i-MED

IndTech 2014 for Schools CONFIDENTIAL of 12

09- 11 April 2014, Athens, Greece

“Industrial Technologies for Schools” initiative

School Name: ZANNEIO MODEL EXPERIMENTAL LYCEUM

Title:

i-MED: A smart medical bracelet that will revolutionize medical treatment

Contact Persons’ Details

Name:

Surname:

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Yannis

Grapsas [email protected]

Date 17-03-2014

Industrial Technologies 2014 Conference, 09-11 April 2014, Athens, Greece

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Industrial Technologies 2014 Conference, 09-11 April 2014, Athens, Greece

PARTICIPANTS

Students (name & surname)

Alexiou Panos

Antoniadis Apostolos

Asimakopoulou Georgia

Bouzali Drini

Droutsas Christos

Gerani Eirini

Ioannidis George

Megalogianni Melina

Nikolaidou Georgia

Oikonomopoulou Maria - Eleni

Papadopoulos Kostas

Spyrou Alexandros

Tsantilas Spyros

Tsavalos Sokratis

Vamnies Yannis

Vasilakou Sofia

Vidalis Kostas

Voglis Theologos

Vousvounis Spyros

Xanthidis George

Zaharopoulos Christos

Supervisors / Teachers (name & surname)

Pantelis Bouboulis

Martha Georgiou

Eva Tegkeri

Sotirios Tsantilas

Dimitrios Vamnies


Content

PARTICIPANTS .................................................................................................................................................. 2

ABSTRACT .......................................................................................................................................................... 4

1. INTRODUCTION....................................................................................................................................... 5

2. NEW PRODUCT / SERVICE DESCRIPTION ....................................................................................... 6

3. CONCLUSIONS ....................................................................................................................................... 11

4. REFERENCES.......................................................................................................................................... 12

Industrial Technologies 2014 Conference


ABSTRACT

One of the major challenges of modern health care is the implementation of a pre-screening process at the Emergency Department (E.D.) of Hospitals. Usually, these rooms are filled with non-urgent cases, that could be redirected to a private physician or a health clinic saving time and money. Although pre-screening methods have already been adopted in many western Hospitals with great success, they are still time consuming as they rely on traditional (low tech) techniques. Undeniably, these methods will benefit, if cutting edge technology is to be adopted. In this report, we propose a high-tech medical bracelet, called i-MED, that will revolutionize medical service both for emergency cases and regular patients. The device (that will be attached to each patient's wrist) will be equipped with multiple sensors that can monitor patients life signs (heart rate, pressure, temperature, O2 and glucose levels in the blood, e.t.c.) using non-invasive techniques. In addition, the device will be able to take small amounts of patients blood to perform further tests (Hb, white cells count, electrolytes, troponin levels, toxins, cancer biomarkers, e.t.c.). i-MED will be able to interact with the Hospital's Computer System and use the patient's history and the aforementioned measurements to make a quick assessment of the severity of each case. When a patient's life is on immediate danger, i-MED will turn red and alert the medical personnel. The proposed device can also be used on regular patients who are admitted to the Hospital (e.g., for a scheduled surgery operation). It can also be used on patients with severe life-threatening conditions that need continuous off-site medical observation.



1. INTRODUCTION

Undoubtedly, Medical Science plays a fundamental role to the improvement of the quality of life. Every technological advance is applied to it, in order to cure diseases, enhance the precision of surgical operations and reduce patients' suffering. However, the current harsh economic environment dictates that the expenses for health care need to be reduced. Moreover, getting care in a crowded Emergency Department (E.D.) is quite difficult, especially for people, whose lives depend on the immediate reaction of doctors. A suitable solution to these issues would be to scan the patients in the emergency room, value the severity of each case and decide which are non-urgent. In this way, people with actual need will stay at the Emergency, while others will be redirected to a less expensive hospital-appointed primary care provider or a health clinic. As any treatment in a Hospital E.D. costs at least twice as much as that of a similar treatment in a primary care physician's office (sometimes the cost increases even further to 300% or 400% [1, 2]), medical expenses will be reduced, while serious cases will get more attention.

During the last decades, there have been some attempts to control the attendance at the E. D. For example, Mercy Fort Smith Hospital has medical personnel making an initial evaluation of each situation [1, 2]. The specialized personnel examine the patients and divide them into categories based on the severity of each case. Although it is a notable initiative, it is still time-consuming and has increased possibilities to mistakenly evaluate a patient’s health. Although some symptoms may seem innocent they can be a warning of some severe sickness. In most hospitals, people are patiently waiting for their turn to be examined, based on the time of their arrival. So, people with insignificant maladies may take priority over those in direct danger.

