Tag: telehealth

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

simonmackay 08/09/2016 Current and Future Trends, Personnel Health Monitoring No Comments

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

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.

FDA to provide health classifications for the various wellness wearables

simonmackay 21/01/2015 Current and Future Trends, Personnel Health Monitoring No Comments

Article

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

My Comments

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.

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.

Show Report–Connect 2014

simonmackay 17/03/2014 Current and Future Trends, Mobile Computing No Comments

On Thursday and Friday this past week, I had visited the Connect 2014 technology convention as an expo visitor mainly to observe key trends affecting business and personal computing that were surfacing over the past few years.

IP-based telephony

A few companies had shown some IP-based telephony systems at Connect 2014. This is due to telephony moving from the traditional circuit between the local exchange (central office) and the customer’s premises towards Internet-based packet-driven end-to-end connectivity. The trend is being assisted by the goal for reduced operating costs, increased competition in the telephony space and the move towards next-generation broadband infrastructure. It is also being assisted by the prevalence of various “over-the-top” IP telephony programs for mobile devices like Skype and Viber.

One company even showed a desktop IP videophones with wired handsets along with IP DECT cordless-phone bases. I even raised the issue of integrating Skype in these videophones because this is seen as the preferred “consumer, small-business and community-organisation” video telephony solution. One path that organisations would have to use is an IP PBX server with a Skype video “trunk” which likes Skype to the videophones. On the other hand, he showed me one of the desk videophones which had an app platform of some sort and mentioned that a Skype front-end could be deployed in these units.

Mobile-device computing in the workplace

A key workplace computing trend is to implement mobile computing devices like smartphones and tablets. This can be as a fleet of equipment owned by the organisation or a “bring-your-own-device” model where employees bring their own devices to the workplace and use them for their job. Here, they may be seen as supplanting regular desktop and laptop computers or serving as a highly-portable adjunct to the regular computers.

If these devices were used in the workplace, they would either work with document-viewing and communications tools, and a Web browser to support office tasks typically performed on a regular computer. On the other hand, they would ether work with a purpose-built device-side app or a Web front (task-specific Web page) as part of a business-specific workflow or system.

A few companies were showcasing mobile-device management systems, typically pitched at large corporate and government customers. These worked on a platform-independent manner yet allowed data security whether by implementing a managed “business realm” and “business app store” on a BYOD device or providing a highly-locked-down device.

BlackBerry have set up presence at Connect 2014 in order to show that they are moving from a hardware-based operation to something that is more software-based. This means that they can provide managed mobile computing to all of the platforms such as iOS, Android and Windows and covering all management arrangements ranging from a totally managed and locked-down fleet to a BYOD setup with a managed “business space” on the employee’s device.

In my conversation with a BlackBerry representative, I raised the issue of small businesses and community organisations neither knowing nor defining their intellectual property. We were raising the issue in relationship to these organisations neither being careful or wise about their data security nor being interested in corporate-grade information-security products and services. He stated it in a simple way as being whatever information places your organisation at risk if it falls in to the wrong hands.

A lot of these systems don’t embrace what I covered in the last paragraph because they are pitched at a larger business with its own IT department and significantly-sized server equipment. An effort that I would like to see achieved is the development of “small-business” variations that can run on a hosted cloud service or on-premises using modest equipment like “business-in-a-box” servers or classic “tower-style” server PCs. They would also have to implement a user interface that simplifies this kind of management for a small-business owner.

3D Printing

Heated 3D printer in action

A technology that has been given a fair bit of Web coverage of late is 3D printing. This is where a single-piece object is constructed using a special machine that builds up that object in layers. An analogy of this is the “3D Jigsaw” which had cardboard pieces that were stacked in a particular way to become a known object, typically a figurine.

There were a few companies who were presenting 3D printers that were in action turning out various pieces. One of these machines, which was a freestanding one the same size as those larger gas barbecues that have adorned may Aussie backyards, is able to “paint” colour on to a piece it is printing using an inkjet system. Another machine, this time about the size of a small fridge, used a heated environment to improve accuracy and reliability.

I had a conversation with a representative of one of the companies who do 3D printing and he and I reckoned that the technology would suit a wide range of short-order fabrication jobs. One application I was even thinking of was the ability to reconstruct a replacement part even though the part is no longer manufactured in quantity. One example that came to mind was a mechanism that has a highly-worn or damaged component that needs to be replaced, something encountered by people who are restoring late-20th-century consumer electronics, especially record players, tape recorders and the like, as a hobby. Here, he could scan the component using a 3D scanner and effectively “re-design” that component to what it was like when new, then make it with the 3D printer for reinstallation in that mechanical subsystem.

