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Beyond Telemedicine: Infrastructures for Intelligent Home Care Technology
The Pre-ICADI Workshop on Technology for Aging, Disability, and Independence
The Royal Academy of Engineering, London, England
Steve Warren, Ph.D.Kansas State University
June 26-27, 2003This material is based upon work supported by the National Science Foundation under grants BES–0093916, CCR/ITR–0205487, and EPS–9874732 (with matching support from the State of Kansas). Opinions, findings, conclusions, or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the NSF.
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Beyond Telemedicine
2Presentation Objectives
Assess telemedicine system design Describe where home care is headed
– Characteristics– Getting there
• Research areas• Infrastructure development
Early work– Component architectures– Standards-based devices
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Beyond Telemedicine
3Where Home Health Care is Headed
In-person visits telemedicine smart sensors
Internet Telemedicine
Home Nets Novel Devices
Patient-Centric
Health Care
“Virtual” medical systems: distributed, networked devices
EPRse-Appliances
MonitorAssess /Predict
Treat
Courtesy Dr. Richard Re,
Ochsner Clinic
PhysicianStation
PatientStation
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Telemedicine Technology Assessment
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Beyond Telemedicine
5What is Telemedicine?
Telemedicine is a technology-rich alternative to a traditional, face-to-face, patient/physician consultation.
Audio/video interaction Data exchange: real-time / store-and-forward Multimedia electronic patient records (EPRs) Medical devices: blood pressure cuff, pulse oximeter,
stethoscope, glucose meter, weight scale, temperature probe, electrocardiogram, ...
HomMed (http://www.hommed.com)American Telecare
(http://www.americantelecare.com)
ProviderStation
Patient Station
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Beyond Telemedicine
6Typical Telemedicine Systems
Point-to-point design Stovepipe systems
(one vendor creates all) expensive and inflexible
Lack of standards for information exchange & plug-and-play operation
Minimal surety mechanisms
Limited read/write access to electronic patient records
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Beyond Telemedicine
7Response
Desirable point-of-care systems– Plug-and-play interoperability
• vendor competition• flexible design
– Surety (security++)– Commodity, commercial-off-the-
shelf (COTS) components
Reduce Cost
Misconception: “Telemedicine” real-time communication with a care provider
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Future Home Care Systems
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Beyond Telemedicine
9Future Home Layout
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Beyond Telemedicine
10Characteristics of Future Home Care Delivery
New Care Delivery Model– High risk patients: continuous monitoring, trend analysis– Health prediction– Patients: greater care roles
Closed-Loop System– Non-traditional consultations– Care providers in exceptional circumstances– Systems seek & assimilate knowledge to make care
decisions Pervasive Monitoring
– Sensor webs within patient environments– Surrogate health indicators– Medical/environmental/behavioral/lifestyle data EPRs
MonitorAssess /Predict
Treat
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Beyond Telemedicine
11Characteristics of Future Home Care Systems
Capable Intelligent
CollectivelyIntelligent
Decision-Capable
Self-, Location-,Owner-, Role-Aware
Interoperable
Plug-and-play
Self-Identifying
Diagnostic
Therapeutic InformationReducing
SensorLaden: Novel,Wearable,Surrogate
EPR-Enabled
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Beyond Telemedicine
12Characteristics of Future Home Care Systems (cont.)
High-Surety
RedundantReliableSecure
Ergonomic
Distributed
Dynamic Fractal
Confederated Hardwired
WirelessFuzzy Bounds
Sensible
Cost Effective
StandardsBased
Commodity
PatientSpecific
SafeRobust
Easy to Use
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Beyond Telemedicine
13Secure, Reliable Exchange of Medical Information
Distributed Medical Information Database
Clinic
Emergency Scene
Hospital
PrisonSchool
Research Facility
BattlefieldCompany
Home
LSTAT , in this artist rendering, is under development by Northrop Grumman
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Getting There: Infrastructure Development Approaches
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Beyond Telemedicine
15
Home Networking Standards & Initiatives
HomeRF: Shared Wireless Access Protocol (disbanded January 2003)
HomePNA (Home Phoneline Networking Association)
Microsoft/3Com (and similar network adapters)
Connected.Home (Intel)
Home API (active thru 1999; status unknown)
802.11b Bluetooth X10 IEEE 1394 (FireWire)
http://www.homerf.org3Com
HomeConnect Home Network
Phoneline Adapter
Linksys HomePNA Adapter
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Beyond Telemedicine
16Interoperability Technology
Architecture– CORBA [OMG]– Java (Java Beans, Jini,
Enterprise Java) [Sun]– .NET [Microsoft]– Generic Web Services– uPnP [Microsoft]– Salutation
Telemedicine Interoperability Architecture http://telemedicine.sandia.gov (2/2003, Chapter 3)Connecting for Health, Markle Foundation http://www.connectingforhealth.org/resources/DSWG_Report.pdf (6/5/2003)
System/Device Bus– IP-based home
LAN– IEEE 1394
(FireWire)– HAVi– 802.11b– Bluetooth*– IrDA– USB– PCMCIA– IEEE 1451 (Smart
Sensors)
Context– .NET My Services– Liberty Alliance– CCOW
Patient Record Access– Good European
Health Record– HL7 CDA– OMG COAS, CIAS– CEN ENV
Medical Interoperability– DICOM– IEEE 1073 (MIB)*– Point of Care Test– TWAIN– PTP
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Beyond Telemedicine
17Component Confederacies
Devices: smart, aware
Collective Intelligence
Distributed Dynamic Secure
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Beyond Telemedicine
18Basic Component Interaction
Beauty– Public interfaces; Private
implementations– Standards: interaction– Object: client or server– Component-level security
Attributes
Methods
A
Attributes
Methods
B
MediatorComponent Object
What it knows
What it can do
– Distributed (C++/Java CORBA/Jini/DCOM)
– Fractal: component = device, collection, etc.
