Transcript Cost Effectiveness and Quality Improvement Slides

Smart Medical
Home
Assist. Prof. Dr. Chuchart Pintavirooj, et. al.
Department of Electronics
Faculty of Engineering
King Mongkut’s Institute of
Technology Ladkrabang (KMITL)
Concept
 The concept of Health Smart House aims at
giving an autonomous life, in their own home,
to people who would normally be placed in
institutions: patients suffering from a chronic
disease, handicapped people, and also
fragiie elderly.
Introduction
 Rapid growth of the elderly population and
increase in life expectancy
 By the year 2035, one third of the American and European
population will be more than 65 years old.
 The elderly person became increasingly isolated
in institution or even in residence. More fragile, it
can be the subject of ill treatments
 A Canadian study undertaken on 2000 elder points out a rate of
4% of subjects having been victims of these violence.
 World Health Organization which points out the figure of 6% of
the old people concerned with such ill treatments.
 Almost 3,000 people of more than 65 years old committed
suicide in 1998 in France .
Objective
 Older adults are being empowered to lead
fulfilling lives and adapt to degenerative changes
to maintain functionality, autonomy and quality of
life
 continue living in their own homes
Evolving Locations of
Health Care
Home
Hospital/Institution
Decentralized Care
Home
•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
The Need
 Economical reasons
 Medical reasons (the most
important)
 Personal reasons
The economical
importance
 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
The medical importance
 Fall detections
 detections of poor medication
treatments
 changes in sleep patterns
 changes in physiological
parameters, or even in
cognitive abilities
The personal importance
 Independent living become
depressed because of their lack
of independence and tendency
to give up on life.
 Smart Home makes it possible to
lengthen the independent living at
home.
Access: Patients with a Medical Home Less Likely to Report
Difficulty Getting Care on Nights, Weekends and Holidays
Without Going to the ER
Percent reporting very/somewhat difficult:
Has medical home
100
75
74
57
No medical home
73
58
57
41
50
41
49
64
58
42
72
61
43
25
0
AUS
CAN
GER
NETH
NZ
UK
US
Note: Medical home includes having a regular provider that knows you, is easy to contact, and coordinates your care.
Source: 2007 Commonwealth Fund International Health Policy Survey.
Data collection: Harris Interactive, Inc.

2007 Commonwealth Fund
International Survey Results
In each of 7 countries, having a
“Medical Home”* improves patient
experiences:
 Access
 Communication
 Patient safety
 Care coordination
 Reduced duplication and delays
 Preventive care
 Chronic care management
 Patient satisfaction
Adults with a Medical Home*
Medical home
Regular doctor/place
100
75
50
88
100
92
84
89
89
80
61
59
48
45
47
AUS CAN GER
NET
47
50
25
0
 But many in each country do not
have a medical home.
NZ
UK
US
*Medical home = Regular provider;
knows you; easy to contact;
coordinates your care
Available at: www.commonwealthfund.org
Medical Home Can
Reduce Disparities
Percent of adults 18–64 receiving a reminder
to schedule a preventive visit by doctors’ office:
Medical home
100
Regular source of care, not a medical home
No regular source of care/ER
75
66
65
64
54
52
25
22
23
- Receive reminders for
preventive care visits.
- Report always getting the
care they need when they
need it.
64
49
48
50
25
21
0
Total
White
African
American
Minorities with a
medical home are just
as likely to
Hispanic
Minorities with a
medical home are less
likely to feel treated
with disrespect.
* Compared with reminders, differences statistically significant after adjusting for income or insurance.
Source: 2006 Commonwealth Fund Health Care Quality Survey (Beal et al., “Closing the Divide: How Medical Homes
Promote Equity in Health Care,” The Commonwealth Fund, June 2007).
Current solution:
Assisted living
environments
Telehealth Resource Centers Funded by Office for
the Advancement of Telehealth in 2006
Natural living habitat
State of Art Smart Home
Project
 In 1988, Togawa et. al. [12] monitored the daily
activities
 Inada et al. [14] monitored the physiological
variables and physical activities for rescue squad
 Noury, 1992 [15] collect at home the physiological
variables and some textual information concerning
the patient through network.
 Richardson [16,17] creates, in the "Adaptable
Smart Home (ASH)", a common network to control
and to monitor the devices from inside and outside
the house.
 Celler et al. [19] measures the behavior and the
health of the person starting from 18 sensors:
State of Art Smart Home
Project
 Roth et al. [24] remotely monitored cardiac patients
at home.
 Leikas et al. [ 25 ] monitoring of the lunatic people
in residence by using simple contact switches on
doors.
 Elger [30] works more on the technical aid to the
people with reduced mobility, or having visual,
auditive or cognitive deficiencies.
