1. mHEALTHCARE
OPPORTUNITIES,CHALLENGES
AND
PROSPECTS
PROFESSOR C R LOWE
UNIVERSITY OF 4th FUTURE OF WIRELESS INTERNATIONAL CONFERENCE
CAMBRIDGE THE MØLLER CENTRE, CHURCHILL COLLEGE, CAMBRIDGE

2. WHY DO WE NEED mHEALTHCARE? THE
WORLD IS CHANGING
LIFESTYLE / WELLBEING
TRADITIONAL RISKS OBESITY
CANCER
PSYCHIATRIC DISORDERS/
NEURODEGENERATIVE
CEREBROVASCULAR DISEASE
DIABETES
RISK FOOD/WATER QUALITY
SIZE URBAN AIR QUALITY
OCCUPATIONAL RISKS
SECURITY / TERRORISM
UNDERNUTRITION
INFECTIOUS DISEASES
WATER
MODERN RISKS SANITATION
HYGIENE
TIME
HUMAN ENVIRONMENT CHEMICAL
INTELLIGENCE
LIFESTYLE
HEALTH & WELFARE
CLINICAL DISORDERS
UNIVERSITY OF WHY DO WE NEED mHEALTHCARE? THE WORLD IS
CAMBRIDGE
CHANGING

3. MOTIVATION FOR mHEALTH
CONSTRAINTS FELT BY HEALTHCARE SYSTEMS
POPULATION GROWTH AND DEMOGRAPHICS
HIGH BURDEN OF DISEASE PREVALENCE
LOW HEALTHCARE WORKFORCE
LARGE NUMBERS OF RURAL INHABITANTS
LIMITED FINANCIAL RESOURCES TO SUPPORT
HEALTHCARE INFRASTRUCTURE AND HEALTH
INFORMATION SYSTEMS
RAPID RISE IN MOBILE PHONE PENETRATION IN
DEVELOPING NATIONS
UNIVERSITY OF
CAMBRIDGE MOTIVATION FOR mHEALTH

4. mHEALTH MARKET SEGMENTATION
INSURANCE
COVERAGE
HOSPITAL
CHRONIC DISCHARGE
DM HOME CARE
CORPORATE
FITNESS
HOME mVISIT
DIAGNOSTICS MEDICAL
HOME
SENIOR PRACTICE
FITNESS
MEDICATION EMR
MONITORING PROFESSIONAL
SELF-CARE
mPERSONAL CARE
MEDICATION HEALTH
RECORDS RETAIL
REMINDER CLINIC
FITNESS FALL
MONITORING ONLINE
TRACKING
DM
WANDER-OFF
MONITORING AT-HOME WELLNESS/ TeleHEALTH
DIET mEXPERT
ACTIVITY FITNESS
CONTROL OPINION
CONSUMER MONITORING
WIKI
mHEALTH mCARE
SELF-PAY
UNIVERSITY OF
CAMBRIDGE mHEALTH MARKET SEGMENTATION

5. FACTORS SHAPING THE FUTURE OF mHEALTHCARE
LIFETIME DIAGNOSTIC MANAGEMENT
EARLY
CONCERN SYMPTOMS DISEASE
HEALTHY WORRIED ACUTELY CHRONICALLY
WELL SICK ILL
FOOD/WATER/AIR QUALITY BLOOD ANALYTES DIABETES
LIFESTYLE LIVER/KIDNEY DYSFUNCTION CANCER
ALCOHOL/DRUGS OF ABUSE FAECAL OCCULT BLOOD ISCHAEMIC HEART DISEASE
STRESS GLUCOSE COPD
SLEEP DISORDERS HAEMOGLOBIN A1C NEURODEGENERATIVE/
MIGRAINE ASTHMA NEUROPSYCHIATRIC DISORDERS
PREGNANCY MENOPAUSE CEREBROVASCULAR DISEASE
FERTILITY COAGULATION/PLATELET FUNCTION HIV/AIDS
INFECTIOUS DISEASES
STI
HOME HOME A&E CENTRAL
WORKPLACE PHYSICIAN’S OFFICE BEDSIDE LABORATORY
CLINICAL CENTRE ITU
UNIVERSITY OF FACTORS SHAPING THE FUTURE OF mHEALTHCARE
CAMBRIDGE LIFETIME DIAGNOSTIC MANAGEMENT

