Ebook: Personalised Health Management Systems

The International Workshop on “Personalised Health: The Integration of Innovative Sensing, Textiles, Information & Communication Technologies” organised in collaboration with the European Commission, took place in Belfast, Northern Ireland, 13–15^th December 2004. At this unique event, addressing personalised health management systems, the workshop endeavoured to promote the synergies between research efforts in three diverse areas; sensor technologies, advanced textiles and nanotechnology and computing. This event followed the International Workshop on “New Generation of Wearable Systems for eHealth” held in Lucca, Italy 2003 and aimed to consolidate the recommendations from this with recent state-of-the-art findings in the evolving health care and health delivery sector, in Europe and world-wide. In addition, the event was timed to coincide with the 4^th call for proposals by the IST programme in the 6^th Framework Programme of the European Commission. The main goal of the workshop was to facilitate a forum to disseminate progress within the research area of personalised health management systems and to foster collaborations and information exchanges for future efforts. In conjunction with this, the workshop aimed to bring together researchers from academia, industry and clinical health care provision and emphasise the need for multi-disciplinary collaborations in the future developments of personalised health management systems.

The development and advancement of personalised health management systems requires the consideration of advances in sensor technologies and advanced textiles in addition to nanotechnologies and evolving information and communication technologies. We are now living in an environment where changes in healthcare structures and requests from patients to have an increased participation in their own health care are demanding the availability of affordable and readily available personalised health management systems. Recent research has taken us a step closer in providing such solutions, however, efforts are still required to address the issues of integration of new technologies into existing health care practices, implications of interoperability of services, analysis of results following large scale clinical evaluations and development of technology which is small, reliable and affordable by its users.

The workshop programme was designed to facilitate presentations being delivered by leading researchers describing current trends in personalised health management systems in addition to the challenges which are ahead. Areas addressed were Wearable Sensing, Smart Textiles, Standards & Interoperability and Community Health. This book is based on the presentations delivered at the workshop and includes full papers describing the developments and trends in the aforementioned topics. Consideration of the vision of these contributions has provided indications of strategic developments which should be considered to allow the deployment of personalised health management systems into our every day lives.

The Editors, Dr Chris Nugent, Dr Paul McCullagh, Dr Eric McAdams, Dr Andreas Lymberis

There is a growing need of renovation in our health care managing systems; people need to be more interactive and more conscious of their own health condition in a way to adjust incorrect lifestyles, to obtain a personalized therapy tuned to their own physiological reactions and on their own environmental condition. To gain knowledge of a citizen's health status and to monitor without harassing them (until they refuse any medical supervision), a comfortable remote monitoring of important physiological parameters is necessary. The approach is therefore to integrate system solutions into functional clothes with integrated textile sensors. The combination of functional clothes and integrated electronics and on-body processing, is defined as e-textile and gives rise to intelligent biomedical clothes. Systems, designed to be minimally invasive, are based on smart textile technologies, where conductive and piezoresistive materials in the form of fiber and yarn are used to realize clothes, in which knitted fabric sensors and electrodes are distributed and connected to an electronic portable unit. These systems are able to detect, acquire and transmit physiological signals. They are conformable to the human body, and move towards improving the patient's quality of life and their autonomy. These systems are also cost-effective in providing around-the-clock assistance, in helping physicians to monitor for example cardiac patients during periods of rehabilitation, and in addition result in decreased hospitalization time. Finally, by providing direct feedback to the users, they improve their awareness and potentially allow better control of their own condition, while the simultaneous recording of vital signs permits parameter extrapolation and inter-signal elaboration that contributes to produce alert messages and personalized synoptic tables of the patient's health.

Monitoring body kinematics has fundamental relevance in several biological and technical disciplines. In particular the possibility to know the posture exactly may furnish a main aid in rehabilitation topics. In the present work a collection of innovative and unobtrusive garments able to detect the posture and the movement of the human body are introduced. This paper deals with the design, the development and the realization of sensing garments, from the characterization of innovative comfortable and spreadable sensors to the methodologies employed to gather information on the posture and movement. Several new algorithms devoted to the device operation are presented and tested. Data derived from the sensing garment are analyzed and compared with the data derived from a traditional movement tracking system.

With the development of critical areas of interdisciplinary research, scientists will lead to an enhanced understanding and control of the key processing stages involved in the design and manufacture of sensor-and electrode-based micro-devices such as micro total analysis systems (μTAS), bio-chips, bio-arrays and DNA sensors. It is anticipated that this fundamental work will lead to tangible technology transfer in the areas of blood analysis, cardiac enzyme detectors, liver and renal function, infectious diseases, gene disorders, etc. These will obviously have major benefits to healthcare delivery. The development of miniaturised, integrated sensor/electrode-based devices are revolutionising both the delivery of health care. In this paper, some of the most exciting research themes in these areas are identified, as well as novel underpinning fabrication technologies and transduction principles, which should make future advances possible.

