Technology Trends in health care

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Technology Trends In Health Care
Poornima Mohanachandran i2iTeleSolutions [email protected]

Outline of my talk
Healthcare Challenges Cardiac Monitoring Medical Imaging Tele Medicine Summary and Q&A

Global Burden of Diseases

Injuries
Communicable diseases, maternal and prenatal conditions and nutritional deficiencies

Chronic (non-communicable) diseases
Sources: WHO study on Burden of Diseases

Preventive Care & Disease Management

The World’s 15 ‘Oldest’ Countries
Percent Age 65 or Older

Sources: Carl Haub, 2006 World Population Data Sheet.

Diabetes

Sources: WHO report on diabetes

Diseases - India
Blindness
India has highest # of Blind People in the World 37 Million Blind in the world 12 Million Blind in India 80% are preventable

Diabetes
India has highest # of Diabetic patients in the World Presently 40 Million are Diabetic In India

Cardiac Diseases
60% of world’s cardiac diseases will be from India by 2010

In case of emergency it takes an average of 300 minutes to reach a hospital in India

* Data courtesy International Diabetes foundation, WHO

Technology Innovation Journey so far & Future

ECG
1901 : Einthoven’s ECG 2009

NICT Japan has entered the fray by developing a wearable ECG Created in collaboration with the Yokohama City University and Research & Innovation for the Environmental Health Medicine, . The device uses short-distance wireless communication technology

12 lead ECG

CARDIAC Monitoring
Holter monitor is a machine that continuously records the heart's rhythms. The monitor is usually worn for 24 - 48 hours during normal activity

Event monitor records short term EKG rhythm patterns, for 30sec-1 minute. Typically the wearer triggers the recording when an event happens.

CARDIAC Monitoring
The electrophysilogy study or EP study involves a catheter with electrodes probing the endocardium and testing the conduction pathways. In the EPS, specialized catheters are placed into the heart. These catheters can be used to "pace" the heart, and also to record the electrical activity of the heart, from various locations within the heart

Vital Signs Monitoring
A medical monitor or physiological monitor is an electronic medical device that measures a patient’s vital signs and displays the data so obtained.

Bedside Monitor

Central Station

Vital Signs Monitoring – New generation

Recent technology advances in wireless networking, micro-fabrication, and integration of physical sensors, embedded microcontrollers and radio interfaces on a single chip, promise a new generation of wireless sensors suitable for many applications, such as stroke rehabilitation, physical rehabilitation after hip or knee surgeries, myocardial infarction rehabilitation, and traumatic brain injury rehabilitation.

Data Analysis

Heart Sound Analysis

ECG waveform Analysis using Labview

Analysis – Large amount of Data Generated, Aid disease detection, Disease quantification

ECG Data Analysis for Heart Rate Variability

Poincare Plot

RR Interval (Ventricular cardiac cycle)

Patient Monitoring - Market
• Global Patient Monitoring Market – 4.9B (2008) to 7B (2015) • Includes Multiparameter patient monitor, wireless & ambulatory monitors, non invasive BP monitors,Remote patient monitors & MEMS based systems • Wireless and ambulatory monitoring and micro-electromechanical systems to be the key segments driving growth globally • Growth drivers: •Tertiary care, Life Style disease management, Home monitoring • Areas of focus by manufactures: • Interoperability • Development of IT integrated Patient Monitoring systems • Information Management Systems
Ref: e-health online

Patient Monitoring – India Market

Indian Patient Monitor Market : Rs 200 Cr Technology Trends: Wired /Wireless Transfer of Vital Parameter Data Information Management Challenges Lack of Regulations for medical devices Ref: Medical Buyer

Medical Imaging
Medical imaging detects critical illnesses at their most curable  stage ‐ and, in many cases, when they are least costly to treat.  Medical imaging is at center‐stage in prevention and early  detection. Molecular imaging allows physicians to go even  further, detecting disease at the cellular level, before any  symptoms or signs are noticeable. 

