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1 Future Trends in Remote Patient Monitoring Tony Tam Candidate MHSc. Clinical Engineering University of Toronto.

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Presentation on theme: "1 Future Trends in Remote Patient Monitoring Tony Tam Candidate MHSc. Clinical Engineering University of Toronto."— Presentation transcript:

1 1 Future Trends in Remote Patient Monitoring Tony Tam Candidate MHSc. Clinical Engineering University of Toronto

2 2 Presentation Outline Challenges in Healthcare Objectives of Remote Patient Monitoring Innovations in Patient Monitoring Future work Q&A

3 3 Challenges of Healthcare Growing number of chronic disease patients (hypertension, diabetes, asthma, cardiovascular problems etc) Costs of health care delivery are increasing First Ministers'. Ottawa: New Release from the First Ministers‘ Meeting: New Federal Investments on Health Commitments on 10-Year Action Plan on Health. September 2004.

4 4 Remote Patient Monitoring The application of technology to assess patient health within and beyond health care facilities Two major types: Long term trending - management of chronic disorders or health problems (periodic data dump) Detection of emergency events of at-risk patients (real- time alert)

5 5 Objectives of Remote Patient Monitoring Continue monitoring the health status of patients outside of the health facility reducing need for checkups/ hospitalization Measurement of treatment effectiveness – more objective and better characterization of patient response to treatment Postpone hospitalization / Discharge patients earlier Extend independent living for the elderly Reduce demand on caregivers, allowing caregivers to provide services for a greater number of patients

6 6 Applications for Non-Invasive and Continuous Monitoring Remote telemedicine In-home care Patient transport (ambulance, aircraft) – send patient data prior to arrival (e.g. in transit), physician consultation in remote situations Military assessment of battlefield conditions Emergency worker monitoring (first responders, firefighters) Inpatient and outpatient clinical monitoring Cardiac monitoring Sleep studies Clinical trials

7 7 Asynchronous home monitors TensioMobile can store up to 600 blood pressure measurements Transfers the stored data via mobile phone to a central monitoring center Physician receives periodic report

8 8 Physiological parameters Blood Pressure (Hypertension) Weight scale (diabetes) Respiratory Flow Meter (asthma, pulmonary function) Glucose meter Blood Oxygen Saturation Level (SpO2) ECG Temperature Blood clotting time and INR ( Coumadin therapy effectiveness)

9 9 Electromyographs (EMGs) provide information about muscle fatigue and recovery time to determine whether treatments are focused on the appropriate muscles, sufficient, and effective. Incontinence - Retraining the pelvic floor muscles to eliminate or reduce incontinence. Rehabilitation - Establish baseline data, measure progress, project duration of rehabilitation, project associated costs, document progress Telemetric EMG Systems

10 10 Implantable Heart Monitor Continuously records heart rate and heart rhythm for 14 months (works like a black box in an airplane) 15-20 minute operation to insert Medtronic monitor under skin After waking from a fainting episode, place Activator over monitor Doctor for analyzes Activator data to determine whether fainting is due to irregular heart rhythm

11 11 Vivago WristCare Back plate and straps measure micro- and macro-movement, as well as skin temperature and skin conductivity. When it detects a significant change from normal activity pattern (e.g. heart attack, unconsciousness), the system automatically sends an alarm to a designated recipient. Monitoring sleep patterns and the impact of changes in medication on activity levels Manual alarm button

12 12 Digital Angel Patient wears a wristwatch containing biosensors, a GPS receiver and a wireless transmitter. Periodic transmission of health status to a central station Sends help in emergencies Locate wandering Alzheimer’s patients, autistic children, lost pets.

13 13 VitalSense Measures core body temperature (pill 1.6 g) and skin temperature (patch). 2 modes: – continuous data log – monitor multiple pills (e.g. group of fire fighters) Each pill is coded for simultaneous monitoring Average 1.5 day use, $45

14 14 Clinical Applications Monitor heat stress in firefighters Battlefield monitoring of soldiers Perioperative monitoring of patients Telemonitoring Clinical studies underway: Menopausal hot flash monitoring Ovulation detection Sepsis detection in hospitals

15 15 Lifeguard Transmit vital signs wirelessly and logs data for up to 8 hours Physiological sensors (ECG/respiration, pulse oximetry, blood pressure) Small wearable computer with internal sensors (activity sensor via 3-axis accelerometers and skin temperature) acquires, logs, and transmits data A display station (Tablet PC). Analysis routines combine all parameters to one basic status indicator of "general health"

16 16 Lifeguard Developed for extreme environments (Under-sea habitat, mountain climbing centrifuge experiments, microgravity). Real-time transmission of vital signs from Licancabur volcano in Chile at 19,700ft, reflected off an Inmarsat satellite, downlinked via France Telecom, sent across the Internet to Standford University demonstrated the feasibility of global telemedicine.

