MHealth and thought control.

First came the joystick. Then came the motion-sensing Wii remote. What´s next? Sensors and mobiles are opening up a new world: thought control.

Co-founded by Allan Snyder, a neuroscientist and former University of Cambridge research fellow, Emotiv says its EPOC headset features 16 sensors that push against the player’s scalp to measure electrical activity in the brain – a process known as electro-encephalography. In theory, this allows the player to spin, push, pull, and lift objects on a computer monitor, simply by thinking. “There will be a convergence of gesture-based technology and the brain as a new interface – the Holy Grail is the mind” says Snyder.

Last month the Defence Advanced Research Projects Agency (Darpa), an arm of the US Defence Department, said it had awarded a $6.7 million contract to Northrop Grumman to develop “brainwave binoculars”. The binoculars use scalp-mounted sensors to detect objects the user might have seen but not noticed – in other words, the computer is used as a kind of brain-aid, giving the user superhuman vision.

Explaining the technology, Dr Robert Shin, an assistant professor of neurology and ophthalmology at the University of Maryland School of Medicine, said: “There is a level where the brain can identify things before it ever makes it to the conscious level. Your brain says, ‘it may be something’, but it might not realize that it is something that should rise to the conscious level.”

Another defence contractor, Honeywell, has been working on a similar technology known as “augmented cognition” to help intelligence analysts to operate more effectively. Based on the same principle as the binoculars, it has been shown to make analysts work up to seven times faster. It can also detect when they are getting tired. In other tests, soldiers have been kitted out with headsets that detect “brain overload”, allowing commanders to know if they can process new information under the extreme pressures of the battlefield.

mHealth and Motion capturing.

Motion capture, or Mocap, is a technique for digitally recording movement. Are we playing games her? Originally used as an analysis tool for biomechanics, mocap is now successfully employed in a wide variety of sectors including mHealth related applications.

Movement is captured through the placement of sensors (or markers) on or near each joint of the body. As each joint moves the positions or angles between the markers are recorded. Software records the, angles, velocities, accelerations and impulses, providing an accurate digital representation of the movement.

Realtime data from mocap enables the diagnosis of problems or enhancement of performance in the arenas of biomechanics and sports. It can also assist in the design of products or buildings when applied to the field of engineering or ergonomics. Animazoo distinguishes three types of Mocap´s.

Gyroscopic systems use tiny inertial gyroscopes that are attached to a body. These directly record the rotations of the body parts. The rotational data is transmitted by radio to a receiver unit where it is mapped instantly to a skeleton in order that the data can be visualized in realtime. These systems perform with no lag in realtime, producing incredibly accurate data. The data retains nuance even with fast moves.

Mechanical systems track body joint angles directly and are often referred to as exo-skeleton mocap systems, due to the way the sensors are attached to the body. A person attaches the skeletal-like structure to their body and as they move so do the articulated mechanical parts, measuring the performer’s relative motion. Mechanical motion capture systems are realtime, relatively low-cost and usually wireless. Movement is captured through the placement of sensors (or markers) on or near each joint of the body. As each joint moves the positions or angles between the markers are recorded. Software records the, angles, velocities, accelerations and impulses, providing an accurate digital representation of the movement.

Optical systems triangulate the 3D position of a marker between one, two or more cameras that have been pre-calibrated for distance to provide overlapping projections. Tracking a large number of markers or multiple performers is accomplished by the adding more cameras. These systems can be expensive to buy, require technical expertise to operate and are studio based. They have a relatively small capture area and can suffer from occlusion as well as being complicated to set up. Magnetic and electrical interference makes these systems highly susceptible to error, they also require extensive data cleaning and technical expertise to operate plus they suffer from limited area of use and lag for realtime use.

Magnetic systems calculate position and orientation by measuring the relative magnetic flux of three orthogonal coils on both the transmitter and each receiver. Magnetic systems require only two-thirds the number of markers compared to optical systems. One drawback is that the markers are susceptible to magnetic and electrical interference from metal objects in the environment and electrical sources. Magnetic and electrical interference makes these systems highly susceptible to error, they also require extensive data cleaning and technical expertise to operate plus they suffer from limited area of use and lag for realtime use.

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.

MHealth business models changing.

The business models for wireless based healthcare are fluid. eHealth style services are online but should the system enable the patient to manage their own health on there health portal? The UK NHSDirect has been set up and the Danish healthcare uses Sundhed.dk

Most ehealth services around the world adhere to a version of the model here on the right. Healthcare providers aspire to a more complex ehealth model. One in which all information flows are automated, data is held centrally and surgery, like other procedures that require physical contact with the patient, is carried out in special treatment centres. See the advanced eHealth Model on the left.

The Sundhed portal, as it is based on IBM’s WebSphere platform, could eventually act as a front end for the disease and public health monitoring applications. However the healthcare IT world has changed by the emergence of Google and Microsoft as potential suppliers of personal healthcare record vendors. IBM has itself acknowledged as much and is now, via the Continua Alliance, working with Google.

The idea that Microsoft and Google are merely a pair of disruptive new players in a healthcare market, where the incumbents cannot provide the tools that enable consumers to manage their own health, is a bit too simplistic. The threat to established healthcare providers is far more subtle than a direct and open attack on their business models. At first viewing, the threat appears to be from Google Health and Microsoft’s HealthVault themselves. However it is the ease to connect to there platform, hand out free of charge, to new entrants to the healthcare market that will create an enormous driving force.

As the ehealth developers armed with Google and Microsoft SDKs take healthcare into the clouds next generation healthcare providers will be start to use the disease knowledge-base their users construct to force the pharma industry into deals. In some cases these deals will disadvantage incumbent healthcare providers. This means that when, with the help of Google and Microsoft, cloud based ehealth providers start establishing themselves in the healthcare market the demise of the incumbent providers will be quick.

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.

The essence of human centered design in a minute.

If you have to explain to someone what human centered design is and you only have about two minutes: show them this movie

A lot of telemedicine-stuff can be seen as mHealth.

Today just a nice video about some latest telemedicine equipment.

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.”

Managing your healthcare process on your mobile.

As medical knowledge advances, healthcare is becoming more complex. Faced with growing volumes of information and new technologies, clinicians are working in ever-more specialised silos. Who ‘s doing what? Is it even possible for a patient to take any responsibility? Yesterday, at the World Health Care Congress Europe, I saw the progress of the webbased Map of Medicine.

The Map of Medicine provides a visualisation of the ideal, evidence-based patient journey. It’s an overview that can be shared across all care settings. Primairely developed and implemented for medics, by the National Health Service in the UK. The Map is a tool for achieving clinical consensus throughout a healthcare community. It:

• Delivers current, evidence-based clinical knowledge from the world’s most authoritative sources, constantly reviewed
• Displays this knowledge in an easy-to-use Pathways format, reflecting the patient journey
• Provides a framework for creating local Pathways using modified or new content specific to a healthcare community.
• Is fully localisable on national and local levels to reflect specific experience and practice.

The Map creates an overarching benchmark for clinical process, a framework for sharing knowledge across care settings, and a tool for mediating a dialogue about the care process.

It’s now available for patients, called Healthguides. It’s even on mobile. This allows patients to see what the next step(s) in medical treatment can be. These steps are presented in a simple workflow, used by the doctors related to the visited medical centre. From symptoms to diagnosis and treatment, using the same easy to follow charts.

“‘The Map of Medicine is used as a healthcare service redesign and clinical knowledge support tool across England and Wales”. said Alexey Brovko, business development manager. “We have international deployments in countries such as Denmark and Australia and have an increasing interest from other countries to”.