The impact
Early /accurate diagnosis Informed treatment decisions Fewer invasive procedures Better patient care

Echo cardiogram -Ultrasound

Coronary Angiography

Cardiac CT

Coronary Arteries and Surrounding Lung The coronary arteries and the surrounding lung tissue are shown in this normal CTA of the heart. Image from Toshiba’s new CT, using 320 row detector Study of Coronary arteries using CT 64 slice CT scanner - GE

X-Ray Imaging
ANALOG Computed Radiography Digital Radiography

FILM Based FILM to be processed No Soft Copy Not easily sharable

Cassette scanned Soft Copy available Not Real time

Real Time Digital Capture No retake Needed Lower Radiation Dosage

DR Systems‐ Electronics
Digital Detectors X Ray Scintillator Light Photo diodes Charge

Higher Resolution Analog Multi channel conversion Low power Special Packaging High Performance processors

Read Out Ckt

Digital Data

Medical Imaging :Increasing Use
USA UK

30-60% Increase in one decade CT,US & MR images on increase Ref: American Journal of Radiology

32% increase in imaging Increased usage of new modalities Ref : Data as published by NHS

Expertise Shortage
USA
Projected Supply and Demand of Radiologists

Number of FTE Radiologists

Demand of Radiologists

Supply of Radiologists

Year

32% increase in imaging Increased usage of new modalities Ref: American Journal of Radiology

Diabetic Retinopathy is Diabetic Retinopathy
retinopathy(damage to the retina) caused by diabetes, which can eventually lead to blindness. It affects 80% of all patients who have had diabetes for 10 years or more

Small blood vessels – such as those in the eye- are impacted

Retinopathy of Prematurity (ROP)
Retinopathy of prematurity (ROP), is an eye disease that affects prematurely born babies

ROP occurs when the development of the

retinal vasculature is arrested and
then proceeds abnormally

Aid Disease Detection - Data to Information
The retina is the innermost layer of the eye. It is composed of several important anatomical structures which can indicate many eye diseases such as glaucoma, diabetic retinopathy

Vessel Extraction

Medical Imaging- Market
• Global Diagnostic Imaging Market – 15.8 B (2008) to 24.6B (2015) • Growth drivers: • Patient Demands • Independent Diagnostic centers (outside of hospitals) • UltraSound will be 23% of mkt (2015) • USA, China, India markets • Areas of focus by manufactures: • Fusion Modalities • Data Analysis Software • IT Integration – Image transmission & Storage •Information Management Systems

Ref: Global Markets Direct

Expertise Shortage

10,000 People /   Cardiologist

100,000 People /   Ophthalmologist

Tele Medicine

The use of electronic information and communications technologies to provide and support health care when distance separates the participants.

Telemedicine Stack

The Six Vital Elements
Monitoring / Screening
Health Parameter Aggregation

Health Parameter Aggregation

Video/Audio Conferencing Data / Image Compression /Transmission JPEG 2000

H.264

Image & Data Archival / Work Flow Management
Microsoft

Hospital Information System Integration PACS / EMR

HealthVault

mHealth ‐ Why

mHealth ‐ Why

Wireless Market Evolution
Today

4G /LTE 3G

2.5G 2G 1G
Analog Cellular
Voice only

Wide-Band Digital Cellular
Video High-end gaming ~100 Mbps 10msec Flexible bandwidth

Digital Cellular
Voice Email Photos Web ~100kbps data

Wide-Band Digital Cellular
Video 300kbps14Mbps

Digital Cellular
Voice Pager 10kbps data

mHealth
Around 6000 Consumer Health

1 Medication Reminder 2 Appointment Reminders 3 Appointment reminders 4 Medical Data on SIM card 5 Patient information to Relatives 6 Post Cardiac surgery report 7 Access to Dietary Information Applications Etc etc

1

2

3

4

Medpage Today Breaking Medical News

Epocrates Drug Information, Dosage Calculation

Medscape Largest,Most comprehensive Med App

E-VAl MD Medical History, examination details

Concern from Physicians on accuracy and validity of instructions!!

Electronic Pill Reminder

mHealth
Modified Nokia phone with breath analyzer – from Applied Nanodetectors

4
Built in ECG recording –EPI Life – Singapore based Ephone International

Tele Ophthalmology Architecture
Ophthalmic Camera

1

Ophthamic TelePACS Server

2

Remote Viewing

3

Reporting Modules

4

PC Ophthamic Worklist

Upload

Secure WEB Download Progressive  Viewing

Ophthalmic Viewer

OR

iPhone

Ophthalmic Worklist

Ophthalmic Viewer

Summary
Many advances in Patient Monitoring Many advances in Medical Imaging Expertise Gap Role of communication Technology in Healthcare m Health 

Slide 40

© Copyright i2i Telesolutions 2009

Questions ?

Radiation Dosages
Imaging Technique Effective Radiation  Doses (mSv) 3.6 0.06 2.1 0.6 1.8 ~7.5 22.5 14

Background Radiation Chest X‐ray Spine X‐ray Mammography CT Head CT Pelvis/Abdomen/Chest CT Whole Body PET Whole Body

Approximate Period of  Natural Background  Radiation 1 Year 6 Days 7 Months 2 Months 6 Months 2 Years, 1 Month 6 Years, 3 Months 4 Years

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