Tele-Health An Introduction

Tele-HealthTele-HealthAn IntroductionAn Introduction

July 27, 2005July 27, 2005

Jeremiah V. Ventry-McGeeJeremiah V. Ventry-McGee

Advisor: Prof. Yu-Dong YaoAdvisor: Prof. Yu-Dong Yao

Stevens Institute of TechnologyStevens Institute of Technology

This presentation made possible by DOD funds.This presentation made possible by DOD funds.

What is Tele-Health?What is Tele-Health?

The use of modern technology to The use of modern technology to improve efficiency and effectiveness improve efficiency and effectiveness of medicineof medicine

Opportunity to save and improve Opportunity to save and improve quality of lifequality of life

Applications are practically limitless: Applications are practically limitless: military, rural/impoverished, first military, rural/impoverished, first world, etc.world, etc.

ApplicationsApplications

Personal AreaPersonal Area– Home Monitoring– Apnea, stressHome Monitoring– Apnea, stress– RehabilitationRehabilitation

Medium AreaMedium Area– Battlefield survivalBattlefield survival– AmbulancesAmbulances

Wide areaWide area– Rural/ no infrastructure situationsRural/ no infrastructure situations– Home Monitoring- TelemedicineHome Monitoring- Telemedicine

Home Monitoring:Home Monitoring:The only way for some The only way for some

ailmentsailments Specific Application: Sleep apneaSpecific Application: Sleep apnea What is sleep apnea?What is sleep apnea?

– Current treatment requires Current treatment requires hospitalization for observationhospitalization for observation

– Because of this, not as many are treatedBecause of this, not as many are treated Specific application: HypertensionSpecific application: Hypertension

– Measurements taken in medical facilities Measurements taken in medical facilities may be inherently biasedmay be inherently biased

Stress MonitoringStress Monitoring

Why is this of interest?Why is this of interest?– Stress is exceedingly pervasive and a major Stress is exceedingly pervasive and a major

contributor to many other illnessescontributor to many other illnesses The nature of stress monitoring requires The nature of stress monitoring requires

real-time applicationsreal-time applications How it is doneHow it is done

– Body-Area Network (BAN) of intelligent sensorsBody-Area Network (BAN) of intelligent sensors– ECG, Core/Skin Temperature, GPS location, ECG, Core/Skin Temperature, GPS location,

activity levelactivity level Military applications, especially for trainingMilitary applications, especially for training

Applications for Long Term Applications for Long Term TreatmentTreatment

Applications for those with chronic Applications for those with chronic ailments such as diabetesailments such as diabetes– Implantable sensorsImplantable sensors– Continuous monitoringContinuous monitoring– Possible and future triggering of drug Possible and future triggering of drug

pumps: for diabetics this would reduce pumps: for diabetics this would reduce or eliminate need for insulin injections, or eliminate need for insulin injections, help to stabilize blood sugar levels, help to stabilize blood sugar levels, improve quality of lifeimprove quality of life

Hardware for Home HealthHardware for Home Health Two categories: Communications and Two categories: Communications and

sensorssensors Criteria: low cost, easy to use, use of off-Criteria: low cost, easy to use, use of off-

the-shelf components when possiblethe-shelf components when possible Communication over POTS when possibleCommunication over POTS when possible Video telephony, either stand-alone or Video telephony, either stand-alone or

using a television setusing a television set Trial Implementation:Trial Implementation:

– Successful, 30 Kbps data rateSuccessful, 30 Kbps data rate– 15-20 “televisits” per day 15-20 “televisits” per day – Only 5-6 in-home visits previouslyOnly 5-6 in-home visits previously possiblepossible

Hardware IIHardware II Monitoring of vitalMonitoring of vital

signs signs

Example: “Ring” sensorExample: “Ring” sensor– Monitors heart rate with plethysographMonitors heart rate with plethysograph– Monitors blood oxygen with infrared LEDsMonitors blood oxygen with infrared LEDs– WirelessWireless

User-friendlyUser-friendly Good battery lifeGood battery life

Evolution of Home HealthEvolution of Home Health

Use of video telephony for Use of video telephony for monitoring, added communication monitoring, added communication between caregivers/nurses and between caregivers/nurses and patients patients

Use of wireless sensors to monitor Use of wireless sensors to monitor patientspatients

Improvements to include continuous Improvements to include continuous monitoring, warnings for critical monitoring, warnings for critical eventsevents

HierarchyHierarchy

Sensors communicate with wireless Sensors communicate with wireless gateway, such as a PDAgateway, such as a PDA

Gateway connects wirelessly with Gateway connects wirelessly with remote computer containing medical remote computer containing medical records, internetrecords, internet

HierarchyHierarchy

Source: Jovanov, O’Donnell Lords, et al. “Stress Monitoring Using a Distributed Wireless Intelligent Sensor System”

Summary of Sensor Summary of Sensor RequirementsRequirements

Source: Winters, Wang, and Winters. “Wireless Sensors and Telerehabilitation”

TelemedicineTelemedicine What is it?What is it?

