U.S. Rules for MBAN’s validate potential of mHealth.

The Federal Communications Commission (FCC) has proposed to allocate radiofrequency spectrum and establish service and technical rules for the operation of Medical Body Area Network (MBAN) systems. Why is the FCC interested in this area? They envision that MBANs would provide a platform for the wireless networking of multiple body sensors used for monitoring a patient’s physiological data, primarily in health care facilities.

MBAN’s could be used to monitor an array of physiological data, such as temperature, pulse, blood glucose level, blood pressure, respiratory function and a variety of other physiological metrics. MBAN systems would primarily be used in health care facilities, with the potential also of being used in other patient care/monitoring circumstances. Unlike traditional medical telemetry systems which rely on separate uncoordinated links for each physiological function being monitored, MBAN systems could serve to wirelessly monitor all of the desired data of a single patient, which could then be aggregated and wirelessly transmitted to a remote location for evaluation.

Using MBAN systems to eliminate much of the wired cables that typically connect patients to monitoring equipment and to facilitate the aggregation and transfer of physiological data will offer several clinical benefits, including improved patient mobility and comfort, reduced risks of infection, reduced clinical errors, and reduced patient monitoring costs.

The Notice of the FCC seeks comment on options for accommodating MBAN operations in several frequency bands, and on the amount of spectrum that should be allocated for such use. More specifically, the Notice seeks comment on the feasibility of using the 2360-2400 MHz; 2300-2305 MHz and 2395-2400 MHz; the 2400-2483.5 MHz; or 5150-5250 MHz bands for this purpose, and on various licensing schemes that would be appropriate for any of these bands under consideration. In addition, the Notice seeks comment on tentative service and eligibility rules that would be similar in many respects to those for other wireless body-worn and implanted medical devices operating in the MedRadio Service in the 401-406 MHz bands.

This action by the Commission is by Notice of Proposed Rule Making (FCC 09-57).

Sensing textiles as part of your Mobile Body Area Network system.

Sensoring your body while doing everything you are used to do. Is this possible? Comfortable smart clothes that monitor the wearer’s heart, breathing and body temperature promise to revolutionise healthcare by allowing patients to lead there normal lives.

Unlike many remote health monitoring systems that rely on sensors strapped to users’ arms or chests connected by wires to bulky equipment, a Greece team from the Sotiria General Chest Diseases Hospital in Athens, has embedded sensing devices directly into textiles, creating garments that are not only smart but also comfortable and practical to wear. Data from the biosignals collected by the clothes is then sent via a mobile connection to caregivers, allowing doctors to check up on their patients and warning if their health deteriorates.

Whereas other remote monitoring systems require different sensors linked to different transmission devices, the HealthWear system collects all the information from the sensors into a single device called a Portable Patient Unit (PPU). The embedded sensors include a six-lead electrocardiograph (ECG), respiration movement, pulse rate and skin temperature monitors, in addition to an external oximeter to measure blood oxygen saturation and a 3D accelerometer inside the PPU to measure body position. The data are then transmitted via a secure GPRS mobile connection to a central server.

“The information is stored on a patient’s electronic health record and can be accessed via a secure TCP/IP internet connection by doctors and caregivers, in either near real-time or off-line mode,” explains Alexis Milsis, a research engineer at the Sotiria e-Health Unit.

Caregivers, meanwhile, can easily access patients’ data, allowing them to visualise the patients’ progress accurately over time and even monitor their data in real time. This feature allows doctors to perform remote checkups by speaking with the patient via a videophone and instructing them to perform different exercises while they monitor their ECG and oximetry readings.

Location Based Services in Uganda using SMS.

The Grameen Foundation on Tuesday launched the first application of its Application Laboratory (AppLab) project. It aims to use the proliferation of mobile phones in Africa as a way to get information and services to poor communities in Uganda without Internet access.

