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
 Well...
Pursuit of Wellness
 State of complete
physical, mental and
social well-being
 Health results from
primarily positive
pe...
Wellness Support
 Growing need for new sources of
data, and data interpretation
 Integration of multiple diagnostic
sour...
Wellness Technologies Monitor
 Nutrition
 Exercise
 Biometrics

 Pain reduction
 Stress reduction
 Sleep improvement...
Wellness Support
 Food coaching
 Rewards
 Exercise
 Nutrition
 Therapeutic compliance

 Consequence reporting
 Cons...
Home Health IT
 New revenue sources:
Medical Cloud
coaching and
Interpretations

Cloud
Interpretations
Proliferation
of Wellness
Tools
 Accelerometer

based

Striiv
Basis

FitBit

 Various models

for data delivery
 Basic
...
KNOWS

LEARNS

You and what is
around you

What you like

SENSING
Local content
& services discovery
Source: Jarrin (Qualc...
KNOWS

LEARNS

You and what is
around you

What you like

SENSING
Local content
& services discovery
Source: Jarrin (Qualc...
Lifewatch AG

new ipad mini
Portable Diagnostics
 iPhone based
portable ultrasound

 EKG
 Otoscope
 Dermatoscope

 Microscope
Cell Scope ™
 Dermatoscope – iPhone clipon
 Transmits high quality magified

pictures of skin blemishes

 “Smart Otosco...
Otoscope Images

Normal Ear Drum

Ear Infection

Ruptured ear drum
Cloud Based Diagnosis of Parkinsons
 Non-invasive phone
based

 Low Cost

 Accurate (98%)

 Scalable to large
populati...
iPhone Body Fluid Diagnostics
 Biosense Technologies
 uCheck

 ToucHb
Continuous Glucose Monitoring

Dexcom
Embedded Wellness Sensors
 Instrument common
fixtures
 Wireless
transmission of data
 Web based
aggregation and

interp...
Action Inspired Instruction
 Real time coaching
 Medically approved
content

 Tailored for individual
Passive Wellness Monitoring

Healthcare providers

Vital Sensor

Urine analyzer
Data management PC

Urine protein
Urine gl...
The M.A.R.C. In-Home
Health Monitoring Project
 Create a model where the impact of chronic
disease is delayed or avoided
...
Passive Remote Sensing
 Wireless Sensor Array (WSA) – gathers data on daily

activities

 Data Manager (DM) –transmits d...
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
...
Passive Vital Sign Bed Monitor
Mattress pad to measure:
• Sleep quality
• Pulse (and HRV)
• Breathing
• Movement/
restless...
Sleep Quality Graphs
Restful Resident

Restless Resident
Remote Automated Triage
 Real time assessment of participant health

status/well being
 Ability to drill down to specifi...
30
One Click Trending
 Health
 Socialization
 System

utilization
Telehome Monitoring Decreases
Costs by 74%
70000
60000

Dollars $

50000
40000
30000
20000
10000

Overall Cost of Care Com...
FUTURE WELLNESS
TECHNOLOGIES
3D Manufacturing
36
Wearable Cancer Detection
 First Warning Systems™ heat distribution sensing
sports bra

0.2cm

1cm

4cm
Underwear That Measures Blood
Pressure
 Pulse wave velocity
correlates with blood
pressure
 Tissue impedance shows
passi...
Automated Pharmaceuticals
 Automated Pill – iPill (Philips)
 Magnatrace™ System looks for pill
ingestion

 Networked pi...
Automated Intestinal Biopsies
 Intestinal diagnostic
imaging coupled with
miniaturized biopsies
 Pillcams with
intestina...
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 c...
Virtual Reality
 Image enhancement,
correction, zoom
 Correction currently

limited to 0.2
logMAR, 20/32
 Full view sof...
Augmented Reality
 Projection of

underlying anatomy
on living tissue
 Relies on
superimposition of
reality and
previous...
Not for the Faint Hearted
Receptivity
 Presenting health vs
wellness to a patient
 Determining what

information is TMI
 Optimizing the time
for ...
Medical Automation.org
A non-profit
educational
organization
improving
healthcare quality
and efficiency
through teaching
...
TagLine - Medical reality
http://medicalautomation.org
Robotic Reality

HRP-4C National Institute of
Advanced Industrial Science and
Technology
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
Transforming Healthcare Through Innovation
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Transforming Healthcare Through Innovation

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Presentation by Robin A. Felder, PhD, Professor and Associate Director of Clinical Chemistry and Pathology, former Director of the Medical Automation Research Center and Chair, Medical Automation

