Smart Medical Home Israel Gannot BioMedical Engineering Department

Smart Medical Home Israel Gannot Bio-Medical Engineering Department, School of Engineering, Tel-Aviv University George Washington University Washington, DC

Introduction The demographic trends of the advanced countries go towards the development of an older population. By the year 2035, one third of the American and European population will be more than 65 years old. Such a development will weigh down the health systems of the countries concerned as much at the economic than social Level. That rapid growth of the elderly population and increase in life expectancy have led to new models of positive ageing where older adults are being empowered to lead fulfilling lives and adapt to degenerative changes to maintain functionality, autonomy and quality of life. The purpose of that models is to make it possible for the elderly population continue living in their own homes.

• Proactive health involves maintaining the three rings of social performance Activity in the community Activity in the household Activity related to body Adapted from Larson MIT

Introduction The need for smart medical homes is due to: l l l Economical reasons Medical reasons (the most important) Personal reasons

The economical importance Growing medical expenditure is a serious problem in the countries with growing population. Earlier detection and treatment of diseases can be the solution to decrease the high costs. Early detection can be achieved by monitoring the health status at home. For example, a study that was made in the UK suggests that private residential living costs only 55% of the costs of full-time residential care [1].

The medical importance l l The health and wellness status of an elderly subject living alone might be remotely monitored to detect possible deterioration in his health status. Fall detections, detections of poor medication treatments, changes in sleep patterns, changes in physiological parameters, or even in cognitive abilities are all essential to managing the changing health status of the elderly.

The personal importance l The idea of independent living at home is very important for many elderly people. Once moved into a facility like nursing homes, it is common for them to become depressed because of their lack of independence and tendency to give up on life. l Technology could play an important role by providing a smart environment. The ability of the “smart home” to measure medical data, and send it to the caregivers through the internet, makes it possible to lengthen the independent living at home.

Curent solution: Assisted living environments

Natural living habitat

“Virtual nursing home” Unit Center

Multi-level health monitoring system Information models networks un so standards Inference Integration wireless l Traditional Vital Signs ua vis d Info-Sensors motion interoperability User Interface (From Pentland (Rochester

The idea l In this system, data acquisition from elderly will be achieved without the awareness of the person. l The detectors will be placed in the house in many different places, and the person will continue his regular life without wearing anything special on her(him)self (except of a wrist watch).

hinged panels to micro-controllers speakers air quality sensors IR illuminators hinged panels to sensor bus cabinet door switches countertop activity cameras From Larson, MIT – n_House refrigerator use sensors microwave use sensors oven & range use sensors cabinet drawer sensors hot water use sensor cold water use sensor hinged panels to sensor bus cabinet door switches sensor network connections internet connections temperature sensors Power integrated into cabinetry hinged panels to subwoofers

More basic ideas/assumptions The requirements from the sensors in the system are: Noninvasive, minimally-wearable, convenient to install and use, without restrictions on the person’s movements, without vibrations, without noise and light signaling, with a high reliability and a long life, wireless or with minimally amount of wires signal transmission, and waterproof [4].

The Computer system All the sensor devices will be connected to a special home network under which each device interacts with others in a “plug and play” manner [3]. A home installed computer performs routine data processing. The information will be transmitted through the internet to a medical center, and some information can be transferred to the relatives. l

The Computer system Middleware l l Middleware comprises both hardware and software – and it’s aim is to provide a platform to which the sensors send their data, and where the data is processed, stored, presented, and transmitted. We have chosen the OSGI Middleware to realize the system.

? What is OSGI l In 1999, OSGi (Open Services Gateway Initiative) was established as an independent non-profit organization working to define and promote delivery of managed services to networks in home and other environments. l OSGi specification requires services to be packaged into software “bundles. ” It also provides a framework on which these software bundles from different vendors can execute and interact.

? What is OSGI l The OSGI standard enables platform independence, and that is thanks to the Java programming language. l The OSGI platform can support and interconnect big number of communication technologies. For example: Bluetooth™ technology, HAVi, IEEE 802. 11®, IEEE 802. 15, IEEE 1394, Jini®, Salutation™, the UPn. P™ architecture, X 10, Home. Plug, and Home. PNA.

Medical standards l l l Medical Information bus (IEEE-1073). DICOM HL-7

Healthcare Devices and Applications

Physiological parameters l l l We want to use a wrist-worn device that can measure the heart rate and the body temperature of the person. The device will be connected to the home network wirelessly by radio frequency protocol. The device will include a RFID tag (small tags that can transfer RF signals) which enables the system to recognize the person and follow movements.

Smart alarms l Decision making from data collected from multiple sensors. • Looking at trends • Multi Parameter Algorithms. • Linkage to other clinical resources. • Decision Support.

The Smart Floor l Fall Detections: Falls are the second leading cause of unintentional-injury death for people of all ages and the leading cause of death for elders 79 years and older. Studies have shown that the medical outcome of a fall is largely dependent upon the response and rescue time [2].

The Smart Floor l The ability to measure the pressure signals on the floor’s cell, and a computer analysis of that signals will help us to know when a fall has occurred. l Another method that is considered is a special piezoelectric sensor coupled to the floor surface. When a fall occurs, typical vibration signature of the floor generated by the person’s body is sent to the computer. l In both ways the signal is sent via wireless device to the computer, and the alarm system is activated.

Mobility assessment l l l Changes in some aspects of mobility have been shown to correlate with changes in cognitive function and can perhaps predict future cognitive decline [7]. We can use the Smart Floor (implemented by pressure cells) to determine typical walking speeds by special algorithms. The value of the speed is less critical than its relative value, which allows assessment of changes.

