Remote monitoring, telemonitoring uses in emerging medical sub branch Telemedicine.

1. BY
DR. RAVIKIRAN H M
MBBS, DNB ANAESTHESIOLOGY
ADMO, CENTRAL HOSPITAL, MALIGAON
DEPARTMENT OF ANAESTHESIOLOGY AND CRITICAL
CARE

2.  Conflict of interest: Medtronic-Stasis

3.  Introduction
 History
 Types
 Components
 Technology
 Advantages
 Applications
 Disadvantages
 Application in our Institute
 Product Example: Stasis

4.  Growing number of chronic disease
 Increased life expectancy
 Cost of health care
 Preventive strategy
 Emergence of telemedicine
 Telemonitring as a subdivision of Telemedicine.

5. Bulky & expensive devices, simple observations of patients’ clinical
variables were recorded and subsequently sent to physician’s office.
Collection and storage of these data in a cloud system which the
physician, at any subsequent point in time, could consult remotely
possibility modifying treatment recommendations based on the results.
Stand-alone systems equipped with self-intelligence and able to acquire
and elaborate data in order to inform the patient, of the need for
therapeutic modification, hospitalization or access to the emergency

6. Clinical
problem
Physician
focus
Whole
person
Office hours Access Anytime
Response
Care team
focus
Manage
& Prevent
Bricks
Site of
service
Mobile/Vi
rtual

7. HISTORY
First: ECG in 1905 by the
inventor of the ECG,
Einthoven.
In 1961 routine use of
telemonitoring began when
the ECG, respiratory rate,
electro-oculogram and
galvanic skin response of the
first human in space, Yuri
Gagarin, were continuously
monitored by doctors on
earth.
ECG tracings from Neil Armstrong, Buzz Aldrin and
Michael Collins, received at the Mission Control Center
approximately 384,467km away, during various periods of
the Apollo 11 mission to the moon in 1969.

8. TYPES
LONG
TERM
Periodic
data dump
EMERGENCY
EVENT
Real-time
alert

9. 1. Data acquisition using an appropriate sensor
2. Transmission of data from patient to clinician
3. Integration of data with other data describing the state of
the patient
4. Synthesis of an appropriate action, or response or escalation
in the care of the patient, and associated decision support
5. Storage of data.

10.  BP
 Blood sugar
 sPO2
 ECG
 Temperature
 Sleep
 EMG
 ETCO2
 Respiratory flow
 EEG

11.  Bluetooth: short range
radio frequency
 Cloud storage: store data
on the internet through
cloud computing provider
& operate data storage as a
service. Ex: Google Drive

12.  Artificial intelligence:
Automation & training a machine
to behave like human. Uses
historical & current data along
with algorithm.
 Machine learning: subset of AI,
making the computer smart
enough to carry out operations n
its own. Uses less data.
 Deep learning: subset of MI,
based on neural network (like
human brain). Uses unlabelled
dat.
Ex.: Tesla car

13.  Internet of things: Physical
objects with sensors, processing
ability, software that connect &
exchange data with other
devices/system over the internet or
other communications network. Ex:
Alexa
 5G: low latency of <5milleseconds,
higher bandwith: more
connections, download speed of
10gigabits/sec.
 Metaverse: Integrated network of
3D virtual worlds. Ex: Sandbox
game

14.  Chronic disease management
 Care at home
 Avoid readmission
 Avoid ER visits
 Avoid hospital acquired infections
 Extend independent living for elderly
 Stigma/Cultural belief
 Personalized health: Wearable, Illness prevention Apps
 Early patient discharge

15.  Reduce demand on caregiver
 Provide care for higher number patients: increased turnover
 Reduce infrastructure
 Few feet or be on different continents

16.  Integrated with ubiquitous mobile
 AI assisted decision making
 Computation of data
 Proper follow up
 More objective measurement of treatment effect
 Research
 Reduce work load: Better concentration on critical events
 Integration of data: Analytics

