Personal Electronic Health Devices

October 2007 Personal Electronic Health Devices A summary of research and applications in personal health including devices based on smartphone, handheld and other small mobile platforms. A shorter version of this presentation was given in the University of Birmingham Biomedical Seminar series Dr Sandra I. Woolley http://www.eee.bham.ac.uk/woolleysi S.I.Woolley@bham.ac.uk Electronic, Electrical and Computer Engineering Picture: http://mlearning.edublogs.org/2006/11/20/m-learning-is-vital-for-industry-compatibility/ Followed by an Example Application “Supporting Children with Anaphylactic Allergies.” Luis U. Hernandez Munoz Picture: http://medfusion.wordpress.com/2006/04/ Personal Health Devices  Mobile computing has come a long way. Can it help do good things for health? Personal health devices can – provide information or – sense and respond, – or both. They can provide emergency or everyday support. They can interface with wired or wireless vital sign or activity sensors to detect and react to events, for example, sending messages, making calls or logging sensed data. Mobile computing has come a long way. Can it help do good things for health? http://www.eee.bham.ac.uk/woolleysi/projects/index.htm http://www.disetronic-ca.com/dstrnc_ca/rewrite/content/en_CA/3.2:20/article/DCM_general_article_53.htm http://mlearning.edublogs.org/2006/11/20/m-learning-is-vital-for-industry-compatibility/    Technologies As well as all manner of mobile computing platforms we now have new sensing and communication technologies. Sensors  Location via: GPS, GSM cell, wi-fi/ network signal, acoustic, etc.  Proximity: RFID tags  Movement: Accelerometers, tilt switches, gyroscopes     Environmental toxins Health : Basic vital signs, Glucose, etc. “Context-awareness” can be derived from multiple sensors. “Smart Spaces” can be created from environments with embedded networks of sensors. Berkeley Engineering News Nov 2003, SMALL PACKAGE: The wireless mote communication chip. Communicating Networks  Local and Personal Area Networks  Wireless wi-fi, bluetooth, Zigbee (Sensor Network) Glucose Biosenor detail www.strath.ac.uk/bioeng/ pginfo/engd/pics.html So Aren’t We “There” Yet?  A carpenters pencil - the oldest known pencil found in the roof of a 17thcentury German house. Photo Sandra Suppa, FABER-CASTELL GmbH & Co., Germany With so much existing technology and research activity ... aren’t we nearly “there”? Is it just a technology race? Or is the cleverness in putting good technologies together? In… … connecting cooperating technologies with people and the things they do. An example, from “The Media History Timeline” – 1565 The graphite pencil – 1770 The eraser – 1858 Eraser fitted to the end of a pencil    Research Questions  System-centred research question – How can sensors, systems and data interact and combine or synergise?  User-centred research question – How can users manage and interpret all this new information? ... more generally – How can all this new information more widely and usefully inform human knowledge?  Research Questions ... for health ...  Can we use new technology to make more people more well more of the time ... and maybe with less money? Can we help people keep well and take control of their own health? Can we avoid exposing people to excessive electromagnetic fields? Did you know about the great medicinal properties of dandelions? Can we also reinform ourselves with traditional health wisdom? http://en.wikipedia.org/wiki/Medicinal_properties_of_dandelion Picture: http://www.herbs-hands-healing.co.uk/articles/quality.html    Illness ... Wellness  Illness signals a need for change. Education is a path to wellness. Personal health devices can provide and collect information to support education and understanding ... and can therefore potentially support wellness. Though ... "It is easier to change a man's religion than to change his diet." Cultural anthropologist Margaret Mead Healing that worked for my family ... Understanding and correcting deficiencies and removing toxins. Treating viral, parasitic and bacterial infections .... and traditional healthful eating high in raw foods.  Medicine ... derived from the Latin ars medicina meaning the art of healing. http://en.wikipedia .org/wiki/Medical   Health, herbal and nature-inspired PDA software examples Vegetable juice, and fermented kefir and kvass drinks http://www.jbpub.com/catalog/9780763752941/ http://www.handango.com/SoftwareCatalog.jsp?platformId=2&siteId=1&language=english&N=96806+4294961135 http://classic.pocketgear.com/software_detail.asp?id=11138 http://www.mobiletopsoft.com/pocket-pc/download-butterfly-animated-free.html http://www.answers.com/topic/vegetable-juice http://www.skazka.co.nz/product-details.aspx?p=1209&pageno=0&Category=18 http://commons.wikimedia.org/wiki/Image:Glass-of-kvass.jpg Natives Were Healthy  “These days the jaws are not big enough for all 32 teeth to erupt and usually there is only room for 28 teeth.” http://www.dentecom.co.uk/patients/pa_wisdomteeth_faq.htm  These days ... we do see more narrow jaws ... more endocrine dysfunction, immune disorders, degenerative diseases, learning and attention dysfunction.  “Good dental health begins with the diet of both parents. The Samoan girl on the left was born to parents who ate nutrient-rich native foods. The Samoan boy on the right was born to parents who had abandoned their traditional diet. He has crowded dental arches and will be more susceptible to dental decay and chronic illness.” http://www.westonaprice.org/brochures/wapfbrochure.html Weston A. Price Nutrition and Degeneration http://www.westonaprice.org/traditional_diets/native_americans.html http://www.westonaprice.org/brochures/wapfbrochure.html Pervasive and e-Health  “Perhaps the most important force behind the current and potential use of pervasive health care is the need to reduce, or at least contain, the skyrocketing health care costs that affect everyone.” The Case for Pervasive Health Care, Part 1 Luis Taveras and Dadong Wan http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/PubsNewsArticleMostWired/data/07Spri ng/070808MW_Online_Taveras&domain=HHNMOSTWIRED  “Consumer health informatics is the branch of medical informatics that analyses consumers’ needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers’ preferences into medical information systems.” (Eysenbach 2000) http://en.wikipedia.org/wiki/Consumer_Health_Informatics http://www.pervasivehealth.org/  Pervasive healthcare to save money...  A new market of “consumers” too ... Most Wired and Wireless Hospitals  Preparing for the Worst “Information technology will play a critical part in pandemic readiness.” Greg Dworkin, M.D. http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/PubsNewsArticleMostWired/data/07Summ er/071017MW_online_Dworkin&domain=HHNMOSTWIRED   “Information technology provides a wide range of tools to help hospitals improve quality.” http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2007/0707HHN_CoverStory_Landing&domain=HHNMAG  Most wired and wireless hospital award criteria – – – – – – – – – Use of Electronic Bed Boards Project Analytics Medications Ordered Electronically Medication Orders Matched Electronically Electronic Surveillance Quality Indicator Compliance Alerts Digital Clinical Imaging Clinical Documentation in the OR Primary Data Center Recovery http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2007/0707HHN_CoverStory_Landing&domain=HHNMAG  “... 28% of medical schools require students to own and use a PDA ...” (April 2006) http://medfusion.wordpress.com/2006/04/ http://medfusion.wordpress.com/2006/04/ Examples of Personal Health Devices My Last Cigarette  PDA and Smartphone application to encourage stopping smoking. ~$10  “Here's another example of mobile persuasion technology for health ...” http://software.palminfocenter.com/product.asp?id=168                Nicotine level readout Expected cravings readout Daily motivational quote or medical fact. Deaths since you quit readout Carbon Monoxide level of your blood Increase in life expectancy readout Time you have been a non smoker readout Number of cigarettes NOT smoked readout Your risk of a heart attack compared to your risk before Your risk of lung cancer compared to your risk before Daily picture of what smoking does to your health Money saved Expected circulatory improvement Expected lung function improvement Readouts updated every second and are based upon your own personal past smoking habits. Screenshots from My Last Cigarette http://software.palminfocenter.com/product.asp?id=168 http://www.pocketnow.com/index.php?a=portal_detail&t=reviews&id=427 Medic Alerts and Records  Traditional medic alerts are engraved bracelets or necklaces bearing simple and (hopefully) recognisable medical icons. Important life-critical allergy or other health data is engraved on the reverse. There is a huge growth in this market with the increase in allergies and lifethreatening anaphylaxis. Also an increasing desire of patients to have and carry their own medical record information. New ideas include USB keyring fobs … and some Birmingham University student PDA projects.   