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Beyond Telemedicine
19Requirements for Smart Home Care Systems
Component Self-Awareness Component Interoperability Component-Level Security
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Beyond Telemedicine
20Requirement: Component Self-Awareness
Each component should know… about itself …
• What it can do• Its limitations• How to interpret its data• How to assess its condition
… about its context …• Who may use it and how it may be used• Roles/scenarios for valid data
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Beyond Telemedicine
21Requirement: Component Interoperability
Procedures
Device Specificatio
ns
Device
The Rest of the Medical System
“I am here!”
“Identify yourself.”
“I am a pulse oximeter that ...”
“Start waveform.”
“235, 233, 230, ...”
Standard, vendor-independent interfaces Lego-like construction of diverse systems “on the
fly”
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Beyond Telemedicine
22Requirement: Component-Level Security
Components will negotiate secure transactions
Point-to-point systems: straightforward to secure – Small user population– Static network topologies– Limited range of technologies
Distributed systems: security is more important/ problematic – Mass-market communications– Less emphasis on private networks– Legacy and leading-edge technologies
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Early Work
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Beyond Telemedicine
24Telemedicine Interoperability Architecture
Backplane
UserInterface
Comms
Processing
ProtocolsMedicalDevices
PatientRecords
“Lego-like” Component Interactions
Goal: Create application-specific, distributed medical systems “on-the-fly”
Benefits:• Flexible• Cost-effective• Secure
Telemedicine Interoperability Architecture: http://telemedicine.sandia.govThe Role of Technology in Reducing Health Care Costs: http://www.sandia.gov/CIS/6200/Telemedicine/
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Beyond Telemedicine
25Smaller-Scale Systems
Backplane
UserInterface
Comms
MedicalDevices
Ophthalmoscope/Otoscope
Thermometer
Backplane
UserInterface
MedicalDevices
Personal Status Monitor
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Beyond Telemedicine
26Typical Point-to-Point Telemedicine System
MedicalDevices
UserInterface
Backplane
Comms
Protocols
Patient Station
UserInterface
PatientRecords
Backplane
Comms
Protocols
Processing
Caregiver Station
Communication Link
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Beyond Telemedicine
27Distributed Telemedicine System
PatientStation
CaregiverStation
Patient
Record
Server
Diagnostic
ServicesSystem
ProtocolServer
PatientRecords
Backplane
Comms
Backplane
Comms
ProcessingMedicalDevices
UserInterface
Backplane
Comms
Backplane
Comms
Protocols
UserInterface
Backplane
CommsLink
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Beyond Telemedicine
28Build 1 Patient Station
USB Hub:WeightHeart RateBlood O2 SatTemperatureBlood PressureECGStethoscope
Telemedicine Interoperability Architecture: http://telemedicine.sandia.govThe Role of Technology in Reducing Health Care Costs: http://www.sandia.gov/CIS/6200/Telemedicine/;http://www.sandia.gov/CIS/6200/Telemedicine/index_tra.htm
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Beyond Telemedicine
29Build 1 Architecture
Temp
SpO2
Physical
Devices
CORBACORBA Services
(Security, Naming,Transactions, Trader, Event)
USB
Backplane
BP
DeviceX
VITALSPulse
BPSpO2
BP12080
Desktop
Virtual Device
System I/F Logic Display
MODEL VIEWCONTROL
Component Pattern:
ala Java Beans
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Beyond Telemedicine
30
Medical Component Design Laboratory
Research Goals– Point-of-care system design– Plug-and-play component
infrastructure– Medical devices EPR’s– Wearable light-based sensors– State of health
assessment/prediction Education Goals
– Project design space– New curriculum and web resources– Community outreach
Support– National Science Foundation– Kansas EPSCoR Program– Sandia National Laboratories
2.17
2.171
2.172
2.173
2.174
2.175
2 2.5 3 3.5 4 4.5 5Time (sec)
Sig
nal
(Vol
ts)
http://www.ieee1073.org/
http://www.bluetooth.com/
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Beyond Telemedicine
31Technology Layout
Set-Top Box
T/R
Wearable Sensor Platforms
Local Electronic Patient Record
Security Server
