col e. friedl - sintef
TRANSCRIPT
COL Karl E. FriedlCOL Karl E. FriedlTelemedicine and Advanced Technology Research CenterTelemedicine and Advanced Technology Research Center
25 June 200925 June 2009Oslo, NorwayOslo, Norway
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About TATRC
Need for advances in personalized health
Program developments
THE LINE UPTHE LINE UP
Summary and outlook2
CUTTING EDGE MEDICAL TECHNOLOGY CUTTING EDGE MEDICAL TECHNOLOGY FOR SOLDIER HEALTHCAREFOR SOLDIER HEALTHCARE
Explore science and engineering Explore science and engineering technologies ahead of regularly technologies ahead of regularly programmed research, leveraging programmed research, leveraging other programs to maximize other programs to maximize benefits to military medicinebenefits to military medicine
Be the model government enabler Be the model government enabler of technology transfer to useof technology transfer to use
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TATRC KEY INITIATIVESTATRC KEY INITIATIVES
•• Robotic rescue & evacuationRobotic rescue & evacuation•• Shelf stable diagnostics & vaccinesShelf stable diagnostics & vaccines•• Blood products & blood safetyBlood products & blood safety
ee--HEALTHHEALTHMEDICINE IN MEDICINE IN
AUSTEREAUSTEREENVIRONMENTSENVIRONMENTS
DIGITALDIGITALWARRIORWARRIOR
INTEGRATIVEINTEGRATIVEMEDICINEMEDICINE
HOSPITALHOSPITALOF THEOF THEFUTUREFUTURE
•• Natural orifice Natural orifice transluminaltransluminalendoscopic surgeryendoscopic surgery
•• Advanced medical imagingAdvanced medical imaging•• Distance medical training & Distance medical training & simulationsimulation
•• Operating room of the Operating room of the futurefuture
•• Prosthetics and human Prosthetics and human performanceperformance
•• Regenerative medicine & Regenerative medicine & biomaterials biomaterials
•• Virtual environmentsVirtual environments•• Computational models & toolsComputational models & tools•• Human/soldier Human/soldier phenomephenome•• Performance & injuryPerformance & injuryprediction modelsprediction models
•• Cell phoneCell phone‐‐based systemsbased systems•• Remote Remote biomonitoringbiomonitoring•• Global Global BiosurveillanceBiosurveillance
•• Health information portalHealth information portalunified EHRunified EHR
•• Research data cube/Research data cube/medical outcomesmedical outcomes
•• PharmacovigilancePharmacovigilance
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TATRC PORTFOIOSTATRC PORTFOIOS
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Resilience &
Retraining
MAJ Brininger
Wellness &Training
Dr. Cardin
Psych Health
Dr. Shore
Simulation& Training
Technology
Mr. Wiehagen
Bio-MonitoringTechnologies
Dr. Lai
MedicalRobotics
Dr. Gilbert
AdvancedProsthetics & Human
Performance
Mr. Turner
Genomics& Proteomics
Ms. Stanley
InternationalHealth
Ms. Barrigan
MedicalImaging
Technologies
Dr. Pacifico
HealthInformation
Technologies
LCDR Steffensen
ComputationalBiology
Dr. Reifman
Nano-Medicine & Biomaterials
Dr. Grundfest
RegenerativeMedicine
Dr. Lai
InfectiousDisease
Dr. Carney
MedicalLogistics
Mr. DePasquale
Blood Products & Safety
Mr. Malloy
Trauma
Dr. Broderick
VisionMr. Read
Acoustic Trauma
Dr. Holtel
Head& Spinal Cord
Injury
Dr. Curley
TATRC PORTFOIOSTATRC PORTFOIOS
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Resilience &
Retraining
MAJ Brininger
Wellness &Training
Dr. Cardin
Psych Health
Dr. Shore
Simulation& Training
Technology
Mr. Wiehagen
Bio-MonitoringTechnologies
Dr. Lai
MedicalRobotics
Dr. Gilbert
AdvancedProsthetics & Human
Performance
Mr. Turner
Genomics& Proteomics
Ms. Stanley
InternationalHealth
Ms. Barrigan
MedicalImaging
Technologies
Dr. Pacifico
HealthInformation
Technologies
LCDR Steffensen
ComputationalBiology
Dr. Reifman
Nano-Medicine & Biomaterials
Dr. Grundfest
RegenerativeMedicine
Dr. Lai
InfectiousDisease
Dr. Carney
MedicalLogistics
Mr. DePasquale
Blood Products & Safety
Mr. Malloy
Trauma
Dr. Broderick
VisionMr. Read
Acoustic Trauma
Dr. Holtel
Head& Spinal Cord
Injury
Dr. Curley
Need for advances in personalized health
THE LINE UPTHE LINE UP
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MILITARY HEALTH SYSTEM PRIORITIESMILITARY HEALTH SYSTEM PRIORITIES
• Enhance warrior care– Strengthen the continuum of care from entry to service to rehabilitation and transition
• Build a bridge to peace– Expand humanitarian missions and disaster relief to support US strategic objectives and champion aspirations for human dignity through better health
• Promote patient choice & accountability, healthy communities, safety & quality
• Strengthen medical education & research