Bio-impedance is the electrical impedance of living matter. Bio-impedance methods present a range of known advantages for medical and clinical applications including low-cost, non-invasiveness and harmlessness. The measured parameter reflects the physiological and pathological processes that take place within human body. The technological progress in instrumentation has significantly contributed to the progress that has been observed during the last past decades in impedance spectroscopy and electrical impedance tomography. Although bioimpedance is not a physiological parameter, the method enables tissue characterisation and functional monitoring and can contribute to the monitoring of the health status of a person. The association of this flexible and versatile method with micro-electronics and wireless telecommunication systems opens a new field of potential applications.

This paper describes the development of a miniaturized wearable vital sign monitor which is aimed for use by elderly at home. The development of a compound sensor for pulse rate, motion, and skin temperature is reported. A pair of infrared sensor working in reflection mode was used to detect the pulse rate from various sites over the body including the wrist and finger. Meanwhile, a motion sensor was used to detect the motion of the body. In addition, the temperature on the skin surface was sensed by a semiconductor temperature sensor. A prototype has been built into a box with a dimension of 2×2.5×4 cm³. The device includes the sensors, microprocessor, circuits, battery, and a wireless transceiver for communicating data with a data terminal.

Cardio-vascular diseases (CVD) are the leading cause of death. The MyHeart Project aims at empowering the citizens to fight cardio-vascular diseases by preventive lifestyle and early diagnosis. The main technical challenges in this project are the combination of novel wearable technologies (novel textile and electronic sensors, personalised algorithms, on-body computing) and user feedback and motivation concepts, in order to make a breakthrough towards new applications for prevention and early diagnose possible.

This paper sketches the vision and first results of a 'Personal Health Assistant' PHA, opening up new vistas in patient centred healthcare. The PHA is comprised of a wearable sensing and communicating system, seamlessly embedded in daily clothing. Several on-body sensors monitor the biometric and contextual status of the wearer continuously. The embedded computer fuses the vital and physiological data with activity patterns of the wearer and with the social environ-ment; based on these data the on-body computer generates the 'Life Balance Factor' LBF as an individual feedback to the user and to the surroundings afford-ing effective disease prevention, management and rehabilitation, the last also involving telemedicine. The state-of-the-art enabling technologies: smart textile technology and miniaturization of electronics combined with wireless communication, along with recent developments in wearable computing are presented and assessed in the context of multiparameter health monitoring.

The combination of textile fabrics with microelectronics will lead to completely new applications, thus achieving elements of ambient intelligence. The integration of sensor or actuator networks, using fabrics with conductive fibres as a textile motherboard enable the fabrication of large active areas. In this paper we describe an integration technology for the fabrication of a “smart textile” based on a wired peer-to-peer network of microcontrollers with integrated sensors or actuators. A self-organizing and fault-tolerant architecture is accomplished which detects the physical shape of the network. Routing paths are formed for data transmission, automatically circumventing defective or missing areas. The network architecture allows the smart textiles to be produced by reel-to-reel processes, cut into arbitrary shapes subsequently and implemented in systems at low installation costs. The possible applications are manifold, ranging from alarm systems to intelligent guidance systems, passenger recognition in car seats, air conditioning control in interior lining and smart wallpaper with software-defined light switches.

This paper provides an overview of research conducted in the development of ambulatory devices for wearable sensing applications. Two configurations of wearable sensing are shown, the first a wearable chemosensor in a wrist-watch configuration, and the second a textile with an integrated foam sensor. The foam sensor is composed of polypyrrole-coated polyurethane foam, which exhibits a piezo-resistive response when exposed to electrical current. The potential of wearable sensing is discussed using these examples to illustrate the relevant concerns.

This chapter will discuss the ongoing development and integration of micro and nano technologies within the Tyndall National Institute that will enable the future vision of ambient intelligence with specific application to the area of personalised health (P-Health). Ambient Intelligent Systems open entirely new possibilities for future applications and resultant markets. Ultimately, these systems will create intelligent environments that cater continuously for the requirements of the individual in everyday life and apply it in a totally coherent manner. They will learn and evolve to anticipate user-requirements. We will discuss ongoing research in the areas of sensors, sensor interfacing, interconnection and packaging, hardware platforms, infrastructure and power delivery for ambient systems with applications in the p-health domain.

The excellent work that is being performed in medical science advances is to be admired and applauded. In each case the quest is for perfection and to bring the task in hand to its final solution. Along the way there are milestones being passed that may be overlooked, as to their particular merits, because the eyes are focused all the time on the ultimate goal. The conference highlights so many areas of interest and endeavour some of which parallel, duplicate, overlap and/or compliment others.

This chapter examines some of the key issues surrounding the incorporation of the Knowledge Management (KM) paradigm for personalised healthcare. We discuss the complex nature of KM, some essential concepts necessary to make personalised healthcare a reality and introduce a schematic which illustrates the efficacy of KM for personalised health.

