April 2010

Grant Results

SUMMARY

From August 2007 to February 2009, researchers at the Center for Future Health explored the idea of using techniques from "machine health monitoring" to create real-time personal health-monitoring systems and developed a prototype system.

Real-time personal health-monitoring systems integrate sensing, communication and data analysis to enable individuals, especially those with chronic illnesses such as heart disease, to track, predict and maintain their health.

Key Result

  • Project researchers and participating companies created and tested a prototype health-monitoring system for patients with heart disease based on commercial, off-the-shelf technologies.

Key Conclusion

  • Personal health monitoring can harness techniques from machine health monitoring to track and predict people's cardiac health accurately.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project with three grants totaling $1,272,861 from September 1, 2006, to February 14, 2009.

 See Grant Detail & Contact Information
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Context

The Center for Future Health was founded in 1998 to use personal technology to give patients, caregivers and medical providers information on patients' health status.

Center staff surmised that the field of machine health monitoring could suggest how to provide a real-time window into changes in each person's health. In that field, sophisticated analysis of information from sensors permits early detection and diagnosis of machine faults to avoid catastrophic failure.

Center staff proposed that personal health-monitoring systems based on similar techniques could enable people to monitor and manage their own health. Such systems also could give medical providers a quantitative window into changes in patient health between clinical visits. Those benefits could help medicine break out of its crisis management mode and help control skyrocketing health care costs.

Prior to the project described in this report, in 2005, with funding from RWJF, center researchers held workshops for patients and caregivers on technologies to help elders—particularly those with heart failure and early dementia—live independently (grant ID# 052618).

In 2005 and 2006, with a second grant from RWJF, center researchers created a searchable online database of self-care technologies for heart failure and early-stage dementia (ID# 053786; see Grant Results).

As a 2006 round-one grantee in RWJF's Project HealthDesign national program, the center began developing a computerized "conversational assistant" to help patients with congestive heart failure manage their health from their homes.

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The Project

From August 2007 to February 2009, researchers at the Center for Future Health explored the idea of using techniques from "machine health monitoring" to create personal health-monitoring systems and developed a prototype system.

Real-time personal health-monitoring systems integrate sensing, communication and data analysis to enable individuals, especially those with chronic illnesses such as heart disease, to track, predict and maintain their health.

Exploratory Workshop: Grant ID# 057689

In the project's first phase, center researchers recruited a group of 40 people to explore the idea of using personal health monitoring to empower patients to manage their health better and to live fuller, more productive lives, as well as the relevance of experience from machine health monitoring, from which analysis of information from sensors permits early detection and diagnosis of machine faults to avoid catastrophic failure.

After holding three web-based meetings, project staff convened a two-and-a-half-day workshop on December 6–8, 2006, in Rochester, N.Y. Participants included:

  • Seven patients managing chronic heart disease.
  • Six of their physicians and caregivers.
  • Five engineering and computer science faculty members from the center, and researchers from other universities.
  • Two or three representatives from each of six small companies working in areas of machine health monitoring, including basic sensing technologies and electronics, data analysis and "prognostics" (predicting the future), system integration, product design and human-computer interfaces. (See Appendix 1 for a list of the firms.)

Conclusions
Project staff drew the following conclusions from the workshop:

  • Patients want to know, "How am I doing now, and how will I be doing in the near future?"
  • A personal health-monitoring system should accept input from the user about how he or she is feeling throughout each day and correlate that input with objective measurements from sensors.
  • A personal health-monitoring system should measure an individual's health status unobtrusively: Users prefer not to be tethered to a monitoring station, even for a few minutes each day.
  • Such a system should ask, "What is normal for this individual?" and answer that question by monitoring the person's health status over time, rather than by comparing personal information to statistical averages.
  • Patients can use such a system to help plan their daily activities if it accepts queries and provides accurate predictions. For example, the system could inform patients if symptoms are due to illness; suggest changes in exercise or diet that would allow specific daily activities; and answer the question, "What will doing this activity today 'cost' me in the future?"