The project began 18 months ago. The Grameen Foundation has been operating a village phone service in Uganda, and had almost 50,000 people receiving “pay-by-the-minute mobile phone services. The foundation wanted to broaden into information services and it sought out Google and MTN as potential partners. They did extensive ethnographic studies to see what kinds of services the Ugandan people wanted and did pilot projects in the field to test out early versions of the services. They’re launching with a few services and hope to add more later. Eventually, they hope to branch out to other countries in Africa.

“The new services work through any phone capable of sending or receiving SMS messages”, Joseph Mucheru, Google’s director of sub-Saharan Africa business, said, adding that almost all phones in Uganda will be able to use the services. “The five applications use Google SMS Search technology and MTN’s telecom network. They include

• Farmer’s Friend, a searchable database with agricultural advice and weather forecasts.
• Health Tips with sexual and reproductive health information, paired with
• Clinic Finder, to locate nearby health clinics.
• Google Trader, which matches buyers and sellers of agricultural produce, commodities and other products.

Content is provided by local partners. Marie Stopes Uganda and the Straight Talk Foundation provide health information, while the Busoga Rural Open Source Development Initiative (BRODSI) provides agricultural information created and tested by small-holder farmers.

Realtime mhealth monitoring slowly forward.

Begin this year there was a boost of mobile health applications and devices with some kind of sensoring. What progress is there? One of the area’s is the integration of different measurements and feedback. The Personal Health Monitor provides personalised, intelligent, non-intrusive, realtime health monitoring using wireless sensors and a mobile phone.

The wireless sensors can be either attached to the users body (for example ECG and Accelerometer) or can be external devices, such as a Blood Pressure Monitor or Weight Scale, that are used when required.

On the phone, the Personal Health Monitor software analyses, in real-time, the data received from the sensors, such as an electrocardiogram (ECG). The phone gives immediate feedback and personalised advice to the user based on the analysis of sensor data collected.

The windows-mobile application is a development of the University of Technology in Sydney, Australia and free to download. The system can also be used as a flexible Cardiac Rhythm Monitoring (CRM) system. It’s different from conventional Holter and Event monitor systems since it is not limited to just recording ECG arrhythmias but offers a range of other functionalities, that make it a personal health monitoring system for people that need to make life style changes such as lose weight or monitor their blood glucose level. The application can detect and record various arrhythmias and can react to serious arrhythmias such as ventricular fibrillation/tachycardia. The ECG signal quality is in the majority of cases of sufficient quality for a cardiologist to make an assessment.

Using 3G, or any other Internet connection available on the mobile phone, the data collected is transmitted to the Health Care data server where it becomes available for viewing and further analysis by qualified specialists. The broad range of features show the way in patient centred healthcare.

Your medical record on your mobile.

There are a still growing number of Personal Health Record (PHR) systems out there. What to choose? Yesterday Communication Software Inc. (CSI), based in Portland, Oregon announced a mobile PHR.

Yes, another application for the iPhone called MotionPHR. It provides a secure environment for the consumer to store and organize their individual or family’s Medications, Immunizations, Current Problems, Test Results, and Allergy information. All data is secured utilizing RSA encryption and password protection.

MotionPHR is in alignment with the ONC with regards to PHR benefits, content, security, interoperability, standards, and accessibility. An important note is that access the potentially life saving information does not need a cell/Internet connection. The data are stored on the device and also accesseble when entering a regions without Internet or Cell coverage. In addition, MotionPHR provides an ICE (In Case of Emergency) feature that provides “First Responder” data such as contact and medical information that is available without a password.

The application helps the consumer to take charge of their wellness by tracking their family’s health information and help following doctors’ instructions. Some interesting features include travel, medication reminders and chronic illness monitoring.

Play to collect your mhealt-data.

The Wii is going buff with the Riiflex by Power Play.  This fun peripheral is basically a pair of ergonomic dumbbells. Designed to help tone your arms while using the Wii Remote and Wii Nunchuck.  End of this week, Juni 8, the Wii MotionPlus will come to market. This accessory will allow for greater motion sensory accuracy.  It gives the player (or researcher) the benefit of accelerometer and sensor bar technology to record both arm position and orientation. Only for the 16th years of age? Oh no. Leading edge innovators in physical rehab and long-term care settings have tiptoed into using Wii as a part of their treatment protocols, and the results have been beyond their expectations.

