Category: Personnel Health Monitoring

Why is there interest in Internet-assisted in-home healthcare

There is a strong interest in using Internet-based connectivity as a tool for facilitating in-home healthcare.

Bluetooth-connected pulse oximeter

A Bluetooth-connected pulse oximeter in action

This involves the use of a mix of sensor types that are typically used to observe a patient along with the use of regular, mobile and other computing devices to process and present this information to the carers and to the medical professionals. It also includes implementing voice and video telephony to allow medical professionals to communicate with the patient without the need to frequently travel to where they live.

Why the interest?

Ageing at home

This is where a senior citizen is able to live independently at their home as much as possible but have supporting care from relatives, friends and professional carers.

tablet computer used as part of in-home telemedicine setup

A tablet used as part of an in-home telemedicine setup

One of the reasons driving “ageing at home” is the fact that the generation of people born through World War II and the post-war Baby Boomers will be entering their senior years which will place strong demands on health care and welfare facilities that cater to this group of people.

Another is that an increasing number of aged-care facilities have been associated with substandard quality of care“I don’t want to end up in the nursing home”.  This is brought about with more of us being aware of this level of care either through observing how those we have known in our life’s journey that were looked after in those facilities were being treated, or hearing about instances of substandard care in the media such as the infamous “kerosene bath” incident that hit the news in Australia in the early 2000s.

This has also been driven by the trend towards health-care deinstitutionalisation affecting geriatric and palliative care where there isn’t a desire to rely on large facilities for this kind of care.

Other healthcare needs

Increasingly hospitals are looking towards “hospital in the home” or similar programs as a way to provide ongoing care for convalescent patients and those with illnesses that require long-term attention. Here, the care associated with what would typically be provided in a hospital, typically nursing-focused procedures, would be offered at the patient’s home but with visiting nurses, doctors and allied staff.

Even obstetric care is also affected by this trend, with an increased preference for minimal hands-on professional care for low-risk mothers when they go in to labour. Similarly, low-risk psychiatric care is being delivered at home thanks to telecommunications-based technologies.

The advantages that are being put forward for this kind of care is that the patient can stay in the familiar surroundings of their home and, again, has been underscored by the concept of deinstitutionalisation in healthcare. Governments and others also see it as a cost-saving because they can focus a hospital’s beds towards those needing acute care.

The rural community are seeing an application for this kind of technology so as to avoid the need for frequent long-distance travel which would be of importance when it comes to specialised or advanced healthcare.

How is the kind of healthcare delivered?

Here, the focus is on observational healthcare where medical professionals can assess the situation based on either the data that is collected or through communications with the patient. In some cases, it may be based on an event-driven principle where the professional is alerted if the situation goes beyond certain limits.

This is facilitated through the concept of “telemedicine” where the data is conveyed through an Internet connection and has been facilitated through various technologies.

One of these is “machine vision” where one or more cost-effective high-resolution cameras feeds images in to a platform-based computer which runs software that recognises and interprets these images for medical use. One application that was put forward was to observe a patient’s pulse using a camera that observed the brightness of one’s face as the heart beats. Another application is to use a smartphone’s or tablet’s camera to read fluid-analysis strips as part of assessing urine or blood while an app in that device interprets this information rather than a person comparing what is seen on the strip against a chart.

Another of these is the implementation of common communications technologies like Bluetooth, Zigbee or Wi-Fi in sensor devices. This can lead towards the existence of cost-effective sensor devices that can work with existing computer devices with a minimal need for extra hardware, while these devices can use cost-effective software to interpret and present this information. This has led to startup companies and tech innovators developing devices like “wandering-alert” socks that work with Bluetooth and apps.

What needs to be done?

An issue that will affect in-home telehealth is where device manufacturers and health providers legally stand when it comes to providing these services.

One of the questions that is being raised is the use of non-medical sensor devices for medical applications. One of the scenarios is the use of a general wellness device like a fitness band or a wellness-focused thermometer as a medical sensor for clinical purposes. Another scenario would be the use of a “non-wellness” sensor like a security system’s PIR and door sensors, a home-automation sensor, or a smartphone’s camera for medical-observation purposes with these devices feeding their data to software running on a platform-based computing device.

These questions are being examined by the US’s Food and Drug Administration with respect to wellness-focused devices serving as medical devices in this context. But implementing home automation and security in this context may require a case-by-case assessment based on the actual installation and would only work with geriatric, psychiatric or allied situations where observational healthcare is the order of the day.

