1. Robin A. Felder, PhD The University of Virginia Department of Pathology

2. Disclosures  University of Virginia  Department of Pathology  Medical Robotics  Medical Automation  Hypogen  WellAWARE Systems  MeyeChem  Proteus Bio  Global Cell Solutions  Monte Piccolo Farm

4. 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

5. 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

6. Wellness Technologies Monitor  Nutrition  Exercise  Biometrics  Pain reduction  Stress reduction  Sleep improvement  Mood enhancement  Health and wellness

7. Wellness Support  Food coaching  Rewards  Exercise  Nutrition  Therapeutic compliance  Consequence reporting  Consequence forecasting Overcome vicarious goal fulfillment or, “exhaustion of self- control”

8. Home Health IT  New revenue sources: Medical Cloud coaching and Interpretations Cloud Interpretations

9. 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

10. SENSING Local content & services discovery SEEING Augmented reality UI: Map, 3D, in building navigation INTERACTING Connection manager (WAN, Wi-Fi) KNOWS You and what is around you LEARNS What you like DISCOVERS Things relevant to you FILTERS Out the irrelevant Source: Jarrin (Qualcomm)

11. SENSING Local content & services discovery SEEING Augmented reality UI: Map, 3D, in building navigation INTERACTING Connection manager (WAN, Wi-Fi) KNOWS You and what is around you LEARNS What you like DISCOVERS Things relevant to you FILTERS Out the irrelevant Source: Jarrin (Qualcomm)

12. new ipad mini Lifewatch AG

13. Portable Diagnostics  iPhone based portable ultrasound  EKG  Otoscope  Dermatoscope  Microscope

14. 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

15. Otoscope Images Normal Ear Drum Ear Infection Ruptured ear drum

16. 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 Initiative TED Conference 2012

17. iPhone Body Fluid Diagnostics  Biosense Technologies  uCheck  ToucHb

18. Continuous Glucose Monitoring Dexcom

19. Embedded Wellness Sensors  Instrument common fixtures  Wireless transmission of data  Web based aggregation and interpretation

20. Action Inspired Instruction  Real time coaching  Medically approved content  Tailored for individual

21. 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

22. 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

23. 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

24. Passive Gait Sensors Vibration sensors placed in the house detect occupant gait

25. Passive Physiologic Sensors Physiologic sensors embedded in common household furniture and fixtures

26. 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

27. 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

28. Restless Resident Restful Resident Sleep Quality Graphs

29. 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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31. One Click Trending  Health  Socialization  System utilization

32. Telehome Monitoring Decreases Costs by 74% N=21 in each group, P<0.05; Telemed J E Health, 2007 13(3):279-85 Unmonitored Monitored

34. 3D Manufacturing

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37. 4cm1cm0.2cm  First Warning Systems™ heat distribution sensing sports bra Wearable Cancer Detection

38. 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

39. 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

40. 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

41. The Eye as the Window to Health Univ. of MD, Baltimore UCSD Medical Robotics Preventive Science Inc.

42. MeyeChem, LLC  Real time glucose monitoring  Alerts for low or high glucose concentrations  Trending analysis  Food coaching via telenutritionalmentoring

43. 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)

44. Augmented Reality  Projection of underlying anatomy on living tissue  Relies on superimposition of reality and previously scanned animated image/data

45. Not for the Faint Hearted

50. Receptivity  Presenting health vs wellness to a patient  Determining what information is TMI  Optimizing the time for the presentation of wellness strategies “Wellformation”

51. A non-profit educational organization improving healthcare quality and efficiency through teaching automation principles and their application in health systems Medical Automation.org http://medicalautomation.org

52. TagLine - Medical reality http://medicalautomation.org

54. Robotic Reality HRP-4C National Institute of Advanced Industrial Science and Technology