Transcript Document

Telemonitoring in Elderly Care
Latest Trend
Amirkabir University of Technology
College of Biomedical Engineering
Division of Medical Information Technology
7/21/2015
Shahram Taleghani MD.
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Ageing With Grace
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Introduction
The need for home care continues to grow rapidly as the
number of older adults continues to grow and the fact that
people are living longer now.
Patients want to remain at home and be
independent but many are suffering from chronic conditions.
How do we care for them with the health care system facing
critical shortages of public resources, as well as nurses, and
other health care professionals.
Health care workers are forced to do more with less, with
decreased reimbursements and increased focus on quality
and clinical outcomes.
This leads the way for technology to be integrated into health
care.
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Percentage of Elderly Population in Year 2006
2006
Percentage of Population over 60 years old Global Average = 10%
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Percentage of Elderly Population in Year 2050
2050
Percentage of Population over 60 years old Global Average = 21%
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Home Telehealth
Home Telehealth encompasses remote care
delivery or monitoring between a health care
provider and a patient outside of a clinical
health facility, in their place of residence
(home or assisted living residence).
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Interactive Home Telehealth
Interactive Home Telehealth includes the
utilization of two-way interactive audio video
involving the patient and a health provider.
This service provides remote care delivery
(i.e. assessment, education, data collection).
Interactive Home Telehealth may include
devices collecting clinical data from the
patient and delivered to the health provider.
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Range of Telemonitoring Devices
High-End
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Mid-Range
Economy
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Telemonitoring
Telemonitoring includes the collection of
clinical data and the transmission of such
data between a patient at a distant location
and a health care provider through a remote
interface so that the provider may conduct a
clinical review of such data or provide a
response relating to such data. This includes
the use of automated laboratory or other
health monitoring equipment, as well as the
manual entry of data.
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Few Telemonitoring Devices
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Honeywell HomMed Products
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Self Monitoring
The periodic and scheduled use of a device
by the patient to obtain clinical data that is
used by the patient to measure their own
health status. Commonly measured data
include blood pressure, glucose, weight, and
temperature.
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Self Monitoring Device
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Patient Encounter
Home Telehealth may or may not involve a patient
encounter. A patient encounter is the communication of a
set of information between a patient and a provider that
establishes the plan of care, has the potential to change the
plan of care, or implements the plan of care. A video
conference between a health care provider and a patient
can be a patient encounter. The interactive transmission of a
set of vital sign data from the patient to the nurse who can
make a care decision is a patient encounter. Encounters
also may include therapy sessions to implement the plan of
care. The collection of patient vital signs at a remote site
generally does not involve a patient encounter.
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Why Telemonitoring
 Improve the quality of patient care.
 Improve patient outcomes and satisfaction.
 Deliver care more efficiently.
 Decrease health care cost.
 Decrease re-hospitalizations.
 Decrease emergency room visits.
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First Study
University of Berkeley
Information Technology for Assisted
living at Home (ITALH)
Building wireless infrastructure for assisted living
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The Main Objectives in this
project
Provide smart monitors and sensors
that will alert user or care provider
in events of accident, acute illness
or deteriorating condition of elderly.
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Prototype Scenario of Application Usage
Home Health System that is able to
monitor one’s health and activity.
Sensors getting information
whether worn by patient or those
mounted in the home.
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Advantages of ITALH
( Information Technology for Assisted living at Home )
Increase self sufficiency
Reduce direct care
Reduce cost
Delay relocation to retirement homes
Improve safety and well being of the users
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Components
1)
2)
3)
4)
5)
6)
Sensor A) Worn by patients.
Sensor B) Devices within the home.
Central home health System.
Sensors Net [made of (1,2,3)].
Bluetooth Wireless Communication.
Zigbee Wireless Communication.
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Components
7)
8)
9)
10)
11)
USB Hard Wire connection.
Telephone
Mobile Gateway
Internet
Home Health system [made of (1-10)]
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Setup
1) Home health system set up with the wireless
sensors around it .
2) Bluetooth integration in to each sensor
device.
3) Zigbee Adaptors
4) Local Ethernet network between gateways
and remote care provider.
5) Mobile phone with Bluetooth connection and
video stream.
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Sensors
Fixed wireless sensors for basic environment
sensing: for example temperature, humidity,
light.
Wearable sensors: motion, heart beat.
Fall detection sensors using unique
algorithms.
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Sensor Net
Heterogeneous wireless network that
connects sensor devices worn or placed at
homes to central home health system.
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Sensor Net Wireless Connectivity
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Gateway System
Application of biometric information gathered
by the sensors and their transmission to the
health care provider at remote place via
Information and Communication Technology
(ICT).