17.  Telemedicine
 In-home care
 Patient transport: Ambulance
 Disaster medicine: Battlefield, natural calamities
 Emergency worker
 Ward patient
 eICU
 Cardiac
 Sleep
 Clinical trial

21.  Lack of a full range of appropriate sensors
 The bulk weight and size of the whole system or its components
 Identification of invalid data
 Battery life
 Available bandwidth, network coverage, and the costs of data
transmission via public networks.
 Produce a mass of data - but this requires interpretation to be of
clinical use and much necessary research work remains to be done.
 Insurance-related issues

22.  Lack of acceptance among patients & Doctors
 Risk of breeching patient privacy
 No one can replace natures best technology: Human brain

23.  High risk cases sent out side for investigation
 Transportation of high risk patient to higher hospital
 Post operative monitoring
 Ward patient: Nursing staff patient ratio
 Isolation ward
 Cabin patients-better privacy
 Central integrated monitoring
 Medico legal issues
 Contractual and billing issues

24.  Remote/Cloud Monitoring

25. Cost-prohibitive and
limited available
connected devices
Lack of IT
infrastructure and
minimal IT team
Complicated and
restrictive clinical
workflows
Cloud-based, no IT
training required to
deploy
Software-first approach
using cost effective, IoT
hardware
Clinical data available on
any device, in any
environment
PROBLEM SOLUTION
25

26. 26
Stasis monitor, a connected care bedside multi-parameter monitoring
system.
Completely manufactured in India, aligning with the government’s vision
of #makeinindia
Clinical
Trust
Data
Insights
Data
Integration
Connected
Care
Actionable
reports Automated vitals
collection
Computer mobile devices
and more
Quality, reliability, and
security

27. COLLECT ANALYZE DELIVER
Devices
Stasis
connected
vital signs
monitor
Algorithms
Stasis AI send
predictive
insights
Stasis
Cloud
Connected
care without
IT
infrastructu
re
Stasis Apps
Easy data
access
anywhere on
web and mobile
Integratio
ns
Send/pull
data with 3rd
party
software
Enable hospital monitoring teams to deliver flexible,
data-driven care
27

28.  The Stasis Monitor
Stasis measures six key vital signs in a single
monitor:
HR,
SPO2,
ECG,
respiratory rate,
blood pressure
temperature.
 The Stasis Tablet
Intuitive monitoring—on a touchscreen.
Stasis makes it easy to customize the system
per patient and automatically document vital
signs to increase nursing productivity.

29.  The Stasis App
 Remote monitoring—on all your devices.
 Stasis provides access to high-resolution patient
charts and powerful notifications to a clinician’s
phone or computer.
 Features:
• Receive Insights to Mobile Device
• View Patient Trends and Waveforms
• Triage Patients Based on Risk
• No Limit to Number of Users per Facility
29

30.  The Stasis Cloud
 Actionable monitoring—securely stored
in the cloud.
 From day one, data is captured in a
historical record to provide data insight
reports to improve patient experience
and safely drive service line growth.
 Features:
• Provide Global View of Patient Recovery
• Identify Risks and Delays
• View Patient Trends & Alarms
• Print to Integrate into Paper Records
• Deploy as Many Dashboards as Needed
30

