UNIVERSITY OF

CAMBRIDGE 4th FUTURE OF WIRELESS INTERNATIONAL CONFERENCE

THE MØLLER CENTRE, CHURCHILL COLLEGE, CAMBRIDGE

mHEALTHCARE OPPORTUNITIES,CHALLENGES

AND

PROSPECTS

PROFESSOR C R LOWE

UNIVERSITY OF

CAMBRIDGE

WHY DO WE NEED mHEALTHCARE? THE

WORLD IS CHANGING

TRADITIONAL RISKS

MODERN RISKS

LIFESTYLE / WELLBEING

OBESITY

CANCER

PSYCHIATRIC DISORDERS/

NEURODEGENERATIVE

CEREBROVASCULAR DISEASE

DIABETES

FOOD/WATER QUALITY

URBAN AIR QUALITY

OCCUPATIONAL RISKS

SECURITY / TERRORISM

RISK

SIZE

TIME

UNDERNUTRITION

INFECTIOUS DISEASES

WATER

SANITATION

HYGIENE

HUMAN ENVIRONMENT

LIFESTYLE

HEALTH & WELFARE

CLINICAL DISORDERS

CHEMICAL

INTELLIGENCE

WHY DO WE NEED mHEALTHCARE? THE WORLD IS

CHANGING

UNIVERSITY OF

CAMBRIDGE

MOTIVATION FOR mHEALTH

MOTIVATION FOR mHEALTH

CONSTRAINTS FELT BY HEALTHCARE SYSTEMS

POPULATION GROWTH AND DEMOGRAPHICS

HIGH BURDEN OF DISEASE PREVALENCE

LOW HEALTHCARE WORKFORCE

LARGE NUMBERS OF RURAL INHABITANTS

LIMITED FINANCIAL RESOURCES TO SUPPORT

HEALTHCARE INFRASTRUCTURE AND HEALTH

INFORMATION SYSTEMS

RAPID RISE IN MOBILE PHONE PENETRATION IN

DEVELOPING NATIONS

UNIVERSITY OF

CAMBRIDGE

mHEALTH MARKET SEGMENTATION

mHEALTH MARKET SEGMENTATION

TeleHEALTH

mCARE mHEALTH

WELLNESS/

FITNESS

HOSPITAL

DISCHARGE

HOME CARE

MEDICAL

HOME

PRACTICE

RETAIL

CLINIC

CHRONIC

DM

HOME

DIAGNOSTICS

mVISIT

EMR

ONLINE

DM

mEXPERT

OPINION CONSUMER

WIKI

CORPORATE

FITNESS

SENIOR

FITNESS

FITNESS

TRACKING

DIET

CONTROL

MEDICATION

REMINDER

FALL

MONITORING

WANDER-OFF

MONITORING AT-HOME

ACTIVITY

MONITORING

INSURANCE

COVERAGE

PROFESSIONAL

CARE SELF-CARE

SELF-PAY

mPERSONAL

HEALTH

RECORDS

MEDICATION

MONITORING

UNIVERSITY OF

CAMBRIDGE

FACTORS SHAPING THE FUTURE OF mHEALTHCARE LIFETIME DIAGNOSTIC MANAGEMENT

FOOD/WATER/AIR QUALITY

LIFESTYLE

ALCOHOL/DRUGS OF ABUSE

STRESS

SLEEP DISORDERS

MIGRAINE

PREGNANCY

FERTILITY

DIABETES

CANCER

ISCHAEMIC HEART DISEASE

COPD

NEURODEGENERATIVE/

NEUROPSYCHIATRIC DISORDERS

CEREBROVASCULAR DISEASE

HIV/AIDS

EARLY

SYMPTOMS DISEASE

HOME

PHYSICIAN’S OFFICE

CLINICAL CENTRE

HOME

WORKPLACE

A&E

BEDSIDE

ITU

CENTRAL

LABORATORY

HEALTHY ACUTELY

SICK

CHRONICALLY

ILL

WORRIED

WELL BLOOD ANALYTES

LIVER/KIDNEY DYSFUNCTION

FAECAL OCCULT BLOOD

GLUCOSE

HAEMOGLOBIN A1C

ASTHMA

MENOPAUSE

COAGULATION/PLATELET FUNCTION

INFECTIOUS DISEASES

STI

CONCERN

FACTORS SHAPING THE FUTURE OF mHEALTHCARE LIFETIME DIAGNOSTIC MANAGEMENT

UNIVERSITY OF

CAMBRIDGE

RISK

PREDICTION

COMPLIANCE TESTING

PATIENT

STRATIFICATION

DIAGNOSIS

TREATMENT REGIME

(THERAPEUTIC

STRATIFICATION)

