Transcript WEARABLE BIOMEDICAL SENSORS IN A TELE-HOME

WEARABLE BIOMEDICAL SENSORS
IN A TELE-HOME-CARE CONTEXT
A FORESIGHT SCENARIO
(with a focus on the patient´s use of tele-medical solitions)
Fensli R.1, Hansen F.Ø.1, Gunnarson E.2, Gundersen T.3
1 Agder University College, Faculty of Technology and Science, Grimstad, Norway
2 Ullevaal University Hospital, Department of Anaesthesiology, Oslo, Norway
3 Sørlandet Sykehus HF, Medical department, Arendal, Norway
© Rune Fensli, 2006
Tromsø Telemedicine and eHealth Conference 2006, 12-14 June 2006
1
Outline
•
•
•
•
•
•
•
•
Trends and challenges in health care
Empowerment and self-care
Sensor technology and new possibilities
Tele-home-care
Body Area Network and reliability
Secure access to the patients “core EHR1”
Scenario: Wearable wireless monitoring
Research challenges
© Rune Fensli, 2006
1
Electronic Health Record
2
Trends and challenges in health care
A European trend:
• Treat and follow up patients in their own home (out-of-hospital treatment)
– (or on the elderly home/nursing-home)
• Medical assistance can partly be achieved up to a defined level
– by the use of new bio-medical sensors and wireless communication
The reason for this is partly because of:
•
•
•
•
Aging of the population
Need of alternative and cheaper medical supervision and assistance
The request for integrated information and co-ordinated medical care
The patients are participating in their own treatment and training
programme: Empowerment and Self-care
“Hospitalization in your own home – hospital@home”
© Rune Fensli, 2006
3
Sensor technology and new
possibilities I
• Vital signs monitoring will be performed by small
wearable biomedical sensors
– Almost all existing medical monitoring parameters
• The patient has to operate non-invasive sensors
– Use when needed for diagnosis and security reasons
– Wireless transfer of information to medical services
• Sensors can monitor, analyze + control therapy
– Invasive sensors can monitor important parameters
• Blood glucose, hormones, drug concentration etc….
• Give automatic control to drug administration (from deposits)
© Rune Fensli, 2006
Rubel P, Fayn J, L S-C, Atoui H, Ohlsson MT, D, Adami S, et al. New paradigms in telemedicine: ambient
intelligence, wearable, pervasive and personalized. Stud Health Technol Inform 2004;108:123-32.
Jovanov E, Raskovic D, Price J, Chapman J, Moore A, Krishnamurthy A. Patient Monitoring Using Personal Area
Networks of Wireless Intelligent Sensors. Biomed Sci Instrum 2001;37:373-8.
4
Sensor technology and new
possibilities II
• Intelligent nano-sensors:
– Can replace disabled functions
• Heading aid, artificial eye, artificial voice, contact elements
replacing sense impression etc.
• Control muscle contractions and limb movements
• “Read your thoughts and give desired actions”
• Lab-on-chip (bio-sensor):
– New possibilities for self-analysing blood samples
– Future invasive analyzing and transferring capability
Foresight projects:
“Avanserte materialer Norge 2020”, The Norwegian Research Council
“Foresight Biomedical Sensors”, a research project: www.nordic-fobis.net
© Rune Fensli, 2006
5
Is really the patient capable of
controlling the new brilliant technology ?
• It is a danger of letting techno-oriented persons
designing health-care services:
– “Are there any patients where we can put in this new
revolutionary technology????”
• The ultimate way of doing it:
– “It all started with a crazy idea – but it was about
solving a life-threatening medical problem”
• The Norwegian company WPR Medical1 is funded on this
philosophy when their wireless ECG-sensors was developed
© Rune Fensli, 2006
Elderly people can handle advanced sensor equipments –
if they find benefits in using the solution (Fensli et. al, 2003)
6
Wearable wireless monitoring
Base station for
Mobile telephone
INTERNET
Wireless
transfer of
encountered
ECG-alarm
situations
The patient is wearing
the WPR wireless
ECG-sensor
WPR Internet
connected server
GPRS/
GSM
The Hand-Held device
receives ECG-signals
and uses automatic
arrhythmia detection
algorithms
Remote WPR
Client at the
hospital
The patient can use a
web-based system to
contact the doctor and
read the encountered
ECG-findings
The Doctor at the Hospital can
make diagnostic evaluations
of the recorded ECG-signals
Fensli R, Gunnarson E, Gundersen T. A Wearable ECG-recording System for Continuous Arrhythmia
Monitoring in a Wireless Tele-Home-Care Situation. In: The 18th IEEE International Symposium on
© Rune Fensli, 2006 Computer-Based Medical Systems; 2005 June 23-24, 2005; Dublin, Ireland; 2005. p. 407-12.
