Transcript Smart Medical Home

Smart Medical Home
Israel Gannot
Bio-Medical Engineering Department, School of
Engineering, Tel-Aviv University
George Washington University
Washington, DC
Introduction
The demographic trends of the advanced countries go towards the
development of an older population. By the year 2035, one third of
the American and European population will be more than 65 years
old. Such a development will weigh down the health systems of
the countries concerned as much at the economic than social
Level.
That rapid growth of the elderly population and increase in life
expectancy have led to new models of positive ageing where older
adults are being empowered to lead fulfilling lives and adapt to
degenerative changes to maintain functionality, autonomy and
quality of life.
The purpose of that models is to make it possible for the elderly
population continue living in their own homes.
•Proactive health involves
maintaining the three rings of
social performance
Activity in the community
Activity in the household
Activity related to body
Adapted from Larson MIT
Introduction
The need for smart medical homes is due to:
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Economical reasons
Medical reasons (the most important)
Personal reasons
The economical importance
Growing medical expenditure is a serious problem in
the countries with growing population. Earlier
detection and treatment of diseases can be the
solution to decrease the high costs. Early detection
can be achieved by monitoring the health status at
home.
For example, a study that was made in the UK
suggests that private residential living costs only
55% of the costs of full-time residential care [1].
The medical importance
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The health and wellness status of an elderly subject
living alone might be remotely monitored to detect
possible deterioration in his health status.
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Fall detections, detections of poor medication
treatments, changes in sleep patterns, changes in
physiological parameters, or even in cognitive abilities
are all essential to managing the changing health
status of the elderly.
The personal importance
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The idea of independent living at home is very
important for many elderly people. Once moved into
a facility like nursing homes, it is common for them to
become depressed because of their lack of
independence and tendency to give up on life.
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Technology could play an important role by providing a
smart environment. The ability of the “smart home” to
measure medical data, and send it to the caregivers
through the internet, makes it possible to lengthen
the independent living at home.
Curent solution:
Assisted living environments
Natural living habitat
“Virtual nursing home”
Unit
Center
Multi-level health monitoring system
Information models
networks
standards
Integration
Traditional
Vital Signs
wireless
Inference
Info-Sensors
motion
interoperability
User Interface
From Pentland (Rochester)
The idea
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In this system, data acquisition from elderly will
be achieved without the awareness of the
person.
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The detectors will be placed in the house in
many different places, and the person will
continue his regular life without wearing anything
special on her(him)self (except of a wrist watch).
hinged panels to micro-controllers
speakers
air quality sensors
IR illuminators
hinged panels to sensor bus
cabinet door switches
countertop activity cameras
refrigerator use sensors
microwave use sensors
From Larson,
MIT – n_House
oven & range use sensors
cabinet drawer sensors
hot water use sensor
cold water use sensor
hinged panels to sensor bus
cabinet door switches
sensor network connections
internet connections
temperature sensors
Power integrated into cabinetry
hinged panels to subwoofers
More basic ideas/assumptions
The requirements from the sensors in the
system are:
Noninvasive, minimally-wearable, convenient to
install and use, without restrictions on the
person’s movements, without vibrations, without
noise and light signaling, with a high reliability
and a long life, wireless or with minimally amount
of wires signal transmission, and waterproof [4].
The Computer system
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All the sensor devices will be connected to a
special home network under which each device
interacts with others in a “plug and play” manner
[3]. A home installed computer performs routine
data processing. The information will be
transmitted through the internet
to a medical center, and
some information can be
transferred to the relatives.
The Computer system
Middleware
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Middleware comprises both hardware and
software – and it’s aim is to provide a platform to
which the sensors send their data, and where
the data is processed, stored, presented, and
transmitted.
We have chosen the OSGI Middleware to realize
the system.
What is OSGI?
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In 1999, OSGi (Open Services Gateway Initiative)
was established as an independent non-profit
organization working to define and promote
delivery of managed services to networks in home
and other environments.
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OSGi specification requires services to be
packaged into software “bundles.” It also provides
a framework on which these software bundles from
different vendors can execute and interact.