6. FACTORS SHAPING THE FUTURE OF mHEALTHCARE
EMERGING THERANOSTIC INTERVENTIONS
COMPLIANCE TESTING
SUSCEPTIBILITY MONITOR PATIENT
RESPONSE
RISK
PREDICTION TREATMENT REGIME
(THERAPEUTIC
DIAGNOSIS STRATIFICATION) ADR
DISEASE EVOLUTION
PROGNOSIS PATIENT
STRATIFICATION
UNIVERSITY OF EMERGING THERANOSTIC
CAMBRIDGE INTERVENTIONS

7. FACTORS SHAPING THE FUTURE OF mHEALTHCARE
DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE
RAPID BLOOD GASES (pO2, pCO2)
REAL-TIME GLUCOSE
IONS (Na+, K+, Cl-
HORMONES (CORTISOL)
NEUROTRANSMITTERS
MEDIUM METABOLITES/BIOMARKERS
UREA
CREATININE
BILIRUBIN
TRIGLYCERIDES
LONG IRON
ALBUMIN
HAEMOGLOBIN A1c
IMMUNOGLOBULINS
CHOLESTEROL
CONCENTRATION RANGE [C] = 10-1-10-18M
UNIVERSITY OF FACTORS SHAPING THE FUTURE OF mHEALTHCARE
CAMBRIDGE DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE

8. NON-INVASIVE
PATIENT SENSOR RECORDING FORMATS
NON-INVASIVE
MINIMALLY
(SPECTROSCOPIC)
INVASIVE INTELLIGENT
CLOTHES/
CONTACT LENS ACCESSORIES/
BREATH JEWELLRY
ANALYSIS
BLOOD
ISF SKIN E-PATCH
CSF WATCH
DIGITAL PLASTER
INVASIVE FINGERSTICK
BREATH
COSMETICS TEARS
INDWELLING SALIVA
SMART TATTOO
CATHETERS SWEAT
BLOOD
SUBCUTANEOUS URINE
IMPLANTS FAECES
SEMEN
UNIVERSITY OF
CAMBRIDGE PATIENT SENSOR RECORDING FORMATS

9. BIOSENSOR PRINCIPLES AND
TRANSDUCERS
ANALYTE
ELECTRICAL
(BIO)RECOGNITION
SYSTEM OPTICAL
ACOUSTIC
THERMAL
TRANSDUCER MAGNETIC
INSTRUMENTATION
MICROENGINEERED
UNIVERSITY OF BIOSENSOR PRINCIPLES AND
CAMBRIDGE TRANSDUCERS

10. KEY ATTRIBUTES OF MOBILE/WEARABLE
SENSORS
QUICK TIME-TO-ANSWER
SIMPLE READOUT
LOW COST
EASILY/INEXPENSIVELY MANUFACTURED
MINIATURE AND LOW (OR NO) POWER BURDEN
GOOD SENSITIVITY AND SPECIFICITY
USED BY MINIMALLY TRAINED PERSONNEL
FUNCTION >30 °C AND AT HIGH HUMIDITY
LONG STORAGE TIMES WITHOUT REFRIGERATION
NO LOCAL REAGENTS/WATER AND/OR SPECIALIZED
EQUIPMENT
DETECT MULTIPLE PATHOGENS
UNIVERSITY OF
CAMBRIDGE KEY ATTRIBUTES OF MOBILE/WEARABLE SENSORS

11. MICROAMPEROMETRIC BIOSENSORS
40
LACTATE
30
20
GLUCOSE
10
0 0
0.5 1 1.5 2 2.5
[SUBSTRATE] (mM)
UNIVERSITY OF
CAMBRIDGE MICROAMPEROMETRIC BIOSENSORS

12. MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)
LIQUID SAMPLE
ACOUSTIC WAVE PIEZOELECTRIC
ALUMINISED QUARTZ DISC
GLASS DISC (AT-cut, 0.25mm
thick, 12mm dia)
RF COIL
N
NdFeB MAGNET RF COIL
AIR GAP
S
UNIVERSITY OF MAGNETIC ACOUSTIC RESONATOR SENSOR
CAMBRIDGE (MARS)

13. MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)
Signal Generator AM Detector Copper Coil
AM DETECTOR
Lock-in Amplifier
OUTPUT
Output
LOCK-IN AMPLIFIER
400
300 SIGNAL GENERATOR
COIL/DEVICE
200
100
16th HARMONIC
A (mV)
0
0 50 100 150 200 250 300 350
-100
-200
-300
f (MHz)
-400
UNIVERSITY OF
CAMBRIDGE MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)