7
Tele-home-care
• The patient can be treated in his own home
–
–
–
–
Wearable sensors will record vital signs parameters
Continuous detection with trend analysis
Automatic detection of un-normal situations
Automatic alarm in case of emergency
• The health-care services can easily follow-up
–
–
–
–
–
Supervising the individual care-plan
Observing the medical condition
Watching changes and effects of medication
Exchange of information with questions and answers
Co-ordinated information between health care
professionals and with the patient
© Rune Fensli, 2006
8
Body Area Network - BAN
• Several international projects are focusing on
BAN-technology with a plurality of sensors
• However, no standard exists and proprietary
solutions are developed with no interoperability
BAN:
Body Area
Network
Wireless sensors
Hand-Held-Device
(receiver unit)
© Rune Fensli, 2006
Several possible radio-frequencies/systems
Different communication protocols
No international standards for wireless vital
signs data-formats
Problems with a plurality of patients without
interfering each other
No interoperability between different
products/manufacturers
WPAN, IEEE 802.15.4 is under development,
but is not suitable for medical purposes 9
Reliability in wireless transfer
• Wireless sensors needs event detection algorithms.
– It is difficult to distinguish between errors in the wireless
transmission from the different sensors used, and pathological
situations detected. This can led to erroneous alarm conditions,
and necessary precautions should be implemented in order to
reduce the number of incorrect alarms.
– Packet loss in the wireless transfer will most likely occur, and the
delay of the transmitted signal can be unacceptable.
• Golmie et. al(2005) showed that packet loss in a WPAN was 100%
and the critical ECG-monitoring information was inaccessible, with
wireless interference from traffic in existing WLAN systems
© Rune Fensli, 2006
A time series of ECG recordings obtained
from a “Holter Monitor”, where the RRintervals are erroneous calculated because
of missing contacts at the electrodes.
The recorded signal has packet losses
(shown by the negative-going lines)
due to an “out-of-range” situation with
wireless transmission errors.
10
C-EHR
• "core electronic health record" (C-EHR) is used to
describe a “common data sets” as the minimum of
information required to get an adequate overview of the
patient's actual situation
– This core journal can in fact be “owned” by the patient himself, and he will
have to take control of the necessary authorizations of who is obliged to
have access to the various parts of the information.
– The patient can write his medical diary into the system and can keep
tracking of medications, actual vital signs recordings, training results etc.
• In cases of emergency, the need of quick medical
assistance can be important and in life threatening
situations there will be a need of quick access to the
patients EHR in order to give the correct treatment.
– Today, no one has a proper solution
© Rune Fensli, 2006
AHIMA: myPHR Personal Health Record,
http://www.myphr.com
11
Scenario
•
•
In an emergency situation, it can be important for the rescuing personnel to
have direct access to the patients EHR information and can in a future
solution be implemented in a C-EHR to be shared between the patient and
the health care services.
A physician at the rescuing station should then be given access to the
central core journal, regulated by a Role Based Access Control mechanism
Rescuing Station
C
n
ile atio
ob ic
M un
S
PR
m
G
om
2. ALARM
TRANSFER
National
Health
Network
1. HEART ALARM
4.
IN AUT
FO O
EX R M M A T
CH AT IC
AN ION
GE
RESCUING PERSONNEL WITH
AUTOMATIC DEFIBRILLATOR
3. INFORMATION
TRANSFER
WPR
Wireless
Sensor
MIS
© Rune Fensli, 2006
Hansen, F.Ø., Fensli, R.: Method for Automatic Escalation of Access Rights to
the Electronic Health Record. To be presented at MIE 2006.