17 17 Lifeshirt Sensors are woven into the shirt around the subject's chest and abdomen. Measures 30+ cardiopulmonary signs, subject posture and physical activity Blood pressure, blood oxygen saturation, EEG, EOG, periodic leg movement core body temperature, skin temperature, end tidal CO2 and cough Lightweight (8 oz.),machine-washable

18 18 Body Sensor Platform Center for the Integration of Medicine and Innovative Technologies (CIMIT) On-body sensor array patch that transmits information through a radio transmitter to a cell phone or PDA (can send alerts) Measures Temperature, Respiration rate, Motion, Heart rate Military application: Physiologic state of soldiers Aid medics in triaging wounded. Sleep study – measure respiration rate

19 19 European Commission MobiHealth Body Area Network (BAN) Sensors Front-end Mobile Base Unit (MBU).

20 20 MobiHealth Body Area Network (BAN) Components (cont.) Sensors Front End: amplify, digitize, and synchronize signals, send the data to the MBU using Bluetooth Mobile Base Unit: (HP iPAQ) transmits the received data through the GPRS or UMTS (wireless broadband) network over the Internet.

21 21 MobiHealth Inputs Shielded ECG electrode leads with snap- connector (for 2-lead, 3-lead or 12-lead ECG) Respiration sensor Activity/movement/position sensor Pulse-oximeter (gives saturation value, plethysmographic waveform and heart rate), Marker/alarm button

22 22 MobiHealth Features Infrastructure built on industry standards Customize sensor array for individual needs Real-time collection of data over the Internet – Front end serial number, type of front end, signal names, signal resolution etc. This information is transmitted to the Backend-Server as part of the data header. Multiple front-ends can be simultaneously connected to the Mobile Base Unit.

23 23 MobiHealth Trials - Netherlands Integrated homecare in women with high-risk pregnancies – Intensive monitoring of both mother and child postponing hospitalization Tele Trauma Team – Paramedics wear trauma team BANs (video camera, audio system, and a wireless communications link to the hospital). – Patient BAN measures vital signs. – Goal: decrease lag-time between the accident and the intervention. Increase survival rates and decrease morbidity

24 24 MobiHealth Trials - Germany Telemonitoring of patients with cardiac arrhythmias ECG measurements have to be taken regularly to monitor efficacy of drug therapy. Patients transmit ECG and blood pressure to the health call centre where the vital signs are monitored by cardiologists. Irregular patterns in these vital signs will be quickly detected for appropriate intervention

25 25 MobiHealth Trials - Sweden Alarm and Locator Trial – Room based alarm replaced with mobile alarm and locator. Monitoring of vital parameters in patients with respiratory insufficiency – early detection of disease progression and detection of emergencies Home care and remote consultation for recently released patients in rural areas

26 26 MobiHealth Trials - Spain Outdoors patient's rehabilitation – Patient rehabilitation in their own environment. Physiotherapist receives on-line information on patient’s exercise performance (e.g. walking speed) and provides feedback and advice. Measure Pulse oximetry, ECG and mobility with audio communication between patient and remote supervising physiotherapist

27 27 Future Work Greater use of home-based monitoring and treatment Intelligent control of medication delivery (e.g. insulin delivery based directly on blood glucose levels) Greater use of nanotechnology and microfluidics (“lab on a chip”)

28 28 Bionic Nano Implants AAMI 2004 Presentation: Latest Wireless Technologies for Medical Applications such as SDR and UWB Ryuji Kohno, Yokohama National University, Japan

29 29 Bionic Nano Implants Yokohama National University, Japan Communication and positioning between bionic nano implant systems Coordination and access of multiple systems based on Spread-Spectrum or UWB (ultra wide band) techniques Remote diagnostic monitoring and system update of bionic nano implant system from outside the body Battery charge by power transmission using UWB AAMI 2004 Presentation: Latest Wireless Technologies for Medical Applications such as SDR and UWB Ryuji Kohno, Yokohama National University, Japan

30 30 Questions?

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