete control of drug delivery

• Security

• Standards

• Size

• Price

• Technology

Digital Pill SystemDiagnosis

Effective regimenHealthier lifestyle

Monitoring

What is Ingestible Digital Pill System

• Daily tracking of exact medicine intake time– Noncompliance is a

major healthcare issue

• Smartphone app• Patch• Ingestible sensor

– Size of a grain of sand (1 x 1 mm)

– Silicon– Enclosed in pill– No battery required

A system for monitor and record medicine taken.

Why Ingestible Digital Pill System

How is Ingestible Digital Pill System Work

• Patient swallows pill

• Stomach fluid activates sensor

• Patch collects data

• Patch sends data to smartphone

• Smartphone notifies in case of non-compliance

Wearable patch sensor and Mobile App

Store data in cloud. Loved ones and doctor can access these data.

Wearable Technology

Wireless technology

Mobile App

Market Ready

Edible technology for Ingestible sensors

Composition Common referenceTypical Nutritional

Guidelines

Copper: 0.0077 mg Magnesium: 0.0098 mg

2 mg in Centrum® tablet

50 mg in Centrum® tablet

1.5 mg per day via IV for nutrition 400 mg US RDA

Ingestible Sensor approved as medical device - Unlimited use by patients ingesting up to 30 sensors per day

Improvements

• Ingestible sensor

– Further reduce size while maintain detectable signal

(Current size: 1mm x 1mm)

– Simple marker of ingestion to a multi-functional data collection platform

• Wearable patch

– Batter power efficiency

(Currently lasts 7 days)

– New materials to make patch re-usable

– Be worn during all activities including showering and bathing

– Tattoo type patch for easy use.

Potential Cost Savings

$290 billion in increased 2009 US

medical costs

13% of total US health expenditures

50% do not take medications as

instructed

Daily tracks the exact medication taken time

record

monitor

feedbackProvide valuable feedback on effectiveness of pharmaceuticaltreatment

Adds visibility into a patient’s actual behaviors for better care

Waste due to missuse

Value Proposition

M-HealthDiagnosis

Effective regimenHealthier lifestyle

Monitoring

A recent trip to NUH

M-Health

• M-Health uses mobile devices and/or communication networks for the provision of health services

• Monitoring of health data

• Three major dimensions: battery life, device capabilities/functionality, size/aesthetics

Basic Monitoring (1)

• ECG, heart rate, respiration rate, activity level, blood pressure, weight, blood glucose

• Remote monitoring of cardiac arrhythmias

• Benefits

– Reduced re-admissions, shortened hospital stays, improved clinical outcomes

Basic Monitoring (2)

• Leading health apps do not monitor anything related to menstruation and reproductive health of half the world’s population

• Menstruation patterns can reveal health problems– Premenstrual syndrome– Premenstrual dysphoric disorder– Polycystic ovarian syndrome– Menorrhagia– Hysterectomy

• Other reasons for tracking– functionality of contraceptive

methods– planning work and leisure activities

• Basal temperature as indication for stage menstrual cycle and ovulation

Advanced Monitoring

• Portable test kits + smartphone camera

• Molecules to detect

– Influenza A

– Vitamin D (mood, anxiety, sleep quality)

– C-receptive protein (inflammation)

vs.

Scale Effects

In biological molecule analysis, reduction in dimensions helps shorten analysis time

This is further compounded by parallelization

M-Health Cost Savings

• In Singapore, M-Health can save health costs by S$3 billion per year– By comparison, venture capital in M-Health reached ~

US$1 billion (2013) in the US• In the EU, savings of €99 billion in 2017

– Fewer complications: doctors and paramedical staff could save 472,000 doctor days

– Other economic costs: worker absenteeism, early retirement costs

New Ways of Powering (1)

• A major limitation to widespread use of mobile health is power with respect to size of device

Power Sustenance

Reduce power consumption

Components

Generation

Human power

Storage

Batteries

Based on 2013 Ultra Low Power Wireless ECG Sensor Tag340 µW, 2V, 100m range

Based on 2012, ultra low power implantable medical sensor

New Ways of Powering (2)

Temporary Biofuel Cell Tattoo

• Electricity from sweat

• Can be twisted and stretched

• Chemically generates electricity

Currently 5 to 70 µW/cm2

New Ways of Powering (3)

• Fibre-based nanotechnology generate electricity via piezoelectric effect

• Textile fibers covered with zinc oxide nanowires

• Nanowires generate electricity when stretched

• 6mm2 generates about 20 mV, 0.8 µA (2.5 mW/mm2)

New Ways of Powering (4)

• Implantable hydroelectric generator

• Heart generates about 1-1.5 W of power

• About 1mW power available for devices e.g. Pacemaker requires 10 µW

Conclusions

Entrepreneurial Opportunities

• Consumer electronics

• IT support

• Healthcare sector

• New software

• Health insurance coverage policies

• Developing countries

Conclusion• Advances in electronic components, biological

molecule analysis, batteries signal the dawn for the next generation of wireless healthcare– New medical procedures (endoscopy)– Greater control of medicinal release – Digitizing our healthy habits (digital pill)– Strengthening patient/doctor dialog (M-

Health)• Greater confidence to both patients and

healthcare professionals• Better integration

– Diagnostics and procedures– Medication– Payment

• Wireless technology: 24/7, everywhere

Back-up

Back-up

Back-up

Smartphone cameras are sufficiently specific and sensitive for diagnostics• Not statistical significant difference between smartphone

cameras and conventional lab optic detectors

Back-up

Examples - Preventice

• Remote monitoring of cardiac arrhythmias via algorithm • Doctors monitor key biometrics

– Reduced re-admissions, shortened hospital stays, improved clinical outcomes

• Components: bandage patch with battery and monitor sensor, mobile device

• Data collected: ECG, heart rate, respiration rate, activity level, blood pressure, weight, blood glucose

• Cloud-based platform collects real-time data from the mobile device• Physicians then review data• Support for numerous device connection types: cellular/smartphone, wi-

fi, Bluetooth

M-Health Cost Savings (1)

• Traveling to a central lab for testing: $10 per test• Also considering indirect cost of taking 0.5 day off to do testing:

$200• Transportation cost: $10• If 10 tests are needed a year, it will cost $2200 per year per patient• If the testing cost can be halved, and test can be done at home, in

Singapore, this can save $3 b per year (assuming 1.5 million people needing tests)

• By comparison, venture capital in M-Health reached $900 million (2012), about $1 billion (2013) in the US

M-Health Cost Savings (2)

• Savings of 99 billion EUR in the EU in 2017• mHealth can help 9.4 million regular users at risk of developing

chronic diseases to expedite diagnosis• 815,000 patients can successfully detect chronic diseases early• These patients could avoid complications and seek medical

attention earlier, reducing the need for hospitalization and saving 3.7 billion EUR in treatment costs

• Doctors and paramedical staff could save 472,000 doctor days by having to treat fewer complications

• Chronic diseases could lead to 718 billion EUR in lost wages in 2017• Healthcare cost savings as a result of improving lifestyles, reducing

risk of chronic disease, saving of hospital and doctor days, healthcare providers staying informed, reducing worker absenteeism, and avoiding early retirement costs