1. Telemonitoring in Elderly Care Latest Trend
Amirkabir University of Technology
College of Biomedical Engineering
Division of Medical Information Technology
Shahram Taleghani MD.
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2. Ageing With Grace
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3. Introduction
The need for home care continues to grow rapidly as the number of older adults continues to grow and the fact that people are living longer now.
Patients want to remain at home and be independent but many are suffering from chronic conditions.
How do we care for them with the health care system facing critical shortages of public resources, as well as nurses, and other health care professionals.
Health care workers are forced to do more with less, with decreased reimbursements and increased focus on quality and clinical outcomes.
This leads the way for technology to be integrated into health care.
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4. Percentage of Elderly Population in Year 2006
Percentage of Population over 60 years old Global Average = 10%
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5. Percentage of Elderly Population in Year 2050
Percentage of Population over 60 years old Global Average = 21%
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6. Home Telehealth
Home Telehealth encompasses remote care delivery or monitoring between a health care provider and a patient outside of a clinical health facility, in their place of residence (home or assisted living residence).
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7. Interactive Home Telehealth
Interactive Home Telehealth includes the utilization of two-way interactive audio video involving the patient and a health provider. This service provides remote care delivery (i.e. assessment, education, data collection). Interactive Home Telehealth may include devices collecting clinical data from the patient and delivered to the health provider.
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8. Range of Telemonitoring Devices
High-End
Mid-Range
Economy
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9. Telemonitoring
Telemonitoring includes the collection of clinical data and the transmission of such data between a patient at a distant location and a health care provider through a remote interface so that the provider may conduct a clinical review of such data or provide a response relating to such data. This includes the use of automated laboratory or other health monitoring equipment, as well as the manual entry of data.
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10. Few Telemonitoring Devices
Honeywell HomMed Products
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11. Self Monitoring
The periodic and scheduled use of a device by the patient to obtain clinical data that is used by the patient to measure their own health status. Commonly measured data include blood pressure, glucose, weight, and temperature.
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12. Self Monitoring Device
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13. Patient Encounter
Home Telehealth may or may not involve a patient encounter. A patient encounter is the communication of a set of information between a patient and a provider that establishes the plan of care, has the potential to change the plan of care, or implements the plan of care. A video conference between a health care provider and a patient can be a patient encounter. The interactive transmission of a set of vital sign data from the patient to the nurse who can make a care decision is a patient encounter. Encounters also may include therapy sessions to implement the plan of care. The collection of patient vital signs at a remote site generally does not involve a patient encounter.
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14. Why Telemonitoring Improve the quality of patient care.
Improve patient outcomes and satisfaction.
Deliver care more efficiently.
Decrease health care cost.
Decrease re-hospitalizations.
Decrease emergency room visits.
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15. University of Berkeley
First Study
University of Berkeley
Information Technology for Assisted living at Home (ITALH)
Building wireless infrastructure for assisted living
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16. The Main Objectives in this project
Provide smart monitors and sensors that will alert user or care provider in events of accident, acute illness or deteriorating condition of elderly.
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17. Prototype Scenario of Application Usage
Home Health System that is able to monitor one’s health and activity.
Sensors getting information whether worn by patient or those mounted in the home.
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18. ( Information Technology for Assisted living at Home )
Advantages of ITALH
( Information Technology for Assisted living at Home )
Increase self sufficiency
Reduce direct care
Reduce cost
Delay relocation to retirement homes
Improve safety and well being of the users
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19. Components 1) Sensor A) Worn by patients.
2) Sensor B) Devices within the home.
3) Central home health System.
4) Sensors Net [made of (1,2,3)].
5) Bluetooth Wireless Communication.
6) Zigbee Wireless Communication.
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20. Components 7) USB Hard Wire connection. 8) Telephone 9) Mobile Gateway
10) Internet
11) Home Health system [made of (1-10)]
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21. Setup
1) Home health system set up with the wireless sensors around it .
2) Bluetooth integration in to each sensor device.
3) Zigbee Adaptors
4) Local Ethernet network between gateways and remote care provider.
5) Mobile phone with Bluetooth connection and video stream.
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22. Sensors
Fixed wireless sensors for basic environment sensing: for example temperature, humidity, light.
Wearable sensors: motion, heart beat.
Fall detection sensors using unique algorithms.
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23. Sensor Net
Heterogeneous wireless network that connects sensor devices worn or placed at homes to central home health system.
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24. Sensor Net Wireless Connectivity
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25. Gateway System
Application of biometric information gathered by the sensors and their transmission to the health care provider at remote place via Information and Communication Technology
(ICT).