Proof of Concept: Grant ID# 060563

The project's second phase entailed developing and testing a prototype health-monitoring system for individuals with cardiac failure. This work involved identifying the least-invasive and most accurate ways to capture data. It also entailed testing the use of models for analyzing data based on machine monitoring to predict changes in individuals' health status.

Project staff:

  • Used electrocardiograms (EKGs) and accelerometers—which measure a wearer's motion—to gather 18 hours of data from each of 10 patients with chronic heart disease and 10 control individuals. These tools monitored participants during both rest periods and periods designated for specific activities. Patients used diaries to record their physical and emotional feelings during these periods.
  • Used statistical techniques from machine health monitoring to analyze the resulting information and predict future heart rates.
  • Conducted focus groups and interviews with 14 people ages 33 to 72 with heart disease to learn their preferences regarding the hardware and user interface for a personal health-monitoring system.
  • Convened a workshop attended by cardiac patients and representatives of participating firms to propose and evaluate potential designs for a health-monitoring system.
  • Subcontracted with the firms to help develop a prototype system, awarding them $50,000 each. The firms provided a $50,000 in-kind match for this work. Mark Fiscella, a Rochester-based technology expert, coordinated the activities of the collaborating companies for several months.

The Future of the Field: Grant ID# 065082

Researchers convened 21 thought leaders for a workshop on December 4–5, 2008, at RWJF in Princeton, N.J., to propose a vision and next steps for real-time personalized health monitoring based on project work. Workshop participants included:

  • Physicians
  • Engineers
  • Computer scientists
  • Behavioral scientists
  • Futurists
  • Data miners
  • Informaticists
  • Innovators and entrepreneurs

For a complete list, see Appendix 2.

Communications

Researchers presented "Involving Patients in Concept Generation" at the 2007 International Conference on Technology and Aging. This paper appeared in the 2008 book Technology and Aging (see the Bibliography for details). Project staff members also spoke about their work on the project at several national and regional meetings on health care technology in 2007 and 2008.

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Conclusions & Results

Proof of Concept: Grant ID# 060563

In a report to RWJF, project staff cited the following conclusion and result:

  • Personal health monitoring can harness techniques from machine health monitoring to track and predict people's cardiac health accurately.

    For example, statistical techniques from a toolbox developed for machine health monitoring allowed researchers to create models that distinguished between the electrocardiograms of healthy and non-healthy participants and to predict their heart rate with 94 percent accuracy. The models based these predictions on the characteristics of each participant as measured over time, as well as the amount of energy he or she had recently expended.

    Researchers found that relatively simple measures of heart rate and motion and indicators such as heart rate recovery time can reveal useful information on an individual's cardiac health. (Two cardiologists helped define the best indicators.) Center staff said that researchers can use project data linking these physiological measures with physical and emotional feelings—the only nonproprietary database with such information—to develop new "vital signs" for each patient.
  • Researchers and companies created and tested a prototype health-monitoring system for cardiac patients based on commercial, off-the-shelf technologies. The system relies on a waist-mounted, three-axis accelerometer to compute the amount of energy the patient is expending. (More burdensome wrist and ankle accelerometers proved unnecessary.) The wearable system also includes a two-lead electrocardiogram to measure heart rate.

    A digital voice recorder on a wireless handset—which looks like a cell phone with a touch-sensitive screen—accepts verbal input from users. Users can query the system for information on their current and future health status and dock the handset to a computer to send data to health care providers.

    Participating patients found the system nonintrusive and "extremely" interesting because it could help them manage their condition proactively and represent themselves to their family and health care providers.

The Future of the Field: Grant ID# 065082

In Building the Field of Real-Time Personalized Health Monitoring, an unpublished white paper, project staff proposed two 5-year goals:

  • Stimulate the growth of a professional community focused on personal health monitoring. A collaboration among government, companies, professional societies, research institutions and health care organizations could fund further studies of personal health monitoring, including its application across entire communities.
  • Establish an "open data resource" as a foundation for further research. This resource would have two components:
    • A highly structured database of information from real-time monitoring of patients with a wide range of health conditions, as well as control subjects. Researchers would agree in advance on the sensing technologies, data formats and longitudinal framework used to provide these data. Researchers could tap this information along with more traditional health records to design and pursue clinical studies.
    • A less-structured database of information from thousands of users of various commercial health-monitoring systems. This more heterogeneous resource would likely spur the development of new techniques for mining and analyzing data and suggest new vital signs to monitor in tracking people's health.