– Use of wireless sensors communicating via telephone to Use of wireless sensors communicating via telephone to physicians’ officesphysicians’ offices

AdvantagesAdvantages– For those who do not like doctors’ visitsFor those who do not like doctors’ visits– Shut-insShut-ins– For othersFor others

Better monitoring, diagnosisBetter monitoring, diagnosis Reduced fuel costsReduced fuel costs No time lost in waiting roomsNo time lost in waiting rooms Less chance of disease transmissionLess chance of disease transmission Improved quality of life for the chronically ill and their Improved quality of life for the chronically ill and their

caregiverscaregivers– Lower medical system costs will affect all!Lower medical system costs will affect all!

Emergency Vehicle Emergency Vehicle ApplicationsApplications

Transmission of video, data to Transmission of video, data to hospital base station hospital base station

Emergency-112 projectEmergency-112 project has been used with has been used with

some success in Italy, some success in Italy, Greece, Cyprus since 1998Greece, Cyprus since 1998– Multiple comm. Links (GSM, Multiple comm. Links (GSM,

satellite, wiredsatellite, wired– Designed for use by bothDesigned for use by both EMTs and non-trainedEMTs and non-trained

personnelpersonnel

Battlefield ApplicationsBattlefield Applications

Continuous monitoring of soldiers for Continuous monitoring of soldiers for injuriesinjuries

Applications for locating and Applications for locating and prioritizing the woundedprioritizing the wounded

Opportunity to decrease mortality, Opportunity to decrease mortality, also to increase the efficiency of the also to increase the efficiency of the fighting forcefighting force

Georgia Tech’s “Smart Shirt”Georgia Tech’s “Smart Shirt”

Rural TelemedicineRural Telemedicine

The Trial ProgramThe Trial Program Background: Alto Amazonas Background: Alto Amazonas

Province, Loreto Region, PeruProvince, Loreto Region, Peru– Twice the surface area of BelgiumTwice the surface area of Belgium– Only 116,200 inhabitantsOnly 116,200 inhabitants– Capital YurimaguasCapital Yurimaguas– Only one paved roadOnly one paved road– All other travel by riverboatAll other travel by riverboat

Current Health Current Health EstablishmentEstablishment

One Hospital in the capitalOne Hospital in the capital 11 Health Centers, each headed by a 11 Health Centers, each headed by a

physician, have limited diagnostic physician, have limited diagnostic equipment for testsequipment for tests

81 Health Posts, each with one 81 Health Posts, each with one healthcare worker, possibly an healthcare worker, possibly an infirmary technician, or intern infirmary technician, or intern physicianphysician

Health Posts refer severe cases to and Health Posts refer severe cases to and receive medicine from Health Centersreceive medicine from Health Centers

StatisticsStatistics Only the hospital and 2 HCs had a Only the hospital and 2 HCs had a

telephonetelephone 71% of HPs have no communication access71% of HPs have no communication access 29% have access to either HF radio or a 29% have access to either HF radio or a

public telephone in the villagepublic telephone in the village Average of 11 hours to go from HP to HC, Average of 11 hours to go from HP to HC,

mean 8.6 for urgent casesmean 8.6 for urgent cases 75% of HPs have no transport vehicle (eg. 75% of HPs have no transport vehicle (eg.

powerboat)powerboat) 4.3 day average roundtrip for medicine 4.3 day average roundtrip for medicine

from Hospital to HPfrom Hospital to HP

Restrictions Restrictions Most rural villages have no electricity. Of the Most rural villages have no electricity. Of the

several do, it is on only several hours a day.several do, it is on only several hours a day. These areas are not serviced by telecom These areas are not serviced by telecom

infrastructure and will not be for the foreseeable infrastructure and will not be for the foreseeable future.future.

Funds are extremely limitedFunds are extremely limited Few have any training to repair computers and.or Few have any training to repair computers and.or

telecommunications equipment.telecommunications equipment. Difficult access makes for extremely high Difficult access makes for extremely high

maintenance costsmaintenance costs Equipment must be robust on account of Equipment must be robust on account of

environmental (rainforest) conditionsenvironmental (rainforest) conditions

The SolutionThe Solution VHF radio access of E-mailVHF radio access of E-mail Health Posts equipped with VHF transceiver, Health Posts equipped with VHF transceiver,

laptop, lighting, and solar power system with laptop, lighting, and solar power system with capacity for five days’ autonomycapacity for five days’ autonomy

HPs communicate to designated Health HPs communicate to designated Health Center.Center.