Similarly, software that uses devices like cameras for medical reasons like “machine vision” may have to be certified by medical-device authorities to be sure that the software provides accurate results no matter the input device. In the case of software that uses cameras, there would be a requirement for a minimum resolution for the camera to turn out consistently accurate results.

Conclusion

Once the issues that affect the provision of Internet-assisted in-home health care are identified and worked out, then it could be feasible for the home to be a place to deliver continual health care.

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The CSIRO considers the Internet Of Things a viable alternative to the alarm pendant

Article

Why the CSIRO is building smart homes for elderly Australians | IT News

My Comments

The typical situation to assure the welfare of an  elderly, disabled or chronically-ill person who is living alone at home is to have them wear a pendant or wristband panic-button that signals carers or loved ones if they need help.

But issues have been raised about these devices being, for example, left somewhere in the home because the person forgets to wear it after they have finished an activity which may not play well with these devices. As well, these wearable devices are only of value if they trigger the device in response to an emergency situation like a fall.

The CSIRO are looking towards the use of the “Internet Of Everything” as a way of monitoring the welfare of these people, a use case which I do frequently refer to in the context of this technology.

Here, they would use commonly-available sensor technology like the motion sensors that are part of every intruder-alarm system, or flow meters and power meters on appliances; or door-contact sensors on wardrobes or kitchen cupboards to observe for normal activity.

Along with this, the CSIRO effort also wants to use health sensors like blood-pressure monitors or scales to register a person’s health statistics and it has been valued because the patients will be wanting to know how they are doing along with the ability to provide more knowledgeable information to their doctor about their symptoms.

They want to use knowledge of past health incidents affecting elderly, disabled or chronically-ill people to train the machine-learning algorithm to identify the abnormalities at an earlier stage rather than when a serious incident occurs. Of course, any machine-learning setup needs to be able to adjust to newer legitimate changes so as to avoid any “false positives”.

A question that will always be raised is the cost to set up this kind of observation with it costing less than AUD$3000 because of the use of common technologies and components rather than specialised hardware.

The topic of privacy has also been raised because the CSIRO monitoring system is based on cloud technology and Internet-based data access, and is of importance to reduce the risk of elder abuse. Here, the goal is to allow the patients to control their data so that it is exposed to whoever they trust in a granular manner. This is more so with relatives because they may be trusting of certain people within their family.

As well, the features that have been raised as being of importance to the elderly community for this personal-health monitoring setup include the ability to know who is at the door, the ability to engage in videocalls with family and friends along with the ability to know if one has forgotten to turn off a tap or appliance. This can easily affect older people who may become increasing forgetful about these things such as a burner on the newer gas cooker being left on but turned really down or not being able to hear clearly that the washbasin tap is still running.

The effort that CSIRO is undertaking is to be able to allow an elderly or other vulnerable person to live independently yet be able to know that help is at hand while their loved ones are sure that they are well.

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Microsoft implements Internet of Things to support ageing at home

Article – From the horse’s mouth

Lab Of Things Helping Seniors Who Live Alone | Microsoft Research

My Comments

I have provided a lot of coverage regarding the concept of technology assisting the “ageing at home” principle where older and infirm people can stay at home and live in dignity knowing that the people close to them and their carers can act as a safety net for them.

Here, I had covered technology being used to guide seniors with shopping and food-preparation along with use of existing technology like cameras for medical observation. I have also covered in an article about CSIRO doing research in this field with a view of using the “Internet Of Everything” technology like energy sensors, movement sensors and smart locks to assess whether someone is keeping well such as knowing if they are going in to the kitchen to keep themselves nourished or if they are surfacing and going outside to collect the paper or mail.

Microsoft is working with their research laboratories in China to address the issue of ageing at home in the Asian communities. This is because these communities are becoming increasingly older like most of the world thanks to the good healthcare that is being made available to them.

Here, they are identifying how older people who are living independently at home coping, including factoring in cultural issues. They are also implementing robotics to build a medical-supplies trolley to serve the medicines that these people will need at the proper times as well as shoehorning the Kinect movement sensor as a fall sensor to detect if one is falling or convulsing.

The medicine trolley doesn’t just work with medicines that require regular doses but also can work with medicines that are taken in response to symptoms like asthma attacks and is based around knowing what the symptoms will look like. The Kinect sensor as a fall sensor has to work in a manner to assure personal privacy which is important because of the fact that some of these falls or convulsions can occur when one is using the bathroom or toilet and these devices could be located there.

What I see of this is various technologies that make use of the computer, the home network and the Internet Of Everything are being used to create a safety net for older people or people with chronic illnesses who want to preserve independence and dignity.