What is OSGI?
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The OSGI standard enables platform
independence, and that is thanks to the Java
programming language.
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The OSGI platform can support and interconnect
big number of communication technologies. For
example: Bluetooth™ technology, HAVi, IEEE
802.11®, IEEE 802.15, IEEE 1394, Jini®,
Salutation™, the UPnP™ architecture, X10,
HomePlug, and HomePNA.
Medical standards
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Medical Information bus (IEEE-1073).
DICOM
HL-7
Healthcare Devices and
Applications
Physiological parameters
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We want to use a wrist-worn device that can
measure the heart rate and the body
temperature of the person.
The device will be connected to the home
network wirelessly by radio frequency protocol.
The device will include a RFID tag (small tags
that can transfer RF signals) which enables the
system to recognize the person and follow
movements.
Smart alarms
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Decision making from data collected
from multiple sensors.
• Looking at trends
• Multi Parameter Algorithms.
• Linkage to other clinical resources.
• Decision Support.
The Smart Floor
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Fall Detections: Falls are the second
leading cause of unintentional-injury death
for people of all ages and the leading cause
of death for elders 79 years and older.
Studies have shown that the medical
outcome of a fall is largely dependent upon
the response and rescue time [2].
The Smart Floor
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The ability to measure the pressure signals on the
floor’s cell, and a computer analysis of that signals
will help us to know when a fall has occurred.
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Another method that is considered is a special
piezoelectric sensor coupled to the floor surface.
When a fall occurs, typical vibration signature of the
floor generated by the person’s body is sent to the
computer.
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In both ways the signal is sent via wireless device to
the computer, and the alarm system is activated.
Mobility assessment
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Changes in some aspects of mobility have been
shown to correlate with changes in cognitive
function and can perhaps predict future cognitive
decline [7].
We can use the Smart Floor (implemented by
pressure cells) to determine typical walking speeds
by special algorithms.
The value of the speed is less critical
than its relative value, which allows
assessment of changes.
Smart Toilet
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Fiber optic evanescent-wave spectroscopy
(FEWS) can be used in the “Smart Toilet” for the
analysis of urinary salts.
By the collections of Urine while the person
doing his needs, the system makes the
analysis, and sends the results to the
computer through the local network.
By the mobility assessment our system
will be able to know for example how
many times during the night the person
visited the toilet.
ECG on a chair and in bed
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Elderly people spend most of the time during
the day on a chair in front of the TV, or in bed
while sleeping.
Studies showed that that ECG waveforms can
be obtained using electrodes fixed on a chair
or in the bed, and measurements obtained
without direct contact with the skin. [5]
The signal will be sent to the home central
computer via Bluetooth signals.
Sleeping Disorders
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The current gold standard for sleep research is recording
of an EEG, EMG, measurements of brain waves, and
muscles activities. That electrodes can assess the sleep
quality, but their attachment the patient’s body affects
sleep.
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Today, it is believed that sleep disorders measurements
can be made the analysis of physiological characteristics
such as body temperature, movement in bed, breathing
rate heart rate, and snoring analysis.
Sleeping Disorders
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An ultra sensitive piezoelectric transducer that will provide
information about heart rate and breathing rate by filter analysis of
the signals.
Temperature sensors attached to the mattress, that can measure
the temperature changes of the person.
Pressure sensors to detect the movements of the person while he
sleeping and when he is out of bed.
Sound recorder for the detection of snoring.
Detection of bacterial infection developed in bed sores
All the sensors above allow the subject to sleep
comfortably without having to wear electrodes or
be hooked up to a machine.
Sleep studies
From Goubran Carleton university
Medication Reminders
According to the American Heart Association,
more than half of all Americans with chronic
disease do not follow their physician’s
medication and lifestyle guidance, and nine out
of ten make mistakes taking their medication [6].
The No.1 problem in treating illness today is
patients' failure to take prescription medications
correctly, regardless of patient age [6].
Medication Reminders
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We want to develop a smart pillbox that
will be able to count the medications, and
communicate with the central computer by RF
medium in real time (for instance: Bluetooth).
