Wearable Health IT Systems

Washington D.C. 05 August 2005 Introduction The 1980's were dominated by the use of personal computers (PC). The 1990's saw the widespread acquisition and use of laptop computers. This decade is seeing the acceptance and use of personal digital assistants (PDA) by many people. It appears the next decade may be dominated by the production and use of wearable IT systems. Wrist watches, pagers, cell phones, pocket calculators, PDAs, and Blackberries are all examples of simple wearable information systems that are already in use. However, the next generation of wearable systems is now starting to emerge. While still on the "bleeding edge", it may be time for some of the larger, more technologically advanced health care institutions to begin collaborating on further research, development, and pilot testing of wearable IT systems in the healthcare setting. This article attempts to pull together relevant information about the development of wearable health care IT systems to date, highlight major issues, and offer a set of recommendations on possible next steps to take with regards to this emerging technology.

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Definitions

Wearable Computing:
"Wearable computing facilitates a new form of human-computer interaction comprising a small body-worn computer (e.g. user-programmable device) that is always on and always ready and accessible. In this regard, the new computational framework differs from that of hand held devices, laptop computers and personal digital assistants (PDAs). The always ready capability leads to a new form of synergy between human and computer, characterized by long-term adaptation through constancy of user-interface."
(From Steve Mann's Keynote Address entitled "WEARABLE COMPUTING as means for PERSONAL EMPOWERMENT"; International Conference on Wearable Computing, May 1998)
Wearable Computing:
"...should be worn, much as eyeglasses or clothing are worn, and interact with the user based on the context of the situation. With heads-up displays, unobtrusive input devices, personal wireless local area networks, and a host of other context sensing and communication tools, the wearable computer can act as an intelligent assistant, whether it be through a Remembrance Agent, augmented reality, or intellectual collectives."
(From the MIT Media Lab Wearable Computing Web site)

Wearable Computer Technology

The idea of wearable computers goes back to the 1960s, but early attempts to create these types of systems were hampered by the size of the hardware. In order for a computer to be "wearable" it has to be fairly small, lightweight, be able to be attached to clothing, or even be integrated into clothing fibers. It must be unobtrusive and conveniently placed on the body, i.e., it should not interfere with a user's normal activities but help simplify them. An essential characteristic which distinguishes wearable computers from digital wrist watches or "walkman radios" is their versatility. They should be able to perform a wide variety of tasks, rather than be limited to tightly restricted functionality.

With ever accelerating innovations and technology, it is difficult to keep pace with developments in this field. Several recent advances have profoundly impacted wearable computer technology:

  • New fibers called Aracon, made of Kevlar, which are super strong, can conduct electricity and be woven into ordinary-looking clothes.
  • A chip packaging allows wearable computers to be washed and dry-cleaned. The electronics are insulated and directly woven into clothing and other textiles.
  • A flexible video screen made of optical fiber can be woven into clothing that can display static and animated graphics downloaded from the Internet, a desktop computer, or a mobile terminal.
  • Head-mounted displays allow users to focus on a task while at the same time, check information on a computer.
  • On-body and off-body enabling technologies are becoming more sophisticated and include VPNs, PANs, ISM, DECT, GSM, and Bluetooth wireless.
  • Nanotechnology is playing a significant role, making computing and communications systems microscopic in size and more conducive to on-body usage.

Wearable IT Systems - Non-Healthcare Related

Companies are already manufacturing and distributing wearable computer systems to various types of organizations. Examples of non-healthcare related wearable IT systems include:
  • Nomad Display Systems - The Nomad® Expert Technician System is a wireless, wearable computer with a unique, head-worn, see-through display - enabling technicians to work using both hands and simultaneously see service and dealership management system (DMS) information. Nomad superimposes text and diagrams from DMS and online repair content directly over the workspace. Service advisors can greet customers at their vehicles, access vehicle history, and fill out work orders while maintaining face-to-face contact with the customer. The following link provides information on wearable computers already in the workplace at Volvo and Honda.
    http://www.microvision.com/nomadexpert/video_testimonials1_2005.html
  • Display and Sight Helmet (DASH) systems enable military pilots to aim their weapons simply by looking at the target. DASH measures the pilot's Line of Sight (LOS) relative to the aircraft, and transfers this information to other aircraft systems. Aircraft sensors, avionics and weapons are thus enslaved to the target. DASH is adaptable to any fighter/attack aircraft and will accommodate advanced missiles and smart weapon lock-on envelopes.
    http://www.elbitsystems.com/lobmainpage.asp?id=198
  • Massachusetts Institute of Technology (MIT)
    MIThril is a next-generation wearables research platform developed by researchers at the MIT Media Lab. The MIThril hardware platform combines body-worn computation, sensing, and networking in a clothing-integrated design. The MIThril software platform is a combination of user interface elements and machine learning tools built on the Linux operating system.

