1. IBM Research © 2006 IBM Corporation HARMONI: Client Middleware for Long-Term, Continuous, Remote Health Monitoring Iqbal Mohomed, Maria Ebling, William Jerome, Archan Misra

2. IBM Research © 2006 IBM Corporation Remote Health Monitoring: The Business Motivation  The United States spends $1.9 trillion on healthcare, or more than 16% of its GDP  More than 90 million Americans live with chronic illnesses. –Chronic diseases account for 70% of all deaths in the United States. –The medical care costs of people with chronic diseases account for more than 75% of the nation’s $1.4 trillion medical care costs. –Chronic diseases require long-term management  By 2010, the US will experience the most citizens in history, age 65 or over –200,000 Doctor Deficit by the year 2010

3. IBM Research © 2006 IBM Corporation Remote Health Monitoring: The Opportunity  Long-term monitoring offers benefits: –Early disease detection and trend analysis for healthy and at-risk individuals –Treatment and progress monitoring for patients –Participants in drug trials or experimental treatments to gauge efficacy, and side effects –Reduced workload on doctors, nurses and other healthcare providers  Enabled by rapid improvements in two key technologies: –Improvements in wireless communications (WiFi, 3G, Bluetooth) –Continuing miniaturization of wireless sensors. Server Patient Diary BT Data

4. IBM Research © 2006 IBM Corporation Challenges of Long-term Monitoring  Technical –Cheap, unobtrusive, relatively accurate sensor technology –Specialized backend data storage, processing, analysis and visualization techniques and infrastructure –Techniques to deal with the limitations of mobile devices –End-to-end security  Non-Technical –Privacy, Bioethics, Healthcare Access, etc.

5. IBM Research © 2006 IBM Corporation Challenges of Long-term Monitoring  Technical –Cheap, unobtrusive, relatively accurate sensor technology –Specialized backend data storage, processing, analysis and visualization techniques and infrastructure –Techniques to deal with the limitations of mobile devices –End-to-end security  Non-Technical –Privacy, Bioethics, Healthcare Access, etc.

6. IBM Research © 2006 IBM Corporation Remote Health Monitoring using Personal Mobile Hub  Three-tier architecture, using a personal pervasive device (cell phone or PDA) as a relay (sensor  pervasive device  server) –Cellphones are becoming the ubiquitous computing device.  Sensors collect variety of physiological and context data, and transmit via Bluetooth –Examples: Heart Rate, Weight, Blood Pressure, GPS  Examples: PCC (IBM), CodeBlue (Harvard), Medical Jacket (Berkeley) PAN (Bluetooth) WAN (CDMA)

7. IBM Research © 2006 IBM Corporation The Evolution of Long-term Monitoring 3-Tier Hub Architecture  Client device functions as a pure relay –All data is relayed to backend server –Provides only “store-and-forward” during disconnection  Optimizing client resources (e.g., bandwidth, energy) not a primary objective –Sensor stream rates relatively modest in practice HARMONI: Healthcare Adaptive Remote Monitoring  Data stream processing distributed across both client and server –Appropriately filtered data relayed to backend server –Local triggering of actions while in disconnected state  Optimized usage of device resources and network bandwidth –Context-aware, adaptive data filtering –Using connectivity predictions for scheduling transmissions –Stream-based data compression

8. IBM Research © 2006 IBM Corporation HARMONI: Opportunities Addressed  Efficient utilization of bandwidth and energy –If you are sitting at your desk, and have a heart rate within a normal range, does the system need to transmit every single value?  Customize behavior for individual users –Is the normal range of your heart rate the same as the person sitting beside you?  Adjust system behavior to the user’s context –If you leave your desk and go to the gym, does the range of your heart rate change?  Cope with disconnections –What happens if an “interesting” pattern in sensor readings occurs when there is no connectivity to the remote server?

9. IBM Research © 2006 IBM Corporation Key Innovations in HARMONI Context-Aware Stream Correlation and Data Filtering Predictive Anticipation and Transmission Scheduling Smart Disconnected Operation Compressed, Energy-Efficient Sensor Data Relaying

10. IBM Research © 2006 IBM Corporation HARMONI Implementation Platform  Nokia 770 Internet tablet –ARM processor, Linux-based –High-resolution display(800x480), touch screen with up to 65,536 colors –64-128 MB RAM, 64 MB FLASH storage (expandable up to 1GB … can be used for virtual memory) –Built-in Bluetooth (BlueZ stack) and 802.11 interfaces –Relatively cheap: $350 –http:///www.maemo.org provides open-source software and development environment.http:///www.maemo.org –Code compiled on an Intel/Debian Linux 3.1 box using cross-compiler (http://www.scratchbox.org)  Nonin Model 4100 Sp02/heart rate monitor –Provides Heart rate and Oxygen saturation –Supports Bluetooth Serial Port Profile (SPP) –120 hours of continuous operation with 2 AA batteries –Three packets transmitted per second, where each packet is 375 bytes

11. IBM Research © 2006 IBM Corporation Variation in User Data

12. IBM Research © 2006 IBM Corporation Summary: Next Steps  (Ongoing) Complete implementation and testing of the HARMONI Middleware –Perform real user studies to validate the impact of data compression and event filtering  Develop algorithms and techniques for efficient connectivity prediction and anticipation.  Connect with backend component to develop personalized filters and rules.

13. IBM Research © 2006 IBM Corporation (Backup) Data rates for different sensors