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26. Types of Gateways A A) Home gateway
Provided by Home health system
Based on Windows XP
Works with blue tooth and zigbee wireless connectivity
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27. Types of Gateways B B) Mobile gateway
Wearable sensors send events by mobile phone.
Nokia by blue tooth connectivity via Symbian Operating System.
These set of mobile phones provide cameras for two way video conferencing.
Third generation(3G) internet accessibility.
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28. Sensor Net Development Setup
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29. Access Permissions
User will grant permission to authorized personnel to monitor him / her.
Authorized personnel can be relatives, neighbors or health care providers.
User defines the access on what to monitor, record or respond in any given case.
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30. Privacy & Security of Information Flow
- Information is not continuously send.
Flow of information is either event activated or requested by the specific order.
So it needs far less band width for transmission.
In case of an event and it’s transmission, information flow will become encrypted.
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31. Alert Notification System
Storing or forwarding data on the daily activity for future analysis.
Querying the user to check their status.
Placing a phone call to the neighbors or relatives.
Signaling the health care providers.
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32. Procedural Response Alert notification will be sent to gateways.
Gateways later determine appropriate response.
Gateway query about person with different sensors.
If normal behavior is detected, it will be regarded as incident.
If no response, emergency signals will be sent immediately.
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33. Conclusion
Information technology for assisted living at home project with wireless infrastructure.
Heterogeneous wireless networks using Bluetooth and zigbee radios as Sensor Net.
Monitoring health with these devices and home health system network.
Secure, private, safe and reliable service to senior citizens.
Improving the quality of health monitoring
Reducing health care cost.
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34. University of Aizu. Japan
Second Study
University of Aizu. Japan
The Mobile Teleconferencing System for Home Care Services
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35. The Main Objective of This Project
Using mobile telecommunication technology to support home care services and application of electronic white board under the scope of telemedicine.
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36. Homecare service support system (HSSS)
- Provide support for real time instruction from doctors to nurses and collect data in mobile condition.
- This communication exists between doctors at service stations and nurses in as service providers in different locations.
- The protocol of communication is based upon Global System for Mobile Communication (GSM) as standard for digital cellular communication over the world.
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37. Network Configuration
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38. The Components of Teleconference System
- Service station.
- Station computer which is equipped with large screen, microphone, speaker, camera.
- Station server.
- Nurse computer usually as a tablet pc.
- Mobile internet card.
- Electronic white board.
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39. Ways of communication
1- Physicians at service stations communicate with the different home sites via internet and give instructions to nurses.
2- Each nurse after collecting data from patient connects to service station and waits for instructions.
3- Physician consult with patient or nurse by voice or image in real time.
4- Since stream requires large band width, they exchange image instead by electronic white board.
5- Images and memos can be saved and retrieved for later use.
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40. Electronic White Board
Image Player= Receives images from different places and displays it on the computer screen.
Image Selector= Shows the list of revived images and sends selected images to image player.
Video Capture= Take the snap shots by the cameras to the image player for display.
Image Controller= Switches image player to electronic white board.
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41. Voice Communication Real Time Transport Protocol (RTP)
Capture Sound Thread: captures sound stream from microphone and delivers it to other targeted computers.
Playback Sound Thread: receives sound stream from other target computers.
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42. Voice Communication Structure
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43. System Management
Manages station computers, nurse computers and database.
Depending on type of massage it gets, take appropriate operation.
Manages data base by PostgreSQL.
PostgreSQL allows the Java API to access database.
Requires ID and Password for access.
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44. System Management Flow Chart
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45. Communication Management
- Communication of all participating computers by communication control platform (CCP).
- One-to-one, one-to-all, one-to-N computers.
- Construction of multi site data transmission.
- Detecting the data transmission errors.
- Hiding the details of transmission from application layer.
- Server has a global IP address.
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46. System Implementation
Plat form is Windows XP.
Image resolution for cameras and white board is 640*480 pixels.
Nurse tablet pc is NEC with 933Mhz CPU, 240M RAM.
DOCOMA Foma P2401 mobile card with 64kbs upload and 384kbs download rate.
Image compression of 70%.
Image transfer rate from nurse to station is 5 Sec for 33k image.
Image transfer rate from station to nurse’s tablet pc is 2 Sec for 33k image.
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47. Station Computer screen
Computer Screens
Nurse Computer screen
Station Computer screen
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48. Conclusion
Using current telecommunication technology for home care services.
Two way communication between service providers and station.
Capability of using multiple devices for decision making.
Real time image and voice transmission for monitoring and diagnosis.
It’s Java technology development makes it operational under Windows, Unix and Mac.
Both wireless and LAN or ADSL availability.
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