This document discusses the potential for passive home-based monitoring and telemedicine to support wellness. It outlines how integrating data from multiple sources can provide ongoing wellness and health information to help maintain healthy lifestyles. Future technologies discussed include automated monitoring of vital signs, medications, sleep, and other biomarkers to facilitate early medical intervention and reduce healthcare costs through remote patient monitoring.

1. 
Passive Home-based
Monitoring in an Era of
Telemedicine
Robin A. Felder, Ph.D.
The University of Virginia
Professor of Pathology
Associate Director Clinical
Chemistry
http://medicalautomation.org
Wellness
 State of complete
physical, mental and
social well-being
 Health results from
primarily positive
perspectives and choices
Physical Social
by hi h to live
b which t li
6.2 9.1
 Technology can provide 8.0
information that facilitates Cognitive
positive choices
© Felder, 2011


2. 
Wellness
 Feeling well
 Achieving wellness
 Wellness strategies
 Denial or retraining
Wellness Support
 Growing need for new
sources of data, and data
,
interpretation
 Integration of multiple
diagnostic sources (clinical,
radiology, molecular
biology, pharmacy, lifestyle)
 Integrated wellness and
health record
 Ongoing information
support for maintaining
healthy lifestyles


3. 
Wellness Support
 Food coaching
g
 Exercise rewards
 Consequence
reporting
 Consequence
forecasting Overcome vicarious
goal fulfillment or,
“exhaustion of self-
control”
Home Health IT
Cloud
 Integration of multiple Interpretations
information sources
(wellness,
socialization, medical)
 New revenue source:
Medical Cloud
coaching and
hi d
Interpretations


4. 
AN EXAMPLE
SALT, THE #1
KILLER
Vogue 4‐10
Example of Medical Cloud
Interpretation
 Hypogen-DX
(Hypertension/Salt
Sensitivity Genomic
Interpretation)
 3 SNP test ($300)
 Proprietary algorithms
 Determines probability
of developing HT or
SS
 1st Example of
Molecular Diagnostics
for Chronic Disease


5. 
Wellness Technologies Cognitive Social
6.2 9.1
 Nutrition 8.0
Physical
 Exercise
 Biometrics
 Stress reduction
 Mood enhancement
 Pain reduction
 Sleep improvement
 Health and wellness monitoring
New Communication Paradigms


6. 
Embedded Wellness Sensors
 Instrument common
fixtures
 Wireless
transmission of data
 Web based
aggregation and
interpretation
Action Inspired Instruction
 Real time coaching
 Medically approved
content
 Tailored for the
individual


7. 
Passive Wellness Monitoring
Healthcare providers
Vital Sensor
·Body temperature
·Pulse
Urine analyzer ·Blood Pressure
·Body fat percentage
Urine protein
Data management PC Urine glucose
The M.A.R.C. In-Home
Health Monitoring Project
 C
Create a model where the impact of chronic
d l h h i f h i
disease is delayed or avoided
 Provide opportunity for medical intervention
before a crisis occurs
 Minimize impact of chronic disease on the
healthcare system
 Potentially delay admittance to a nursing home
and reduce the cost of healthcare


8. 
Passive Wireless
Sensor Systems
 WellAWARE™, provides unobtrusive, highly
accurate wellness monitoring services to allow
individuals to age with options.
15
Passive Remote Sensing
 The WellAWARE™ solution has three primary
elements that work together to provide passive, yet
informative, monitoring of seniors:
 Wireless Sensor Array (WSA) – gathers data on daily activities
 Data Manager (DM) –transmits data to data analysis servers
 Capture Analysis & Reporting Engine (CARE) – captures potential
problems and alerts caregiver


9. 
Sleep Monitoring
 Sleep apnea affects more
than 40 million people in the
United States alone of which
85% are currently
undiagnosed
 sleep apnea testing and
therapy market that is
expected to reach more that
$4 billion by 2012
Passive Vital Sign Bed Monitor
Polysomnography
Mattress pad to measure:
• Sleep quality
• Pulse (and HRV)
• Breathing
• Movement/
restlessness
• Bed exit
• Subject position/
turning
• Body temperature
• Blood Pressure
Passive Sensing


10. 
Sleep Quality Graphs
Restful Resident
Restless Resident
Remote Automated Triage
 Real time assessment of participant health
status/well being
 Ability to drill down to specifics
 Built in automated optimized dispatching
 Manual override of dispatch event or
downstream processes


11. 
21
One Click Trending
 Health
 Socialization
 System
utilization


12. 
Telehome Monitoring Decreases
Costs by 74%
Overall Cost of Care Comparison
80000
70000
$67,757.88
60000
onitored
50000
Dollars $
40000 Unmo
30000
20000
$17,407.02
10000 Monitored
0
N=21 in each group, P<0.05;
Telemed J E Health, 
FUTURE WELLNESS
TECHNOLOGIES


13. 

Underwear That Measures Blood
Pressure
 Pulse wave velocity
correlates with blood
pressure
 Tissue impedance shows
passing pulses
 Pulse timing correlated
with relative pressure
 Continuous blood
pressure monitoring


14. 
Automated Pharmaceuticals
 Automated Pill – iPill (Philips)
 Magnatrace™ System looks for p
g y pill
ingestion
 Networked pills (Proteus
Biomedical)
 Instrumented Pills
 Cost < $0.01
 Measure and send physiologic signals
through body electrically
 Receiver is a patch worn on the body
that also logs respiration, heart rate and
body movement, sleep patterns
Automated Intestinal Biopsies
 Intestinal diagnostic
imaging coupled with
miniaturized biopsies
 Pillcams with
intestinal “Velcro” to
arrest the camera at
a selective l
l ti location
ti
 Continuous
monitoring
MIT Technology Lab


15. 
The Eye as the Window to Health
UCSC
Univ. of MD, Baltimore
Medical Robotics
Medical Robotics, LLC
 Real time glucose
monitoring
 Alerts for low or high
glucose concentrations
 Trending analysis
 Food coaching via
telenutritionalmentoring


16. 
Receptivity
 Presenting health vs
wellness to a patient
 Determining what
information is TMI
 Optimizing the time
for the presentation
of wellness strategies
“Wellformation”
Augmented Reality
 Projection of
underlying anatomy
d l i t
on living tissue
 Relies on
superimposition of
reality and
previously scanned
animated image/data


17. 
Not for the Faint Hearted
Robotic Reality
HRP‐4C National Institute of
Advanced Industrial Science and
Technology


18. 
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19. 
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20. 
The Wellness Health Paradigm
Evaluation
Predictive Continuous
and
Diagnostics Monitoring
Reporting

Medical Automation.org
A non-profit
educational
organization
improving
healthcare quality
and efficiency
through teaching
automation
principles and
their application in http://medicalautomation.org
health systems


21. 
TagLine ‐ Medical reality
http://medicalautomation.org
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