Smart Beds: Non-Contact Patient Monitoring

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Without a cuff, electrodes or leads attached to the patient, Hoana Medical’s Passive Sensory Array (PSA) pad installed in a hospital bed monitors heart rate and respiration and sounds an alarm when the patient gets out of bed unexpectedly. Based on proprietary signal processing algorithms developed for the military, Hoana’s LIFEguard product is pitched to the general care floor of acute care hospitals to optimize nurses’ time,  to improve patient safety, enhance quality of care, deliver a positive ROI while at the same time "addressing the hospital’s risk of ‘failure to rescue.’"
Video clips from news coverage of the actual product in action are available on the company’s press page, but the futuristic animation at the left (launch an external player if you don’t see the video) is a lot more fun and prompts the inevitable comparisons to the Star Trek sick bay.

Outsourcing Intensivists

TelemdhospitalIn the neurosurgery ICU at the UCLA Medical Center, recovering patient Tim Copeland mimics the hand movements of Dr. Neil Martin as part of post-op clinical assessment (click to enlarge). Dr. Martin is only virtually present, beamed in
via an RP-6 robot supplied by Santa Barbara-based InTouchHealth.

UCLA reports that the robot is used for "leveraging the health
care expert’s time"
:

The patient sees, hears and interacts with the doctor through the
nearly 5-foot-6-inch tall robot, which displays a live video image of the
physician’s face on its monitor/head. The physician, seated at a computer
console called a ControlStation, also sees and hears the patient through a live
video image projected on a monitor. The ControlStation comes equipped with a
joystick, which allows the physician to drive the robot to the patient’s
bedside, control movements of the robot’s head and even zoom in to take a
closer look at the patient or bedside monitors.

Studies show that the presence in the ICU of intensivists, the physicians who specialize in the care of critically ill patients, can decrease morbidity, mortality, length
of stay and cost of care.
But in the U.S. today, there are fewer than 6,000 practicing intensivists and more than 5 million patients admitted to ICUs each year. Telepresence robots can jam more minutes of consultation into every specialist’s day, but it’s easy to imagine that it won’t be too long before the robot is connected to cheaper doctors in developing countries, outsourcing critical care via the Internet.


Mesh Wrap for Enlarged Hearts

Heartmesh_2Acorn Cardiovascular’s CorCap Cardiac Support Device (at left, click to enlarge), a proprietary mesh wrap implanted around the heart, is intended to control the progression of heart failure by improving the heart’s
structure and function. A proprietary multi-filament mesh knit of implant-grade polyethylene terepthaliate (PET-polyester), the device is now in clinical trials involving 300 patients with at 29 centers in North America. A recent report at the Late Breaking Clinical Trials Session of the American Heart Association Scientific Sessions indicated that CorCap reversed heart failure progression and improved patient quality of life.

OsiriX: Converging Macintosh, iPod, Open Source and Medical Images

OsirisRadiologists are viewing and manipulating MRI, CT, PET and other digital medical images on the latest generation Apple Macintosh computers, and they’re storing files and even viewing some images on the pocket-sized iPod Photo multimedia player, displacing expensive workstations, complicated file servers and proprietary software with store-bought consumer electronics gear.

Dr. Osman Ratib and colleagues at UCLA have re-written their previous generation Mac- and Unix-based Osiris system to take advantage of the Open Source graphics environment of the Mac’s System X operating system. The new product — OsiriX — displays medical-standard DICOM (.dcm) files and can be  downloaded free-of-charge from the web.

As the web site describes it:

OsiriX has been specifically designed for navigation and visualization of multimodality and multidimensional images: 2D Viewer, 3D Viewer, 4D Viewer (3D series with temporal dimension, for example: Cardiac-CT) and 5D Viewer (3D series with temporal and functional dimensions, for example: Cardiac-PET-CT). The 3D Viewer offers all modern rendering modes: Multiplanar reconstruction (MPR), Surface Rendering, Volume Rendering and Maximum Intensity Projection (MIP). All these modes support 4D data and are able to produce image fusion between two different series (for example: PET-CT).

OsiriX demonstrates the convergence of some important information technology and healthcare developments:

  • IpodsvideoOpen consumer electronics architectures
  • Open Source software and utilities
  • Streamlined development environments
  • Internet filesharing
  • Medical digital imaging standards
  • On-line medical consultation and collaboration

An article on the Apple Developer Connection tells the full story, and the Osiris web site offers some stunning screen shots of DICOM images on the Mac. One of the coolest shows a kid displaying a PET CT reconstruction through the iPod’s video interface onto a Sony Trinitron TV (above, right).