14. REMOTE ACOUSTIC MEASUREMENTS WITH A TOROIDAL
ELECTRIC FLUX
SUBCUTANEOUSLY IMPLANTED
e-PATCH 30
CONTACT LENS
20
MRAS QUARTZ DISC
10
0
-10
-20
-30
20.1 20.12 20.14 20.16 20.18 20.2
f (MHz)
100
100 pH
50
pH
50 pH
Amplitude (mV)
0 pH
Amplitude mV
0 pH
-50 pH
-50 pH
-100 pH
-100
pH
-150
-150 pH
TOROIDAL ANTENNA -200 pH
-200
(TRANSCEIVER) -250
-250
6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73
6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73
Frequency MHz
Frequency (MHz)
UNIVERSITY OF REMOTE ACOUSTIC MEASUREMENTS WITH
CAMBRIDGE A TOROIDAL ELECTRIC FLUX

15. ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS
O
1.0 O
O
6MHz
-B
Normalised Amplitude
20MHz HOH 2 C
0.8 HO
33MHz
HO
47MHz HO
0.6 60MHz
73MHz
0.4
0.2
0
0 5 10 15 20
[Glucose](mM)
Poly (acrylamide-co-3-APB)(78.5mol% acrylamide; 1.5mol% MBA; 20mol% 3-APB)
PBS Buffer pH 7.4
UNIVERSITY OF
CAMBRIDGE ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS

16. DYNAMIC GLUCOSE AM Detector
MEASUREMENT SYSTEM PC
Lock-in
Amplifier
Signal
Generator MARS Jig
250 Gilson minipuls 2
Amplitude of the experimental
y = 1.0434x - 19.187 Pump
200 R² = 0.9969
fludic system (mV)
150
100
50
0
50 100 150 200 250
Amplitude of the static system (mV)
UNIVERSITY OF DYNAMIC GLUCOSE
CAMBRIDGE MEASUREMENT SYSTEM

17. SPATIAL
LASER FILTER
MIRROR
ACHROMAT
GLASS TANK
EMULSION 4°
MIRROR
UNIVERSITY OF
CAMBRIDGE FABRICATION OF HOLOGRAPHIC SENSORS

18. n
“Smart” Polymer
θ COLOUR
BRIGHTNESS
IMAGE/ALPHANUMERIC
MESSAGE
POSITION
OPTICAL ELEMENTS
ΣRi MICRO-HOLOGRAMS
35
30
reflectance (%)
25 d
20 lpk
15 Rpk
λmax = 2ndcosθ
10
5
0
600 610 620 630 640 650 660
wavelength (nm)
UNIVERSITY OF
CAMBRIDGE PRINCIPLE OF HOLOGRAPHIC SENSORS

19. DIABETIC MONITORING WITH GLUCOSE
HOLOGRAMS
WHOLE BLOOD O O
O
INDWELLING CATHETER -B
HOH 2 C
SUBCUTANEOUS NEAR-IR HO
HO
CONTACT LENS HO
SKIN PATCH/TATTOO
180 mol% 3-APB
160 25
140
120 15
max(nm)
100
80
12
60
40 10
20 8
5
0
-20 2 4 6 8 10
[GLUCOSE] (mM)
UNIVERSITY OF DIABETIC MONITORING WITH GLUCOSE
CAMBRIDGE HOLOGRAMS

20. CONTACT LENS HOLOGRAPHIC GLUCOSE
SENSOR
TOXICITY
TEAR [GLUCOSE]<BLOOD [GLUCOSE]
pH VARIABILITY (5.8-7.8)
TIME LAG (~MIN)
SELECTIVITY (LACTATE/FRUCTOSE)
OPTICAL PHYSICS
COMFORT/COSMETIC APPEARANCE
INSTRUMENTATION
UNIVERSITY OF
CAMBRIDGE CONTACT LENS HOLOGRAPHIC GLUCOSE SENSOR

21. TRACKING OF BLOOD GLUCOSE IN TEAR
FLUID IN VIVO
160 740
Blood-Glucose [mg%]
140
Wavelength [nm]
720
120
700
100
80 680
0 12 16 19 23 26
Time [minutes]
UNIVERSITY OF TRACKING OF BLOOD GLUCOSE IN TEAR FLUID
CAMBRIDGE IN VIVO

22. HUMAN BREATH ANALYSIS
DIABETIC KETOACIDOSIS
RENAL FAILURE
H2
ETHANE LIVER DYSFUNCTION
n-PENTANE ALCOHOL INTOXICATION
BUTANE
NO CANCER
CO CYSTIC FIBROSIS
NH3
ETHANOL ASTHMA
ACETONE GIT DISORDERS (H pylori)
THIOLS
HALITOSIS
STRESS
UNIVERSITY OF
CAMBRIDGE HUMAN BREATH ANALYSIS

23. RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES
90
A B 1-Butyne
80
Butane
70 1-Butene
Iso-butane
60 Propane
50 Propyne/propadione
 (nm) Propene
40 Ethane
Ethyne
30
20
10
0
0 2 4 6 8 10 100 200 300
Time (s) Time (s)
80
590 100 1-Butyne
580 Butane 60  (nm)10 Butane
570 1
1-Butene
560  (nm)
10 20 30 40
40 isoButane
 (nm)
Temperature (°C)
550
540 20
Propane
530 Propene
520 0 Ethane
Ethyne
510
0 100 200 300 400 500 600 700 0 20 40 60 80 100
Time (s) Concentration (%v/v)
UNIVERSITY OF
CAMBRIDGE RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES

24. PHYSICIAN’S WANTING PATIENTS TO TRACK/MONITOR
HEALTH AT HOME
No (12%)
Digestive health
Acid reflux/indigestion
Bladder control Yes (88%)
Cardiac rhythm
Sleep patterns
Pain level
Calories/fat content taken in
Exercise/physical activity
Vital signs (Blood pressure/heart
rate/respiratory rate)
Blood sugar
Weight
0
20
40
60
% 80
Source: PriceWaterhouseCoopers HRI Physician Survey (2010)
UNIVERSITY OF PHYSICIAN’S WANTING PATIENTS TO
CAMBRIDGE TRACK/MONITOR HEALTH AT HOME

25. IMPACT OF mHEALTH ACCORDING TO
PHYSICIANS
HAVE NOT AFFECTED
ALLOW MORE MY DAY-TO-DAY WORK
TIME WITH (24%)
PATIENTS (26%)
EXPEDITE DECISION
MAKING (56%)
INCREASE COLLABORATION DECREASE TIME IT
AMONG PHYSICIANS TAKES FOR
(36%) ADMINISTRATIVE TASKS
(39%)
UNIVERSITY OF
CAMBRIDGE IMPACT OF mHEALTH ACCORDING TO PHYSICIANS

26. mHEALTH AND HEALTHCARE OUTCOMES
IMPROVED HEALTH OUTCOMES AND COST SAVINGS
INCREASED ACCESS TO HEALTHCARE AND HEALTH-
RELATED INFORMATION
ACCESS TO HARD-TO-REACH POPULATIONS
REGIONS OF POOR LITERACY RATES AND LIMITED LOCAL
LANGUAGE-ENABLED PHONES
IMPROVED ABILITY TO DIAGNOSE AND TRACK DISEASES
TIMELIER, MORE ACTIONABLE, PUBLIC HEALTH
INFORMATION
EXPANDED ACCESS TO ONGOING MEDICAL EDUCATION
AND TRAINING FOR HEALTH WORKERS
IMPROVED HEALTHY LIFESTYLES
UNIVERSITY OF
CAMBRIDGE mHEALTH AND HEALTHCARE OUTCOMES

27. EMERGING TRENDS IN mHEALTHCARE
EMERGENCY RESPONSE SYSTEMS (ROAD
TRAFFIC ACCIDENTS, OBSTETRIC CARE)
MOBILE VOICE AND SMS SUPPORT TO REMOTE
CLINICIANS
REMOTE PATIENT MONITORING
MONITORING OUTBREAKS AND EPIDEMICS
HEALTH-RELATED mLEARNING FOR PUBLIC
TRAINING AND CONTINUED PROFESSIONAL
DEVELOPMENT FOR HEALTHCARE WORKERS
HEALTH PROMOTION AND COMMUNITY
MOBILIZATION
SUPPORT OF LONG-TERM CHRONIC CONDITIONS
(DIABETES,NEUROPSYCHIATRIC DISORDERS)
UNIVERSITY OF
CAMBRIDGE EMERGING TRENDS IN mHEALTHCARE

28. CLOUD
MOBILE HEALTH TOOL
REAL-TIME MONITORING
PHYSICIAN TRACKING
FEEDBACK
CARER ALERTS
DRUG AUTOMAT
PATIENT
SENSOR/
TRANSMITTER
SERVER
Intelligent
WATCH algorithms
PHYSICIAN Messaging
WIRELESS
MONITOR DRUG HEALTHCARE
AUTOMAT PROVIDER
UNIVERSITY OF
CAMBRIDGE mHEALTH