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With a special film, a smartphone can detect HIV and other diseases

Article

Smartphone accessory puts HIV diagnosis in doctors’ pockets | Engadget

My Comments

Samsung Galaxy Note 2 smartphone

Smartphones will soon come in to play with more pathology tests

Increasingly, the smartphone’s integrated camera is being used as part of machine vision for medical applications. These technologies are based on the concept of litmus paper which changes between different colours depending on whether a chemical solution is acidic or alkaline, something a few of you may have seen demonstrated in the high-school chemistry class. The first application I highlighted was to use a urinalysis “control stick” along with the smartphone’s camera and a special app to identify what is in urine that is passed. Now this technology is being brought to blood analysis mainly to test for HIV, E. coli and staph in a patient’s blood. Here, a very small amount of the patient’s blood needs to be put on the film and it be examined by the smartphone’s camera with that phone running a special app. It avoids the need to send the sample to a laboratory to be analysed, because the film turns a different colour in the presence of an antibody makeup representing a particular disease. This is pitched at third-world communities or rural communities where it is cost-prohibitive for them to have a pathology laboratory located in a short-enough distance to provide quick-enough turnaround for test results for these diseases. There is even the ability where the pictures can be sent out to somewhere else for better expert opinion if the testing centre doesn’t have someone who is skilled enough. There are plans to even adapt this technology to detect more illnesses or check for pathogens in food and water. What I also see of this is it could open the path to “on-the-spot” screening-type pathology tests that dodge the need for sending out samples to a lab which I see as a boon for rural communities or telemedicine applications.

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Bluetooth Smart technology to detect if Grandpa has the wanders

Article

16 Year Old Develops Bluetooth Smart Solution to Keep Alzheimer’s Patients from Wandering | Bluetooth Blog

From the horse’s mouth

SafeWander (SensaRx)

Home Page

Video

Overview (Click / Tap to play in YouTube)

NBC 4 New York News report (Click / Tap to play in YouTube)

My Comments

A 16-year-old had developed a device which alerts someone else if a person like an Alzheimer’s patient wanders out of bed. This boy, Kenneth Shinozuka, was inspired to develop this device because of an incident where he was out with his grandfather at age 4 and Grandpa wandered off and was lost. Here, this brought to his family’s attention that Grandpa had Alzheimer’s disease.

A situation that was very common for him and his family was that his aunt who was his Grandpa’s primary carer wasn’t sleeping properly because she worried that if she slept, he would climb out of bed and wander absent-mindedly.

Here, he designed the device to be attached to the patient’s sock, slipper or foot to sense foot pressure associated when they climb out of bed to start wandering. This device uses a Bluetooth Smart (Bluetooth Low Energy) link to a suitable smartphone that is equipped with an “alarm” app that audibly alerts the carer and shows up a timer to show how long they have been off the bed. There is the ability to set up a threshold and a “hold time” so as to allow for situations like the patient going to the bathroom at night to do what he has to do.

He developed this device through a few science fairs including the Google Science Fair where he got the respect and was given the Google Science Fair Global Finalist prize amongst a few other awards. Scientific American and Popular Mechanics, both respected science and technology magazines even gave him awards for this device. He was able to use the prototype with his Grandpa and his aunt in this situation and she was able to claim a lot more sleep each night because of not worrying if he was about to get the wanders overnight.

Kenneth saw this as being important for the “ageing at home” phenomenon where older people are staying at home in the care of family members and friends rather than going in to care at nursing homes or similar facilities. He is evolving the technology towards other aspects of this phenomenon like a bathroom floor that senses if someone is falling and a medicine box which alerts the older person to take their pills at the right time.

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FDA to provide health classifications for the various wellness wearables

Article

FDA draws line between wearable health gizmos and proper medical gear | The Register

My Comments

Sony Smart Band - Sony press image

FDA to be able to qualify wearables like this Sony Smart Band to a standard acceptable for general wellness

As the market fills up with more wearable gizmos that measure our health, health-protection and consumer-protection authorities need to step in to properly and independent qualify a device’s health or wellness abilities.

Here, the US Food and Drug Administration have defined two levels of classification for these devices. They will have one, known as “general wellness”, which will cover measuring heart rates, distance walked and similar parameters that one needs to know about staying well. This is compared to a higher level for equipment needed to diagnose or cure illnesses. The differences that would be highlighted would be that the higher level is that the device is subjected to rigorous testing to be sure it can show consistently-accurate measurements and operate in a consistently-reliable manner.

Bluetooth-connected medical sensors

But these Bluetooth-connected medical sensors are still considered medical devices

They see this more as a line in the sand between something you could buy off the shelf and use at home versus a medical machine that is used as part of clinical treatment.

