Do-it-yourself healthcare

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Do-it-yourself healthcare
Self-monitoring technology should ease the burden on hospitals
Published: 22/09/2010 at 12:00 AM
Bangkok Post: Newspaper section: Database

In modern society, it can be hard for family members to find the time to stay at home and care for elderly or disabled relatives, but innovative home-based healthcare technologies which combine sensors, embedded systems, remote monitoring, wireless devices and intelligent software are all set to help make emergency responses and self-monitoring easier and quicker.



"Hospitals are facing a shortage of nurses and doctors who can take care of senior patients with chronic diseases, while patients' families are under economic pressure and cannot take time off work, so the they find it hard to watch over their parents," said Prakasit Kayasith, Researcher at the Rehabilitation Engineering and Assistive Technology Institute, National Electronics and Computer Technology Centre (Nectec).

This situation has inspired the 'Smart home and Activities Monitoring', or SAMs, research project, which features sensor-based and video-based monitoring.

In the meantime, Nectec has signed a three-year joint research collaboration agreement with The Institute for Infocomm Research in Singapore for video-based monitoring, which will last until 2013.

In the first year, Nectec will develop various types of sensor-based technology to serve different scenarios in the hospitals which are taking part in the field study, such as Phramongkutklao Hospital in Ratchathewi.

In the first year, Thailand and Singapore will develop their own technologies. Nectec will mainly cover sensor-based detection, while Singapore will focus on video-based detection by using image processing technology.

"Both sensor and video can complement each other," said Prakasit.

"In the room with less light, video may not work well, so sensor can help to cross-check the movements. Or, in cases when a patient is concerned about privacy, sensors may help to avoid the use of video."

Sensor-based monitoring can help reduce patient risk, especially from unwanted movements such as patients falling out of bed or getting up without permission, or for monitoring space occupancy detection, bed status and sleep patterns. Optical/pressure sensors can be installed at the leg of a bed.

The technology can also help monitor patients who are taking fluids intravenously and automatically adjust their doses when necessary. For example, an optical sensor could detect drops in fluid levels and adjust flow rates. Meanwhile, the acoustic sensor can monitor respiratory rates.

When unwanted movements, errors or malfunctions are detected, the system will alert the nurse centre, and if the nurses are on the move, it can alert them by mobile phone.

By end of this year, Nectec expects to pilot its system at Phramongkutklao Hospital to test the response and allow the artificial intelligence to improve its capabilities and reduce false detection.

Next year, Nectec will integrate its sensor-based platform with video-based technology, while the third year will see the technology rolled out for use in homes and care centres for the elderly.

Detection technologies are already available in the market but these are mostly piece-by-piece devices which are not integrated with other platforms.

In the past, such sensor-based technologies have been expensive, but today they boast high accuracy and small sizes at affordable prices, so combining this with access to high-bandwidth networks means detection devices are becoming more accessible and practical.

The project's aim is to build low-cost technologies that are suitable for mass adoption, especially by public hospitals which in Bangkok average one nurse to every 15 beds. Even in private hospitals, the technology can be applied to private rooms.

If the system can detect more information about patients and their movements at an earlier time, it could help them recover quicker, which improves not only their health but also saves time and money for the hospitals and the nation.

"These technologies will act like tools or nursing assistants and will allow care workers to reduce their detection and monitoring workload," said Prakasit.

When the research is complete, Nectec aims to license and transfer the technology to private organisations to implement or provide detection systems in hospitals and senior care centres, as well as home-based healthcare."

Nectec will also co-operate with several organisations to build assistive technology that provides preventive measures and fast emergency responses, as well as improving the quality of life of elderly and disabled people, said Wantanee Phantachat, Director, Rehabilitative Engineering and Assistive Technology Institute at Nectec.

The institute will join with the Social Development and Human Security division of Khon Kaen Tambon Administration to train students at Khon Kaen Technical College in building emergency alert systems and remote environmental control units which help families with vulnerable persons.

"We have opened to community volunteers such as electrical engineers and students the chance to train in our related technologies, such as system for households with elderly or disabled family relatives, and this model will help the members of the community to rely on themselves and take care of each others," said Wantanee.

In such households, if those vulnerable people need help, they can push a telephone button set to speed-dial the emergency centre, or they can push a button which activates a siren installed at the front of the house.

This model could be implemented at city level, and Nectec plans to discuss with the Bangkok Emergency Medical Service (EMS) Erawan Centre a plan to collate a database of addresses which house disabled and senior citizens so that emergencies can be responded to in a timely fashion.

Preventive health monitoring will help Thailand to improve the quality of life of its senior citizens, which is especially important when considering it is projected that by 2025, 20 percent of the kingdom's population will be elderly, said Nectec Director Dr Pansak Siriruchatapong.

Combining the monitoring technology with medical expertise will encourage new preventive health monitoring services, he said.

Recently, Nectec has collaborated in research and development with King Chulalongkorn Memorial Hospital of the Thai Red Cross Society in electronic and medical information.

They will start by offering Interactive Multi-modality (IMM) technology, which encourages self-monitoring by highlighting the strengths of each communication channel, such as Interactive Voice Response Speech Synthesis, the Internet, email and CD Rom.

"This is the first project in Thailand to develop and implement IMM for self-management support among patients with type 2 diabetes," said Pansak.

Wiroj Jiamjarasrangsi MD, PhD, of the Faculty of Medicine, Chulalongkorn University, added that the first year of the project will mainly focus on the internal patients of Chulalongkorn Hospital, expanding to other Bangkok hospitals later.

The idea of the project is to use medical domain knowledge, behavioural science and technology to support and encourage patients to carry out self-management at home and reduce communication barriers with medical staff which currently exist due to the poor ratio of doctors and nurses per patient.

Currently, there are 4,000 diabetes patients registered with Chulalongkorn hospital who have to visit a doctor at least every three months.

The new system will help patients to access and interact with medical services and knowledge, which should instill in them more self-discipline in terms of monitoring themselves and control their behaviour appropriately to their condition. It also allows the hospitals and staff to better monitor their patients.

"We decided to look at diabetes patients first because they display a range of complex symptom requiring different treatments, meaning effective communication with doctors is very important," said Wiroj.

"We expect to have 200 patients use this system within the first year and then we will consider rolling it out widely to encompass other diseases, such as high blood pressure.

"Mostly diabetes patients are senior citizens who do not find it convenient to attend hospitals so often, so if they can monitor themselves more effectively, it will reduce the frequency of their doctor visits."

The project will have two available services that allow patients to select self-management by phone or via the Internet. The phone service will use Interactive Voice Response and Speech Synthesis technology.

The system will automatic call the patient's home at specified times and ask about symptoms, and based on the information provided it may make primary suggestions.

This information will then be sent to the database for doctors and nurses to process and analyse whether there are any emergencies or serious complications require hospital staffs to call back personally.

Meanwhile, the Internet channel will allow patients to register to use the service for health planning.

The system can make automatic suggestions based on the patient's self-assessment, such as taking more exercise, or adjusting calorie intake.

There will also be an opportunity for the exchange of experiences and knowledge between patient communities through social networking. This service is being developed through the use of Interactive Behavioural Technology.

"To develop an effective home-based monitoring and self-management health system will require several years, because it depends on the accuracy of information and details of patients," said Wiroj.

"Most importantly, it relates to people's lives."

http://bangkokpost.com/tech/technews/197578/do-it-yourself-healthcare