• Create healing environments8
PERSONALIZED BIOMONITORING ON PERSONALIZED BIOMONITORING ON THE BATTLEFIELD AND AT HOME THE BATTLEFIELD AND AT HOME
continuous monitoring from readiness to reset
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Urgent military needs drive demand for better solutions
Military is often “early adopter”of new medical technology
“Dual use”applications flow to civilian use
CONFLUENCE OF TECHNOLOGIES = CONFLUENCE OF TECHNOLOGIES = PERSONALIZED HEALTHPERSONALIZED HEALTH
• Cell phone connectivity ‐ individual access to personalized resources
• Electronic health record – portable, accurate, personalized to “learn its soldier”
• Phenomics – comprehensive physiological models that interpret and predict the individual
• Closed loop systems – highly reliable monitoring and feedback to support the individual
• Integrative health ‐ empowered people with responsibility for their own health and wellness
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Need the innovation that comes from a marriage of science and engineering with a focus on problem solving
Biomonitoring technologies are critical to each of the goals
Program developments
THE LINE UPTHE LINE UP
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CELL PHONE CONNECTIVITY BETWEEN CELL PHONE CONNECTIVITY BETWEEN PATIENT AND HEALTH CARE PROVIDERPATIENT AND HEALTH CARE PROVIDER
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Better Better compliancecompliance
Better careBetter care
Greater Greater efficiency= efficiency= lower cost lower cost
INDIVIDUAL INDIVIDUAL AWARENESS AWARENESS FOR ACTIONFOR ACTION
CELL PHONE CONNECTIVITY BETWEEN CELL PHONE CONNECTIVITY BETWEEN PATIENT AND HEALTH CARE PROVIDERPATIENT AND HEALTH CARE PROVIDER
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There is no There is no requirement requirement
for for complexity!complexity!
INDIVIDUAL INDIVIDUAL AWARENESS AWARENESS FOR ACTIONFOR ACTION
mCare Web Portal - Dashboard
• biomonitoring of person & decision support tools (“skin‐in”)
• record of individual environmental exposures (“skin‐out”)
• virtual “friend” for stress management
• medical advice to extend limited physician access (virtual medic)
• automatic “911” for medical alert
CELL PHONE CONNECTIVITY BETWEEN CELL PHONE CONNECTIVITY BETWEEN PATIENT AND HEALTH CARE PROVIDERPATIENT AND HEALTH CARE PROVIDER
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We monitor vehicles and equipment for fatigue and failure better than we do humans
““mm‐‐HEALTHHEALTH”” BY CELL PHONEBY CELL PHONE
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Clinical consultationEducationResearchBiosurveillance
1.8 B cell phones in the developing world
1 M new cell phones every day
The explosive spread of mobile phone networks across the developing world has created a unique opportunity to significantly transform how countries can tackle global health challenges.
Dr. Howard Zucker, Assistant Director-General, WHO
SURGICAL TELEMENTORING BY CELL SURGICAL TELEMENTORING BY CELL PHONE SMS!PHONE SMS!
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SURGICAL TELEMENTORINGSURGICAL TELEMENTORING
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Deployment47th CSH, Iraq
System Development
HAND HYGIENE REMINDER AND HAND HYGIENE REMINDER AND MONITORING SYSTEMMONITORING SYSTEM
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Food Prep A
rea
Transmitter
Wearable Device
Wash Monitor
Protected Zone
Hospital-acquired infections cause at least 88,000 deaths annually and cost $4.5B
Personal monitoring: from federal to general healthcare to food industry
“Wash Zone”transmitters send out signals when hand washing has occurred
Small receivers worn by staff, vibrates when washing should occur –also records when washing has or has not occurred. All data can be downloaded via USB or wireless link.
“Protection Zone”transmitters send out unique, short range signals near food prep stations, bathrooms, patient beds, etc.
NATIONWIDE HEALTH INFORMATION NATIONWIDE HEALTH INFORMATION NETWORK INTERFACENETWORK INTERFACE
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HEALTH HEALTH INFORMATION INFORMATION FOR ACTIONFOR ACTION
• Standards‐based exchange of health information
• Infrastructure facilitates health information exchange between DoD, federal partners, and civilian participants
WIRELESS PERSONAL INFORMATION WIRELESS PERSONAL INFORMATION CARRIER (WPIC)CARRIER (WPIC)
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Gives medical personnel accurate and instantaneous access to patient medical records at a distance of 10m, without physical contact.