Today the Wii continues to be in the spotlight with more and more seniors utilizing the benefits of Wii Sports and other physical activity-based games for rehabilitation, exercise, and just plain fun.  This week’s latest article “Seniors choose the way of the Wii” from Niagra Falls Review, explains how the Wii became a senior favorite in North America.

• In 2006 before the Wii hit the market, Nintendo showcased the Wii at an Association of American Retired Persons trade expo.  Seeing the aging population as a lucrative market, they also donated dozens of games to retirement residences across the United States.
• In 2007, a rehabilitation hospital in Edmonton became the first hospital in North America to use Wii technology to treat patients with balance and movement issues.
• Later that year, the Wii hit Canada’s senior market with Wii games popping up in Chippawa’s Bella Senior Care facility.
• In May 2008, the University of South Carolina launched the Health Games Research Center to study how interactive games like Wii can be used as health-care tools.  Preliminary reports show that the Wii encourages physical activity and strengthens cognitive ability.

Mershon Hinkel, an occupational therapist at Meadowbrook Occupational Therapy, is known as the “WII OT”.  She has practiced occupational therapy for over 25 years and is an expert in “Wiihab,” or rehabilitative techniques using the Wii and other interactive devices. “I use Wii with my patients all of the time.  Using virtual reality and video feedback systems bring fun and engagement into the rehab setting.” Mershon says.  Mershon teaches a workshop called  “Wii-Hab – Using the Nintendo Wii in a Therapeutic Setting” and has a great blog.

Russ Tolliver, Program Manager at Genesis Rehabilitation Services in the Jacksonville, Florida area, has also found the magic of utilizing the Wii in the rehab setting. “We currently utilize the Wii with six Wii programs for our facility, sports, Wii Fitness, and cognitive game/exercises,” Russ notes.  “It’s an extremely resourceful tool to have in the therapy gyms, and the clients are always are talking about how they are doing-from where to they started to ways in which the program has helped them functionally get better.”

Laura Minck, CEO of Ergonomic Energy Consulting in Raleigh-Durham, NC, is seeing more and more clients integrating Wii into their treatment plans. “I have seen several long term care facilities using Wii in therapy and also as an activity during free time,”  Laura observes.  “Some of the facilities are forming bowling leagues using the Wii, since their clients have difficulties lifting heavy bowling balls. This allows them to participate in an activity they love, give them exercise and keep their minds active.”

Michelle Lucas-Webb, owner at Rehab Dimensions, Inc, in the Charlotte, NC area, sees its value in a treatment plan to address balance, ROM and endurance.  “I have seen this in action in several geriatric settings and residents seem to love it!” says Michelle.

Neuro rehab is another clinical area where patients gain improved function with Wii as an integrated part of the treatment plan.  Clayton Fowlie, President and CEO at Maine Center for Integrated Rehab, enthusiastically says, “We use them in my neuro rehab clinics here. Our clients love them. They are primarily used by our PTs and Recreational Therapists. Great results!” said Clayton, while noting humorously, “Staff loves them too!”

The Wii accomplishes three crucial health goals for seniors:

1. Maximize brain function
2. Exercise
3. Social Interaction

Mobile energymonitoring usefull in homecare.

Energy and care, an interesting couple. Suppose you know how much energy is used in a home on an average basis. Just at once it’s going up. Is this a signal we can use? Energy monitoring is not just profitable or good for the environment, it tells us about the behaviour in the house. The refrigeratordoor is left open, the electric heater is making overhours, the TV-set never stops. Time to have a look.

Peter Troast, founder of Energy Circle, a company that sells energy-saving products, has created a new energy-monitoring system that sends his home’s energy usage stats to Twitter and on to your mobile. Inspired by the open source power monitoring kit from Tweet-a-Watt, Troast’s system also sends his home’s energy data to the web, but it’s not in the form of once-a-day tweets like Tweet-a-Watt provides. Instead, his system uses a monitoring device called TED (The Energy Dectective) to create charts and then tweeted to see.