 Van Berlo [32] introduced Smart Model House for
Senior Citizen" while insisting on safety on the one
hand and the comfort and energy saving on the
other hand.
State of Art Smart Home
Project

In 2002, Georgia Tech Institute
(Aware House [39]), the MIT ("MIT'
S House of the future" [ 40]), the
University
of
Whashington
("Assistive Cognition" [ 41 ]), the
Honeywell company ("Independent
Lifestyle Assisting (ILSA)"), the
University of Rochester-NY coresearch within the project "Center
for future Health" [42] which has
networked video cameras and PDA
in all the parts of a housing to
interact ubiquitously with the
occupants
Multi-level health monitoring
system
Information models
networks
standards
Integration
Traditional
Vital Signs
wireless
Inference
Info-Sensors
motion
interoperability
User Interface
From Pentland (Rochester)
Health & Wellness in the
Smart Home
Diagnosis
Discovery
Support
Monitoring
Training
Enterprise PC
Workstation
Tablet PC
Nurse
Researcher
Coach
Home PC
Caregiver
Support
Community
Internet
Broadband
Doctor
Home PC
Home
Sensor
AP
Health Coach
Home PC
Privacy Filter/
Firewall
Home
Server
Secure
Storage
EGC
Smart
Shirt
Glucose
Sensor
Bloodpressure
Cuff
Wearable
Data
Collector
Health Information
Smart
Fitness
Equip.
Pedometer
Home,
Sweet
Digital
Home
Sensors
 Data acquisition from elderly without the
awareness of the person.
 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
Physiological Sensors
More basic
ideas/assumptions
 Noninvasive
 Minimally-wearable
 Convenient to install and use, without
restrictions on the person’s movements without
vibrations, without noise and light signaling
 High reliability and a long life
 Wireless or with minimally amount of wires
signal transmission
 Waterproof
The Computer system
Middleware
 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.
Health content as the new media
type?
On the PC
PEDIATRICS
NEWSLETTER
Ear Infections
Personal health data mining
Health education
Doctor conferencing
Staying in touch
Ear infections occur in the middle ear behind the eardrum.
They often develop as a side effect of a cold or flu. Children
have a hard time draining substances from their ears
and these trapped substances can promote the growth
of bacteria. Children who have an ear infection will
seem irritable and they may also have trouble sleeping.
The infected fluid puts pressure on the eardrums causing
considerable pain and discomfort.
To treat ear infections, pediatricians will prescribe antibiotics
to k ill the bacteria and pain medication to help relieve any
pain or fever. Even with an ear infection, children can
play outside and even swim (as long as the eardrums are
not torn). If you travel by plane, have the child swallow fluids
or chew gum during tak e-off and landing.
Child Safety
Child safety tips:
Lock away all household cleaners and medications.
Place a pet's food and water out of the reach of children.
When riding in a car, always secure your child in a car seat.
Never leave a hot stove or BBQ unattended.
Bolt book shelves to the wall.
Keep some Ipecac Syrup handy for poisoning emergencies.
Limit direct and lengthy sun exposure and use high SPF sunblock .
Have fire drills and discuss fire safety with your children.
Buy only age-appropriate toys.
Use safety gates near stairs.
Cover all unused electrical outlets.
Content
Chronic Disease Mgmt
Acute Care
Wellness
Fitness
Relaxation
Baby ultrasound
CAT scan / MRI
Patient’s Health Portal
On the Go
Around the Home
Cell Phone / PDA
Medical devices / peripherals
Personal Fitness / Wellness Coach
Digital Health Appliance
Portable data collector / transmitter
Sensor network
Smart watch
Set-top box
Kitchen appliance
Ambient interface device
Internet Connection
 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
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.
Internet Connection
Healthcare Devices and Applications
Physiological parameters
 a wrist-worn device that can measure the
heart rate and the body temperature.
 connected to the home network
wirelessly by radio frequency protocol.
 RFID tag which enables the system to
recognize the person and follow
movements.
Physiological parameters
Smart alarms
 Decision making from data collected from
multiple sensors.
 Looking at trends
 Multi Parameter Algorithms.
 Linkage to other clinical resources.
 Decision Support.
The Smart Floor
 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.
The Smart Floor
 Measure the pressure signals on the
floor’s cell
 A special piezoelectric sensor
coupled to the floor surface.
Mobility assessment
 Changes in some aspects of mobility
correlate with changes in cognitive function
and can perhaps predict future cognitive
decline .
 Use the Smart Floor 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
 Analyze of urinary salts and sends
the results to the computer through
the local network.
 Able to know for example how
many times during the night the
person visited the toilet.