MONITOR PATIENT

RESPONSE

SUSCEPTIBILITY

ADR

FACTORS SHAPING THE FUTURE OF mHEALTHCARE EMERGING THERANOSTIC INTERVENTIONS

PROGNOSIS

DISEASE EVOLUTION

EMERGING THERANOSTIC

INTERVENTIONS

UNIVERSITY OF

CAMBRIDGE

FACTORS SHAPING THE FUTURE OF mHEALTHCARE DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE

MEDIUM METABOLITES/BIOMARKERS

UREA

CREATININE

BILIRUBIN

TRIGLYCERIDES

LONG IRON

ALBUMIN

HAEMOGLOBIN A1c

IMMUNOGLOBULINS

CHOLESTEROL

CONCENTRATION RANGE [C] = 10-1-10-18M

RAPID

REAL-TIME

BLOOD GASES (pO2, pCO2)

GLUCOSE

IONS (Na+, K+, Cl-

HORMONES (CORTISOL)

NEUROTRANSMITTERS

FACTORS SHAPING THE FUTURE OF mHEALTHCARE

DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE

UNIVERSITY OF

CAMBRIDGE

PATIENT SENSOR RECORDING FORMATS NON-INVASIVE

INVASIVE

MINIMALLY

INVASIVE INTELLIGENT

CLOTHES/

ACCESSORIES/

JEWELLRY

NON-INVASIVE

(SPECTROSCOPIC)

INDWELLING

CATHETERS

SUBCUTANEOUS

IMPLANTS

BREATH

ANALYSIS

SMART TATTOO

SKIN E-PATCH

DIGITAL PLASTER

COSMETICS

CONTACT LENS

WATCH

FINGERSTICK

PATIENT SENSOR RECORDING FORMATS

BREATH

TEARS

SALIVA

SWEAT

BLOOD

URINE

FAECES

SEMEN

BLOOD

ISF

CSF

UNIVERSITY OF

CAMBRIDGE

BIOSENSOR PRINCIPLES AND

TRANSDUCERS

ANALYTE

(BIO)RECOGNITION

SYSTEM

TRANSDUCER

ELECTRICAL

OPTICAL

ACOUSTIC

MAGNETIC

THERMAL

MICROENGINEERED

INSTRUMENTATION

BIOSENSOR PRINCIPLES AND

TRANSDUCERS

UNIVERSITY OF

CAMBRIDGE

QUICK TIME-TO-ANSWER

SIMPLE READOUT

LOW COST

EASILY/INEXPENSIVELY MANUFACTURED

MINIATURE AND LOW (OR NO) POWER BURDEN

GOOD SENSITIVITY AND SPECIFICITY

USED BY MINIMALLY TRAINED PERSONNEL

FUNCTION >30 °C AND AT HIGH HUMIDITY

LONG STORAGE TIMES WITHOUT REFRIGERATION

NO LOCAL REAGENTS/WATER AND/OR SPECIALIZED

EQUIPMENT

DETECT MULTIPLE PATHOGENS

KEY ATTRIBUTES OF MOBILE/WEARABLE

SENSORS

KEY ATTRIBUTES OF MOBILE/WEARABLE SENSORS

UNIVERSITY OF

CAMBRIDGE

0

10

20

30

40

0

0.5 1 1.5 2 2.5

LACTATE

GLUCOSE

[SUBSTRATE] (mM)

MICROAMPEROMETRIC BIOSENSORS

MICROAMPEROMETRIC BIOSENSORS

UNIVERSITY OF

CAMBRIDGE

MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)

RF COIL

NdFeB MAGNET

LIQUID SAMPLE

N

S AIR GAP

ACOUSTIC WAVE

RF COIL

PIEZOELECTRIC

QUARTZ DISC

(AT-cut, 0.25mm

thick, 12mm dia)

ALUMINISED

GLASS DISC

MAGNETIC ACOUSTIC RESONATOR SENSOR

(MARS)

UNIVERSITY OF

CAMBRIDGE

MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)

MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)

-400

-300

-200

-100

0

100

200

300

400

0 50 100 150 200 250 300 350 A (

mV

)

f (MHz)

Signal Generator

Lock-in Amplifier

AM Detector Copper Coil

Output

16th HARMONIC

SIGNAL GENERATOR

AM DETECTOR

LOCK-IN AMPLIFIER

COIL/DEVICE

OUTPUT

UNIVERSITY OF

CAMBRIDGE

REMOTE ACOUSTIC MEASUREMENTS WITH A TOROIDAL

ELECTRIC FLUX

TOROIDAL ANTENNA

(TRANSCEIVER)