Local Terminal
Protocol Server
Internet
Telemetric Link
Hospitals & Other External Entities
Other Devices Patient Identity
Verification
Heart Rate
Blood Oxygen Saturation
Respiration
Vessel Compliance
Activity
Vital Parameter Processing Modules
Blood Flow
Blood Pressure Indicators
Trend Analysis
Continuous Monitoring Modules
Information Reduction
Arrhythmias
State-of-Health Assessment
Internet Gateway
Home
Local Area Network
Motion Artifact Removal
Processing Repository
Security Server
Internet Gateway
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Beyond Telemedicine
32Wearable Monitoring System
Base Station
(PC)
Data Logger
Sensor
Sensor
Sensor
Internet
Data Logger Sensor
Sensor
Telemetry
Telemetry
Ambulatory ECG & Pulse Oximeter; Data Logger in a ‘Fanny Pack’
Nested Master/Slave ConfigurationsBluetooth – Telemetry; Device discoveryMIB – Device Association; Nomenclature; Data exchange
ECG
Data Logger
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Beyond Telemedicine
33Monitoring System Hardware
Bluetooth Telemetry – Brightcom Callisto II
Pulse Oximeter
Electrocardiogram
Data Logger
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Beyond Telemedicine
34Light-Based Sensors
Heart rate Oxygen saturation Respiration Motion (activity) Vessel hemodynamics Relative blood
pressure Wearer identity Hemoglobin
derivatives Hematocrit 2.17
2.171
2.172
2.173
2.174
2.175
2 2.5 3 3.5 4 4.5 5Time (sec)
Sig
nal
(Vol
ts)
-0.01
-0.005
0
0.005
0.01
3 4 5 6 7 8Time (sec)
Sig
nal (
volt
s)
Red Plethysmograph - Fingertip, Hamamatsu S5106 Large Area Detector, TM, SW - 8/19/96
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 2 4 6 8 10Time (sec)
Sig
nal
(vol
ts)
0.93
0.94
0.95
4 5 6
ACpp: 10 mVDC: 0.94 VAcpp/DC: 1.1%
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Beyond Telemedicine
35Components in Education
Laboratory
Lecture
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Beyond Telemedicine
36Community Outreach
Girls Researching Our World
Light-Based Sensors to Indicate Hypertension
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Beyond Telemedicine
37Application: Animal Monitoring
Cow with sensor
Fast analysis
Bluetoothreceiver
Offline analysis
rapidtreatment
Medical centers
Goal: Continuously assess and predict cattle state of health
Impact: Improve the ability of the livestock industry to react to and predict disease onset and spread Mechanisms: Wearable/remote biomedical sensors,
environmental sensors, and global positioning devices
Bluetooth-enabled monitoring stations Regional information infrastructure
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Beyond Telemedicine
38Prototype System
Handheld
computer
Bluetooth
telemetry link
GPS HR Core Temp
SpO2
Microcontroller-based sensor module with serial
communication to a Bluetooth telemetry moduleActivit
yAmbient
TempHumidity
Mobile Monitoring Components
Ear Tags Light-Based Sensors
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Concluding Remarks
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Beyond Telemedicine
40Key Messages
Home health care– Reactive/episodic preventative/predictive – Closed-loop systems: beyond “telemedicine”– Novel sensing technology & pervasive
infrastructures Medical systems: Component confederacies
– Ability: Smart, decision-enabled, and capable– Layout: Distributed and dynamic– Practicality: Cost-effective & high-surety
Interoperable & Secure
Vendor Competition &
Economy of Scale
Cost
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Beyond Telemedicine
41Challenges
Standards– Require consensus from entities with competing
goals– Difficult to define given quickly changing
technology
High-Surety
RedundantReliableSecure
ErgonomicSafe
Robust
Easy to Use
– Rules of engagement for role-based devices– Control of systems with nebulous boundaries– Unintended component interactions (“model checking”)– Systems that incorporate non-medical devices– Inexperienced users
Surety & Regulation– Closed loop, high reliability
systems constructed on-the-fly
– Read/write access to secure information
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Beyond Telemedicine
42Contact Information
Steve Warren, Ph.D.Associate ProfessorDepartment of Electrical & Computer EngineeringKansas State University2061 Rathbone HallManhattan, KS 66506 USAPhone: (785) 532-4644Fax: (785) 532-1188Email: [email protected]://www.eece.ksu.edu