Smart Toilet
 to analyze blood sugar levels, body weight and
fat percentage, and there's even a blood
pressure cuff
Ball Body Check
 it sends a weak current through you,
measuring body fat, bone density and
percentage of muscle.
Full Body Sensor
 Compute weight, body fat, BMI, visceral fat,
skeletal muscle, resting metabolism, and
physical age.
ECG on a chair and in bed
 ECG waveforms can be obtained using
electrodes fixed on a chair or in the bed,
and measurements obtained without
direct contact with the skin.
 The signal will be sent to the home
central computer via Bluetooth signals.
Sleeping Disorders
 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.
 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
 Piezoelectric transducer that will provide information about
heart rate and breathing rate.
 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
Patient with chronic disease do not
follow their physician’s medication and
lifestyle guidance, and nine out of ten
make mistakes taking their medication.
The No.1 problem in treating illness
today is patients' failure to take
prescription medications correctly,
regardless of patient age .
Medication Reminders
 A smart pillbox count the medications,
and communicate with the central
computer by RF medium in real time
(for instance: Bluetooth).
 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.
Voice Analysis
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!
Image acquiring and
processing
 Detect changes in skin temperature or
condition (pale, red,…).
 Detection of changes in nevi (color, size,
structure).
TELECARE
 Tele-Home Care allows to offer medical
assistance to the patients directly to their
home
 Tele-Home Care may improve the quality
of life of patients
 Home-care and community based health
service are becoming an increasingly
important part of the healthcare services,
allowing the so called “Continuity of care”
Telemedicine Devices
 The new generation of such devices,
deliver the measured information over
the internet, usually by RF protocol
connection to the local computer.
 Easy to connect such devices to our
smart home system.
 It completes the whole picture of the
person’s health status.
Telemedicine Applications
1. Remote Consultation
2. Remote Monitoring
3. Remote Education
4. Telementoring
Tele Consulation
Tele - Monitoring
Telemedicine Devices
Examples of the CardGuard company:
 Wireless 12 lead ECG - SelfCheck™
ECG Cardiac Monitor
 SelfCheck™ BP Wireless non-invasive
blood pressure and pulse rate monitor.
 Oxy Pro Wireless Oximeter
Lifeguard System
Lifeguard System
 Sensor Pad
CPOD–
Device
Crew Physiological Observation
Base Station
Base Station
Radio Frequency Identification
Device (RFID)
 The technology used in RFID has been around
since the early 1920s
 British used RFID sensors to distinguish
between friendly and enemy aircraft during
World War II
Today, Wal-Mart is requesting its top 100 suppliers to
put RFID tags on all cases and pallets by 2005
RFID Physics – Inductive
Coupling (3/4)
Similar Products Using RFID
 HomeSeer / iAutomate
 Simple turn-key system
 Only compatible with
proprietary tags
(1/2)
Common Uses for RFID
 Animal tracking
 Airline baggage tracking
 Commercial inventory control
 Medical records
RFID Application
RFID Application
RFID Application
 Wrist band
RFID for Eldely
 The idea behind this
tablet/pda-ish device is to
track every movement of the
elderly people, Nokia believe
this is the best way to keep
them around. By monitoring
(via RFID tags) what they
consume; from expired foods,
medicine, possible allergens
and nutritional info. This easy
to read and use information
pad hopes to be a vital tool for
the upcoming explosion of
elderly Baby Boomers
RFID Home
Smart (Intelligence)
Home




Smart Home is a home
environment that adapts to the
inhabitants
It has to sense the state of the
home and the presence of
people
It has to predict their behavior
It has to make decisions in
order to automate the home
Smart House
Automated blinds
Door/lock
controllers,
Face
recognition,
Surveillance
system
Climate
control appliances
Intelligent
automated
door
entry
Remote site monitoring and control
Robot vacuum cleaner
Robot lawnmower
Intelligent Entertainment
Smart sprinklers
Lighting control
Wiring
Progression Towards the Intelligent Home
 Domestic Robots:
 Assistance for the disabled
 Entertainment - Sony’s AIBO that
can learn through experience, as well
as read emails and take photographs
with its onboard camera)
 Household maintenance - Dyson
(DC06 – still on home trial - below),
Electrolux (‘Trilobite’ - below), iRobot
(‘Roomba’ - below) and Probotics
(‘Cye’ - next)
Progression Towards the Intelligent Home
 Challenges:
 household environment is a complex
mass of wires (resolved by wireless
network), confined spaces and uneven
floors
 Uncontrolled environment with humans
interacting in the space
 A safe, powerful, portable power supply
is needed
 Robots with AI or other behavioural
complexities still have technical
difficulties
 Economic concerns mean that design,
functionality and materials can be
compromised
Summary
 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.