The real-time data can be viewed online. Google’s Visualization API is able to create a graph with the data from TED energy-monitoring device. As there are spikes and dips in the graph, a family member annotates those occurrences and those notes are automatically tweeted to a special Twitter account at Twitter.com/EnergyCirclekw.

When you are a “do-it-yourself” developers and hold them over until Google gets their PowerMeter rolling, you need:

• TED (The Energy Detective)
• ASUS WL 500G Deluxe wireless router
• OPEN Wrt operating System
• Google Visualization API

Methode:

1. You’ll need a wireless router that has a USB Port and is capable of running an OPEN Wrt operating system. The Troasts went with the ASUS WL 500G Deluxe.
2. Replace the router’s existing operating system with the OPEN Wrt operating system (Here’s how.)
3. A customized script (customized software) has to then be put into the OPEN Wrt operating system. OK, so this is the hard part, Troast says the developers will post the script online at the EnergyCircle blog in a couple of days if there’s interest.
4. Plug the TED into the wireless router using TED’s USB port.
5. Write the ability to add an annotation to the data into the web site database so that you can annotate the data in the database.
6. Write the data display page using the Google visualization API, which enables you to take the data and annotations and make a chart like the one that you see on the EnergyCircle site. (Specifically, they used the Annotated Time Line feature in Google’s visualization API).

The mHealth information management system at home.

The confrontation with MHealth-services lies in the homes, office-buildings and even the streets where people go. What do we know about that context? Who’s in charge of health information at work? Who plays the main nursing role in the home? It’s important to learn what livingconditions are, starting with the household.

Patti Brennan, professor at the University of Wisconsin-Madison, spoke on the emerging field of home-health information technology last week. She stressed that, “if we truly want to get the power of healthcare in the hands of people and have them use health information technology, we need to think about people where they are.” It’s essential to know about the home environment.  There are at least five influencing factors to consider: living conditions, social, technological, psychological and health service options. “What tools might be useful to people as they face health care in homes?” asked Brennan. The question is how to help patients with chronic illnesses improve their health by helping them record, understand and act on information they record about their daily lives.

These observations of daily living, or ODLs, are thought to be the key to designing effective health 2.0 tools. People are not apt to keep a daily health journal of habits and behaviors. Focus on creating innovative ways to capture this information. You can’t sell health by just delivering cool tools. There must be an understanding of the daily lives of individuals.

What could these capture tools possibly look like? Brennan described smart clothing that monitor critical health indicators, or carpeting with sensors that will recognize a change in a person’s cadence – an early sign of confusion and cognitive ailment. Air sensors and other environmental tools could monitor for pollen density in homes. Tools can be mobile, such as a portable health diary, a key fob that would encourage exercise, or cell phone application that captures food intake and connects to medical records.

“The popularity of consumer electronic devices such as the iPhone, iPod and even gaming systems like the Wii could provide the so-called “killer ap” said Brennan. “This will drive patient adoption of data-capture devices. Challenges lie in monitoring and reporting the data in stream, and figuring out what the data means”.

The idea behind ODLs is moving consumers to the next level of responsibility for their own choices and their own health. There has to be thought given to the shift in accountability for health care decision-making. Environmental readiness will be a key issue. Future development of healthcare IT in the home is guided by principals that promote dignity, autonomy and well being in communities. Moving beyond industrial services and toward patient activation and engagement. Brennan:”People need to be trained, perhaps starting as early as Kindergarten, to think about taking an active part in their own health.”

MHealth also means check your parents home.

The iPhone has the potential to command any electronic component that can be remotely controlled. Can we open the iPhone application for home control.  Control lights, audio, video, heating, gardening, air conditioning, doors, security, even spas and swimming pools. Yes, the interface varies from company to company, but the basic premise is always the same.

Touch a button on the main menu screen to open up a menu with more specific control options. For example, Crestron’s app offers on-screen buttons for such categories as Media, Lights and Climate. Touch one of these buttons and you can choose to control specific devices in those categories.