Similarly, the car-restoration scene could benefit from 3D printing at least when it comes to re-constituting vehicle detail-work such as marque badges and hood ornaments which have been often damaged or stolen from vehicles. This could allow a vehicle owner to make sure their pride and joy is still complete even if any of the detail-work went missing.

The connected home

It was often said that the connected home concept was “nearly there but not complete”. The problems hightlghted here were lack of a desire by industry to implement application-level standards for home-automation setups. This is manifesting in the form of manufacturers developing their own control apps for mobile platforms, making it harder for customers to use competing “smart devices” at the one location or establish task-appropriate control setups in a “smart-home” environment.

Similarly, the home-AV market is being centered around content producers tying up deals with smart-TV and video-peripheral manufacturers or connected-AV platforms. This affects consumers because they are not sure if their favourite content producers or distributors, or their favourite titles are going to appear on a particular connected-AV platform that they intend to buy into. Similarly, it affects content producers and distributors who want to run an IPTV or video-on-demand service because they have to obtain deals with various equipment manufacturers and connected-AV platforms.

Both these situations effectively have the manufacturers, content producers and other companies effectively owning the consumers and stifling innovation and competition in the connected-home space.

In-home telemedicine

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

One concept that was being shown at Connect 2014 was in-home telemedicine, known also as in-home telehealth or simply as telecare. This is something I have covered in this Website in relation to standing for access to proper broadband in rural and peri-urban communities. Here, this technology allows people in these sparse communities access to continual specialist medical care without the need for the patient or caregiver to frequently travel between home and larger towns or cities when clinical supervision is needed.

Bluetooth-connected medical sensors

A functioning demonstration setup which is currently used in the field involved the use of medical-parameter sensors like a blood-pressure monitor or pulse oximeter linked to a tablet via Bluetooth with this setup at the patient’s home. This, in turn was linked to the clinic via mobile-broadband technology and the staff at the clinic were able to look at what’s going on using a Web-based dashboard that highlights critical conditions affecting patients in their care.

A Bluetooth-connected pulse oximeter in action

It is being pitched at community-care organisations and would typically be seen as being useful for rural applications. But there have been some Melbourne hospitals implementing this as part of a “hospital-at-home” program for managing certain chronic diseases. But there was a setup being shown that allowed this kind of telemedicine setup to work as part of an “independent ageing” setup to assure older people the ability to live independently but know they are still being looked after, which is also being factored as the baby boomers become the ageing population.

Conclusion

These technologies that were presented at Connect 2014 are being more about what the connected work and home life is all about with the current technologies.

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

simonmackay 01/11/2013 Current and Future Trends, Mobile Computing, Personnel Health Monitoring No Comments

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.

Your smartphone’s camera can take your pulse courtesy of Fujitsu

simonmackay 19/03/2013 Current and Future Trends, Personnel Health Monitoring No Comments

Article

Fujitsu tech takes your pulse with your camera phone – popular science, mobile applications, mobile, Fujitsu – PC World Australia

My Comments

The platform smartphone or tablet is starting to play an increasingly important role on personal health and wellbeing without the need to be dependent on extra peripherals. It is becoming increasingly relevant for these devices so you can keep an electronic record of observations or easily send the data to a doctor or clinic via email or cloud data service. This would lead to these devices becoming part of various home-based healthcare setups like management of chronic illnesses or catering to the idea of “ageing at home” where older people can stay at home independently or under the care of their relatives, friends or paid carers.

Previously I reported on the use of a smartphone camera and app that implements machine vision for “reading” certain urinalysis sticks, avoiding the need to check against confusing charts. I even put forward the idea of using similar “fluid-analysis” sticks and a smartphone app to check other liquids like drinks for “spiking” or “loading” or to check the pH level in a swimming pool.

Now Fujitsu has developed software code that makes a small digital camera like that installed in a smartphone or tablet as machine vision for taking someone’s pulse.This may be seen to displace the medical skill where you “pinch” the patient’s wrist near their hand and count the beats that you feel for a minute measured by a stopwatch or watch with second hand.

This concept works on the fact that the brightness of one’s face changes slightly as their heart beats and uses the presence of green light to look for haemoglobin which is part of the red (just oxygenated) blood cells. The procedure requires 5 seconds versus a minute with the orthodox method and the software can assess when patient is still for improved accuracy.

Fujitsu hopes to commercialise the technology in 12 months but there are questions on whether they will implement it in their own equipment or license it to other developers. For it to be popular, they would have to license the algorithms to other software developers to integrate in to their projects and / or release a finished software product to the platform app stores for people to use on their devices.

They also see this technology as facilitating unobtrusive measurement of one’s pulse using the camera on a PC, smartphone, smart TV, or tablet this being part of long-term observational-healthcare situations like chronic illness management.

What I see of this is the ability to use the cost-effective and ubiquitous hardware i.e. the multi-functional smartphone, tablet or Ultrabook to work as part of remote health care and allied applications with minimum need to use extra peripherals.