The white paper also summarized conclusions from the December 2008 workshop of thought leaders:

  • Personal health monitoring will be a key to wellness. Software embedded in health monitors will distill longitudinal data to enable people in all socioeconomic groups to manage their own health.
  • Information from real-time health monitoring of heart and lung functions, motion and activity, sleep, cognition, social interactions and feelings will yield insights into a broad spectrum of conditions.
  • Widespread personal health monitoring will improve the efficiency of the health care system and help contain its cost. Such systems will shift much routine care to less highly skilled, lower-cost health care workers and to consumers themselves. That will free highly trained providers to focus on diagnosing and treating the most challenging medical conditions.

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Lessons Learned

  1. Ask your institution to approve research protocols as early as possible. Securing approval from the University of Rochester's Research Subjects Review Board for the project's many corporate and academic partners to work with patients took three months. While the board pondered, the clock was ticking on RWJF funding. (Project Director/Pentland)
  2. It may be more efficient for a few researchers to devote all their time to a project rather than for more researchers to make a partial commitment. Full-time researchers at the Center for Future Health typically devote only a portion of their time to any given project. That pulls them in several directions and delayed this project. (Project Director/Pentland)

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Afterward

Center staff members are developing noncontact EKG sensors with grants from Blue Highway, a Welch Allyn company located in Syracuse, N.Y., and from New York state.

Center staff members presented the technical paper "Methods to Extract Respiration Information from ECG Signals" at the 35th Institute for Electrical and Electronic Engineers International Conference on Acoustics, Speech and Signal Processing in Dallas in March 2010. An article on that subject appears in the proceedings of the conference.

Impact Technologies—a machine diagnostics firm based in Rochester, N.Y., that participated in the project—is using a federal Small Business Innovation Research grant to develop a personal health monitor for use by emergency first responders.

Center staff members, in collaboration with researchers at the University of Rochester School of Nursing, have been awarded a four-year R-01 award from the National Institutes of Health (NIH) for the development and validation of an automated asthma symptom monitoring system for use in asthma research in adolescent populations. This award builds on the automated wireless monitoring technologies developed in previously funded center programs. Also, the research team filed a patent application for an "Automated Device for Asthma Monitoring."

Center staff members and faculty members in the University of Rochester's Department of Clinical and Social Sciences in Psychology won two NIH awards for the study of early parent-child interactions. These awards employ automated wireless monitoring technologies developed in previously funded center programs.

Center researchers also are pursuing funding from the NIH to discern the "signatures" of various kinds of heart failure from project data. This work would build on the center's work to develop a Computer Assistant for Robust Dialogue Interaction and Care (CARDIAC), a "conversational assistant" for patients with heart disease.

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GRANT DETAILS & CONTACT INFORMATION

Project

The future of personal health monitoring

Grantee

University of Rochester Center for Future Health (Rochester,  NY)

  • Creating synergies between personal health monitoring and machine health monitoring
    Amount: $ 372,392
    Dates: September 2006 to August 2007
    ID#:  057948

  • Creating synergies between personal health monitoring and machine health monitoring
    Amount: $ 800,909
    Dates: May 2007 to October 2008
    ID#:  060563

  • Workshop on how innovative data mining can yield personalized health care and health status signatures, allowing consumers to manage their own health
    Amount: $ 99,560
    Dates: September 2008 to February 2009
    ID#:  065082

Contact

Alice Pentland, M.D.
(585) 275-1998
Alice_Pentland@URMC.Rochester.edu

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Collaborating Firms

Impact Technologies
Rochester, N.Y.

Foster Miller, Inc.
Waltham, Mass.

RLW, Inc.
Las Vegas, Nev.

The PCB Group:
STI Technologies Inc.
Rochester, N.Y.

PCB Piezotronics
Buffalo, N.Y., and
Xelic Inc.
Rochester, N.Y.