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  • On April 1924, when Radio News published a cover story titled, "Radio Doctor - Maybe," it offered readers one of the first glimpses into what medicine and the patient-physician relationship might (or should) look like in the future. Like most predictions, this glimpse into the future of "telemedicine," while fairly successful in foreshadowing new technologies in medicine, was predictably more myopic in understanding its full impact on patients, their families, and their physicians.The image on the Radio News cover depicts a young boy sitting on the edge of his bed, with his tongue sticking out, as he stares into the monitor of a sophisticated device: a radio equipped with interactive video transmission and several medical instruments. At the other end of the connection, as represented in the monitor, a physician peers into the patient's throat, while simultaneously listening to his heartbeat through a stethoscope applied to the boy's chest.On a scientific level, the Radio News cover is quite remarkable, considering it appeared before most of the technologies it represents became available. The multimedia platform depicted in the image was probably identified as a "radio" because that was the only communication device with a name and function that would ring familiar to a general readership of that era. In fact, the device was more like a television than a radio. In 1924, the television, as we know it, would not be tested for another 3 years, and videoconferencing, which is now increasingly used in patient-to-physician and physician-to-physician telecommunication had not even been invented. The stethoscope depicted in the image foreshadowed the variety of diagnostic, monitoring, and other medical instruments that are routinely employed today in telemedicine.
  • Helping patients understand their medical issues in order to enable them to make informed choices has always been challenging. Furthermore, physicians have to integrate data coming from multiple diagnostic sources. Third party sites are proliferating that provide knowledgeable interpretation using public or proprietary algorithms. Highly motivated individuals who generally make healthy choices will fall off the wagon when presented with unhealthy choices.
  • Helping patients understand their medical issues in order to enable them to make informed choices has always been challenging. Furthermore, physicians have to integrate data coming from multiple diagnostic sources. Third party sites are proliferating that provide knowledgeable interpretation using public or proprietary algorithms. Highly motivated individuals who generally make healthy choices will fall off the wagon when presented with unhealthy choices.
  • Helping patients understand their medical issues in order to enable them to make informed choices has always been challenging (data on how many people make wrong choices and why). Furthermore, physicians have to integrate data coming from multiple diagnostic sources. Third party sites are proliferating that provide knowledgeable interpretation using public or proprietary algorithms
  • Pill looking device _ Shine MisFit By now, if you don’t already have an activity-tracking device like a FitBit, you’ve at least heard of them. In early 2013, more than 500 companies make self-tracking tools. While the bulk of these are consumer devices, it’s likely that the functionality of these devices will continue to expand going forward, and will begin to resemble medical devices. Already, wearable products from BodyMedia are certified by FDA as a Class II medical device and the roster of FDA-cleared apps continues to tick upwards. In years to come, breakthroughs in flexible electronics and eventually nanotechnology could ultimately take the self-tracking field to a whole new level.Shown here is the Shine from Misfit Wearables, a wearable fitness tracker. The company, which was founded by medical device veteran Sonny Vu, has hinted that its future products will detect a range of health parameters.
  • The uChek iPhone app was invented by 29-year-old MIT graduate MyshkinIngawale, co-founder of Biosense Technologies, a company based in Mumbai that specializes in accessible and cheap medical technologiesRead more at http://www.medicaldaily.com/articles/14162/20130228/urinalysis-app-turns-iphone-mobile-urine-test.htm#PkbqTv4R7RTfcc58.99http://www.medicaldaily.com/articles/14162/20130228/urinalysis-app-turns-iphone-mobile-urine-test.htm
  • WellAWARE™, provides unobtrusive, highly accurate wellness monitoring services to allow individuals to age with options.
  • The Ascendance of 3D PrintingAs 3D printing mingles with regenerative medicine and stem cell research, scientists will become increasingly adept at using it to create engineered organs, grafts, and for orthopedic applications. In an interview, Daniel Kraft, MD, executive director of FutureMed at Singularity University in Silicon Valley notes that 3D printing, or, more broadly, digital manufacturing, could result in breakthroughs in everything from diagnostics to medical device development.Qmed http://www.qmed.com/mpmn/gallery/image/ascendance-3d-printing
  • BionicsThe potential of bionics to disrupt healthcare is huge. Already, Ekso Bionics has developed a robotic system that enables paralyzed patients to walk. The company’s CEO, Eythor Bender says that, in the future, bionic exoskeletons will be “the jeans of the future.”
  • Proteus ingestible event markers (IEMs) are tiny, digestible sensors made from food ingredients, which are activated by stomach fluids after swallowing. Once activated, the IEM sends an ultra low-power, private, digital signal through the body to a microelectronic receiver that is either a small bandage style skin patch or a tiny device insert under the skin. The receiver date- and time-stamps, decodes, and records information such as the type of drug, the dose, and the place of manufacture, as well as measures and reports physiologic measures such as heart rate, activity, and respiratory rate. The IEM is manufactured on silicon wafers, and is extremely economical to produce, costing a few cents per sensor in large quantities. The IEM is the cornerstone of the company’s Raisin™ System, which is currently in clinical development. The Raisin™ System measures the body’s response to medications and is intended to improve the management of chronic diseases like heart failure, infectious disease and psychiatric disorders.
  • Transforming Healthcare Through Innovation