12
Mobile patient-doctor communication
• Development of new mobile phone services can also be
used in medical treatment and diagnosis
• Case:
–
–
–
–
–
–
Man, 56, at vacation in his sail-boat suddenly gets a heart attack
His wife finds his emergency suitcase with wireless ECG-sensors
She helps him putting on the wireless ECG-recording equipment
Automatically the real-time recordings are transferred to the doctor
He can discover un-regular heart beats with atrial fibrillation
By use of the mobile with a camera, the doctor can speak with the
patient about his condition, but can also observe the lip colours
– His quick investigation is immediate medication (from the suitcase)
– The patient needs quick treatment at the nearest hospital
– The doctor records his voice-epicrisis and helps with escalating
the EHR-access for doctors at the nearest hospital
© Rune Fensli, 2006
13
Privacy and confidentiality
• In automatic wireless monitoring solutions, it is important
to regulate the access to the EHR-information
–
–
–
–
The patient can give different access rights to different parts of information
The doctor don't need the patients location unless a critical situations
No need of transferring a waste of normal recordings
No need of instant actions unless an un-normal situation is detected
• To protect privacy, security must be ensured
– Information transfer within National Health Networks
– Encryption solutions must be implemented in handheld wireless units
– PKI systems and smart cards used for secure access to information
• Administration of access control is done by using
an SRBAC1 solution with location based services
1
© Rune Fensli, 2006
Spatial Role Based Access Control
14
The ECG-solution of WPR1
• This system has several possible uses:
– Long time ECG-recordings with arrhythmia detection (Holter),
Telemetry solutions and Monitoring purposes
– Continuous event recording and alarm system
• Primarily designed for use in a Tele-home-care situation
– Patients outside the hospital can be under continuous monitoring
in cases where the medical diagnostics and treatment needs a
close follow-up by the doctors
• This can be situations for:
–
–
–
–
Early observation or screening for possible arrhythmia incidents
Arrhythmia diagnostic of patients with rarely occurrences
Control of medication for patients with atrium fibrillation
Patient follow up after intervention and treatment
1
© Rune Fensli, 2006
Wireless Patient Recording Medical AS, www.wprmedical.com
15
Research challenges
• Development of new tele-medical services will face a lot of
technical research challenges
– Technical difficulties in sensor design, antenna construction, battery
consumptions, miniaturization, wireless transfer etc.
– A lack of suitable standards defining interoperability
– Reliability in monitoring procedures and automatic event detection
– User interface and easily understandable solutions
• Main obstacles can be getting new procedures accepted
– A lack of tele-medical standards defining procedures and intervention
– New ways of co-ordinated medical care and support
• Research projects need to focus on patient outcome
– What are the benefits from the patients point of view ?
© Rune Fensli, 2006
16
Publications
•
Fensli R, Gunnarson E, Gundersen T. A Wearable ECG-recording System for Continuous
Arrhythmia Monitoring in a Wireless Tele-Home-Care Situation. In: The 18th IEEE International
Symposium on Computer-Based Medical Systems; 2005 June 23-24, 2005; Dublin, Ireland;
2005. p. 407-12.
•
Fensli R, Gunnarson E, Hejlesen O. “A Wireless Cardiac Alarm System for Continuous Event
Recording”. Medinfo2004; September 7-11, 2004; San Francisco; USA; pp 1598.
•
Fensli R, Gunnarson E, Hejlesen O. “A Wireless ECG System for Continuous Event Recording
and Communication to a Clinical Alarm Station”. 26th Annual International Conference IEEE
Engineering in Medicine and Biology Society; September 1-5, 2004; San Francisco; USA; pp
2208-11.
•
Fensli R, Gundersen T, Gunnarson E. “Design Requirements for Long-Time ECG recordings in
a Tele-Home-Care Situation, A Survey Study”. Scandinavian Conference in Health Informatics
2004 ; August 23 -25, 2003; Arendal, Norway. pp. 14-18.
•
Fensli R, Gunnarson E. “Mobile Monitoring of Vital Parameters within the Electronic Health
record - Medical, Technological and Legal aspects”. Tromsø Telemedicine and eHealth
Conference - TTeC2004; 21.-23. June 2004; Tromsø, Norway; pp 46.
•
Fensli R, Thorstensen H. “Security aspects of Wireless Medical Computer Networks. A
proposal of combined security measures”. Scandinavian Conference in Health Informatics
2003 ; June 13 -14, 2003; Arendal, Norway. pp. 21-29.
© Rune Fensli, 2006
17