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Published on October 3, 2007

Author: Ethan

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Beyond Telemedicine: Infrastructures for Intelligent Home Care Technology :  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, 2003 This 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. Presentation Objectives:  Presentation 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 Where Home Health Care is Headed:  Where 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 EPRs e-Appliances Monitor Assess / Predict Treat  Courtesy Dr. Richard Re, Ochsner Clinic Physician Station Patient Station Telemedicine Technology Assessment:  Telemedicine Technology Assessment What is Telemedicine?:  What 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) Provider Station Patient Station Typical Telemedicine Systems:  Typical 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 Response:  Response 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 Future Home Care Systems:  Future Home Care Systems Future Home Layout:  Future Home Layout Characteristics of Future Home Care Delivery:  Characteristics 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 Monitor Assess / Predict Treat Characteristics of Future Home Care Systems:  Characteristics of Future Home Care Systems Capable Intelligent Collectively Intelligent Decision- Capable Self-, Location-, Owner-, Role-Aware Interoperable Plug-and-play Self-Identifying Diagnostic Therapeutic Information Reducing Sensor Laden: Novel, Wearable, Surrogate EPR-Enabled Characteristics of Future Home Care Systems (cont.):  Characteristics of Future Home Care Systems (cont.) High-Surety Redundant Reliable Secure Ergonomic Distributed Dynamic Fractal Confederated Hardwired Wireless Fuzzy Bounds Sensible Cost Effective Standards Based Commodity Patient Specific Safe Robust Easy to Use Secure, Reliable Exchange of Medical Information:  Secure, Reliable Exchange of Medical Information Distributed Medical Information Database Clinic Emergency Scene Hospital Prison School Research Facility Battlefield Company Home LSTAT , in this artist rendering, is under development by Northrop Grumman Getting There: Infrastructure Development Approaches:  Getting There: Infrastructure Development Approaches Home Networking Standards & Initiatives:  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.org 3Com HomeConnect Home Network Phoneline Adapter Linksys HomePNA Adapter Interoperability Technology:  Interoperability 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 Component Confederacies:  Component Confederacies Devices: smart, aware Collective Intelligence Distributed Dynamic Secure Basic Component Interaction:  Basic Component Interaction Beauty Public interfaces; Private implementations Standards: interaction Object: client or server Component-level security Mediator Component  Object What it knows What it can do Distributed (C++/Java  CORBA/Jini/DCOM) Fractal: component = device, collection, etc. Requirements for Smart Home Care Systems:  Requirements for Smart Home Care Systems Component Self-Awareness Component Interoperability Component-Level Security Requirement: Component Self-Awareness:  Requirement: 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 Requirement: Component Interoperability:  Requirement: Component Interoperability Procedures Device Specifications 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” Requirement: Component-Level Security:  Requirement: 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 Early Work:  Early Work Telemedicine Interoperability Architecture:  Telemedicine Interoperability Architecture “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.gov The Role of Technology in Reducing Health Care Costs: http://www.sandia.gov/CIS/6200/Telemedicine/ Smaller-Scale Systems:  Smaller-Scale Systems Ophthalmoscope/Otoscope Thermometer Personal Status Monitor Typical Point-to-Point Telemedicine System:  Typical Point-to-Point Telemedicine System Patient Station Caregiver Station Communication Link Distributed Telemedicine System:  Distributed Telemedicine System Patient Station Caregiver Station Patient Record Server Diagnostic Services System Protocol Server Link Build 1 Patient Station:  Build 1 Patient Station USB Hub: Weight Heart Rate Blood O2 Sat Temperature Blood Pressure ECG Stethoscope Telemedicine Interoperability Architecture: http://telemedicine.sandia.gov The 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 Build 1 Architecture:  Build 1 Architecture Temp SpO2 Physical Devices CORBA CORBA Services (Security, Naming, Transactions, Trader, Event) USB Backplane BP DeviceX Desktop Virtual Device System I/F Logic Display MODEL VIEW CONTROL Component Pattern: ala Java Beans Medical Component Design Laboratory :  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 http://www.ieee1073.org/ http://www.bluetooth.com/ Technology Layout:  Technology Layout Wearable Monitoring System:  Wearable Monitoring System Ambulatory ECG & Pulse Oximeter; Data Logger in a ‘Fanny Pack’ Nested Master/Slave Configurations Bluetooth – Telemetry; Device discovery MIB – Device Association; Nomenclature; Data exchange Monitoring System Hardware:  Monitoring System Hardware Bluetooth Telemetry – Brightcom Callisto II Pulse Oximeter Electrocardiogram Data Logger Light-Based Sensors:  Light-Based Sensors Heart rate Oxygen saturation Respiration Motion (activity) Vessel hemodynamics Relative blood pressure Wearer identity Hemoglobin derivatives Hematocrit Components in Education:  Components in Education Laboratory Lecture Community Outreach:  Community Outreach Girls Researching Our World Light-Based Sensors to Indicate Hypertension Application: Animal Monitoring:  Application: Animal Monitoring 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 Prototype System:  Prototype System Handheld computer Bluetooth telemetry link GPS HR Core Temp SpO2 Microcontroller-based sensor module with serial communication to a Bluetooth telemetry module Activity Ambient Temp Humidity Mobile Monitoring Components Ear Tags  Light-Based Sensors Concluding Remarks:  Concluding Remarks Key Messages:  Key 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  Challenges:  Challenges Standards Require consensus from entities with competing goals Difficult to define given quickly changing technology 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 Contact Information:  Contact Information Steve Warren, Ph.D. Associate Professor Department of Electrical & Computer Engineering Kansas State University 2061 Rathbone Hall Manhattan, KS 66506 USA Phone: (785) 532-4644 Fax: (785) 532-1188 Email: swarren@ksu.edu http://www.eece.ksu.edu

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