No longer do you have to find a touchscreen if you want to dim a light. No longer do you have to carry a wireless touchscreen around if you want convenient control. Simply reach into your pocket, pull out your iPhone, punch a few buttons and the entire home obeys every command.

The only limit is the range of your home’s WiFi network, which is what the iPhone uses to communicate with your home automation system. And of course, if WiFi extenders can expand a network’s range to cover an entire hospital, they can do the same.

Some companies are exploiting the iPhone’s cell phone capability to let you control your home systems from practically anyplace. As Crestron marketing communications manager Jeff Singer explained, “Anywhere in the world, our customers can see the lighting levels in their homes, the positions of the shades, the temperatures of all the rooms in the house, the status of the home alarm systems. And from anywhere in the world, they can change all that.” So children can look into the homes of their dementing parents and even correct some settings if nessecary.

A huge advantage is cost. Big touchscreens can run as much as $10,000, and even the smallest ones typically cost around $2,000. Compare that to $199 for an iPhone with a service contract.

Last week Perceptive Automation announced the release of version 4.0 of Indigo, their intelligent home control and automation server for Mac OS X.  New with this release is support for Indigo Touch, a native iPhone and iPod touch application, which allows a user to control their home automation system from anywhere using WiFi, 3G, or Edge connectivity.  Indigo Touch is available now as a free download from the iTunes App Store (see nice videodemonstration). We can expect almost every company in the field of home automation systems to come out with their own iPhone control interfaces. Most of those systems are now based on Internet Protocol (IP), which makes controlling them through an iPhone (or an Internet-connected computer) fairly simple.

The list of iPhone-controllable home automation gear now include AMX, Control4, Convergent Living, Crestron, Elk, HAI, Life|ware, Savant Systems and SmartLabs. All of these companies offer their own iPhone control apps, and in most cases they’re free. Also, all Z-Wave–compatible home automation gear can be controlled by Melloware’s  ZWave Commander app.

Mobile Health can have a serious impact on disastermanagement.

The impuls to look for your mobile phone when you see an accident is rising. Is this just excitment or usefull behavior? Disaster experts are taking the use of mobile phones dead seriously.

Dr. Jeannette Sutton of the University of Colorado at Boulder’s National Hazards Center spoke yesterday about the role of the micro-content communications network. Prior to her research results, which will come out this summer, she focused on how people used Twitter during the recent Tennessee Valley Authority coal ash spill. “Twitter hosted conversations about the spill, despite the fact that mainstream press attention was almost entirely absent” she said. “These tools are creating tremendous opportunities that we know are going to lead to safer communities.”

From the earthquake in China’s Sichuan Province to the Australian brush fires to the plane crash in the Hudson River to the Mumbai attacks, people have mobiles and access to Twitter. “When a crisis hits, people use what they are familiar with and what’s close at hand. Twitter on mobiles allows users to rely on pre-existing social relationships, and that’s tremendously hard to replicate by outside aid groups. Disaster experts are looking to mobile Twitter-use to boost situational awareness, warning dissemination and recovery coordination”, said Sutton It even could have an impact on the Disaster Healthcare Core Competenties list as educated on the National Disaster Life Support Foundation.

In the immediate aftermath of disasters, myths about what has happened arise. Looting and panic doesn’t happen very often. That said, researchers have found, said Sutton, that both online and off “there’s a lack of antisocial behavior in the immediate aftermath of a disaster.” In fact, Twitter supports some self-validation. Speaking of post-TVA spill tweets, Sutton reported that “they consistently contained a URL. Almost every post that was information linked to a credible source of information.”

Researchers are eager to dive more deeply into how people are organically using Twitter on mobiles during times of crisis. Tracking how conversations flow and how information ripples out isn’t straightforward. Twitter makes automated data collection difficult, but there is hard work on new tools. As the use of Twitter rises, and both people and organizations grow to depend on it, understanding how long-term conversations are sustained will be key to making sense of the new medium; already, people are using the #coalash hashtag popularized during last spring’s TVA spill to talk about, for example, a spill upstream of Washington DC earlier this month.