Smart Toilet l l l Fiber optic evanescent-wave spectroscopy (FEWS) can be used in the “Smart Toilet” for the analysis of urinary salts. By the collections of Urine while the person doing his needs, the system makes the analysis, and sends the results to the computer through the local network. By the mobility assessment our system will be able to know for example how many times during the night the person visited the toilet.

ECG on a chair and in bed l l l Elderly people spend most of the time during the day on a chair in front of the TV, or in bed while sleeping. Studies showed that ECG waveforms can be obtained using electrodes fixed on a chair or in the bed, and measurements obtained without direct contact with the skin. [5] The signal will be sent to the home central computer via Bluetooth signals.

Sleeping Disorders l The current gold standard for sleep research is recording of an EEG, EMG, measurements of brain waves, and muscles activities. That electrodes can assess the sleep quality, but their attachment the patient’s body affects sleep. l Today, it is believed that sleep disorders measurements can be made the analysis of physiological characteristics such as body temperature, movement in bed, breathing rate heart rate, and snoring analysis.

Sleeping Disorders l l l An ultra sensitive piezoelectric transducer that will provide information about heart rate and breathing rate by filter analysis of the signals. Temperature sensors attached to the mattress, that can measure the temperature changes of the person. Pressure sensors to detect the movements of the person while he sleeping and when he is out of bed. Sound recorder for the detection of snoring. Detection of bacterial infection developed in bed sores All the sensors above allow the subject to sleep comfortably without having to wear electrodes or be hooked up to a machine.

Sleep studies From Goubran Carleton university

Medication Reminders According to the American Heart Association, more than half of all Americans with chronic disease do not follow their physician’s medication and lifestyle guidance, and nine out of ten make mistakes taking their medication [6]. The No. 1 problem in treating illness today is patients' failure to take prescription medications correctly, regardless of patient age [6].

Medication Reminders l We want to develop a smart pillbox that will be able to count the medications, and communicate with the central computer by RF medium in real time (for instance: Bluetooth). l The computer program will know the treatment schedule, and will be able to alert the person by a human voice message when a mistake has occurred. That way all the mistakes will be prevented.

Example: Speech Prosody Spectrogram Directly measure pitch vs. time … Contains a wealth of information! Pentland - Rochester

Image acquiring and processing l l Detect changes in skin temperature or condition (pale, red, …). Detection of changes in nevi (color, size, structure).

Telemedicine Devices l l Today there a lot of companies that develop telemedicine devices. The new generation of such devices, deliver the measured information over the internet, usually by RF protocol connection to the local computer. Our mission is to make it easy to connect such devices to our smart home system. It completes the whole picture of the person’s health status.

Telemedicine Devices Examples of the Card. Guard company: l Wireless 12 lead ECG - Self. Check™ ECG Cardiac Monitor l Self. Check™ BP Wireless non-invasive blood pressure and pulse rate monitor. l Oxy Pro Wireless Oximeter

Multi disciplinary effort l l l l Engineering (Sensing gadgets…, network design, signal and image processing, pattern recognition). Computer science (AI, Neural networks, Control programming ). Biomedical Informatics (Electronic medical records). Medicine (Geriatrics, internal medicine, Neurology and practically all disciplines). Architecture (re-design houses for the elderly people). Psychological (Behavior under constant monitoring). Philosophical (Ethical issues, cognitive changes in high tech environments). Economical (Are all these developments worth the investments, macro and micro).

Israeli companies in related home care field l Haldor: www. haldor-tech. com , RFID technology Nexense: www. nexense. com , smart sensors Card Guard: www. cardguard. com , telemedicine. Aerotel: www. aerotel. com , telemedicine HOMEFREE: www. homefreesys. com , Wireless Resident Monitoring Visonic: www. visonic. com , Senior Living Suites Early. Sense: www. earlysense. com , care of chronic patients Wide. Med: www. widemed. com , Sleep analysis Aeroscout: www. aeroscout. com , RFID solutions Shahal: www. shahal. co. il , Telemedicine leading company Medic 4 All: www. medic 4 all. com , Telemedicine l CNoga: www. cnoga. com , Physiological parameters with video camera l l l l l

Summary l l Health monitoring devices are of great importance for the design of smart homes for older persons. Continues monitoring of the health condition of the person may contribute to the extension of life expectancy and to a better quality of life.

Acknowledgements Alice Pentland - Rochester Kent Larson - MIT Steve Kell - UVA Tom Rose - Duke J. Michael Youngblad –UNC-Charlotte Rafik Goubran - Carleton

References l l l l [1] Tang, P. and T. Venables (2000). "Smart homes and telecare for independent living. " Journal of Telemedicine and Telecare 6: 8. [2] Alwan, M. , P. J. Rajendran, et al. (2006). A Smart and Passive Floor. Vibration Based Fall Detector for Elderly. [3] Warren, S. and R. L. Craft (1999). Designing smart health care technology into the home of the future. [4] Stefanov, D. H. , B. Zeungnam, et al. (2004). "The smart house for older persons and persons with physical disabilities: structure, technology arrangements, and perspectives. " Neural Systems and Rehabilitation Engineering, IEEE Transactions on [see also IEEE Trans. on Rehabilitation Engineering] 12(2): 228. [5] Yong Gyu, L. , K. Ko Keun, et al. (2006). "ECG measurement on a chair without conductive contact. " Biomedical Engineering, IEEE Transactions on 53(5): 956. [6] American Heart Association, Statistics you need to know. [7] R. Camicioli, D. Howieson, B. Oken, G. Sexton, and J. Kaye, "Motor slowing precedes cognitive impairment in the oldest old, " Neurology, vol. 50, pp. 1496 -8, 1998.