Each HC equipped with email server. This Each HC equipped with email server. This stores messages and relays them to Internet stores messages and relays them to Internet via 5 telephone calls per day (to optimize via 5 telephone calls per day (to optimize costs)costs)

Servers powered with battery charger to take Servers powered with battery charger to take advantage of limited electricity supplyadvantage of limited electricity supply

Main server in Lima connects HCs to InternetMain server in Lima connects HCs to Internet This server also stores messages until This server also stores messages until

telephone connection with HC is establishedtelephone connection with HC is established Locally developed open-source softwareLocally developed open-source software Average speed 17 Kbps of real dataAverage speed 17 Kbps of real data

ResultsResults

Mean evacuation time reduced from 8.61 Mean evacuation time reduced from 8.61 to 5.17 hours, or by 60%to 5.17 hours, or by 60%

At least 60 lives saved in 237 evacuations At least 60 lives saved in 237 evacuations as a DIRECT IMPACT of the programas a DIRECT IMPACT of the program

Before the pilot program , 93% of the Before the pilot program , 93% of the personnel felt medical consultations to be personnel felt medical consultations to be difficult or impossible. After the pilot difficult or impossible. After the pilot program, 93% felt consultations to be easyprogram, 93% felt consultations to be easy

Total cost: $4,195 US per establishmentTotal cost: $4,195 US per establishment Monthly telephone bill of $704 for entire Monthly telephone bill of $704 for entire

systemsystem

ReferencesReferences

1.1. Martinez A., Villarroel V., Seoane J., Del Pozo F. “Rural Martinez A., Villarroel V., Seoane J., Del Pozo F. “Rural Telemedicine for Primary Helathcare in Developing Telemedicine for Primary Helathcare in Developing Countries.” Countries.” IEEE Technology and Society MagazineIEEE Technology and Society Magazine 3(4):13-23, 2004.3(4):13-23, 2004.

2.2. Winters J.M., Wang Y., Winters J.M. “Wearable Sensors and Winters J.M., Wang Y., Winters J.M. “Wearable Sensors and Telerehabilitation.” Telerehabilitation.” IEEE Engineering in Medicine and IEEE Engineering in Medicine and

Biology Biology MagazineMagazine 3:56-66, 2003. 3:56-66, 2003.

3.3. Jovanov E., O’Donnell Lords A., Raskovic D., Cox P.G., Jovanov E., O’Donnell Lords A., Raskovic D., Cox P.G., Adhami R., Adhami R., Andrasik F. “Stress Monitoring Using a Andrasik F. “Stress Monitoring Using a Distributed Wireless Distributed Wireless Intelligent Sensor System.” Intelligent Sensor System.” IEEE IEEE Engineering in Medicine and Engineering in Medicine and Biology MagazineBiology Magazine 3:49- 3:49-55, 2003.55, 2003.

4.4. Sungmee P., Jayaraman S. “Enhancing the Quality of Life Sungmee P., Jayaraman S. “Enhancing the Quality of Life Through Wearable Technology.” Through Wearable Technology.” IEEE Engineering in IEEE Engineering in

Medicine Medicine and Biology Magazineand Biology Magazine 3:41-48, 2003. 3:41-48, 2003.

References (cont’d)References (cont’d)5. Boric-Lubecke O., Lubecke V.M. “Wireless House Calls: Using 5. Boric-Lubecke O., Lubecke V.M. “Wireless House Calls: Using

Communciations Technology for Health Care and Communciations Technology for Health Care and Monitoring.” Monitoring.” IEEE MicrowaveIEEE Microwave, Sept. 2002., Sept. 2002.

6. Pattichis C.S., Kyriacou E., Voskarides S., Pattichis M.S., 6. Pattichis C.S., Kyriacou E., Voskarides S., Pattichis M.S., Istepanian Istepanian R., Schizas C.N. “Wireless Telemedicine R., Schizas C.N. “Wireless Telemedicine Systems: An Systems: An Overview.” Overview.” IEEE Antennas and Propagation IEEE Antennas and Propagation MagazineMagazine. 44(2), . 44(2), 2002.2002.

7. Shimizu, Koichi. “Telemedicine by Mobile Communication: 7. Shimizu, Koichi. “Telemedicine by Mobile Communication: Techniques for Multiple Data Transmission from Techniques for Multiple Data Transmission from

Moving Moving Vehicles in Emergency Medicine Situations.” Vehicles in Emergency Medicine Situations.” IEEE Engineering IEEE Engineering in Medicine and Biologyin Medicine and Biology, July/August , July/August 1999.1999.

8. 8. Bai J., Zhang Y., Shen D., Wen L., Ding C., Cui Z., Tian F., Yu Bai J., Zhang Y., Shen D., Wen L., Ding C., Cui Z., Tian F., Yu B., B., Dai B., Zhang J. “A Portable ECG and Blood Pressure Dai B., Zhang J. “A Portable ECG and Blood Pressure

Telemonitoring System.” Telemonitoring System.” IEEE Engineering in IEEE Engineering in Medicine and Medicine and BiologyBiology, July/August 1999., July/August 1999.

Thank you for your time!Thank you for your time!

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