A question that may be raised is if a device is being used as part of medical supervision and monitoring, especially for a chronic illness is whether a “general wellness” class of device would be considered suitable for this application rather than a fully-qualified clinical-grade health-monitoring device. This could be seen as being of issue when it comes to in-home monitoring of diseases like, especially, diabetes where the patient’s blood sugar levels are to be monitored constantly.

Another question that has to be raised is if a device is dependent on extra software such as devices that work according to the “app-cessory” model, whether the software would be tested to see if it is compliant for medical-grade or general wellness use. This is more so as an increasing number of medical devices in the hospital and home are dependent on external computing power or there is the increased use of “software-only” diagnosis functionalities like Webcam-based machine-vision to measure one’s pulse using a computer or smartphone.

This issue may be worth investigating further by other health authorities and consumer-protection authorities especially when it comes to classifying devices that are pitched for personal healthcare.

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Swatch to bridge the Swiss watchmaking craft to the new connected wearable technology

Articles (German Language / Deutsche Sprache)

Swatch bringt seine eigene Smartwatch | PCTipp.ch

Swatch arbeitet an Fitnessuhr | Netzwoche.ch

My Comments

The Swiss aren’t far behind on the smart-watch bandwagon but are taking it a different path so as to preserve their craft and identity.

Swatch is developing a fitness-focused smartwatch that is totally different from the rest of the crowd. Here, this is more a watch that tells the time but is equipped with fitness sensors to measure how healthy you are. They are drawing on EM Microtechnology who is part of the Swatch Group and this company also have worked on GPS technology for a variety of fitness-driven applications.

But Swatch and Tissot, both part of the Swatch Group, are focusing on simpler fitness-focused smartwatch designs rather than the current equivalent of the 80s-era digital multifunction watch. They are approaching watch design on a “horses for courses” basis where different watches suit different people and different occasions. I see this as being highly important because, for example, a woman may want a watch that looks the part on her slender wrist or a man may want to have a dress watch for going out to impress along with a fitness watch for long walks and a utility smartwatch for day-to-day use.

Apple have been “picking Swatch’s brains” about their watch-construction methods but Swatch deny the idea of forming a partnership with them, especially concerning the iWatch idea that has been floating around. As well Swatch are trying to achieve the “best smartwatch” goal rather than being the first.

What I see of this is that the Swatch group are being the first of the Swiss watch legends to link their special craft with today’s smart-wearable technology development.

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Alliance to provide a level playing field for Internet Of Things

Articles

A New Alliance Will Let "Internet Of Things" Devices Talk To Each Other  | Fast Company

Home Appliance Makers Connect Open Source Internet Of Things | PC World

From the horse’s mouth

AllSeen Alliance

Web site

My Comments

As the hype builds up about the “Internet Of Things” where devices can use a heterogenous network for exchanging data or receiving commands, there is oomething that can easily go wrong here. This is where particular vendors see the “Internet Of Things” as being the “Internet Of Things Around Our Products”, something that can stifle competition and, especially, innovation.

But steps have been taken towards creating a truly heterogenous Internet Of Things which is similar to what has happened with Bluetooth and Wi-Fi wireless technologies. Here, it involved the creation of industry-based multiple-vendor alliances who put forward what is required for all devices working to a technology to communicate with each other.

The Linux Foundation have set up the AllSeen Alliance in conjunction with Qualcomm with their AllJoyn protocol which was just lately made “open-source”. The goal is about implementing heterogenous transport layers that work without need for Internet connectivity and work in a vendor-independent manner.

At the moment, they are working on modular services that look at the following functions: discovery, pairing / set-up, message routing, and data security. THis will include proper user interface requirements including a rich user experience with the Internet of Things; along with an application-specific requirement  for streaming audio over many connected speakers.

There will still need to be an effort to assure secure interoperability on a function-based level so that a system based on units from different vendors can work as a system rather than having he need for software or hardware function bridges to allow devices of one manufacturer to work with those of another.

Once this happens, this can allow the Internet Of things to be affordable for most users and be a breeding ground of innovation.

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CSIRO to use mobile-platform app as part of system to support ageing at home

Article

CSIRO app to help older people live at home safely | Aged And Community Services Australia

My Comments

Increasingly, the home network is becoming a key feature to support the “ageing at home” concept where an older person can live in their home yet is monitored for signs of ill-health or is assisted as they complete regular tasks using the technology supported by these networks.