Advances in ICT promising universal access to high quality care, reduction of medical errors, and containment of health care costs, have renewed interest in electronic health records (EHR) standards and resulted in comprehensive EHR adoption programs in many European states. Health cards, and in particular the European health insurance card, present an opportunity for instant cross-border access to emergency health data including allergies, medication, even a reference ECG. At the same time, research and development in miniaturized medical devices and wearable medical sensors promise continuous health monitoring in a comfortable, flexible, and fashionable way. These trends call for the seamless integration of medical devices and intelligent wearables into an active EHR exploiting the vast information available to increase medical knowledge and establish personal wellness profiles. In a mobile connected world with empowered health consumers and fading barriers between health and healthcare, interoperability has a strong impact on consumer trust. As a result, current interoperability initiatives are extending the traditional standardization process to embrace implementation, validation, and conformance testing. In this paper, starting from the OpenECG initiative, which promotes the consistent implementation of interoperability standards in electrocardiography and supports a worldwide community with data sets, open source tools, specifications, and online conformance testing, we discuss EHR interoperability as a quality label for personalized health monitoring systems. Such a quality label would support big players and small enterprises in creating interoperable eHealth products, while opening the way for pervasive healthcare and the take-up of the eHealth market.

This chapter describes a software process improvement framework, structured to ensure regulatory compliance for the software developed in medical devices. Software is becoming an increasingly important aspect of medical devices and medical device regulation. Medical devices can only be marketed if compliance and approval from the appropriate regulatory bodies of the Food and Drug Administration (US requirement), and the European Commission under its Medical Device Directives (CE marking requirement) is achieved.

Functional and semantic interoperability requirements for ubiquitous personalised health services reach beyond current concepts of health information integration among professional stakeholders and related Electronic Patient Records (“eHealth”): Future health telematics infrastructures have particularly to maintain semantic interoperability among systems using different coding schemes and terminologies and to include home, personal and mobile systems.

“With medical knowledge expanding every day, no physician can keep up without help. By using high-tech medical communication, high-performance computers, high resolution video, and fibre-optic information “superhighways,” we have been able to put the entire world of medical science at the fingertips of even the most isolated rural family doctor." [1] This quote by a former Surgeon General encapsulates the promise and potential for healthcare technology. Service organization and stakeholders' commitment are the real crucial issues for actual e-Health services deployment. In such a contest Homecare services start playing such a role of services integration and new care models development.

Cataract surgery and intraocular lens implantation has taken on many significant advances since its earliest inception. As the prevalence of the aged population increases the number of cataract operations also increases year on year. In the UK last year over 300,000 cataract operations were performed with 2 million in Europe and 1.5 million in the USA. Globally 8.7 million cataract operations are performed per annum. Technical advances are occurring ever more rapidly in this procedure enabling improved preoperative assessment and surgical management. This has produced a sophisticated procedure which is eminently reproducible. In concordance with such improvements both patient and doctors expectations for visual results have also risen. The expectation is now that the operation will achieve more than mere removal of a pathological opacity interfering with the visual process. The possibility and expectation is that the procedure will be tailored specifically to the patient in such a way that the best possible visual result will be achieved through customization of the surgical process to optimize the individual's optical system. Optimization of any particular process may be complex, and cataract surgery is no exception. Careful consideration of many interrelated factors including a patient's functional visual requirements, along with specific anatomical and unique optical factors will be required if an optimum result is to be achieved. The decision making process involved in determining how an individual eye should be surgically customised, can therefore be complicated. These are the situations where decision support systems become most beneficial, to ensure consistent successful results, particularly if technical measurements are being performed by individuals with varying degrees of experience.

Ubiquitous computing is shifting healthcare from treatment by professionals in hospitals to self-care, mobile care, home care and preventive care. In order to support the healthcare evolution, a global healthcare system, which links healthcare service providers to an individual's personal and physical spaces, is expected to provide personalized healthcare services at the right time, right place and right manner. This paper presents an overall architecture for such a context-aware healthcare system. The key technologies such as device self-sensing mechanism, context processing framework and a service interoperability platform are identified and elaborated. A personalized healthcare adviser service has been described to illustrate how personalized healthcare can be well supported by the proposed infrastructure.

Smart Home technology offers a viable solution to the increasing needs of the elderly, special needs and home based-healthcare populations. The research to date has largely focused on the development of communication technologies, sensor technologies and intelligent user interfaces.

We claim that this technological evolution has not been matched with a step of a similar size on the software counterpart. We particularly focus on the software that emphasizes the intelligent aspects of a Smart Home and the difficulties that arise from the computational analysis of the information collected from a Smart Home. The process of translating information into accurate diagnosis when using non-invasive technology is full of challenges, some of which have been considered in the literature to some extent but as yet without clear landmarks.