Robin A. Felder, PhD The University of Virginia Department of Pathology

TRANSFORMING HEALTHCARE THROUGH INNOVATION

Disclosures

 University of Virginia  Department of Pathology         Medical Robotics Medical Automation Hypogen WellAWARE Systems MeyeChem Proteus Bio Global Cell Solutions Monte Piccolo Farm

Pursuit of Wellness

 State of complete physical, mental and social well-being  Health results from primarily positive perspectives and choices by which to live  Technology can provide information that facilitates positive choices Physical Social 6.2

9.1

8.0

Cognitive

Wellness Balance

© Felder, 2011

Wellness Support

    Growing need for new sources of data, and data interpretation Integration of multiple diagnostic sources (lifestyle, self testing) Integrated wellness and health record Ongoing information support for maintaining healthy lifestyles

Wellness Technologies Monitor

        Nutrition Exercise Biometrics Pain reduction Stress reduction Sleep improvement Mood enhancement Health and wellness

Wellness Support

    Food coaching Rewards    Exercise Nutrition Therapeutic compliance Consequence reporting Consequence forecasting Overcome vicarious goal fulfillment or, “exhaustion of self control”

Home Health IT

 New revenue sources: Medical Cloud coaching and Interpretations Cloud Interpretations

   Proliferation of Wellness Tools Accelerometer based Various models for data delivery Basic physiologic measurements FitBit BodyMedia Striiv Shine Misfit Basis Nike Feulband Scanadu Tricorder Zephyr Information Week BodyMedia

KNOWS

You and what is around you

LEARNS

What you like

DISCOVERS

Things relevant to you

FILTERS

Out the irrelevant

SENSING

Local content & services discovery Source: Jarrin (Qualcomm)

SEEING

Augmented reality UI: Map, 3D, in building navigation

INTERACTING

Connection manager (WAN, Wi-Fi)

KNOWS

You and what is around you

LEARNS

What you like

DISCOVERS

Things relevant to you

FILTERS

Out the irrelevant

SENSING

Local content & services discovery Source: Jarrin (Qualcomm)

SEEING

Augmented reality UI: Map, 3D, in building navigation

INTERACTING

Connection manager (WAN, Wi-Fi)

new ipad mini Lifewatch AG

Portable Diagnostics

     iPhone based portable ultrasound EKG Otoscope Dermatoscope Microscope

Cell Scope ™

  Dermatoscope – iPhone clip on  “Smart Otoscope” – iPhone ear drum microscope  Transmits high quality magified pictures of skin blemishes Transmits pictures of videos of the ear canal and ear drum  Looks at progression or regression of disease

Otoscope Images

Normal Ear Drum Ear Infection Ruptured ear drum

Cloud Based Diagnosis of Parkinsons

   Non-invasive phone based Accurate (98%) Remote, non-expert    Low Cost Rapid diagnosis Scalable to large populations Max Little - Parkinson’s Voice Initiative TED Conference 2012

iPhone Body Fluid Diagnostics

 Biosense Technologies  uCheck  Touc Hb

Continuous Glucose Monitoring

Dexcom

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 individual

Passive Wellness Monitoring

Healthcare providers Data management PC Urine analyzer Urine protein Urine glucose Vital Sensor ·Body temperature ·Pulse ·Blood Pressure ·Body fat percentage

The M.A.R.C. In-Home Health Monitoring Project    Create a model where the impact of chronic disease is delayed or avoided Provide opportunity for medical intervention before a crisis occurs Minimize impact of chronic disease on the healthcare system

Passive Remote Sensing

   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

Passive Gait Sensors Vibration sensors placed in the house detect occupant gait

Passive Physiologic Sensors Physiologic sensors embedded in common household furniture and fixtures

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

Restless Resident

Sleep Quality Graphs

Restful 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

30

One Click Trending

   Health Socialization System utilization

Telehome Monitoring Decreases Costs by 74% 80000 70000 60000 50000 40000 30000 20000 10000 0

Overall Cost of Care Comparison $67,757.88

$17,407.02

Monitored

N=21 in each group, P<0.05; Telemed J E Health, 2007 13(3):279-85

FUTURE WELLNESS TECHNOLOGIES

3D Manufacturing

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

Wearable Cancer Detection

First Warning Systems™ heat distribution sensing sports bra 0.2cm

1cm 4cm

Underwear That Measures Blood Pressure

 Tissue impedance shows passing pulses  Pulse timing correlated with relative pressure  Continuous blood pressure monitoring

Automated Pharmaceuticals    Automated Pill – iPill (Philips) Magnatrace™ System looks for 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 location  Continuous monitoring

MIT Technology Lab

The Eye as the Window to Health

Medical Robotics UCSD Preventive Science Inc.

Univ. of MD, Baltimore

MeyeChem, LLC

    Real time glucose monitoring Alerts for low or high glucose concentrations Trending analysis Food coaching via telenutritionalmentoring

Virtual Reality

 Image enhancement, correction, zoom  Correction currently limited to 0.2 logMAR, 20/32  Full view software modulated images  Superimposed augmented reality Off axis projection with transflective diffuser 90 ° field eyewear iOptik Gas-permeable nanopolarizer (iOptik contact lens) Diopter adjustable mini-scleral lens and wearable computer (iOptik) Zoom lens (3X) UCSD

Augmented Reality

 Projection of underlying anatomy on living tissue  Relies on superimposition of reality and previously scanned animated image/data

Not for the Faint Hearted

Receptivity

  Presenting health vs wellness to a patient  Determining what information is TMI Optimizing the time for the presentation of wellness strategies “Wellformation”

Medical Automation.org

A non-profit educational organization improving healthcare quality and efficiency through teaching automation principles and their application in health systems http://medicalautomation.org

TagLine - Medical reality

http://medicalautomation.org

Robotic Reality

HRP-4C National Institute of Advanced Industrial Science and Technology