To address these issues, we propose the use of a multitasking bracelet, called i-MED. Besides the replacement of the typical medical bracelet, our approach considers a complete medical service that will help medical personnel in multiple ways. i-MED will not only be able to take pressure and temperature measurements, but it will also monitor heart and analyze blood samples, in order to make generic or specialized blood tests to detect infectious diseases or anomalies that indicate the existence of greater threats. The results of all these measurements will be immediately sent to a server that will judge the severity of each case and will order the bracelet to light red in high jeopardy, yellow in medium and green in non-urgent cases. i-MED can also track the location where each patient is at any time, an application really useful for patients suffering from dementia, Alzheimer or memory loss. It can even prevent young unsupervised children from entering rooms without access saving medical personnel's time and effort.

The rest of this report is organized as follows. Section 2.1 is devoted to analyze the pre-screening rationale at E.D. employed by major western Hospitals. A complete description of the i-MED device can be found in Section 2.2, while Section 2.3 analyzes the main functions of the i-MED system.



2. NEW PRODUCT / SERVICE DESCRIPTION

2.1 E.D. pre-screening

Thankfully, our civilization has reached a point, where many serious conditions can be efficiently dealt with. However, in most western hospitals the care of urgent cases is less than efficient. Many times, the E.D. are crowded with worried patients without severe symptoms, spending valuable medical time, which should have been redirected to more critical cases [2]. As a result, the rate of treatments is slowed down keeping many patients in immediate danger. Moreover, the costs of all these visits at the E.D. are excessive. If a way to minimize E.D. visits and costs was found, countries would save money from their health care budget, that could be invested in scientific research and further improvement of the quality service.

It is widely accepted that Medical Science is a fundamental factor for the improvement of life. However, health care is among the first that suffers budget cut-offs in time of economic recession. Although diminishing health care costs has instant effects in a country’s budget, over time the governments need to help those whose financial situation is restrictive to receive the proper health care. Thus, the money that has been saved will be subsequently lost in social benefits. Clearly, this is not a viable solution. In this report we propose a medical service that addresses these problems more efficiently, without undermining public health care benefits. Our focus is the decongestion of the E.D. from patients without immediate danger, a policy which has already attracted attention in the U.S. as a means to reduce health care costs [1,2]. Many hospitals assign specialized medical personnel to pre-screen patients, in order to control the attendance at the E.D. It has been found that this policy is quite effective in saving money. As noted by an emergency physician at a major US health care center, i.e., the New York's Presbyterian Hospital, in the E.D., a sore throat could cost $600, while treatment in a primary care physician's office would be only $120 [1,2]. That's a significant cost reduction. Besides, primary care physicians and health clinics offer more flexible hours and a wide range of less expensive healthcare services. More and more US hospitals adopt pre-screening techniques as a means to reduce their operating expenses [2]. For example, Milwaukee-based Aurora Sinai Medical Center, reduced its annual E.D. visits by 23 percent by matching non-urgent patients with other providers, while Florida's Halifax Health pre-screens patients aged 18 to 64 prior entering the E.D. and redirects the non-urgent cases (as determined by a physician or a physician's assistant) to an on-site health clinic.

However, these means are still at their infancy. It takes a lot of time for the medical personnel to pre-screen every case at the E.R. and be sure that their judgment is accurate. On the other hand, an intelligent medical bracelet that could evaluate fast each patients case, would be ideal. Such a device would analyze each case separately by monitoring the patients' life signs (heart rate, temperature, blood pressure, e.t.c.) and possibly taking and analyzing blood samples to determine infections or other conditions. The device would then transmit the acquired information to the Hospital's Server, which, in turn, will compare the results to the patient's medical history and asses the severity of the case. The medical personnel will use this information to decide on the fly which case takes priority, while the non-urgent cases will be redirected elsewhere. Besides, such a device would revolutionize health care as we know it, since it could also be used by Hospitals to monitor patients with life-threatening



conditions, who are currently off site either for personal reasons (e.g., visiting relatives, talking a walk), or because they do not need permanent Hospital attention.

Figure 1. The i-MED bracelet.

2.2 i-MED's description i-MED will be a wrist bracelet (Figure 1) incorporating the flexible screen technology, and will be given to each patient along his entrance to the hospital. This high technology bracelet will be in contact with each patient’s skin through internal sensors incorporated at its back side (Figure 2). These sensors will be able to periodically analyze the patient's life signs (heart rate, temperature, pressure, e.t.c.) using non-invasive techniques. The sensors will also be able to get some blood-related measurements that do not require an actual blood sample (like SatO2, CO, glucose, radiation levels, e.t.c.). Note, that there is ongoing research to identify non-invasive methods that can take accurate blood measurements and the interest of the medical community for such methods is increasing [3,4, 5,7,9].



