1. Tele-Health An Introduction July 27, 2005 Jeremiah V. Ventry-McGee Advisor: Prof. Yu-Dong Yao Stevens Institute of Technology This presentation made possible by DOD funds.

2. What is Tele-Health? The use of modern technology to improve efficiency and effectiveness of medicine The use of modern technology to improve efficiency and effectiveness of medicine Opportunity to save and improve quality of life Opportunity to save and improve quality of life Applications are practically limitless: military, rural/impoverished, first world, etc. Applications are practically limitless: military, rural/impoverished, first world, etc.

3. Applications Personal Area Personal Area –Home Monitoring– Apnea, stress –Rehabilitation Medium Area Medium Area –Battlefield survival –Ambulances Wide area Wide area –Rural/ no infrastructure situations –Home Monitoring- Telemedicine

4. Home Monitoring: The only way for some ailments Specific Application: Sleep apnea Specific Application: Sleep apnea What is sleep apnea? What is sleep apnea? –Current treatment requires hospitalization for observation –Because of this, not as many are treated Specific application: Hypertension Specific application: Hypertension –Measurements taken in medical facilities may be inherently biased

5. Stress Monitoring Why is this of interest? Why is this of interest? –Stress is exceedingly pervasive and a major contributor to many other illnesses The nature of stress monitoring requires real- time applications The nature of stress monitoring requires real- time applications How it is done How it is done –Body-Area Network (BAN) of intelligent sensors –ECG, Core/Skin Temperature, GPS location, activity level Military applications, especially for training Military applications, especially for training

6. Applications for Long Term Treatment Applications for those with chronic ailments such as diabetes Applications for those with chronic ailments such as diabetes –Implantable sensors –Continuous monitoring –Possible and future triggering of drug pumps: for diabetics this would reduce or eliminate need for insulin injections, help to stabilize blood sugar levels, improve quality of life

7. Hardware for Home Health Two categories: Communications and sensors Two categories: Communications and sensors Criteria: low cost, easy to use, use of off-the- shelf components when possible Criteria: low cost, easy to use, use of off-the- shelf components when possible Communication over POTS when possible Communication over POTS when possible Video telephony, either stand-alone or using a television set Video telephony, either stand-alone or using a television set Trial Implementation: Trial Implementation: –Successful, 30 Kbps data rate –15-20 “televisits” per day –Only 5-6 in-home visits previously possible possible

8. Hardware II Monitoring of vital signs Monitoring of vital signs Example: “Ring” sensor Example: “Ring” sensor –Monitors heart rate with plethysograph –Monitors blood oxygen with infrared LEDs –Wireless User-friendly User-friendly Good battery life Good battery life

9. Evolution of Home Health Use of video telephony for monitoring, added communication between caregivers/nurses and patients Use of video telephony for monitoring, added communication between caregivers/nurses and patients Use of wireless sensors to monitor patients Use of wireless sensors to monitor patients Improvements to include continuous monitoring, warnings for critical events Improvements to include continuous monitoring, warnings for critical events

10. Hierarchy Sensors communicate with wireless gateway, such as a PDA Sensors communicate with wireless gateway, such as a PDA Gateway connects wirelessly with remote computer containing medical records, internet Gateway connects wirelessly with remote computer containing medical records, internet

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

12. Summary of Sensor Requirements Source: Winters, Wang, and Winters. “Wireless Sensors and Telerehabilitation”

13. Telemedicine What is it? What is it? –Use of wireless sensors communicating via telephone to physicians’ offices Advantages Advantages –For those who do not like doctors’ visits –Shut-ins –For others  Better monitoring, diagnosis  Reduced fuel costs  No time lost in waiting rooms  Less chance of disease transmission  Improved quality of life for the chronically ill and their caregivers –Lower medical system costs will affect all!

14. Emergency Vehicle Applications Transmission of video, data to hospital base station Transmission of video, data to hospital base station Emergency-112 project Emergency-112 project has been used with has been used with some success in Italy, Greece, Cyprus since 1998 –Multiple comm. Links (GSM, satellite, wired –Designed for use by both EMTs and non-trained EMTs and non-trainedpersonnel

15. Battlefield Applications Continuous monitoring of soldiers for injuries Continuous monitoring of soldiers for injuries Applications for locating and prioritizing the wounded Applications for locating and prioritizing the wounded Opportunity to decrease mortality, also to increase the efficiency of the fighting force Opportunity to decrease mortality, also to increase the efficiency of the fighting force Georgia Tech’s “Smart Shirt” Georgia Tech’s “Smart Shirt”

16. Rural Telemedicine The Trial Program The Trial Program Background: Alto Amazonas Province, Loreto Region, Peru Background: Alto Amazonas Province, Loreto Region, Peru –Twice the surface area of Belgium –Only 116,200 inhabitants –Capital Yurimaguas –Only one paved road –All other travel by riverboat

17. Current Health Establishment One Hospital in the capital One Hospital in the capital 11 Health Centers, each headed by a physician, have limited diagnostic equipment for tests 11 Health Centers, each headed by a physician, have limited diagnostic equipment for tests 81 Health Posts, each with one healthcare worker, possibly an infirmary technician, or intern physician 81 Health Posts, each with one healthcare worker, possibly an infirmary technician, or intern physician Health Posts refer severe cases to and receive medicine from Health Centers Health Posts refer severe cases to and receive medicine from Health Centers