One of the main goals is to support the concept of deinstitutionalisation in aged care and allied health care, which is becoming more relevant as we see an increasingly-ageing population accelerated by the baby boomers reaching the old age. This concept also reduces the need to build many aged-care facilities which also reduces the costs associated with building them.

There have been efforts in the UK to provide for dignified independent living for older people including the use of projected text to remind Alzheimer’s patients of stages in a cooking procedure and a GPS system to help with shopping. Similarly, IRIS who is a company in the US is distributing through an American chain of  hardware stores products and services that also are about keeping tabs on one’s elderly relatives. This is being augmented by Fujitsu refining technology that makes a digital-camera image sensor measure one’s pulse which comes in handy with in-home aged care.

In the latest effort, the CSIRO have established a system to help with this concept. This is based around a mobile-platform tablet that works along with a system of sensors to observe the health and well-being of the senior citizen.

Energy sensors aren’t just to “be green” in this case, but to monitor use of appliances as part of a healthy daily lifestyle. For example, knowing if they have used the kettle to make a cup of coffee or tea at all or the use of a “cooking device” such as the stove, the microwave oven or toaster oven indicates if the person is well and looking after themselves. Similarly, knowing if they have left the oven or stove hob on for too long can indicate a dangerous situation.

Similarly, those motion detectors that are part of a security system can also identify whether the person has entered particular rooms like the kitchen as part of their regular activities. These work alongside various health sensors like blood glucose monitors or pulse monitors to observe the health of the older person.

This information is presented on a mobile-platform tablet to allow the person to see how they are keeping with life and a carer or the person’s loved ones can know what is going on if there are abnormalities. There are options in this system to help with assuring data privacy so that people only have access to this data only if they need it as part of the health-care plan for the elderly person.

Some other devices can work as part of this same equation such as the new breed of residential “smart locks” that effectively work as a business-grade access-control system for our homes. Here, they could be able to identify whether the door was locked or not and, preferably, identify whether it was locked or unlocked from inside or outside. This could, for example identify whether they got up and went outside to get the paper or mail for example thus knowing if they are well.

There can be questions raised about the use of technology as part of “ageing at home” in the context of over-monitoring the elderly population or stripping out the personal aspect of the care that is to be provided to this population. What needs to happen is that relatives and friends, along with professional carers need to engage with the older person for their health and welfare and not just have these systems monitor them for abnormalities.

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A Wi-Fi-based clinical observation thermometer appears on the scene

Article – From the horse’s mouth

Solwise

http://www.solwise.co.uk/wireless-cadisense.htm

CadiSense

Product Page

My Comments

There have been some trends taking place to make the home network become part of in-home health care. One of the previous trends was Fujitsu using a digital camera like what is equipped in a smartphone or Webcam as a tool for measuring your pulse. Similarly, another company implemented a set of urinalysis “control sticks” that can be assessed not through a reference chart on the packaging but by a platform smartphone app that uses the phone’s camera to read these sticks.

Now a device has been launched in the UK through Solwise which uses a wireless temperature sensor to provide continual body temperature monitoring using the home network. This device, known as “Cadisense” implements a wireless temperature sensor that attaches to the patient’s nappy (diaper) or undergarment and touches the lower abdomen to measure the temperature. This device sends these temperature readings to a plug-in network bridge that connects to your home network via Wi-Fi or Ethernet, with the network bridge keeping a long-term record of these observations that are taken every 30 seconds.

The data can be viewed on a Web server integrated in the network bridge that is accessible through the home network or via a remote link like what is used for most network devices that implement “remote access” or “cloud” functionality. The “dashboard” Website hosted by this Web server is optimised for viewing on a regular computer, tablet or smartphone and has the ability for regular-computer users to download the observations to the hard disk as a CSV file to import in to a spreadsheet application or email to their doctor. There are also the mobile-computing apps that work tightly with the iOS and Android platforms

At the moment, this device is focused towards observation-based clinical temperature measurement but shows that this concept can be proven beyond this application. There is a current limitation where the Cadisense temperature sensors can only work with the supplied network bridge but it is made up for the fact that the network bridge is a “3-way” wireless network device that can be either a Wi-Fi client bridge, a Wi-Fi range extender or an infill Wi-Fi access point.

For that matter, Cadisense are on a good wicket with their design because they could work this platform for a lot of in-home health-care applications including “ageing at home”. For example, their network bridge could come in to its own with the Ekahau Wi-Fi Pager Tags to be the core of a network-based “emergency-call” system that is a necessary part of caring for older people.

Once a system like this is built around industry-accepted standards like Z-Wave or Zigbee, it could mean a lot more for at-home health care and wellness applications amongst other applications like security and home automation.

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