Wearable Healthcare IT Systems

Although wearable computers have started to enter health care delivery environments, wearable systems for both physicians and patients will more fully emerge over the next decade. Wearable computers for physicians will allow them to treat patients and complete their rounds while connected via wireless networks to computerized patient records. Wearable computers are already allowing physicians to remotely observe patients' vital signs and monitor progress of surgery from outside the operating room using palm held devices.

Medical sensors are now available for use by patients, ranging from conventional sensors based on piezo-electrical materials for pressure measurements to infrared sensors for body temperature estimation and optoelectronic sensors monitoring blood oxygen, heart rate, heart recovery ventilation, and blood pressure. Other health monitoring devices, such as the vestibular-ocular test apparatus, the glucose counter, and the insulin delivery system can also be hooked up to a wearable computer without wiring the patient's body.

The following are some examples of Wearable Health IT Systems:

  • US Army Institute of Soldier Nanotechnologies, a research unit devoted to developing military applications for nanotechnology, is working with MIT and attempting to incorporate wound detection and treatment systems within uniforms made of smart materials, such as a responsive system that provides an instant splint for a broken bone.
  • The Ring Sensor is an ambulatory, telemetric, continuous health monitoring device developed by d'Arbeloff Laboratory for Information Systems and Technology at MIT. It combines basic fundamental photo plethysmographic techniques with low power, telemetry. Worn by the patient as a finger ring, it is capable of monitoring vital signs related to cardiovascular health. Remote monitoring is possible via a wireless link transmitting patient's vital signs to a cellular phone or computer. Clinical trials have been done in conjunction with Massachusetts General Hospital's Emergency Room, and researchers are now working on commercialization of the ring-sized device (from Technology Review Magazine, April 2004).
  • The Sensate Liner for Combat Casualty Care or "SmartShirt" was first developed by researchers at the Georgia Institute of Technology under the auspices of the U.S. military's 21st Century Land Warrior Program and the Defense Advance Research Projects Agency (DARPA). The "SmartShirt" is a fiber optic-laden garment with a built-in patented conductive fiber/sensor system that relays a soldier's vital signs in real-time, his location and the exact time of injury. This technology can also be woven into children's sleepwear, possibly preventing sudden infant death syndrome (SIDS) by alerting parents (via PDA or wristwatch) the moment a baby stops breathing.
  • Vigilance is being used by anesthesiologists at Vanderbilt University Medical Center (VUMC). A portable computer and high-tech eyepiece allow them to simultaneously monitor multiple operating rooms. Vigilance integrates information from multiple pre-existing sources: the operating room's anesthesia machine, heart monitor and video cameras are connected to Vanderbilt's secure data network, and surgical teams use in-room workstations to document care and vital signs. The physical package was assembled from off-the-shelf components, but its software was developed at Vanderbilt. (Healthcare Informatics, Jan 2005; Wearable Computers).
  • The Vocera Wearable Communication System is being used at the Providence Portland Medical Center. This wireless system provides hands-free, voice activated communications within networked buildings/campuses. Aimed at mobile workers in hospitals, retail operations, and other industries, the system allows users to wear a device that weighs less than two ounces to interact with each other instantly and make decisions quickly with simple voice commands.
  • BodyKom is a new system being tested by a Swedish technology company called Kiwok, TeliaSonera AB and Hewlett Packard that connects wirelessly to sensors on the patient. If changes are detected in the patient's body, the hospital/health care services are automatically alerted over a secure mobile network connection. It could be used to monitor heart rate, diabetes, asthma, and other diseases that require timely intervention.
  • BodyMedia, a Pittsburg company, makes a special "smart band" that is worn on the upper arm and collects data on the wearer's physical state, such as the way the body releases heat. It is also scheduled for release to health clubs as a weight-loss monitoring tool. Within the next year, BodyMedia plans to release special bands for monitoring the well-being of infants and the elderly.
  • The LifeShirt System, developed several years ago by VivoMetrics, in Ventura, California, is being used in several top medical schools. The garment, which collects and analyzes its wearer's respiration flow, heart rate, and other key metrics, demonstrates in real-time whether a new treatment is working. There will also be a shirt for emergency-services workers, such as firefighters, that will wirelessly alert commanders when a firefighter's core body temperature or stress levels reach critical levels. VivoMetrics expects to introduce a shirt in 2006 that will allow parents to monitor asthmatic children.

Future Scenarios

The following scenarios provide a glimpse at the not-so-distant future of health care computing and patient monitoring involving wearable IT systems.

A physician is making morning rounds. Using his wearable PC, which has a wireless connection back to the hospital's electronic health record (EHR) system, the physician is able to readily view the patient's medical record on a small head mounted display (eyeglasses) and place orders while moving from patient to patient on a particular ward. While walking the floor the physician can also receive alerts, lab results, and other desired information without breaking stride.

