Research and innovation for personalized telemedicine and ehealth systems for chronic, age and lifestyle related diseases

Transcription

1 C e n t r e f o r r e s e a r c h - b a s e d i n n o v a t Research and innovation for personalized telemedicine and ehealth systems for chronic, age and lifestyle related diseases sture.pettersen@telemed.no

2 Norwegian Centre for Telemedicine Established i 1992 Centre of expertise in telemedicine Research & Development WHO collaborating centre Centre for research-based innovation Technology Other Law Economy Social Science Medicine

3 Skyrocketing health care costs More than 1 billion people in the world are overweight. Without action, more than 1.5 billion people are expected to be overweight by Over 600 million people worldwide have chronic diseases, and the spending on chronic diseases is expected to increase. In the US alone, spending is expected to increase from $500 billion a year to $685 billion by Registrated and projected Globally, the number of persons 60 and older was 600 million in It is expected to double to 1.2 billion by 2025.

4 Persons per month Care level 2 (1) University hospital 13 (9) Local hospital Patients and level of care 150 General practitioners 500 Self-care 85 Symptoms, no treatment 250 No symptoms 1000 Risk population Source: Anders Grimsmo

5 St. Olavs Hospital More doctors and nurses treats less and less patients Man-labour year New patients treated. Exl acute help Doctors Nurses Hospitalization Policlinic Total activity. Exl acute help But elderly patients is controlled more and more often Hospitalization Follow-up Source: Professor Dag Bratlid Økonomisk forum 2002

6 90 Have you used the Internet for health purposes? Total

7 Tromsø Telemedicine Laboratory Forskningsdrevet innovasjon i telemedisin og e-helse for kroniske-, alders- og livstilsrelaterte sykdommer. Hvordan kan nye intelligente sensorer og personlige terminaler tilpasses personer med kronisk sykdommer og integreres (trådløst og usynlig) mot helsetjenesten? Hvordan kan nye pasientnære informasjonskildene integreres mot eksisterende pasientinformasjon og vil gi mulighet for utvidet klinisk beslutningstøtte som dataassistert diagnostikk Kan dette gi mulighet for automatisk helseovervåking på individ og gruppenivå? Hvilke nye former for datastøttet samarbeidsteknologi må etableres. Hvordan må brukergrensesnitt, integrasjon, sikkerhet og reorganisering av helsetjenester understøtte helhetlige pasientforløp

8 UNN 50% UIT 23 % Industri 27 % Telenor Well DIPS IBM Norut IT Norsk Helsenett Helse Nord IKT Stimulerer innovasjon gjennom satsing på langsiktig forskning i et nært samarbeid mellom forskningsaktive bedrifter, offentlig virksomhet og fremstående forskningsmiljøer Utvikler kompetanse på høyt internasjonalt nivå på områder som er viktig for innovasjon og verdiskaping Styrker teknologioverføring, internasjonalisering og forskerutdanning

9 The Board Lars Vorland (chair), CEO Northern Norway Regional Health Authority Steinar Pedersen, Managing director NST Hans-Christian Haugli, Research director Telenor R&I Morten Thorkhildsen, CEO IBM Norway Pål Myklebust, Chairman of the board Well Diagnostic Jan Børre Rydningen, Managing Director Norut IT Bengt Olsen, CFO Dips ASA Toralf Hasvold Dean University of Tromsø

10 Tromsø Telemedicine Laboratory Sensor-Based Systems for Vital Signs and surveillance Extended Decision-Support Sensors Wireless communication Personal terminals Computer-aided diagnostics Early warning systems Clinical decision-support sys. ComputerSupported Cooperative Work Usability Collaboration Integration Reorganization

11 Research areas Integrated Medical sensors Health terminals for Personalized Health Care Health intelligence Computer aided diagnoses Workflow management Clinical decision support

12 Sensor-Based Systems for Vital Signs and Surveillance Intelligent (smart) sensors - detect and respond to changing context - self-diagnostic, self-configurable, power - data capture and information aggregation Wireless communication - standardization of communication protocols - secure and efficient communication - Bluetooth, ZigBee, RF Personal terminals - Incorporate sensor data to mobile units - Give feedback to patient and health provider - Re-programmable computer HW technology - Residential ehealth/ecare gateways

