Assistive Technologies for Chronically Ill

1. Assistive Technologies for Chronically Ill Dola Saha

2. Background • Assist Directly • Communication Assistance • Mobility Assistance • Wayfinding • Improving Self Monitoring • Monitor Conditions and Alarm System • Patient Monitoring

3. Background (Patient Monitoring) • BASUMA – The Sixth Sense for Chronically Ill Patients • Thomas Falck, Javier Espina, Jean-Pierre Ebert, Daniel Dietterle • Development of a Novel Contactless Mechanocardiograph Device • Kouhyar Tavakolian, FaranakM. Zadeh, Yindar Chuo, Ali Vaseghi, and Bozena Kaminska • Feasibility Study and Design of aWearable System-on-a-Chip Pulse Radar for Contactless Cardiopulmonary Monitoring • Domenico Zito, Domenico Pepe, Bruno Neri, Fabio Zito, Danilo De Rossi and Antonio Lanat`a • Real-Time and Secure Wireless Health Monitoring • S. Da˘ gtas¸, G. Pekhteryev, Z. S¸ahino ˘ glu, H. C¸ am, and N. Challa • A Pervasive Telemedicine System Exploiting the DVB-T Technology • Gianmarco Angius, Danilo Pani, Luigi Raffo, Stefano Seruis, Paolo Randaccio • Ambulatory monitor derived clinical measures for continuous assessment of cardiac rehabilitation patients in a community care model • Niranjan Bidargaddi and Antti Sarela

4. Background (Patient Monitoring) • BASUMA – The Sixth Sense for Chronically Ill Patients • Body worn sensors monitor ECG, Blood Pressure, etc., No clinical trials • Development of a Novel Contactless Mechanocardiograph Device • Heart rate and respiration rate were measured, How to handle multiple patients in close proximity? No clinical trials • Feasibility Study and Design of aWearable System-on-a-Chip Pulse Radar for Contactless Cardiopulmonary Monitoring • Theoretical Channel Model, Theoretical System Analysis, Prototype UWB Antenna. But no clinical trials • Real-Time and Secure Wireless Health Monitoring • Framework of patient monitoring using BSN and Zigbee, no clinical trials • A Pervasive Telemedicine System Exploiting the DVB-T Technology • Patient Controlled, What happens in emergency conditions? No clinical trials • Ambulatory monitor derived clinical measures for continuous assessment of cardiac rehabilitation patients in a community care model • Monitors ECG and Mobility, No clinical trials

5. SMART – An Integrated Wireless System for Monitoring Unattended Patients • JAMIA February 2008 • (Journal of the American Medical Informatics Association 2008;15(1):44-53) • Authors (10) • Dorothy W. Curtis a • Esteban J. Pino b • Jacob M. Bailey e • Eugene I. Shih a • Jason Waterman a • Staal A. Vinterbo c d • Thomas O. Stair e • John V. Gutagg a • Robert A. Greenes f • Lucila Ohno-Machado c d • Collaboration (6 academic institutes) • aCS and AI Lab, Massachusetts Institute of Technology, Cambridge, MA • bUniversidad de Concepción, Departamento de Ingeniería Eléctrica, Concepción, Chile • cDecision Systems Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA • dDivision of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA • eDepartment of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA • fDepartment of Biomedical Informatics, Arizona State University, Phoenix, AZ.

6. SMART – Scalable Medical Alert Response Technology • Goal • Provide patient monitoring in overcrowded Emergency Department and at Disaster Sites • System • Integrates patient monitoring (ECG, SpO2), geo-positioning, signal processing, targeted alerting, and a wireless interface for caregivers • Implementation • Prototype implemented and evaluated with 145 post-triage patients at Brigham and Women’s Hospital’s Emergency Department in Boston, MA

7. SMART System Architecture Wireless 802.11 SSL

8. Patient Monitoring Device Patient wearing SMART Monitoring Gear PDA and Sensor box • SpO2 Sensor is available from Nonin • ECG Sensor was developed at MIT • PDA is HP iPAQ running Linux

9. Geo-Positioning System & Wireless Communication • Indoor Positioning System from Sonitor • Consists Active tags worn by patients and caregivers • Detectors at wall • Also integrated with two other Geo-Positioning Systems • Cricket • Global Positioning System • Wireless Communication is 802.11b based • (0.5Mbps of data generated for 10 patients)

10. SMART Central • Runs on PC with Linux • Streaming Data Manager • Receives SpO2, ECG and location data and provides access to the raw data • Decision Support Module • Analyzes the data and triggers alarm • Logistic Support Manager • Dispatches alarms to appropriate (nearest and not busy) care provider • Does not alarm a care provider within 10 minutes of last alarm acceptance • Forwards to next nearest nurse if the first one is busy

11. Caregiver Module • Modes • Roster of Patients • Detailed Vital Signs • Handling Alarm Conditions • Alarm • Audible buzz and vibration • “Respond” button • “Unavailable” button forwards to next provider • “Defer” button to defer for a short time Patient View Alarm View

12. Pilot Study • June 19, 2006 – March 30, 2007 • Total of 151 patients, maximum four at the same time

13. Disaster Drill • 150 healthy individuals participated in a city-wide disaster drill, 20 were transferred to BWH • SMART system setup in five minutes • Seven patients monitored simultaneously for life-threatening symptoms • Caregiver PDA was not used as all patients were in the same room.

14. Conclusion • Affordable, off-the-shelf, portable, easy to deploy and untethered • Security Issues with wireless ECG Data Collection • Limitation – No data showing dynamic scheduling of effective personnel utilization • Can be utilized for SMART Home for chronic care • Future work – improve the algorithms to decrease false positive