The potential use of mobile and wearable sensor devices in the

management of chronic diseases

Timothy Delany09322833

Supervised by Dr. Brian Caulfield

Source: Statistics Bureau

World Population Pyramids

• High cost of healthcare

• Inefficient management of chronic diseases

• Poor regulation of health interventions

• Overcrowding of the hospital setting

Difficulties which currently exist in the healthcare ecosystem

• 2nd Highest household expense

The Cost of Healthcare

• The number of insured is decreasing annually

• 32% of people refuse to see doctor when sick/injured

47% of this is because of the high cost

In 10 years, the Irish healthcare spend has doubled to $19 billion

Year % GDP (US) Cost ($)

2010 17.9 2.6 trillion

2020 19.8 4.6 trillion

Obesity forecasts

Source: E-health Strategy

• In the United States they make up ¾ of the healthcare costs, affecting more than 140 million individuals and accounting for $2 trillion/annum

• Major cause of mortality, accounting for 46% of global diseases

Chronic Diseases

• By 2020 – 89% of diseases in high income countries will be chronic

• In Ireland – chronic diseases make up 80% of the healthcare costs

• Cardiovascular disease

• Diabetes

• COPD

Non – Communicable Diseases

In 2011, WHO called on governments to focus on reducing the prevalence of these major chronic diseases

This case study will cover the following aims: 1. To describe the burdens the current healthcare ecosystem

faces, specifically with regards to chronic diseases. 2. To explain the potential that mobile and wearable technologies could have if integrated into this ecosystem.  3. To give an overview of various vital signs and measurements these devices can assess; specifically focussing on cardiovascular problems, diabetes and lung function. 4. To outline the potential implementation of current devices into the ecosystem of these chronic diseases.

Aims of this Case Study

• Inefficient clinical trials

• Access to healthcare

• Patient compliance

• Nosocomial infections

• Access and transportation

Other Burdens

Hospital Setting

• Full of highly resistant bacteria and pathogens

• 2/3rds of hospitals are contaminated

• Extranasal-methicillin resistant Staphylococcus aureus (MRSA)

• Potential to accelerate patient’s illness

• >100,000 fatalities in the US every year due to wrong medicines being received

Clinical Trials• Current gold standard for configuring efficacy

of health interventions is randomised clinical trials (RCT)

• Have evolved slowly over time

Source: ClinicalTrials.gov

• Long time lag between recruiting participants and publication

• High costs

• Limitations to current rating scales

• Irregularity of measurements/titrations

• Controlled circumstances and environments – significant outcomes already determined

Problem with Clinical Trials?

What can be done to overcome these

burdens?

Evolution of Internet Connected Devices

Source: Cisco

Creation of a New Patient-Centric Environment

Source: E-health Strategy

Source: HIS Inc.

Forecast for wearable tech revenue growth ($bn)

• Evaluation of disease, environmental toxins, motion, hormones, behaviour and other physiological variables

• Clinical trials to be carried out in multiple environments

• Improve knowledge of the etiology of illnesses

• Monitor fluctuations in health

• Continuous monitoring

Potential

Important measurements

1. Cardiovascular Problems

2. Diabetes

3. Chronic Obstructive Pulmonary Disease

1. Cardiovascular Problems

• The heart beats roughly 3 billion times in a person’s lifetime

• No surprise that cardiovascular problems are the leading cause of death worldwide

Blood Pressure

Crucial in prevention of cardiovascular diseases

Past measurements have failed to account for circadian rhythms

Ishikawa et al (2011) found 24 Hour monitoring of blood pressure provides a significant amount of information

Difficult to exercise or shower with

Holter Monitor - 1949

1999

Device Integration

MacManus et al 2010 – mean systolic blood pressure decrease by 5.4mm Hg

Continuous monitoring has also lead to the discovery of ‘White Coat Hypertension’ and ‘Masked Hypertension’

iHealth Sensor

Heart RateHeart Rate

Arrhythmias, bradycardia and tachycardia often indicate asymptomatic diseases

Device Integration

2. Diabetes – Glucose monitoring

Global total has surpasses 350 million

It is estimated that 40% of diabetics in the U.S. are undiagnosed

Mobile phone intervention improved the glycated haemoglobin by 1.8%

Source: Quinn et al 2011

Nanosensor Tattoo

Amperometric sensing contacts

3. Lung Function

3rd Leading Cause

210 million

Difficult to measure

Varying levels of air flow volumes for lung diseases

Source: Cleveland Clinic

Plethysmography and pneumography devices have been implemented into wearable technology

Spiro Vest

Source: Enokibori et al

Device Integration

Discussion

Possible Problems

Security – 43% of identity thefts are medical

Privacy – maintaining annomyinity

Data – sheer volume

Regulation – FDA list of guidelines

Noise – can obscure measurements

Telehealthcare evolution (no. of people)

Source: E-health Strategy

Future and Recommendations

• Pros appear to outweigh the Cons

• Numerous studies have found that continuous measurement is more effective

• Integrate sensors into current clinical trials

• Technologies will be obsolete though? Solution = continuous evaluation of evolving interventions (CEEI)

Conclusion

• Advance the quality of health services and decrease overall cost of healthcare

• Improved studies outside of laboratory environment

• More high-quality RCTs need to be carried out to evaluate the clear advantage of these technologies

• In order for monitoring to succeed in the long term, integration of biomedical functionality, fashion and health added value are crucial

• Accurate and reliable real-time information -> better management

Higher precision, improved sampling frequency, fewer misleading data, greater convenience,

and lower cost

Thank You

Questions?

I’d like to acknowledge Dr Brian Caulfield for his guidance and support

Acknowledgments and Questions