A patient requires hospitalization for examination, treatment, and rehabilitation periods. The health care provider offers the patient a chance to reduce their hospital stay through home health monitoring. The patient is fitted with wearable computing technology that monitors the patient's vital parameters (e.g., intraocular pressure, glucose levels, blood pressure, temperature, etc.) and wirelessly transmits the information to the patient's PDA or similar device. The data is transmitted through a network to a database storing patient records. The health care provider keeps track of the patient's file and communicates instructions to the patient at home. If any irregularities in the patient's vital signs are detected, an ambulance is automatically sent to the patient's location, which is determined via GPS in the patient's PDA (or similar device).

It is hypothesized that as sensor and computing technologies continue to evolve, their integration into wearable medical devices for monitoring, diagnosis, and treatment of illnesses will become commonplace. A personalized health management device would allow a person to be more interactive and more conscious of his/her own condition in a way to adopt a healthier lifestyle and obtain personalized therapy. These devices could also help health care providers monitor patients during rehabilitation, thereby decreasing hospitalization time.

Potential Benefits

The following are some of the potential benefits for providers, patients, and healthcare organizations interested in using wearable IT systems.

For health care providers it could enhance their ability to rapidly respond to medical care regardless of geographic barriers, particularly in rural and under-served areas. It could improve timely access to a patient's electronic medical record (EMR) where and when it is needed, provide timely access to clinical protocol and operational procedures, and allow providers to complete a number of complex tasks in less time and with less effort.

For the patient, it could improve their quality of life due to speedier recoveries and fewer, shorter hospitalizations. It could promote more healthy lifestyles, reduce medical care costs for the patient, cut travel expenses for medical appointments, and possibly even lower death rates for a number of chronic diseases (e.g., cardiac diseases and diabetes).

Finally, for healthcare organizations, it could reduce hospital operating costs while possibly increasing the number of patients receiving care.

Other Issues & Challenges

Innovations@Georgia Tech web site lists four limitations to wearable computing, including:
  • Power - the more features added to the computer, the more power is needed, and the larger and heavier the battery will be, causing discomfort due to size and amount of generated heat.
  • Networking - involves networking off your body to the Internet, and networking between the computer's components on your body. An on-body wireless bus (an internal electrical pathway along which signals are sent from one part of the computer to another) is an area of research.
  • Privacy - wearable computers give access to information you normally don't have, e.g., personal notes, recorded conversations, schedule, diary, medical record. This amount of information in one place requires a combination of security measures like encryption, guarding your computer, and keeping your computer on you.
  • Interface - involves how we communicate with the computer and how it communicates with us for maximum efficiency and comfort.

Conclusions & Next Steps

Current and emerging developments in wireless communications integrated with developments in pervasive and wearable technologies will have a radical impact on future health care delivery systems. It is anticipated that wearable computing will become a routine part of health care delivery and patient self-management in the coming decade. Public and private organizations around the world are collaborating on research, development and testing of wearable computers, some of which are already being used in medicine, mining, automobile and aircraft maintenance, telecommunications, aerospace, military defense, education, and travel.

The following are a set of preliminary recommendations related to next steps technologically advanced healthcare organizations ought to consider taking with regards to wearable health IT systems:

  • Consider establishing an inter-disciplinary workgroup to identify functional requirements and/or potential uses of wearable health IT systems for physicians and patients.
  • Identify potential partners to collaborate with on the development of wearable health IT systems and determine each organization's roles (e.g., research, development, pilot testing).
  • Conduct a feasibility study and cost benefit analysis for this potential initiative.
  • Conduct a detailed literature search and obtain lessons learned from existing projects in this field.
  • Establish a pilot project to acquire, develop, and test wearable technology that could eventually be incorporated into the healthcare organization.
  • Investigate changes in clinical practices and business processes that may need to be made in anticipation of utilizing wearable computing technology.

Authors:

Peter J. Groen is the Director of the Health IT Sharing (HITS) program within the Veterans Health Administration, U.S. Department of Veterans Affairs. He is also an adjunct faculty member at Shepherd University in West Virginia.

Marc Wine is the Coordinator for Intergovernmental Health IT within the Office of Intergovernmental Solutions, U.S. General Services Administration (GSA). He also is a guest lecturer on Medical Informatics at the George Washington University in Washington, D.C.

Douglas Goldstein is a "Practical Futurist", author, keynote speaker, and President of Medical Alliances, Inc.

Joanne Marko is a consultant in the metropolitan D.C. area with over 20 years experience in healthcare and information systems.


Peter J. Groen, Mark Wine, Douglas Goldstein, Joanne Marko

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