 

Nano-Typography for Printing DNA Microarrays

A nano-printing technique developed at MIT could dramatically lower the cost of nanomedical tools for diagnosis and experimentation, potentially making DNA analysis "as common and inexpensive as blood testing," according to an MIT news release. A team of scientists led by Francesco Stellacci describes the process to cheaply duplicate DNA data in an article in the Nano Letters Journal of the American Chemical Society titled Supramolecular Nanostamping: Using DNA as Movable Type.

MitnanoOne important prospective application is the DNA microarray, a silicon or glass chip
printed with up to 500,000 tiny dots. Each dot comprises multiple DNA
molecules of known sequence, a piece of an individual’s genetic
code. Scientists use DNA microarrays to analyze a person’s
DNA or messenger-RNA genetic code. Tests like the early
diagnosis of liver cancer, the genetic predisposition to certain diseases or the efficacy of some drug treatments are based on these analyses. The DNA dots in the image at right (click to enlarge), each only about 200 nanometers in diameter, were printed using the supramolecular nanostamping developed at MIT.  Conventional microarrays require hundreds of steps to produce and cost $500 apiece. The new technique requires just three steps and could result in costs as low as $50 per array.

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Disruptive Healthcare Innovations

Bk1_1In his 1997 bestseller The Innovator’s Dilemma, Harvard Business School professor Clayton Christensen describes "sustaining" versus "disruptive" technologies. Sustaining technologies are the incremental improvements in quality, price and service that exemplify sound management. Disruptive technologies are out-of-left-field; they change the value proposition in a market, and while they often provide lower performance (measured in traditional terms) they are usually cheaper, smaller, simpler and easier-to-use so they broaden the customer base, often quite dramatically.

Photocopies versus offset printing; home pregnancy tests versus doctor’s office visits; scratchy mobile handsets versus high quality wireline phones; computer-based disease simulations versus clinical trials; blogs versus mainstream media — disruptive innovations can bury entrenched organizations.

In the healthcare field, there are many entrenched organizations, and many compete against each other. Physicians, hospitals, insurance companies, HMOs, pharmaceutical companies, device manufacturers, researchers, regulators — it’s no wonder that healthcare systems around the world are difficult to manage and impossible to change. Disruptive innovations don’t care about entrenched interests and they may hold the brightest promise for changing healthcare for the better.

For the Health IC Summit in January 2006, we’ve developed a list of disruptive healthcare innovations (they’re not all technologies, some are business processes) that help illustrate new possibilities in regenerative medicine, innovative patient care and medical informatics:

ADAPTIVE PROSTHETICS • ARTHROSCOPIC SURGERY • ARTIFICAL INTELLIGENCE • ARTIFICIAL TISSUE • BIOMIMETICS • COMPLEMENTARY MEDICINE • DATA MINING • DIGITAL HOSPITAL • DIGITAL LABS • DISEASE SIMULATIONS • ELECTRONIC MEDICAL RECORDS • ENDOSCOPIC SURGERY • ENTERPRISE HEALTHCARE • E-PRESCRIPTIONS • EVIDENCE-BASED MEDICINE • GENE THERAPY • GENETIC PROFILING • GENOMIC PROFILING • HOME PREGNANCY TESTS • IMPLANTED DEVICES • INHALED THERAPY • INTELLIGENT HEALTHCARE AGENTS • LIFE EXTENSION • MEDICAL INFORMATICS • MEDICAL ROBOTICS • MEDICAL SAVINGS ACCOUNTS • MEDICAL TOURISM • MEMORY AUGMENTATION • MEDICAL INFORMATICS • MODELING AND VISUALIZATION • NANOMEDICINE • NETWORKED BIOSENSORS • NEURAL CONTROL • NON-INVASIVE SURGERY • ORGAN ASSISTANCE • ORGAN SUBSTITUTION • PERSONAL MEDICAL DEVICES • PERSONALIZED THERAPEUTICS • PERVASIVE NETWORKING • PORTABLE ULTRASOUND • REMOTE PATIENT MONITORING • RFID • SELF-CARE • SELF-TESTING • STEM CELLS • TELEMEDICINE • TELEMETRY • WEARABLE MONITORS • WEB-BASED MEDICAL INFORMATION • WELLNESS MONITORING • XML MEDICAL FORMATS

Are there items we should add? Change? Delete?