18. Statistics Only the hospital and 2 HCs had a telephone Only the hospital and 2 HCs had a telephone 71% of HPs have no communication access 71% of HPs have no communication access 29% have access to either HF radio or a public telephone in the village 29% have access to either HF radio or a public telephone in the village Average of 11 hours to go from HP to HC, mean 8.6 for urgent cases Average of 11 hours to go from HP to HC, mean 8.6 for urgent cases 75% of HPs have no transport vehicle (eg. powerboat) 75% of HPs have no transport vehicle (eg. powerboat) 4.3 day average roundtrip for medicine from Hospital to HP 4.3 day average roundtrip for medicine from Hospital to HP

19. Restrictions Most rural villages have no electricity. Of the several do, it is on only several hours a day. Most rural villages have no electricity. Of the several do, it is on only several hours a day. These areas are not serviced by telecom infrastructure and will not be for the foreseeable future. These areas are not serviced by telecom infrastructure and will not be for the foreseeable future. Funds are extremely limited Funds are extremely limited Few have any training to repair computers and.or telecommunications equipment. Few have any training to repair computers and.or telecommunications equipment. Difficult access makes for extremely high maintenance costs Difficult access makes for extremely high maintenance costs Equipment must be robust on account of environmental (rainforest) conditions Equipment must be robust on account of environmental (rainforest) conditions

20. The Solution VHF radio access of E-mail VHF radio access of E-mail Health Posts equipped with VHF transceiver, laptop, lighting, and solar power system with capacity for five days’ autonomy Health Posts equipped with VHF transceiver, laptop, lighting, and solar power system with capacity for five days’ autonomy HPs communicate to designated Health Center. HPs communicate to designated Health Center. Each HC equipped with email server. This stores messages and relays them to Internet via 5 telephone calls per day (to optimize costs) Each HC equipped with email server. This stores messages and relays them to Internet via 5 telephone calls per day (to optimize costs) Servers powered with battery charger to take advantage of limited electricity supply Servers powered with battery charger to take advantage of limited electricity supply Main server in Lima connects HCs to Internet Main server in Lima connects HCs to Internet This server also stores messages until telephone connection with HC is established This server also stores messages until telephone connection with HC is established Locally developed open-source software Locally developed open-source software Average speed 17 Kbps of real data Average speed 17 Kbps of real data

21. Results Mean evacuation time reduced from 8.61 to 5.17 hours, or by 60% Mean evacuation time reduced from 8.61 to 5.17 hours, or by 60% At least 60 lives saved in 237 evacuations as a DIRECT IMPACT of the program At least 60 lives saved in 237 evacuations as a DIRECT IMPACT of the program Before the pilot program, 93% of the personnel felt medical consultations to be difficult or impossible. After the pilot program, 93% felt consultations to be easy Before the pilot program, 93% of the personnel felt medical consultations to be difficult or impossible. After the pilot program, 93% felt consultations to be easy Total cost: $4,195 US per establishment Total cost: $4,195 US per establishment Monthly telephone bill of $704 for entire system Monthly telephone bill of $704 for entire system

22. References 1. Martinez A., Villarroel V., Seoane J., Del Pozo F. “Rural Telemedicine for Primary Helathcare in Developing Countries.” IEEE Technology and Society Magazine 3(4):13-23, 2004. 2. Winters J.M., Wang Y., Winters J.M. “Wearable Sensors and Telerehabilitation.” IEEE Engineering in Medicine and Biology Magazine 3:56-66, 2003. 3. Jovanov E., O’Donnell Lords A., Raskovic D., Cox P.G., Adhami R., Andrasik F. “Stress Monitoring Using a Distributed Wireless Intelligent Sensor System.” IEEE Engineering in Medicine and Biology Magazine 3:49-55, 2003. 4. Sungmee P., Jayaraman S. “Enhancing the Quality of Life Through Wearable Technology.” IEEE Engineering in Medicine and Biology Magazine 3:41-48, 2003.

23. References (cont’d) 5. Boric-Lubecke O., Lubecke V.M. “Wireless House Calls: Using Communciations Technology for Health Care and Monitoring.” IEEE Microwave, Sept. 2002. 6. Pattichis C.S., Kyriacou E., Voskarides S., Pattichis M.S., Istepanian R., Schizas C.N. “Wireless Telemedicine Systems: An Overview.” IEEE Antennas and Propagation Magazine. 44(2), 2002. 7. Shimizu, Koichi. “Telemedicine by Mobile Communication: Techniques for Multiple Data Transmission from Moving Vehicles in Emergency Medicine Situations.” IEEE Engineering in Medicine and Biology, July/August 1999. 8. Bai J., Zhang Y., Shen D., Wen L., Ding C., Cui Z., Tian F., Yu B., Dai B., Zhang J. “A Portable ECG and Blood Pressure Telemonitoring System.” IEEE Engineering in Medicine and Biology, July/August 1999.

24. Thank you for your time!

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