1. Ambulatory Monitoring of Patients
gadgets’ h_pe : hype or hope?
Assoc. Prof. Katarzyna Wac
University of Geneva & University of Copenhagen
{katarzyna.wac@unige.ch, wac@di.ku.dk}
http://www.qol.unige.ch
5th February 2015, SOFAMEA

2. 36 years old
female
161 cm, BMI = 23.3
BP: 117/76 mmHg
glucose (fasting): 5.8 mmol/l
RHR: 60 BPM, Sp02=97%
fatigue: 0-1/10
pain: 0/10
no bone fractures
no medications
blood A+, blood donor since 2004
Lifestyle
single, no children
sedentary office worker (since 2003)
light activity (walking ~1h/day, ~2-3/week 30min endurance session)
was vegetarian (age 13-25), red meat: ~1/month
non-smoker
social drinker of alcohol (~1/month)
Meet your patient…
?
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3. A typical night

4. A typical day (+ a gym session)
Moves
FREE
FitBit
99CHF
BASIS
169CHF
Speed of walking 1.6m/s

5. Meeting, email, Skype
Office applications
Reading, literature search
standing desk use, fatigue 1-2, pain 0
LifeSlice
FREE
RescueTime
FREE

6. Next
• Body posture
• Respiration rate
• Continuous glucose monitoring
• Diet, eating patterns
• Medications compliance
• Even further: blood, hormones
– cortisol, oxytocin, serotonin, dopamine
Lumback
249$
SPIRE
79$
FreeStyle
170€
HappiFork
99$
GlowCaps
99$
Talking20
99$

7. Gut Sample
AmericanGut
99$

8. The Challenge
?
[G. Wolf and K. Kelly, Wired, 2007; Wac, IMIA 2012; Wac, SAA 2013; Wac, AAAI, 2014]
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9. Causes of Premature Deaths: Behavioral
• Cost of ‘behavioural’ diseases: 47 trillion USD for the next 20 years
(US)
[McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff 2002;21:78-93]
[Mokdad AH, Marks JS, Stroup JS, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238-1245]
23andMe
99$

10. ambulatory monitoring / mhealth / telemedicine

11. mhealth
Service Provider
Mobile Network
Operator
Care Professional (specialist)
Patient(s)
Care Professional
Internet
[e.g., Wac et al., IEEE EMBC, 2009]
Telemedicine/mhealth Example (2003)

12. Telemedicine/mhealth Example (2020+)
m-health
Service Provider
Mobile Network
Operator
Care Professional (specialist)
Patient(s)
Care Professional
Internet
[Strickland, IEEE Spectrum, 2012]

13. hype

14. Strengths & Weaknesses
• Design Principles
– Miniaturized, (always) connected
~ Personalized
~ Easier to use, relatively cheap
~ Battery-efficient
– Gamification to increase “compliance” (  smartphone)
– Towards: actionable feedback addressing psychological biases
• e.g., myopia (“short-term vs. long-term” state)
• overconfidence (“not me”)
BUT (“colonization phase”)
– Unreliable (‘what is a step?’) vs. ground truth
– Not clinically validated
• Diagnosis, rehabilitation, treatment support?
[G. Wolf and K. Kelly, Wired, 2007; Wac, IMIA 2012; Wac, SAA 2013; Wac, AAAI 2014]

15. Success Factors
[Broens et al., Determinants for Successful Telemedicine Implementations (literature review), 2007]
Attitude
Usability
Evidence-based solutions

16. hope
self-management & support for caregivers

17. Example Projects (I)
AAL TraiNutri
- Smartphone Acc
- Physical activity levels
& patterns
- IC: Gold standard
EyeWalker
- Cameras, Acc sensor
- Mobility patterns
AAL MyGuardian
- Mild cognitive impairments
- Smartphone GPS
- Mobility patterns & security
zones
[www.qol.unige.ch/apps/ALE.html; cvml.unige.ch/doku.php/mmi/eyewalker; myguardian-project.eu]

18. Example Projects (II)
FP7 ICT Giraffplus
- Activities of Daily Living
- In home-based
measurements
FP7 ICT
iStoppFalls
- Kinect and Acc
- Measure movements
- ‘Exergame’
FP7 ICT CuPiD
- Parkinson’s ‘freeze of
gait’
- Smartphone + Inertial
Measurement Units
- Measure + give an
auditory feedback
[http://www.giraffplus.eu; http://www.istoppfalls.eu; http://www.cupid-project.eu]

19. Conclusive Remarks
• Challenges Ahead
– Human factors &
User acceptance
– Privacy, security, trust
– Evaluation method vs. RCT
• e.g., Sequential, Multiple
Assignment, Randomized Trials
(SMART)
– Organizational issues
– Interoperability,
standardization
– Legal, liability (e.g., FDA, EC)
– Financial aspects,
reimbursements
• Recommendations
– mHealth technologically
feasible for non-critical
cases
– Inter/trans-disciplinary
approach needed
• Translational
• User-centered design
– Bridge the gap via an open,
trustworthy dialogue
– Encode implicit
expectations &
requirements
– Innovation: “who’s turn is
now”?
• Innovating the intervention[Wac, IMIA 2012; Wac, SAA 2013; Wac, AAAI 2014]

20. Quality of Life by
[WHOQOL group, 1995]
?

21. Q&A
ambulatory monitoring of patients
http://www.qol.unige.ch