SUBCUTANEOUSLY IMPLANTED

e-PATCH

CONTACT LENS

MRAS QUARTZ DISC

-30

-20

-10

0

10

20

30

20.1 20.12 20.14 20.16 20.18 20.2

f (MHz)

-250

-200

-150

-100

-50

0

50

100

6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73

Frequency MHz

Am

plit

ud

e m

V

pH 2

pH 3.5

pH 4

pH 5

pH 5.1

pH 5.2

pH 5.25

pH 5.5

pH 6

pH 7

pH 8

100

50

0

-50

-100

-150

-200

-250

Am

pli

tud

e (

mV

)

6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73

Frequency (MHz)

REMOTE ACOUSTIC MEASUREMENTS WITH

A TOROIDAL ELECTRIC FLUX

UNIVERSITY OF

CAMBRIDGE

Poly (acrylamide-co-3-APB)(78.5mol% acrylamide; 1.5mol% MBA; 20mol% 3-APB)

PBS Buffer pH 7.4

ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS

O

HO

HOH 2 C

O

HO

O

B

HO

- 6MHz

20MHz

33MHz

47MHz

60MHz

73MHz

0 5 10 15 20

0.2

0.4

0.6

0.8

1.0

[Glucose](mM)

No

rmalised

Am

pli

tud

e

0

ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS

UNIVERSITY OF

CAMBRIDGE

PC Lock-in

Amplifier

Signal

Generator

AM Detector

MARS Jig

Gilson minipuls 2

Pump y = 1.0434x - 19.187

R² = 0.9969

0

50

100

150

200

250

50 100 150 200 250

Am

pli

tud

e o

f th

e e

xp

eri

me

nta

l fl

ud

ic s

ys

tem

(m

V)

Amplitude of the static system (mV)

DYNAMIC GLUCOSE

MEASUREMENT SYSTEM

DYNAMIC GLUCOSE

MEASUREMENT SYSTEM

UNIVERSITY OF

CAMBRIDGE FABRICATION OF HOLOGRAPHIC SENSORS

MIRROR

EMULSION

GLASS TANK

ACHROMAT

LASER SPATIAL

FILTER

MIRROR

4°

UNIVERSITY OF

CAMBRIDGE

ΣRi

PRINCIPLE OF HOLOGRAPHIC SENSORS

wavelength (nm)

refle

cta

nc

e (%

)

0

5

10

15

20

25

30

35

600 610 620 630 640 650 660

lpk

R pk

n

“Smart” Polymer

θ

d

λmax = 2ndcosθ

COLOUR

BRIGHTNESS

IMAGE/ALPHANUMERIC

MESSAGE

POSITION

OPTICAL ELEMENTS

MICRO-HOLOGRAMS

UNIVERSITY OF

CAMBRIDGE

DIABETIC MONITORING WITH GLUCOSE

HOLOGRAMS

-20

0

20

40

60

80

100

120

140

160

180

2 4 6 8 10

[GLUCOSE] (mM)

25

15

12

10

8 5

mol% 3-APB

max(n

m)

O

HO

HOH 2 C

O

HO

O

B

HO

-

WHOLE BLOOD

INDWELLING CATHETER

SUBCUTANEOUS NEAR-IR

CONTACT LENS

SKIN PATCH/TATTOO

DIABETIC MONITORING WITH GLUCOSE

HOLOGRAMS

UNIVERSITY OF

CAMBRIDGE

CONTACT LENS HOLOGRAPHIC GLUCOSE

SENSOR

TOXICITY

TEAR [GLUCOSE]<BLOOD [GLUCOSE]

pH VARIABILITY (5.8-7.8)

TIME LAG (~MIN)

SELECTIVITY (LACTATE/FRUCTOSE)

OPTICAL PHYSICS

COMFORT/COSMETIC APPEARANCE

INSTRUMENTATION

CONTACT LENS HOLOGRAPHIC GLUCOSE SENSOR

UNIVERSITY OF

CAMBRIDGE

80

100

120

140

160

0 12 16 19 23 26

Time [minutes]

Blo

od

-Glu

co

se

[m

g%

]

680

700

720

740

Wa

ve

len

gth

[n

m]

TRACKING OF BLOOD GLUCOSE IN TEAR

FLUID IN VIVO

TRACKING OF BLOOD GLUCOSE IN TEAR FLUID

IN VIVO

UNIVERSITY OF

CAMBRIDGE

HUMAN BREATH ANALYSIS

DIABETIC KETOACIDOSIS

RENAL FAILURE

LIVER DYSFUNCTION

ALCOHOL INTOXICATION

CANCER

CYSTIC FIBROSIS

ASTHMA

GIT DISORDERS (H pylori)

