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Ambulatory Monitoring of Patients
gadgets’ h_pe : hype or hope?
Assoc. Prof. Katarzyna Wac
University of Geneva & Universi...
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...
A typical night
A typical day (+ a gym session)
Moves
FREE
FitBit
99CHF
BASIS
169CHF
Speed of walking 1.6m/s
Meeting, email, Skype
Office applications
Reading, literature search
standing desk use, fatigue 1-2, pain 0
LifeSlice
FREE...
Next
• Body posture
• Respiration rate
• Continuous glucose monitoring
• Diet, eating patterns
• Medications compliance
• ...
Gut Sample
AmericanGut
99$
The Challenge
?
[G. Wolf and K. Kelly, Wired, 2007; Wac, IMIA 2012; Wac, SAA 2013; Wac, AAAI, 2014]
%error
Causes of Premature Deaths: Behavioral
• Cost of ‘behavioural’ diseases: 47 trillion USD for the next 20 years
(US)
[McGin...
ambulatory monitoring / mhealth / telemedicine
mhealth
Service Provider
Mobile Network
Operator
Care Professional (specialist)
Patient(s)
Care Professional
Internet
[e.g...
Telemedicine/mhealth Example (2020+)
m-health
Service Provider
Mobile Network
Operator
Care Professional (specialist)
Pati...
hype
Strengths & Weaknesses
• Design Principles
– Miniaturized, (always) connected
~ Personalized
~ Easier to use, relatively c...
Success Factors
[Broens et al., Determinants for Successful Telemedicine Implementations (literature review), 2007]
Attitu...
hope
self-management & support for caregivers
Example Projects (I)
AAL TraiNutri
- Smartphone Acc
- Physical activity levels
& patterns
- IC: Gold standard
EyeWalker
- ...
Example Projects (II)
FP7 ICT Giraffplus
- Activities of Daily Living
- In home-based
measurements
FP7 ICT
iStoppFalls
- K...
Conclusive Remarks
• Challenges Ahead
– Human factors &
User acceptance
– Privacy, security, trust
– Evaluation method vs....
Quality of Life by
[WHOQOL group, 1995]
?
Q&A
ambulatory monitoring of patients
http://www.qol.unige.ch
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Ambulatory Monitoring of Patients (mhealth’ h_pe : hype or hope?)

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Reference/Citation: Katarzyna Wac, Maddalena Fiordelli, Mattia Gustarini, Homero Rivas, Quality of Life Technologies: Experiences from the Field and Key Research Challenges, IEEE Internet Computing, Special Issue: Personalized Digital Health, July/August 2015.

Presented at the XIV Congrès de la Société Francophone d'Analyse du Mouvement chez l'Enfant et l'Adulte (SOFAMEA), Geneva, Switzerland, Feb 2015. See Video of recording: https://mediaserver.unige.ch/play/87916

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Ambulatory Monitoring of Patients (mhealth’ h_pe : hype or hope?)

  1. 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. 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… ? %error
  3. 3. A typical night
  4. 4. A typical day (+ a gym session) Moves FREE FitBit 99CHF BASIS 169CHF Speed of walking 1.6m/s
  5. 5. Meeting, email, Skype Office applications Reading, literature search standing desk use, fatigue 1-2, pain 0 LifeSlice FREE RescueTime FREE
  6. 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. 7. Gut Sample AmericanGut 99$
  8. 8. The Challenge ? [G. Wolf and K. Kelly, Wired, 2007; Wac, IMIA 2012; Wac, SAA 2013; Wac, AAAI, 2014] %error
  9. 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. 10. ambulatory monitoring / mhealth / telemedicine
  11. 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. 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. 13. hype
  14. 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. 15. Success Factors [Broens et al., Determinants for Successful Telemedicine Implementations (literature review), 2007] Attitude Usability Evidence-based solutions
  16. 16. hope self-management & support for caregivers
  17. 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. 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. 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. 20. Quality of Life by [WHOQOL group, 1995] ?
  21. 21. Q&A ambulatory monitoring of patients http://www.qol.unige.ch

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