The future is old

Remote health monitoring will help keep seniors in their homes, and costs of care from skyrocketing.

Eric Topol, a cardiologist in California, can check his patients’ heart palpitations no matter where he is or what he’s doing — so long as he’s carrying his smartphone and getting a signal. Topol uses software from AirStrip Technologies that displays data from a patient’s bedside electrocardiogram machine on the doctor’s phone, allowing him to view the scrolling peaks and valleys of a heartbeat in real time. “It’s been around a few months, and I’m still awestruck by it,” he says.

Topol, who’s on the board of the West Wireless Health Institute, a non-profit that advances wireless health solutions, is even more awestruck by what lies ahead. “Today, people check their e-mail and surf the web,” he says. “Tomorrow, they’ll be able to check all their vital signs continuously.” We’ll have a better understanding of our own health, and physicians will know much earlier when something is amiss, intervening sooner and perhaps lowering care costs.

And that cannot happen fast enough. The developed world is rapidly aging, placing a tremendous burden on health-care systems. This year, the first cohort of baby boomers turns 65. There are roughly five working-age Canadians for every person over 65 today. By 2033, that ratio is projected fall to just 2.5, and seniors will make up fully half the population by 2070. How will Canada — and the rest of the developed world — care for a growing population of seniors when the tax base is shrinking?

Part of the answer lies in technology. Not only do developments underway promise to help us cope with an aging population, but they’re facilitating a shift in how we experience health care. Today, the system is largely impersonal and reactive; we typically visit a doctor when an illness or accident has already occurred. In the years to come, health care will become far more personalized, and will focus more on prevention.

These issues are very much on the mind of Cameron Powell, an obstetrician in Texas who co-founded AirStrip a few years ago. The company is now running pilot projects in U.S. hospitals for its expanded patient-monitoring system — essentially, capturing data from nearly every bedside device to display on smartphones. (AirStrip hopes to receive regulatory approval in Canada this year.) But a more important step is a move into the home, something that could occur as early as next year. Say a patient has just checked out of a hospital after surgery. Continuous monitoring in the home can reduce the chances of a costly hospital readmission. “If we can keep an eye on our patients, and the people in the hospital are [only] the ones who absolutely need to be there, then everybody wins,” Powell says.

Just as the software to display heath data has improved, so has the hardware needed to collect it. These days, patients can attach a BandAid-like device to their bodies, or wear a wrist or ankle cuff that reads vital signs such as heart rate, breathing rate and even motion. Down the road, these sensors may be located in clothing — researchers at the University of Southern California have tested sensors that nestle inside underwear waistbands. Such devices can wirelessly send updates to a server, accessed by the patient’s or caregiver’s mobile device, and sound an alert at the first sign of trouble. “You will have an embedded sensor for detecting cancers [and] the earliest signs of an impending heart attack,” Topol says. “That’s where the whole thing can go — true prevention.”

One of the first applications may be a device for people at risk of congestive heart failure. A California company called Corventis has developed an adhesive sensor that monitors the amount of fluid in the body. When too much fluid collects, it constrains the muscle, leading to heart failure. But through wireless monitoring, a physician knows when to up the dosage of a drug that prevents fluid buildup, saving an elderly patient a trip to the emergency room.

Some health-monitoring systems will be marketed directly to consumers. Wireless giant Qualcomm is working with partners on what Clint McClellan, senior director for market development, calls “wellness kits.” Such packages will consist of a sensor, perhaps worn around the ankle, and software to record and display vital signs in a format average people can understand. “We’re going to collect more data than we ever had before,” McClellan says. “Now we need to figure out how to make it meaningful.” The goal is to record long-term health trends so users can set goals, such as lowering their heart rate.

Conditions such as Alzheimer’s and other cognitive impairments bring an entirely new set of monitoring challenges. Over the past few years, Intel has been researching ways to use the telephone to detect illness before it shows up through other means. Trouble dialling could indicate arthritis, for example; taking longer to recognize the caller could point to the onset of dementia. Intel sees a huge opportunity in the home health market as the population ages. Last month, it formed a joint health technology venture with GE called Care Innovations. The premier product is the Health Guide, a system consisting of a home touch-screen tablet that prompts the owner with reminders about proper nutrition and taking medications.

Some of the most interesting research in this arena comes from the laboratory of Alex Mihailidis, director of the Intelligent Assistive Technology and Systems Lab at the University of Toronto. His goal is to develop technologies that will allow seniors to live comfortably and independently for as long as possible. His first invention is a system to coach Alzheimer’s patients through simple tasks such as hand-washing. A ceiling-mounted camera watches constantly, feeding data to a computer that analyzes the information and intervenes when necessary. It can give audio or visual cues through a screen mounted by the sink, and even direct the user to where the towel or soap is located. A few nursing homes are testing the system. Residents who previously needed assistance are now managing more independently. Mihailidis hopes to eventually expand the technology to tasks like dressing and cooking. “It’s often when the burden of needing to be there to give these prompts becomes too much for the family that the person is removed from their home,” he says.

Mihailidis is also trying to commercialize a fall detection system. Falling is a huge risk for seniors, particularly those living alone. In Mihailidis’s system, the camera recognizes when someone has fallen, and triggers a voice response that asks questions to determine the best course of action — call an ambulance, a neighbour, or no one, if it’s a false alarm.

He’s planning to take monitoring to the next level by incorporating predictive algorithms, so systems learn a person’s behaviour and detect when something is unusual, such as more frequent trips to the bathroom. “A lot of research says that a good way to monitor the health of an older adult is to monitor their pattern of living,” Mihailidis says.

His latest project is embedding sensors in floor tiles to measure vital signs, thereby eliminating or reducing the need for wearable and implanted sensors. Ultimately, Mihailidis envisions integrating these monitors into the house building materials. The invisible sensors would constantly collect information, even knowing, for instance, where the occupant misplaced her glasses. “It’s a home that’s sensing my needs at all time, and only intervening when required,” he says. Is a sentient home a tad unsettling? That reality is at least two decades away.

Players to watch:

Proteus Biomedical
The U.S. firm is developing “smart” pills embedded with sensors that record how patients respond to medication and help ensure seniors take pills in proper dosages.

The chip giant is researching apps that allow people to track their moods and overall emotional health, prompting users with easy techniques to reduce stress.

The San Francisco firm’s system tracks physical fitness — even time it takes to fall asleep. The data appear in charts and graphs so the user can monitor trends.

Entra Health Systems
The California company makes a Bluetooth-enabled blood glucose monitor that can send data to a mobile device and remind users when to take a reading.

The Atlanta company’s hospital bed records vital signs through the mattress, checks for movement to prevent bedsores, and notifies staff via mobile alerts.