Simplify record keeping, medical examinations and provide immediate and secure access to medical data in emergency or normal healthcare use
PERSONAL AREA NETWORK FOR PERSONAL AREA NETWORK FOR REMOTE HEALTH MONITORINGREMOTE HEALTH MONITORING
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HEALTH HEALTH INFORMATION INFORMATION FOR ACTIONFOR ACTION
SPARNET is an integrated system for capture, analysis, communication, display, and archive geo‐location and physiologic‐sensor data.
Real time medical status data and geo-location for increased safety during training
MEDICAL SITUATIONAL AWARENESS MEDICAL SITUATIONAL AWARENESS FOR COMMANDERS AND MEDICSFOR COMMANDERS AND MEDICS
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PERVASIVE PERVASIVE HEALTH HEALTH MANAGEMENTMANAGEMENT
Cognitive State
MetabolicMonitoring
Through ClothingThoracic Sensor
Textile BasedSensors
New Hydration Assessment Technologies Enhanced
Remote Triage
NoninvasiveCardiac Output
Lab onChip Life Saving
Interventions
Adaptive Models• “Learn” Individual “Normal”
Enhanced Technologies• Saturated Pulse Oximetry • Cardiac Output• Blood Pressure• Lab on a Chip• Neurological Assessment
Enhanced Remote Triage• Injury Severity• Cognitive Assessment • Priority of Care• Priority of Evacuation
Better Sensor Fusion • Electro Textiles• Stealth Wireless Network
MEDICAL SITUATIONAL AWARENESS MEDICAL SITUATIONAL AWARENESS FOR COMMANDERS AND MEDICSFOR COMMANDERS AND MEDICS
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PERVASIVE PERVASIVE HEALTH HEALTH MANAGEMENTMANAGEMENT
Cognitive State
MetabolicMonitoring
Through ClothingThoracic Sensor
Textile BasedSensors
New Hydration Assessment Technologies Enhanced
Remote Triage
NoninvasiveCardiac Output
Lab onChip Life Saving
Interventions
Adaptive Models• “Learn” Individual “Normal”
Enhanced Technologies• Saturated Pulse Oximetry • Cardiac Output• Blood Pressure• Lab on a Chip• Neurological Assessment
Enhanced Remote Triage• Injury Severity• Cognitive Assessment • Priority of Care• Priority of Evacuation
Better Sensor Fusion • Electro Textiles• Stealth Wireless Network
COMMON THEMES FOR COMMON THEMES FOR PERSONALIZED MONITORINGPERSONALIZED MONITORING
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CONCEPTS CONCEPTS FOR THE FOR THE FUTURE FUTURE SOLDIER SOLDIER FROM NATO FROM NATO ALLIESALLIES
FELIN (Fantassin à Équipements et Liaisons Intégrés)
IdZ (Infanterist der Zunkunft)FFW (Future Force Warrior)
FIST
NORMANS
COMMON THEMES FOR COMMON THEMES FOR PERSONALIZED MONITORINGPERSONALIZED MONITORING
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There are many There are many energy energy expenditure expenditure measurement measurement devices devices
Health Health monitoring also monitoring also requires energy requires energy intake intake monitoring monitoring solutionssolutions
GPS Wrist monitor(Garmin Fortrex 201)
COMMON THEMES FOR COMMON THEMES FOR PERSONALIZED MONITORINGPERSONALIZED MONITORING
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ALGORITHMS ALGORITHMS AND MODELS AND MODELS TO CONVERT TO CONVERT DATA TO DATA TO IMPORTANT IMPORTANT KNOWLEDGE KNOWLEDGE IS A CRITICAL IS A CRITICAL GAPGAP
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GPS + magnetic compass + electronic pedometer + solid state gyro + altimeter
http://www.pointresearch.com
Dead Reckoning Navigation SystemTotal weight + geolocation + USARIEM Equation Metabolic cost of locomotion
MINIATURIZED WIRELESS IMPLANTABLE MINIATURIZED WIRELESS IMPLANTABLE BIOSENSORS FOR MULTIPLE ANALYTE BIOSENSORS FOR MULTIPLE ANALYTE
MONITORINGMONITORING
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HEALTH HEALTH INFORMATION INFORMATION FOR ACTIONFOR ACTION
Provides for continuous monitoring of the soldier’s metabolic and medical status, combined with telemetry for remote situational awareness of a Warfighter’sphysiological and medical condition.
sensor 0.5 x 0.5 x 5 mm
18 gauge hypodermal used for implantation
analytes display
Veri Chip for size comparison
SURFACE ACOUSTIC WAVE SENSORSURFACE ACOUSTIC WAVE SENSOR
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HEALTH HEALTH INFORMATION INFORMATION FOR ACTIONFOR ACTION
Acoustic wave sensors are unique platforms that are capable of sensing multiple bio markers and manipulating bio‐films.