Internet-based health care–now a reality

simonmackay 19/12/2011 Personnel Health Monitoring No Comments

Article

BBC News – Health care by TV and remote control

My Comments

The home network and the Internet is now becoming an essential part of personal health care in may ways thanks to a variety of technologies.

Facilitation technologies

Level playing field for health-care sensor devices

Certain technologies are making this feasible through the use of device classes for health-specific devices such as blood-pressure / pulse cuffs, blood sugar monitors and heart-rate monitors. They are also being enabled with low-voltage wireless technologies like Bluetooth Smart and up-and-coming low-voltage Wi-Fi designs.

These devices are being made able to work from two AA batteries or a 3V watch battery for a long time, yet use an industry-common data link and device class. The actual benefit from these design factors is the ability to supply health-care sensor devices that are cost-effective to buy and maintain; yet are able to integrate with common computing devices.

Ubiquity of open computing platforms for this application

It is being extended with the availability of regular, mobile and TV-based computing platforms like Windows, MacOS X, iOS and Android as foundations for software that records and / or reports medical-status information.

The software can be designed to keep a local or cloud-based record and signal to health-carers and/or close relatives and friends if there are abnormal events. In some cases, details can be passed through immediately to the health-care professional who is supervising the patient.

Where do I see this being applicable

I see this technology being applicable for the management of chronic illnesses where the patient can manage the illness themselves with little outside intervention. This may extend to the care of pregnant women who have a low risk of birth complications. Even when the patient must travel to the health-care professional for an appointment, both the professional and the patient are in a better position to know “what’s going on” through the treatment process.

It also adds a sense of dignity to the care and treatment process by allowing one to integrate the management procedures in to their lifestyle without feeling awkward about it. This would benefit younger and middle aged people more so especially when they are encumbered with these illnesses like diabetes.

I see it also benefiting people living in rural areas in many ways. The telehealth technology can allow a specialist based at a small or larger town to manage multiple patients and only have to travel out to attend those at risk. As well, the patient wouldn’t need to travel out to the doctor unless necessary.

It can also assist with the ageing process for seniors who want to live in their own home, live in an “own space” near their relatives such as a granny flat or live in low-needs supported retirement accommodation. Here, the technology can help with supervising medical and other therapies or simply make sure they are OK without intruding on their lifestyle and dignity. In this case, it could augment other technology projects that are in progress or being completed that assist older people with their daily lives.

Similarly, the technology would help with sports medicine in allowing athletes and fitness enthusiasts, along with their trainers, know their limits and how they are performing through their workouts so they can exercise in an optimum way.

Conclusion

I would still like to see the telehealth technologies work as a complement to the personal touch in personal health care rather than distance the patient from the professional. The technologies can be seen as a tool for helping us stay well and independent; as well as conquer distance.

How Will We Benefit From Super-Fast Broadband (BBC 5 Live interview)

simonmackay 20/08/2011 Internet Access And Service, Next-generation broadband service No Comments

Article

BBC News – How will we benefit from super-fast broadband? (Audio – radio interview)

My Comments

I have listened to a BBC Radio 5 Live radio broadcast that was available on-demand from the BBC Website about how we will benefit from the next-generation broadband Internet technology that is being rolled out now.

The BBC Radio 5 Live interview compared the current situation with what happened 10 years ago when broadband “hot-and-cold running Internet” came on the scene. At that time, the primary method of connection to the Internet was dial-up, typically with a second PSTN phone line for Internet use. The primary personal Internet applications were emailing and Web surfing, with some instant-messaging thrown in. There were questions about whether we needed the higher bandwidth of the always-on broadband services or not.

Nowadays, the norm for Internet connectivity is an “always-on” broadband service of at least 1Mbps, more like 2Mbps and we are doing more with these services. Here we are using the Social Web, with services like Facebook and Twitter; as well as multimedia-driven computing applications like YouTube and IPTV / Web video. It would also include IP-driven telephony applications like VoIP including Skype; where you benefit from low-cost long-distance telephone calls, FM-grade voice telephony and the arrival of the videophone which was only thought of in science fiction.

This is although there is a persistent group of naysayers who continue to doubt the need for next-generation broadband. They would reckon that the current technology would satisfy current usage needs. Personally, I have seen the effects of Moore’s Law where the capacity increases and the cost decreases for a technology, thus opening up new applications or enhancing the experience of current applications.

One main application group that the broadcast talked of as being feasible with super-fast broadband was health and well-being applications mainly in the form of telehealth services. This included the idea of “independent ageing” which I would see as a reality as people live longer and the age-associated degradation takes longer to set in.

Personally, I would find that as the next-generation broadband Internet services light up in many neighbourhoods, it will be more about an enhanced and rich Internet experience.