    1. 1. Robin A. Felder, PhD The University of Virginia Department of Pathology TRANSFORMING HEALTHCARE THROUGH INNOVATION
    2. 2. Disclosures  University of Virginia  Department of Pathology  Medical Robotics  Medical Automation  Hypogen  WellAWARE Systems  MeyeChem  Proteus Bio  Global Cell Solutions  Monte Piccolo Farm
    3. 3. 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
    4. 4. 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
    5. 5. Wellness Technologies Monitor  Nutrition  Exercise  Biometrics  Pain reduction  Stress reduction  Sleep improvement  Mood enhancement  Health and wellness
    6. 6. Wellness Support  Food coaching  Rewards  Exercise  Nutrition  Therapeutic compliance  Consequence reporting  Consequence forecasting Overcome vicarious goal fulfillment or, “exhaustion of selfcontrol”
    7. 7. Home Health IT  New revenue sources: Medical Cloud coaching and Interpretations Cloud Interpretations
    8. 8. Proliferation of Wellness Tools  Accelerometer based Striiv Basis FitBit  Various models for data delivery  Basic physiologic measurements Shine Misfit BodyMedia Nike Feulband Scanadu Tricorder Zephyr Information Week BodyMedia
    9. 9. KNOWS LEARNS You and what is around you What you like SENSING Local content & services discovery Source: Jarrin (Qualcomm) DISCOVERS Things relevant to you FILTERS Out the irrelevant SEEING INTERACTING Augmented reality UI: Map, 3D, in building navigation Connection manager (WAN, Wi-Fi)
    10. 10. KNOWS LEARNS You and what is around you What you like SENSING Local content & services discovery Source: Jarrin (Qualcomm) DISCOVERS Things relevant to you FILTERS Out the irrelevant SEEING INTERACTING Augmented reality UI: Map, 3D, in building navigation Connection manager (WAN, Wi-Fi)
    11. 11. Lifewatch AG new ipad mini
    12. 12. Portable Diagnostics  iPhone based portable ultrasound  EKG  Otoscope  Dermatoscope  Microscope
    13. 13. Cell Scope ™  Dermatoscope – iPhone clipon  Transmits high quality magified pictures of skin blemishes  “Smart Otoscope” – iPhone ear drum microscope  Transmits pictures of videos of the ear canal and ear drum  Looks at progression or regression of disease
    14. 14. Otoscope Images Normal Ear Drum Ear Infection Ruptured ear drum
    15. 15. Cloud Based Diagnosis of Parkinsons  Non-invasive phone based  Low Cost  Accurate (98%)  Scalable to large populations  Remote, non-expert  Rapid diagnosis Max Little - Parkinson’s Voice Initiative TED Conference 2012
    16. 16. iPhone Body Fluid Diagnostics  Biosense Technologies  uCheck  ToucHb
    17. 17. Continuous Glucose Monitoring Dexcom
    18. 18. Embedded Wellness Sensors  Instrument common fixtures  Wireless transmission of data  Web based aggregation and interpretation
    19. 19. Action Inspired Instruction  Real time coaching  Medically approved content  Tailored for individual
    20. 20. Passive Wellness Monitoring Healthcare providers Vital Sensor Urine analyzer Data management PC Urine protein Urine glucose ·Body temperature ·Pulse ·Blood Pressure ·Body fat percentage
    21. 21. 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
    22. 22. 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
    23. 23. Passive Gait Sensors Vibration sensors placed in the house detect occupant gait
    24. 24. Passive Physiologic Sensors Physiologic sensors embedded in common household furniture and fixtures
    25. 25. 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
    26. 26. Passive Vital Sign Bed Monitor Mattress pad to measure: • Sleep quality • Pulse (and HRV) • Breathing • Movement/ restlessness • Bed exit • Subject position/ turning • Body temperature • Blood Pressure Passive Sensing Polysomnography
    27. 27. Sleep Quality Graphs Restful Resident Restless Resident
    28. 28. 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
    29. 29. 30
    30. 30. One Click Trending  Health  Socialization  System utilization
    31. 31. Telehome Monitoring Decreases Costs by 74% 70000 60000 Dollars $ 50000 40000 30000 20000 10000 Overall Cost of Care Comparison $67,757.88 Unmonitored 80000 $17,407.02 Monitored 0 N=21 in each group, P<0.05; Telemed J E Health, 2007 13(3):279-85
    32. 32. FUTURE WELLNESS TECHNOLOGIES
    33. 33. 3D Manufacturing
    34. 34. 36
    35. 35. Wearable Cancer Detection  First Warning Systems™ heat distribution sensing sports bra 0.2cm 1cm 4cm
    36. 36. 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
    37. 37. 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
    38. 38. 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
    39. 39. The Eye as the Window to Health Medical Robotics UCSD Preventive Science Inc. Univ. of MD, Baltimore
    40. 40. MeyeChem, LLC  Real time glucose monitoring  Alerts for low or high glucose concentrations  Trending analysis  Food coaching via telenutritionalmentoring
    41. 41. 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
    42. 42. Augmented Reality  Projection of underlying anatomy on living tissue  Relies on superimposition of reality and previously scanned animated image/data
    43. 43. Not for the Faint Hearted
    44. 44. Receptivity  Presenting health vs wellness to a patient  Determining what information is TMI  Optimizing the time for the presentation of wellness strategies “Wellformation”
    45. 45. 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
    46. 46. TagLine - Medical reality http://medicalautomation.org
    47. 47. Robotic Reality HRP-4C National Institute of Advanced Industrial Science and Technology
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