HALITOSIS

STRESS

H2

ETHANE

n-PENTANE

BUTANE

NO

CO

NH3

ETHANOL

ACETONE

THIOLS

HUMAN BREATH ANALYSIS

UNIVERSITY OF

CAMBRIDGE

90

80

70

60

50

40

30

20

10

0

0 2 4 6 8 10 100 200 300

Time (s) Time (s)

(nm)

A B 1-Butyne Butane 1-Butene Iso-butane Propane Propyne/propadione Propene Ethane Ethyne

RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES

590 580

570

560

550 540

530

520

510

(

nm

)

0 100 200 300 400 500 600 700

Time (s)

Butane

80

60

40

20

0

0 20 40 60 80 100

Concentration (%v/v)

(n

m)

1-Butyne

Butane

1-Butene

isoButane

Propene Propane

Ethyne Ethane

Temperature (°C)

10 20 30 40

1

10

100

(nm)

RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES

UNIVERSITY OF

CAMBRIDGE

0 20

40 60

80

Weight

Blood sugar

Vital signs (Blood pressure/heart

rate/respiratory rate)

Exercise/physical activity

Calories/fat content taken in

Pain level

Sleep patterns

Cardiac rhythm

Bladder control

Acid reflux/indigestion

Digestive health

%

Yes (88%)

No (12%)

PHYSICIAN’S WANTING PATIENTS TO TRACK/MONITOR

HEALTH AT HOME

PHYSICIAN’S WANTING PATIENTS TO

TRACK/MONITOR HEALTH AT HOME

Source: PriceWaterhouseCoopers HRI Physician Survey (2010)

UNIVERSITY OF

CAMBRIDGE

IMPACT OF mHEALTH ACCORDING TO

PHYSICIANS

IMPACT OF mHEALTH ACCORDING TO PHYSICIANS

EXPEDITE DECISION

MAKING (56%)

DECREASE TIME IT

TAKES FOR

ADMINISTRATIVE TASKS

(39%)

INCREASE COLLABORATION

AMONG PHYSICIANS

(36%)

ALLOW MORE

TIME WITH

PATIENTS (26%)

HAVE NOT AFFECTED

MY DAY-TO-DAY WORK

(24%)

UNIVERSITY OF

CAMBRIDGE mHEALTH AND HEALTHCARE OUTCOMES

mHEALTH AND HEALTHCARE OUTCOMES

IMPROVED HEALTH OUTCOMES AND COST SAVINGS

INCREASED ACCESS TO HEALTHCARE AND HEALTH-

RELATED INFORMATION

ACCESS TO HARD-TO-REACH POPULATIONS

REGIONS OF POOR LITERACY RATES AND LIMITED LOCAL

LANGUAGE-ENABLED PHONES

IMPROVED ABILITY TO DIAGNOSE AND TRACK DISEASES

TIMELIER, MORE ACTIONABLE, PUBLIC HEALTH

INFORMATION

EXPANDED ACCESS TO ONGOING MEDICAL EDUCATION

AND TRAINING FOR HEALTH WORKERS

IMPROVED HEALTHY LIFESTYLES

UNIVERSITY OF

CAMBRIDGE EMERGING TRENDS IN mHEALTHCARE

EMERGENCY RESPONSE SYSTEMS (ROAD

TRAFFIC ACCIDENTS, OBSTETRIC CARE)

MOBILE VOICE AND SMS SUPPORT TO REMOTE

CLINICIANS

REMOTE PATIENT MONITORING

MONITORING OUTBREAKS AND EPIDEMICS

HEALTH-RELATED mLEARNING FOR PUBLIC

TRAINING AND CONTINUED PROFESSIONAL

DEVELOPMENT FOR HEALTHCARE WORKERS

HEALTH PROMOTION AND COMMUNITY

MOBILIZATION

SUPPORT OF LONG-TERM CHRONIC CONDITIONS

(DIABETES,NEUROPSYCHIATRIC DISORDERS)

EMERGING TRENDS IN mHEALTHCARE

UNIVERSITY OF

CAMBRIDGE

SENSOR/

TRANSMITTER

WIRELESS

MONITOR

CLOUD

SERVER

Intelligent

algorithms

Messaging

PATIENT

HEALTHCARE

PROVIDER

MOBILE HEALTH TOOL

REAL-TIME MONITORING

PHYSICIAN TRACKING

FEEDBACK

CARER ALERTS

DRUG AUTOMAT

PHYSICIAN

DRUG

AUTOMAT

mHEALTH

WATCH