As the rate of information technology increases at an exponential rate, more and more devices and sensors which are capable of harnessing crucial data (such as vital signs) are being integrated into the healthcare ecosystem. The benefit of mobile technologies to intervene and improve health is increasingly becoming a topic of discussion. Through the use of examples from three primary chronic conditions, this report will critically analyse the scientific findings of the use of these sensors and the possible impact they might have on future diagnoses and improving the overall efficiency and accuracy of healthcare management. This report will specifically interrogate the multiple technologies which can be integrated for cardiovascular problems, diabetes and chronic obstructive pulmonary disorder. The overall findings concluded that these novel technologies would provide considerable improvements to healthcare, but would have to overcome several obstacles prior to total integration. A cost-benefit analysis would have to be done to overcome the previous more traditional approach.

1. The potential use of mobile
and wearable sensor devices
in the management of
chronic diseases
Timothy Delany
09322833
Supervised by
Dr. Brian Caulfield

2. Source: Statistics Bureau
World Population Pyramids

3. • High cost of healthcare
• Inefficient management of chronic diseases
• Poor regulation of health interventions
• Overcrowding of the hospital setting
Difficulties which currently exist in the healthcare ecosystem

4. • 2nd Highest household expense
The Cost of Healthcare
• The number of insured is decreasing annually
• 32% of people refuse to see doctor when sick/injured
47% of this is because of the high cost
In 10 years, the Irish healthcare spend has doubled to $19 billion
Year % GDP (US) Cost ($)
2010 17.9 2.6 trillion
2020 19.8 4.6 trillion

5. Obesity forecasts
Source: E-health Strategy

6. • In the United States they make up ¾ of the healthcare costs,
affecting more than 140 million individuals and accounting for $2
trillion/annum
• Major cause of mortality, accounting for 46% of global diseases
Chronic Diseases
• By 2020 – 89% of diseases in high income countries will be chronic
• In Ireland – chronic diseases make up 80% of the healthcare costs

7. • Cardiovascular disease
• Diabetes
• COPD
Non – Communicable Diseases
In 2011, WHO called on governments to focus on reducing the
prevalence of these major chronic diseases

8. This case study will cover the following aims:
1. To describe the burdens the current healthcare ecosystem faces,
specifically with regards to chronic diseases.
2. To explain the potential that mobile and wearable technologies
could have if integrated into this ecosystem.
3. To give an overview of various vital signs and measurements these
devices can assess; specifically focussing on cardiovascular problems,
diabetes and lung function.
4. To outline the potential implementation of current devices into
the ecosystem of these chronic diseases.
Aims of this Case Study

9. • Inefficient clinical trials
• Access to healthcare
• Patient compliance
• Nosocomial infections
• Access and transportation
Other Burdens

10. Hospital Setting
• Full of highly resistant bacteria and pathogens
• 2/3rds of hospitals are contaminated
• Extranasal-methicillin resistant Staphylococcus aureus
(MRSA)
• Potential to accelerate patient’s illness
• >100,000 fatalities in the US every year due to wrong
medicines being received

11. Clinical Trials
• Current gold standard for configuring efficacy of
health interventions is randomised clinical trials
(RCT)
• Have evolved slowly over time
Source: ClinicalTrials.gov

12. • Long time lag between recruiting participants and
publication
• High costs
• Limitations to current rating scales
• Irregularity of measurements/titrations
• Controlled circumstances and environments –
significant outcomes already determined
Problem with Clinical Trials?

13. What can be done to
overcome these
burdens?

15. Evolution of Internet Connected Devices
Source: Cisco

16. Creation of a New Patient-Centric Environment
Source: E-health Strategy

17. Source: HIS Inc.
Forecast for wearable tech revenue growth ($bn)

18. • Evaluation of disease, environmental toxins, motion,
hormones, behaviour and other physiological
variables
• Clinical trials to be carried out in multiple
environments
• Improve knowledge of the etiology of illnesses
• Monitor fluctuations in health
• Continuous monitoring
Potential

19. Important measurements
1. Cardiovascular Problems
2. Diabetes
3. Chronic Obstructive Pulmonary Disease

21. 1. Cardiovascular Problems
• The heart beats roughly 3 billion times in a person’s lifetime
• No surprise that cardiovascular problems are the leading
cause of death worldwide

22. Blood Pressure
Crucial in prevention of cardiovascular diseases
Past measurements have failed to account for circadian rhythms
Ishikawa et al (2011) found 24 Hour monitoring of blood pressure
provides a significant amount of information

23. Difficult to exercise or shower with
Holter Monitor - 1949
1999
Device Integration
MacManus et al 2010 – mean systolic blood pressure decrease by 5.4mm Hg
Continuous monitoring has also lead to the discovery of
‘White Coat Hypertension’ and ‘Masked Hypertension’

24. iHealth Sensor

25. Heart Rate
Heart Rate
Arrhythmias, bradycardia and tachycardia often indicate asymptomatic diseases

26. Device Integration

29. 2. Diabetes – Glucose monitoring
Global total has surpasses 350 million
It is estimated that 40% of diabetics in the U.S. are undiagnosed
Mobile phone
intervention
improved the
glycated
haemoglobin by 1.8%
Source: Quinn et al 2011

30. Nanosensor Tattoo

31. Amperometric sensing contacts

32. 3. Lung Function
3rd Leading Cause
210 million
Difficult to measure

33. Varying levels of air flow volumes for lung diseases
Source: Cleveland Clinic

34. Plethysmography and pneumography devices have been
implemented into wearable technology
Spiro Vest
Source: Enokibori et al
Device Integration

35. Discussion

36. Possible Problems
Security – 43% of identity thefts are medical
Privacy – maintaining annomyinity
Data – sheer volume
Regulation – FDA list of guidelines
Noise – can obscure measurements

37. Telehealthcare evolution (no. of people)
Source: E-health Strategy

38. Future and Recommendations
• Pros appear to outweigh the Cons
• Numerous studies have found that continuous
measurement is more effective
• Integrate sensors into current clinical trials
• Technologies will be obsolete though? Solution =
continuous evaluation of evolving interventions
(CEEI)

39. Conclusion
• Advance the quality of health services and decrease overall
cost of healthcare
• Improved studies outside of laboratory environment
• More high-quality RCTs need to be carried out to evaluate the
clear advantage of these technologies
• In order for monitoring to succeed in the long term,
integration of biomedical functionality, fashion and health
added value are crucial
• Accurate and reliable real-time information -> better
management
Higher precision, improved sampling frequency, fewer
misleading data, greater convenience, and lower cost

40. Thank You
Questions?
I’d like to acknowledge Dr Brian Caulfield for his guidance and support
Acknowledgments and Questions