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