31. • Bluetooth encryption with AES-128 bit via RFC 4493; FIPS-compliant with data integrity through custom CRC
acknowledgements and Bluetooth retransmissions
• No extraction ports on the monitor;
• Tablet is locked to the Stasis Software using Mobile Device Management Software to ensure all data on device is secure and
allows for device lockdown. The Tablet can be remote-wiped if lost
• No local storage of any Protected Health Information (PHI) and all data on Monitor & Tablet is immediately erased upon
discharge of patient
• Patient Data on Tablet is removed from device upon the discharge and archival of the patient file on the Tablet
Security Protocols
• Encrypted in transit via TLS/SSL 256-bit certificates..
• Tablets are authenticated and authorized to the Cloud using a role-specific username and password
• HTTPS is enforced on all web requests
• Encrypted in transit via TLS/SSL 256-bit certificates..
• HTTPS is enforced on all web requests
• Apps require an authorized login with OTP and passwords for remote access managed by the designated Hospital
• The Apps are secure by requiring a clinical login and through in-built security measures (device passcode). Data is pulled
from the cloud as and when required without local storage
• Confidentiality
• Stasis is a processor and not owner of identifiable PHI
• Stasis is aligned with the Information Technology Act, 2000 and Cinemark rules made thereunder
• Stasis Cloud is domiciled in Mumbai and hosted on Amazon Web Services with data integrity, backup, and security
functionality provided by AWS
DATA SECURITY & CONFIDENTIALITY
Flow of data

32.  DRIVING PROACTIVE PATIENT CARE
32
US NON-PROVISIONAL PATENT GRANTED
• Covers patient health monitoring platform
• Claims are directed to analysis of health data
using machine learning models to predict short
term future health status
STASIS SMART ALERTS AI
• Predicts patient will alarm 20 minutes in advance
• Based on two peer-reviewed publications
• Training with beta hospital customers for 4 years

33. 33
48%
Reduction in
ICU Transfers
10%
Reduction in
Length of Stay
$1.48M
Annual Cost
Savings
86%
Reduction in Patient
Code Events
 1. Taenzer AH et al. Anesthesiology. 2010 Feb; 112(2):282-287
 2. Harvey Brown. Continuous Monitoring in an Inpatient Medical-Surgical Unit. 2014.
 American Journal of Medicine, Vol 127 No 3.
Proven repeatedly to deliver higher quality care at a lower cost

34. 90% Clinical Satisfaction in Outside of ICU Monitoring
Independent 5-month Peer Reviewed Published Clinical Study in
Indian Hospital
4x Reduction
in Cardiac
Arrests
Better Health Outcomes
80% Reduction
in Patient Cost
Lower Cost of Care
Improved Patient
Experience
76% Skipped
the ICU
Entirely

35. STASIS IN IP
Intensive
Care Unit
& Step
Down
Units
Acute
Care –
HDUs,
post-
surgical
wards,
A&E
General
Floor &
Private
Rooms
Outpatien
t Facilities
Rehabilitat
ion
Centers
Home
Health
INSIDE HOSPITAL OUTSIDE HOSPITAL
STASIS IN OP

36. Simply Connect | October, 2021 |
Confidential, for Internal Use Only 36
A Different Kind of Patient Monitoring
System
Here are some videos that I can think of maybe helping here. Let us know if need original video file
Stasis Explainer: https://www.youtube.com/watch?v=KnFQKidqc4I
Stasis India 1 minute case study: https://www.youtube.com/watch?v=itfB6omuXWA
Other testimonial examples: https://www.youtube.com/watch?v=yVRHabPWQS0&list=PLVmrnpao-Qf9npLfyDBYqe95p4Tx1Dshc
Stasis US video: https://www.youtube.com/watch?v=IkPtchzcBfI

37.  Appropriate use of technology
in this electronic era can make
an emergence of Medical sub
branch- Telemedicine.
 Nothing can replace human
touch & emotions.

38.  Nangalia V, et al.: Health technology assessment review: Remote
monitoring of vital signs - current status and future challenges.
Critical Care 2010, 14:233.
 Malasinghe LP, Ramzan N, Dahal K. Remote patient monitoring: a
comprehensive study. J Ambient Intell Human Comput (2019)
10:57–76
 Pronovost PJ et al. Remote Patient Monitoring During COVID-
19,An Unexpected Patient Safety Benefit. JAMA March 22/29, 2022
Volume 327, Number 12.
 Volterrani M, Sposato B. Remote monitoring and telemedicine .
European Heart Journal Supplements (2019) 21 (Supplement M),
M54–6.

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