The document discusses the potential of ambulatory monitoring technologies in healthcare, highlighting the benefits and challenges associated with mobile health (mHealth) and telemedicine. It emphasizes the need for user acceptance, privacy considerations, and evidence-based solutions, while showcasing various example projects aimed at improving patient monitoring and self-management. The author suggests that while mHealth is technologically feasible for non-critical cases, there are significant obstacles, such as interoperability and organizational issues, that must be addressed for successful implementation.

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