www.MedicAlert.org www.MedicalTags.co.uk  Dying for Data Robert N. Charette IEEE Spectrum October 2006  Photo: Joshua Lutz http://www.spectrum.ieee.org/oct06/4589 PATIENT BEWARE: Cheryl Conrad [right] makes sure she always keeps a copy of husband Tom’s medical records on hand, after he experienced an excruciating delay in getting treated at a local hospital. Blood Pressure/Pulse Monitors  Automatic large LED blood pressure systolic / diastolic / pulse readout with fuzzy logic. Automatic inflation & deflation 48 sets of memory to monitor your progress plus date / time / average pressure Requires 2 x AAA batteries. Tatung http://www.tatung.com/med/product.html    Wearable Insulin Pumps  The catheter at the end of the insulin pump is inserted through a needle into the abdominal fat of a person with diabetes.  Dosage instructions are entered into the pump's small computer and the right amount of insulin is injected in a controlled manner. [Medline Plus] AMON - Advanced Telemedical Monitor A European project from ETH, Zurich  Designed to be worn by cardiac outpatients, the device allows remote monitoring of blood pressure, pulse, oxygen saturation, body temperature and 2-channel ECG signals.   AMON: A Wearable Medical Computer for High Risk Patients, P. Lukowicz, U. Anliker, J. Ward, G. Tröster, E. Hirt, C. Neufelt, ISWC 2002: Proceedings of the 6th International Symposium on Wearable Computers, 7.-10. October 2002, pp 133-34 SensVest    C.Baber, A.Schwirtz and J. Knight The “Lab of Tomorrow” EU project (C.Baber @ Birmingham) to enable students to capture and analyse “activity” sensor data. Senses temperature Heart rate (ECG) and activity via accelerometers. HR 200 180 160 140 120 Heart rate (bpm) Body movement 100 80 60 40 20 0 -20 -40 -60 -80 -100 0 2 4 6 8 10 12 14 16 18 20 22 Time (mins) Biofeedback and “Inner-active” Games  Biofeedback is a process for monitoring a body function such as breathing, heart rate, blood pressure and altering that function through relaxation or imagery.  “ANTENSE® Biofeedback anti-tension device Combat stress in the privacy of your home” $160  “Introducing emWave Personal Stress Reliever, an entertaining stress relief technology to help you balance your emotions, mind and body.” $199 “..The Journey to Wild Divine, the first in a series of “Inner-Active” computer adventures to combine the science of biofeedback with a beautiful, enchanting and entertaining multimedia experience. Over 10 hours of game play!” $187.50 Top left: Antense® Anti-Tension Device Top right: http://www.holisticonline.com/Biofeedback.htm Bottom: http://www.myemwave.org/about_emwave_stress.html http://www.luxevivant.com/index.asp?PageAction=VIEWPROD&ProdID=166  “Women’s” Health   Pregnancy and ovulation tests. A substantial market potential for personal health care, but fraught with concerns over correct usage and interpretation ... and the potential for expensive litigation. 2002 BBC news - new Persona legal cases The “Digital Plaster”  A device meant to be embedded in ordinary plaster that includes sensors for monitoring health-related metadata such as blood pressure, temperature and glucose levels.  The “digital plaster” contains a Sensium silicon chip, powered by a small battery, which sends data via a cellphone or PDA to a central computer database. If the results show any worrisome signs, patients and doctors alike would be notified of the change in the data patterns. They also plan to add a motion sensor to the device so it could additionally serve in the role of “granny monitor” by detecting things like falls or complete inactivity.  [The Toumaz Digital Plaster] A Short Selection of Notes on Electrosensitivity and Electrotherapy Electrosmog?  3G telephone masts, indoor cordless (DECT) telephones and Wi-Fi networks are just a few examples of new electromagnetic sources. http://www.electrosmog.org.uk/ http://www.sheffielder.com/SHAM/s10.html  Electric blankets, microwave ovens, computers, and bluetooth devices also add to our exposure. University campuses and many public spaces are now wirelessly networked. Soon there will be many more wireless devices including Personal Area Networks or Body Area Networks WSN (IEEE 802.15.4) and Zigbee. What about the health environments of the future? Might we expect a large amount of EMF? “Hospital's phone mast has highest signal in UK” Feb 19 2003 By Susanne Elsworth Daily Post Staff  “Hospital defiant over phone masts”  27 May 2005 Chartered Inst. Environmental Health, Addenbrooke’s Hospital now has around 30 masts on the roof of its main ward block. Departments in close proximity to the masts include the maternity and breast units and the oncology centre. The masts, or base stations, are used for mobile phones, pagers, and the Tetra police radio system  Electrosensitivity  Electrosensitivity: “A unhealthy sensitivity to a particular source of electricity, for example mobile phones, computers, power lines or even minor electrical equipment.1” The Health Protection Agency produced a good summary of the condition in a November 2005 report.2 The most high-profile case of electrical hypersensitivity is Gro Harlem Brundtland the last Secretary-General