Besides the non-invasive measurements that will be periodically taken through the sensor array, i-MED will also include a needle-like component at the back side of the bracelet that will be able to receive blood samples in order to analyze them, using an inbound chip mechanism. These tests will be carried out only if the medical personnel orders them and they will cover the basic blood measurements. It is of high importance for doctors at the E.D. to have a quick and direct outlook of the function of the circulatory system, thus the bracelet will be able to perform the basic blood examinations that involve the level of leucocytes, platelets, cholesterol, allergies, e.t.c., or identify the presence of infections, viruses, chemical agents, e.t.c.

Figure 2. Front and Back side of the (unfolded) i-MED bracelet.

The bracelet's front side will be a flexible screen, which will be separated into three different areas. The first one will depict temperature and pressure measurements periodically together with the non-invasive blood tests, while the second one will depict heart rate measurements. Finally, the third area will show everything else including, possible blood tests, medical history, diagnosis, e.t.c. The bracelet will be made of graphene's compounds and it will change colour depending on the patient’s health and how critical his condition is. In order to send and receive data (i.e., patient's history, condition at the E.D., emergency calls, e.t.c.), i-MED will also be equipped with a wireless port. Hence, i-MED will be able to communicate with the Hospital's computer server to complete its task. Moreover, i-MED will include a GPS module that will make possible the positioning of the patients inside the Hospital's perimeter. This is of paramount importance for patients suffering from dementia,



or other conditions that compromise brain functions. i-MED will be composed of nanomaterials, which will give it both flexibility and endurance, as well as make it compact and lightweight. While the patient waits for his turn to be examined by a doctor, the bracelet will transmit the data to the main server through the wireless interface and the patient will be able to monitor the results. Finally, the device will contain a rechargeable battery, which will be recharged wirelessly. 2.3 i-MED's functionality i-MED is a multitasking gadget that is able to accommodate a wide variety of Hospital's functions. In this section we divide its functionality into three different modes: a) ED Mode, b) Regular Mode and c) Off-site Mode. The ED Mode will help medical personnel perform pre-screening of patients in the E.D. An i-MED bracelet will be given to each patient arriving at the E.D. The bracelet will immediately start taking the non-invasive measurements and if doctors decide that the patient needs further tests (or if its software decides that this is necessary), they can remotely command the bracelet to do any additional examinations (e.g. blood tests through the needle), provided that they supply it with the needed chip and chemical agent. Due to its programmable nature, i-MED’s system will be designed to be configurable, so that new tests or even generic functions can be integrated by specialists without the need of a complete restructuring of its internal mechanism. We should point out that devices that can run cheap and efficient measurements using only a small drop of blood are already in existence (e.g. the V-Chip (see figure 3) [6,8,10]). These devices only require the right agents to react with the blood ingredients one wants to check. Hence, in a case of an outbreak, i-MED will indicate the existence of viruses in the blood and it will immediately alert the medical personnel to put the host in quarantine. i-MED will use all the acquired information together with the patient's history to decide the priority of the particular case and dynamically allocate the patient's place in the E.D. queue. Depending on the severity of the case, the i-MED will light using a specific colour.

Green, if patient’s health is well or relatively well and his symptoms are negligible Yellow, if the patient needs to be examined but immediate medical attention is not

necessary Red, if the patient has to be examined right away because of a potential critical

condition. This provides an immediate priority system for medical personnel which works in parallel with the server communication system. For example, if the symptoms depict severe disorders regarding homeostasis, the bracelet will light red make a beeping sound to alert the medical personnel that the patient needs to be in the priority queue. When a patient’s life signs are in the normal rates, the bracelet will light green and he/she will be able to set an appointment with a private physician or a public health clinic. i-MED will suggest the specialty for the patient’s needs, based on a questionnaire he/she will answer about his condition. This will be filled in while i-MED runs the various medical tests. The Regular Mode will be applied to patients during their scheduled hospitalization (e.g., for surgery, check up, or other reasons). In this case, the bracelet will provide accurate and continuous monitoring of the patient's health and the effectiveness of the treatment they follow. For example, i-MED can run blood tests that will display the effects of the medicine to the monitored patient. The results of those tests will be combined in order to build a map that indicates how each drug interacts with each organ and whether they provoke any side effects. Blood pressure, pulse and other life signs will be continuously monitored and the