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Types of Gateways A
A) Home gateway
Provided by Home health system
Based on Windows XP
Works with blue tooth and zigbee
wireless connectivity
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Types of Gateways B
B) Mobile gateway
Wearable sensors send events by mobile
phone.
Nokia 6670-6680 by blue tooth
connectivity via Symbian Operating
System.
These set of mobile phones provide
cameras for two way video conferencing.
Third generation(3G) internet accessibility. 27
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Sensor Net Development Setup
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Access Permissions
User will grant permission to authorized
personnel to monitor him / her.
Authorized personnel can be relatives,
neighbors or health care providers.
User defines the access on what to monitor,
record or respond in any given case.
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Privacy & Security of Information Flow
-
Information is not continuously send.
Flow of information is either event activated
or requested by the specific order.
So it needs far less band width for
transmission.
In case of an event and it’s transmission,
information flow will become encrypted.
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Alert Notification System
Storing or forwarding data on the daily
activity for future analysis.
Querying the user to check their status.
Placing a phone call to the neighbors or
relatives.
Signaling the health care providers.
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Procedural Response
Alert notification will be sent to gateways.
Gateways later determine appropriate
response.
Gateway query about person with different
sensors.
If normal behavior is detected, it will be
regarded as incident.
If no response, emergency signals will be
sent immediately.
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Conclusion
A)
B)
C)
D)
E)
F)
Information technology for assisted living at
home project with wireless infrastructure.
Heterogeneous wireless networks using
Bluetooth and zigbee radios as Sensor Net.
Monitoring health with these devices and home
health system network.
Secure, private, safe and reliable service to senior
citizens.
Improving the quality of health monitoring
Reducing health care cost.
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Second Study
University of Aizu. Japan
The Mobile Teleconferencing
System for Home Care Services
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The Main Objective of This Project
Using mobile telecommunication
technology to support home care
services and application of electronic
white board under the scope of
telemedicine.
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Homecare service support system
(HSSS)
- Provide support for real time instruction from
doctors to nurses and collect data in mobile
condition.
- This communication exists between doctors at
service stations and nurses in as service
providers in different locations.
- The protocol of communication is based upon Global
System for Mobile Communication (GSM) as
standard for digital cellular communication over
the world.
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Network Configuration
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The Components of Teleconference
System
- Service station.
- Station computer which is equipped with large
screen, microphone, speaker, camera.
- Station server.
- Nurse computer usually as a tablet pc.
- Mobile internet card.
- Electronic white board.
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Ways
of
communication
1- Physicians at service stations communicate with
the different home sites via internet and give
instructions to nurses.
2- Each nurse after collecting data from patient
connects to service station and waits for
instructions.
3- Physician consult with patient or nurse by voice or
image in real time.
4- Since stream requires large band width, they
exchange image instead by electronic white board.
5- Images and memos can be saved and retrieved for
later use.
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Electronic White Board
Image Player= Receives images from different
places and displays it on the computer screen.
Image Selector= Shows the list of revived images
and sends selected images to image player.
Video Capture= Take the snap shots by the cameras
to the image player for display.
Image Controller= Switches image player to
electronic white board.
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Voice Communication
Real Time Transport Protocol (RTP)
Capture Sound Thread: captures sound
stream from microphone and delivers it to
other targeted computers.
Playback Sound Thread: receives sound
stream from other target computers.
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Voice Communication Structure
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System Management
Manages station computers, nurse
computers and database.
Depending on type of massage it gets, take
appropriate operation.
Manages data base by PostgreSQL.
PostgreSQL allows the Java API to access
database.
Requires ID and Password for access.
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System Management Flow Chart
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Communication Management
- Communication of all participating computers
by communication control platform (CCP).
- One-to-one, one-to-all, one-to-N computers.
- Construction of multi site data transmission.
- Detecting the data transmission errors.
- Hiding the details of transmission from
application layer.
- Server has a global IP address.
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System Implementation
Plat form is Windows XP.
Image resolution for cameras and white board is 640*480
pixels.
Nurse tablet pc is NEC with 933Mhz CPU, 240M RAM.
DOCOMA Foma P2401 mobile card with 64kbs upload and
384kbs download rate.
Image compression of 70%.
Image transfer rate from nurse to station is 5 Sec for 33k
image.
Image transfer rate from station to nurse’s tablet pc is 2
Sec for 33k image.
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Computer Screens
Nurse Computer screen
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Station Computer screen
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Conclusion
Using current telecommunication technology for
home care services.
Two way communication between service
providers and station.
Capability of using multiple devices for decision
making.
Real time image and voice transmission for
monitoring and diagnosis.
It’s Java technology development makes it
operational under Windows, Unix and Mac.
Both wireless and LAN or ADSL availability.
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