of the World Health Organisation, W.H.O, she is a medical doctor and former Prime Minister of Norway. "It's not the sound, but the waves I react on. My hypersensitivity has gone so far that I even react on mobiles closer to me than about four metres,“ Translation from Cover story in Norwegian newspaper "Dagbladet" March 9, 2002: http://www.dagbladet.no/nyheter/2002/03/09/318013.html © Dagbladet http://www.electrosensitivity.org.uk/doctorsguidance.htm#Appendix%201 1http://www.electrosensitivity.org/ 2http://www.hpa.org.uk/radiation/publications/hpa_rpd_reports/2005/hpa_rpd_01 0.htm  Left: Gro Harlem Brundtland Right: http://www.electrosensitivity.org.uk/What%20is%20ES.htm    http://www.electrosensitivity.org/   FDA Reports  “Kinetics of Microbial Inactivation for Alternative Food Processing Technologies Oscillating Magnetic Fields” http://vm.cfsan.fda.gov/~comm/ift-omf.html  An FDA publication on the effects of oscillating magnetic fields on pathogens. of Microbial Inactivation for Alternative Food Processing Technologies Pulsed Electric Fields” http://vm.cfsan.fda.gov/~comm/ift-pef.html  “Kinetics  An FDA publication on the effects of pulsed electric fields on pathogens. http://www.electroherbalism.com/Bioelectronics/FrequenciesandAnecdotes/CAFL.htm  These reports summarise the research findings of these fields on a variety of bacteria, including inactivation of microorganisms such as E. coli, Streptococcus thermophilus and various strains of yeast. and more links at http://rifehealth.com/index.html TENS Transcutaneous Electrical Nerve Stimulators  TENS machines are used for pain relief, for example, by chronic pain sufferers or for pain during child birth.  “TENS machines deliver small electrical pulses to the body via electrodes placed on the skin. TENS machines are thought to affect the way pain signals are sent to the brain. Pain signals reach the brain via nerves and the spinal cord. If pain signals can be blocked then the brain will receive fewer signals from the source of the pain. We may then feel less pain.” http://www.patient.co.uk/showdoc/23069069/ An NHS-Approved TENS machine http://www.maternitytens.com/index.asp?function=DISPLAYPRODUCT&productid=9  From NHS Direct: “a pad that administers small amounts of electrical current, blocking pain signals and stimulating endorphins” http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=914 http://www3.telus.net/chemelec/Projects/Tens/Tens.htm “Electrotherapy” ... from IEEE Spectrum  There is slow but increasing interest in various electrotherapies. Zap Schoenbach, K.H.; Nuccitelli, R.; Beebe, S.J.; Spectrum, IEEE. Vol 43, Iss 8, Aug. 2006 p20-26 A huge voltage for a just billionths of seconds kills cancer cells. “Researchers from different disciplines; electrical engineers, cell biologists and medical professionals, work side by side at the Center for Bioelectrics to explore the cellular responses to nanosecond pulsed electric fields.” http://www.odu.edu/engr/bioelectrics/biogateway.htm     Zapping away the blues: a pacemakerlike device to treat depression takes a giant step forward Moore, S.K.; Spectrum, IEEE Vol 42, Issue 5, May 2005 pp16-17 http://www.odu.edu/engr/bioelectrics/index.html http://www.ece.odu.edu/nuccitelli.htm http://www.odu.edu/engr/bioelectrics/biogateway.htm Personal Mobile Electrotherapy?  NovoCure is currently performing clinical trials using 100-200 kHz electric fields, which they call tumour treating fields (TTFields), to stunt the growth of cancer cells. Animal and early human trials appear very promising. cells divide, a molecular motor called the microtubule spindle helps segregate chromosomes into the resulting daughter cells. ... if a 200-kHz field is applied to these macromolecules, the spindle can't form properly. As a result, cells stop dividing and eventually die.” http://sciencenow.sciencemag.org/cgi/content/full/2007/530/3  “When  Might these be the personal health devices of the future? http://sciencenow.sciencemag.org/cgi/content/full/2007/530/3 Safety cap. A glioblastoma patient wears the NovoTTF-100A. Personal Health Devices  Mobile computing has come a long way. Can it help do good things for health? ... and what about ... – mobility and usability – privacy and security – accountability and ownership ... there are certainly many other issues we should consider. There may be challenges ahead, but pervasive health technology is undoubtedly on its way. There is certainly great potential. Hopefully these devices will help in the art of healing.    Other presentations on-line http://www.eee.bham.ac.uk/woolleysi/thebodyelectric.ppt http://www.eee.bham.ac.uk/woolleysi/wearablecomputingreading2005.ppt Thank You Sandra Woolley s.i.woolley@bham.ac.uk http://www.eee.bham.ac.uk/woolleysi/projects/index.htm and student projects