combination of the results will be evaluated. Every disorder will be considered by all possible symptom checks and the bracelet will make a primary diagnosis. In the case of an emergency (e.g., if an abnormality in patient's life signs is detected) the i-MED will alert the medical personnel. Furthermore, i-MED will be able to automatically position each patient inside the Hospital's perimeter. This is quite useful for people suffering from dementia or other related conditions. It is also useful for young children and patients who need special care. The Off-site Mode: A lot of people suffer from severe medical conditions, that require regular treatments, but not a continuous hospitalization. In fact, the latter might negatively influence a patient's psychology leading to undesirable outcomes. In cases where a patient faces a severe problem and has to be monitored continuously, there will be a specialized i-MED for certain major conditions, which will be provided to each patient to enable doctors for discrete constant ‘surveillance’ of the patient’s condition. The i-MED will continuously monitor patient's life signs and location and in case of emergency a special unit will be directed to the patient's position to provide assistance. Apart from its medical use, i-MED will be a practical tool for the administration department. Information gained from the bracelet will be sent to a server that will have the medical record of each patient. This data can be used in statistic research about the effectiveness of a treatment, or the number of patients suffering from a certain disease. Moreover, the server can combine the information from multiple patients about the side effects of the treatment. These results can be utilized by the pharmaceutical companies in order to improve their products. The server will keep record of the hospitalization costs for each patient as well and the cost and effectiveness of each treatment.

Figure 3. The V-Chip



3. CONCLUSIONS

We presented a medical device, which has the potential to greatly improve the quality of medical service, and thus offering a lot to modern society, addressing a part of today’s worldwide issue of Health Care. It is an innovation that will help to solve the problem of congestion in the Emergency Department by improving the pre-screening techniques. Thus, hospitals will be able to channel their recourses to their primary goal: saving lives. i-MED will, also, reduce the unnecessary visits at the E.D. That can be interpreted as a significant amount of money saved from the annual budget and can be invested in further scientific research. This bracelet will be able to run general blood examinations on demand and monitor heart rate, blood pressure, temperature and other life signs periodically. Every bracelet will be connected through wi-fi to a computer server and the results will be instantly transferred to the medical record of each patient. It will evaluate the severity of each case and decide which patient should be treated firstly employing a simple colour coding. The system will give priority to life threatening conditions, while in trivial cases it will redirect the patients to a health clinic or a private physician. This will result to a significant gain in medical time that will be redirected to more severe cases. Moreover, it will have further use in monitoring patients suffering from chronic diseases, who remain in the hospital area in fear of complications without receiving any additional treatment than that they could receive at their home.




4. REFERENCES

[1] Alicia Caramenico, Trend: Hospitals pre-screen, divert ER patients to cut visits, http://www.fiercehealthcare.com/story/trend-hospitals-pre-screen-divert-er-patients-cut-visits/2012-03-06

[2] Rusty Garrett, ER Screening Policies In Place At Local Hospitals, Times Record (online edition), URL swtimes.com/sections/business/er-screening-policies-place-local-hospitals.html

[3] Lior Golan, Daniella Yeheskely-Hayon, Limor Minai, Eldad J Dann, and Dvir Yelin,, Noninvasive imaging of flowing blood cells using label-free spectrally encoded flow cytometry, Biomed. Opt. Express, (2012)

[4] Robert Hahn, Y Li and Johann Zdolsek, Non-invasive monitoring of blood haemoglobin for analysis of fluid volume kinetics, 2010, Acta Anaesthesiologica Scandinavica, (54), 10, 1233- 1240.

[5] Mark Heimberg, Raman technique enables noninvasive blood test, Laser Focus World, URL http://www.laserfocusworld.com/articles/print/volume-39/issue-3/world-news/raman-technique-enables-noninvasive-blood-test.html

[6] Elizabeth Holmes, Theranos, URL www.theranos.com/

[7] J. U. Kang, Non-Invasive Fiber-Optic Glucose Sensor Based on Stimulated Raman Scattering, The 20th Annual Meeting of the IEEE Lasers and Electro-Optics Society, 2007. LEOS 2007.

[8] Tuan C. Nguyen, How To Run 30 Health Tests On a Single Drop of Blood, Smisthonian magazine (online) URL www.smithsonianmag.com/innovation/how-to-run-30-health-tests-on-a-single-drop-of-blood-180949983/?no-ist

[9] Wei-Chuan Shih, Quantitative biological Raman spectroscopy for non-invasive blood analysis, Ph.D. Thesis, MIT, 2007

[10] Yujun Song, Yuanqing Zhang, Paul E. Bernard, James M. Reuben, Naoto T. Ueno,Ralph B. Arlinghaus, Youli Zu, Lidong Qin, Multiplexed volumetric bar-chart chip for point-of-care diagnostics, Nature Communications 3, article ID 1283, 2012.

http://swtimes.com/sections/business/er-screening-policies-place-local-hospitals.html

http://swtimes.com/sections/business/er-screening-policies-place-local-hospitals.html

i-MED

Education

Transcript of i-MED