Surface acoustic wave sensor combined with a biofluidcollection system will enable for measurement of biochemical changes occurring after injury.
INTERACTIVE COGNITIVE INTERFACE INTERACTIVE COGNITIVE INTERFACE AND HEALTH MONITORING SYSTEMAND HEALTH MONITORING SYSTEM
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SMART HOME SMART HOME CONCEPTCONCEPT
Remote, home monitoring of soldier’s health status combined with interactive cognitive interface for soldier’s rehabilitation.
‐in‐home sensor network optional‐wearable, physiological devices‐ indoor GPS tracking
TRAINING IN VIRTUAL TRAINING IN VIRTUAL ENVIRONMENTSENVIRONMENTS
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Center for the Intrepid, San Antonio, Texas The CAREN system for rehabilitation and retraining
REHABILITATIONREHABILITATIONTRAININGTRAINING
Pneumatic balloon actuators for tactile feedback
HAPTIC FEEDBACK SYSTEMS FOR HAPTIC FEEDBACK SYSTEMS FOR PROSTHETICS AND REHABILATIONPROSTHETICS AND REHABILATION
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Fan et al. "Haptic feedback system for lower-limb prostheses," IEEE Transactions on Neural Systems and Rehabilitation Engineering, 16(3), 270-277, 2008.
NEUROPSYCHOLOGICAL STATUS NEUROPSYCHOLOGICAL STATUS MONITORING MONITORING
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Testing and behavioral Testing and behavioral status monitoring status monitoring embedded in games and embedded in games and regular activitiesregular activities
EYE TRACKING FOR SCREENING EYE TRACKING FOR SCREENING FATIGUE AND TBIFATIGUE AND TBI
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HEALTH HEALTH INFORMATION INFORMATION FOR ACTIONFOR ACTION
LED
Power Supply(embedded in frame)
Electronics, Bluetooth, Processing(embedded in frame)
Micro‐Camera (Endo‐Right Eye)
LEDs
Micro‐camera and LEDsReplicated for Endo‐Left Eye(Not shown for clarity)
Optional: Mini‐USB Connected Tether for Media Download and Power Recharging
Non‐invasive screening for determination of soldier’s fitness for duties
WEARABLE, WIRELESS PHYSIOLOGICAL WEARABLE, WIRELESS PHYSIOLOGICAL STATUS MONITORINGSTATUS MONITORING
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HEALTH HEALTH INFORMATION INFORMATION FOR ACTIONFOR ACTION
Provides for continuous monitoring of the soldier’s physiological status, combined with telemetry for remote situational awareness of a Warfighter’sphysiological and medical condition.
Meaures SpO2, HR, RR, Perfusion Index, Posture, Activity, Skin Temperature
VITUAL HUMANS AND AVATARS FOR VITUAL HUMANS AND AVATARS FOR TRAINING AND TREATMENTTRAINING AND TREATMENT
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“Justina” – interactive PTSD patient to train new physician interview techniques
Personal projections and biofidelic artificial intelligence interactions need biomonitoring data from nonverbal signals
Examples of nonverbal signals that may be diagnostically important:• voice stress• eye movement• body position• movement • physiological responses
When will we have When will we have a virtual physician a virtual physician providing reliable providing reliable advice?advice?
INTELESENSE TECHNOLOGIES AND INTELESENSE TECHNOLOGIES AND PROJECT ARGUSPROJECT ARGUS
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ENVIRONMENT ENVIRONMENT AWARENESS AWARENESS FOR ACTIONFOR ACTION
Provides real time public health status and environmental situational awareness through combination and integration of data from wireless sensors and public health information through the web and other databases
ROBOTIC STANDOFF UV RAMAN ROBOTIC STANDOFF UV RAMAN FLORENCE CBE SENSORFLORENCE CBE SENSOR
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ENVIRONMENT ENVIRONMENT AWARENESS AWARENESS FOR ACTIONFOR ACTION
• Self‐contained teleoperated proximity system for detection and identification of chemical, biological, nuclear, radiological and explosive (CBNRE) agents on environmental surfaces
• Sensing technology based on spatially‐resolved Raman spectroscopy capable of the high levels of discrimination required for environmental analysis
• Reliability of measurements and predictions• Transparency and open architecture • Interoperability • Validation and certification• Personal data privacy• Cost effectiveness• Wear-and-forget convenience
KEY CHALLENGES TO PERSONAL KEY CHALLENGES TO PERSONAL MONITORING TECHNOLOGIESMONITORING TECHNOLOGIES
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• Dr. Eva Lai, PhD• COL Ron Poropatich, MD
• TATRC staff• TATRC academic and industrial partners
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
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