Robin A. Felder, PhD
The University of Virginia
Department of Pathology
TRANSFORMING HEALTHCARE
THROUGH INNOVATION

Disclosures
 University of Virginia
 Department of
Pathology
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 Medical Robotics
Medical Automation
Hypogen
WellAWARE Systems
MeyeChem
Proteus Bio
Global Cell Solutions
Monte Piccolo Farm

Pursuit of Wellness
 State of complete physical, mental and social well-being
 Health results from primarily positive perspectives and choices by which to live
 Technology can provide information that facilitates positive choices
Physical Social
6.2
9.1
8.0
Cognitive
Wellness Balance
© Felder, 2011

Wellness Support
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Growing need for new sources of data, and data interpretation
Integration of multiple diagnostic sources (lifestyle, self testing)
Integrated wellness and health record
Ongoing information support for maintaining healthy lifestyles

Wellness Technologies Monitor
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Nutrition
Exercise
Biometrics
Pain reduction
Stress reduction
Sleep improvement
Mood enhancement
Health and wellness

Wellness Support
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Food coaching
Rewards
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Exercise
Nutrition
Therapeutic compliance
Consequence reporting
Consequence forecasting
Overcome vicarious goal fulfillment or,
“exhaustion of selfcontrol”

Home Health IT
 New revenue sources:
Medical Cloud coaching and
Interpretations
Cloud
Interpretations

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Proliferation of Wellness
Tools
Accelerometer based
Various models for data delivery
Basic physiologic measurements
FitBit
BodyMedia
Striiv
Shine Misfit
Basis
Nike Feulband
Scanadu
Tricorder
Zephyr
Information Week
BodyMedia

KNOWS
You and what is around you
LEARNS
What you like
DISCOVERS
Things relevant to you
FILTERS
Out the irrelevant
SENSING
Local content
& services discovery
Source: Jarrin (Qualcomm)
SEEING
Augmented reality UI:
Map, 3D, in building navigation
INTERACTING
Connection manager
(WAN, Wi-Fi)

KNOWS
You and what is around you
LEARNS
What you like
DISCOVERS
Things relevant to you
FILTERS
Out the irrelevant
SENSING
Local content
& services discovery
Source: Jarrin (Qualcomm)
SEEING
Augmented reality UI:
Map, 3D, in building navigation
INTERACTING
Connection manager
(WAN, Wi-Fi)

new ipad mini
Lifewatch AG

Portable Diagnostics
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 iPhone based portable ultrasound
EKG
Otoscope
Dermatoscope
Microscope

Cell Scope ™
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Dermatoscope – iPhone clipon
 Transmits high quality magified pictures of skin blemishes
“Smart Otoscope” – iPhone ear drum microscope
 Transmits pictures of videos of the ear canal and ear drum
 Looks at progression or regression of disease

Otoscope Images
Normal Ear Drum Ear Infection Ruptured ear drum

Cloud Based Diagnosis of Parkinsons
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 Non-invasive phone based
Accurate (98%)
Remote, non-expert
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Low Cost
Rapid diagnosis
Scalable to large populations
Max Little - Parkinson’s
Voice Initiative
TED Conference 2012

iPhone Body Fluid Diagnostics
 Biosense Technologies
 uCheck
 Touc Hb

Continuous Glucose Monitoring
Dexcom

Embedded Wellness Sensors
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Instrument common fixtures
Wireless transmission of data
Web based aggregation and interpretation

Action Inspired Instruction
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Real time coaching
Medically approved content
 Tailored for individual

Passive Wellness Monitoring
Healthcare providers
Data management PC
Urine analyzer
Urine protein
Urine glucose
Vital Sensor
·Body temperature
·Pulse
·Blood Pressure
·Body fat percentage

The M.A.R.C. In-Home
Health Monitoring Project
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Create a model where the impact of chronic disease is delayed or avoided
Provide opportunity for medical intervention before a crisis occurs
Minimize impact of chronic disease on the healthcare system

Passive Remote Sensing
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Wireless Sensor Array (WSA) – gathers data on daily activities
Data Manager (DM) –transmits data to data analysis servers
Capture Analysis & Reporting Engine (CARE) – captures potential problems and alerts caregiver

Passive Gait Sensors
Vibration sensors placed in the house detect occupant gait

Passive Physiologic Sensors
Physiologic sensors embedded in common household furniture and fixtures

Sleep Monitoring
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Sleep apnea affects more than 40 million people in the
United States alone of which
85% are currently undiagnosed sleep apnea testing and therapy market that is expected to reach more that
$4 billion by 2012

Passive Vital Sign Bed Monitor
Polysomnography
Mattress pad to measure:
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Sleep quality
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Pulse (and HRV)
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Breathing
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Movement/ restlessness
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Bed exit
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Subject position/ turning
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Body temperature
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Blood Pressure
Passive Sensing

Restless Resident
Sleep Quality Graphs
Restful Resident

Remote Automated Triage
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 Real time assessment of participant health status/well being
Ability to drill down to specifics
Built in automated optimized dispatching
Manual override of dispatch event or downstream processes

30

One Click Trending
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Health
Socialization
System utilization

Telehome Monitoring Decreases
Costs by 74%
80000
70000
60000
50000
40000
30000
20000
10000
0
Overall Cost of Care Comparison
$67,757.88
$17,407.02
Monitored
N=21 in each group, P<0.05;
Telemed J E Health, 2007 13(3):279-85

FUTURE WELLNESS
TECHNOLOGIES

3D Manufacturing

36

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Wearable Cancer Detection
First Warning Systems™ heat distribution sensing sports bra
0.2cm
1cm 4cm

Underwear That Measures Blood
Pressure
 Tissue impedance shows passing pulses
 Pulse timing correlated with relative pressure
 Continuous blood pressure monitoring

Automated Pharmaceuticals
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Automated Pill – iPill (Philips)
Magnatrace™ System looks for pill ingestion
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Networked pills (Proteus
Biomedical)
 Instrumented Pills
Cost < $0.01
Measure and send physiologic signals through body electrically
 Receiver is a patch worn on the body that also logs respiration, heart rate and body movement, sleep patterns

Automated Intestinal Biopsies
 Intestinal diagnostic imaging coupled with miniaturized biopsies
 Pillcams with intestinal “Velcro” to arrest the camera at a selective location
 Continuous monitoring
MIT Technology Lab

The Eye as the Window to Health
Medical Robotics
UCSD
Preventive Science Inc.
Univ. of MD, Baltimore

MeyeChem, LLC
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Real time glucose monitoring
Alerts for low or high glucose concentrations
Trending analysis
Food coaching via telenutritionalmentoring

Virtual Reality
 Image enhancement, correction, zoom
 Correction currently limited to 0.2 logMAR, 20/32
 Full view software modulated images
 Superimposed augmented reality
Off axis projection with transflective diffuser 90 ° field eyewear iOptik
Gas-permeable nanopolarizer
(iOptik contact lens)
Diopter adjustable mini-scleral lens and wearable computer (iOptik)
Zoom lens (3X)
UCSD

Augmented Reality
 Projection of underlying anatomy on living tissue
 Relies on superimposition of reality and previously scanned animated image/data

Not for the Faint Hearted

Receptivity
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 Determining what information is TMI
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Presenting health vs wellness to a patient
Optimizing the time for the presentation of wellness strategies
“Wellformation”

Medical Automation.org
A non-profit educational organization improving healthcare quality and efficiency through teaching automation principles and their application in health systems http://medicalautomation.org

TagLine - Medical reality http://medicalautomation.org

Robotic Reality
HRP-4C National Institute of
Advanced Industrial Science and
Technology