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The computer program will know the treatment
schedule, and will be able to alert the person by
a human voice message when a mistake has
occurred. That way all the mistakes will be
prevented.
Example: Speech Prosody
Spectrogram
Magnitude
4000
3500
Frequency(Hz)
3000
2500
2000
1500
1000
500
0
0
0.2
0.4
0.6
0.8
1
Time
1.2
1.4
1.6
1.8
Directly measure pitch vs. time …
Contains a wealth of information!
Pentland - Rochester
Image acquiring and processing
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Detect changes in skin temperature or
condition (pale, red,…).
Detection of changes in nevi (color, size,
structure).
Telemedicine Devices
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Today there are a lot of companies that develop
telemedicine devices.
The new generation of such devices, deliver the
measured information over the internet, usually
by RF protocol connection to the local computer.
Our mission is to make it easy to connect such
devices to our smart home system.
It completes the whole picture of the person’s
health status.
Telemedicine Devices
Examples of the CardGuard company:
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Wireless 12 lead ECG - SelfCheck™
ECG Cardiac Monitor
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SelfCheck™ BP Wireless non-invasive
blood pressure and pulse rate monitor.
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Oxy Pro Wireless Oximeter
Multi disciplinary effort
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Engineering (Sensing gadgets…, network design, signal and
image processing, pattern recognition).
Computer science (AI, Neural networks, Control programming ).
Biomedical Informatics (Electronic medical records).
Medicine (Geriatrics, internal medicine, Neurology and practically
all disciplines).
Architecture (re-design houses for the elderly people).
Psychological (Behavior under constant monitoring).
Philosophical (Ethical issues, cognitive changes in high tech
environments).
Economical (Are all these developments worth the investments,
macro and micro).
Israeli companies in related
home care field
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Haldor: www.haldor-tech.com , RFID technology
Nexense: www.nexense.com , smart sensors
Card Guard: www.cardguard.com , telemedicine.
Aerotel:
www.aerotel.com , telemedicine
HOMEFREE: www.homefreesys.com , Wireless Resident Monitoring
Visonic:
www.visonic.com , Senior Living Suites
EarlySense: www.earlysense.com , care of chronic patients
WideMed: www.widemed.com , Sleep analysis
Aeroscout: www.aeroscout.com , RFID solutions
Shahal:
www.shahal.co.il , Telemedicine leading company
Medic4All: www.medic4all.com , Telemedicine
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CNoga: www.cnoga.com , Physiological parameters with video camera
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Summary
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Health monitoring devices are of great
importance for the design of smart
homes for older persons.
Continues monitoring of the health
condition of the person may contribute to
the extension of life expectancy and to a
better quality of life.
Acknowledgements
Alice Pentland - Rochester
Kent Larson - MIT
Steve Kell - UVA
Tom Rose - Duke
J. Michael Youngblad –UNC-Charlotte
Rafik Goubran - Carleton
References
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[1] Tang, P. and T. Venables (2000). "Smart homes and telecare for
independent living." Journal of Telemedicine and Telecare 6: 8.
[2] Alwan, M., P. J. Rajendran, et al. (2006). A Smart and Passive FloorVibration Based Fall Detector for Elderly.
[3] Warren, S. and R. L. Craft (1999). Designing smart health care technology
into the home of the future.
[4] Stefanov, D. H., B. Zeungnam, et al. (2004). "The smart house for older
persons and persons with physical disabilities: structure, technology
arrangements, and perspectives." Neural Systems and Rehabilitation
Engineering, IEEE Transactions on [see also IEEE Trans. on Rehabilitation
Engineering] 12(2): 228.
[5] Yong Gyu, L., K. Ko Keun, et al. (2006). "ECG measurement on a chair
without conductive contact." Biomedical Engineering, IEEE Transactions on
53(5): 956.
[6] American Heart Association, Statistics you need to know.
[7] R. Camicioli, D. Howieson, B. Oken, G. Sexton, and J. Kaye, "Motor
slowing precedes cognitive impairment in the oldest old," Neurology,
vol. 50, pp. 1496-8, 1998.