13 Extended Decicion-Support Computer aided diagnostics - automatic image segmentation - pattern recognition Early warning systems - process time series - separating dynamic changes - differentiating between nonpathology and disease Clinical decision support - medical probabilistic platform

14 Computer-Supported Cooperative Work Usability - context of use - design suggestions Collaboration - technology for mediated collaboration - organizational models Integration - adapt current health information sys. - integrating multimedia - cross organizational borders Reorganization - organization efficient service provision

15 Ambisjoner 18 Doktorgrader minimum 6 Postdoc 80 Mastergrader 20 Patenter 90 Vitenskapelige publikasjoner 150 Forskerårsverk 179 mill kroner i budsjett 50 % ekstra finansiering Produkter og nyetableringer

16 Diabetes 200 mil with diabetes, increases to 330 mil i In Norway: Poorly regulated blood sugar increases the chance for diabetic complications. Diabetic complications with diabetes can occur in the heart, veins, nerves, kidneys and eyes. In Norway: 4 bill NOK per year Needs for self-help How do we support personalized lifestyle changes? Measures activity and blood sugar... Sent automatically and wireless to a mobile phone through the Health Net. And becomes available to the diabetic nurse which are connected to the EPR client Customized and personalized feedback

17 Knowledge about the current situation Physical activity (movement per day) Food habits (difficult, no sensors!?) Encouragement for change Suggestions based on the current situation Did you know (knowledge) Acceptance and rewards

18 Anticoagulation treatment Patients with a risk of blood clot Warfarin decrease the prothrombin time Risk of blood clot and hemorrhage In deaths, of which 48% are caused by anticoagulant home laboratory data are sent automatically and wireless to a cell phone and through the Health Net to decision support system based upon a pharmakinetic model.. assist doctors in dosage planning and ensure the patient against wrong medication

19 Automatic detection of malignant melanoma Malignant melanoma rapid increasing type of cancer Up to 100% get well if detected at an early stage Limited recourses for screening of cancer patients Picture for cellphone camera are sent to... Computer aided diagnostics for picture segmentation (asymmetry, color, bounder and diameter) Need for a Computer Aided Diagnostic system (CAD) Feedback to patient

20 Eczema 20-25% has atopic eczema Up to 90 % reduction of degree of seriousness with repeated training and demonstrations Parents can manage their child disease better Picture from cell phone camera are sent to... Nurse and doctor, who consider treatment Feedback on SMS and

21 49 Syndromic Healthcare surveillance Number of people falling ill (line). Number diagnosed (bars) Often long time before contagious diseases are diagnosed Locale variations are not intercepted Early warning of outbreaks can reduce the health-related consequences and costs Week of diagnosis Week of sympom onset Mobile agents gather information from data sources Symptom gather from data sources on laboratories, hospitals, medical offices and directly from patient Model and calculating risks Week number 2004

22 Elderly patients with COPD, diabetes or kidney failure 50% over 65 years don't use PC need for a simple interface Better individual follow-up Legible education information Group education/ conversation Lecture, attend exercise program Individual follow-up based on ex. Blood sugar measurements, oxygen saturation in the blood Discussion with health care personnel and with other chronics

23 A residential ehealth gateway A small dedicated computer Provides a secure and reliable communication channel between the home and the public health service Authentication (pin-code) Encrypted storage, message transmission and video conferencing Local storage Acquisition and visualization at home Open source components (Linux, Tomcat, Firefox, Postgres, Gnomemeeting, Xine)

24 Telemedisinsk avdeling Net-based medication card Mismedication causes 5-10% of hospitalizations (10-20% for older people) 9,5 deaths per 1000 hospitalizations ( 18% of all deaths in the hospital) Current legislation prohibits shared access to sensitive information Nursing home General practitioner Emergency ward Home care Hospital Regionsykehuset i Tromsø Patient relatives All access via EPR, automatic message to administrator Automatic message when his/her patient s medication card is changed Automatic updating of local medication card (eventually sign)

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