KEK Associates Rochester, N.Y.


Appendix 2

Participants in the Second Workshop, December 2008

Nancy Barrand, M.P.A.
Special Adviser for Program Development
Robert Wood Johnson Foundation
Princeton, N.J.

Clement Bezold, Ph.D.
Chair
Institute for Alternative Futures
Alexandria, Va.

Mark Bocko, Ph.D.
Center for Future Health
Professor and Chair of Electrical and Computer Engineering
University of Rochester
Rochester, N.Y.

R. Paul Crawford, Ph.D.
Director of Health Research
Product Research and Innovation/Digital Health Group
Intel Corp.
Sacramento, Calif.

Elizabeth Dickson
Research Assistant
Robert Wood Johnson Foundation
Princeton, N.J.

Stephen Downs, S.M.
Deputy Group Director, Health Group
Robert Wood Johnson Foundation
Princeton, N.J.

George Ferguson, Ph.D.
Research Scientist
Department of Computer Science
University of Rochester
Rochester, N.Y.

Bridget Gallagher, G.N.P., M.S.N.
Senior Vice President
Community Service Division
Jewish Home and Hospital Lifecare System
New York, N.Y.

Cecelia Horwitz, M.B.A.
Executive Director
Center for Future Health University of Rochester
Rochester, N.Y.

Holly B. Jimison, Ph.D.
Associate Professor
Deptartment of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
Portland, Ore.

David Kibbe, M.D., M.B.A.
Founder
Center for Health Information Technology
Leawood, Kan.

Vince Kuraitis, J.D., M.B.A.
Principal
Better Health Technologies, LLC
Boise, Idaho

Joseph C. Kvedar, M.D.
Director, Center for Connected Health
Partners Healthcare System, Inc.
Associate Professor/Vice-Chair of Dermatology
Harvard Medical School Boston, Mass.

Lena Mamykina, Ph.D.
Georgia Institute of Technology
Atlanta, Ga.

Doug McClure, M.I.M.
Corporate Manager
Technology and Operations
Center for Connected Health
Boston, Mass.

Vincent M. McNeil, Ph.D.
Business Development Manger
Wireless Connectivity, Medical and High Reliability
Texas Instruments Incorporated
Stafford, Texas

Alice Pentland, M.D.
Director, Center for Future Health
Chair, Department of Dermatology
University of Rochester
Rochester, N.Y.

Colonel Ron Poropatich, M.D.
Deputy Director
Telemedicine and Advanced Technology Research Center (TATRC)
Army Medical Research and Materiel Command (US/VMRMC)
Fort Detrick, Md.

Rey Ramsey, J.D.
CEO
One Economy Corp.
Washington, D.C.

Spencer Z. Rosero, M.D.
Director of the Pacemaker Clinic
Assistant Professor of Medicine
University of Rochester
Rochester, N.Y.

Jay H. Sanders, M.D.
CEO, Global Telemedicine Group
Professor of Medicine, Johns Hopkins School of Medicine
President Emeritus of the American Telemedicine Association
McLean, Va.

George Scriban
Product Manager
HealthVault
Microsoft Corp.
Redmond, Wash.

Albert Shar, Ph.D.
Vice President, Information Technology
Robert Wood Johnson Foundation
Princeton, N.J.

Ivo Stivoric
Chief Technology Officer
Bodymedia
Pittsburgh, Pa.

Paul Tarini
Pioneer Team Leader
Senior Program Officer
Robert Wood Johnson Foundation
Princeton, N.J.

Jonathan N. Tobin, Ph.D.
President/CEO Clinical Directors Network, Inc.
New York, N.Y.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Book Chapters

Horwitz C and Pentland A. "Involving Patients in Concept Generation: Unusual Collaborations Spur Self-Care Technology Innovation." In Technology and Aging, Mihailidis A et al. (eds). Amsterdam: IOS Press, 2008. Available online.

Presentations and Testimony

Cecelia Horwitz and Alice Pentland, "Involving Patients in Concept Generation: Unusual Collaborations Spur Self-Care Technology Innovation." Presentation at the Second International Conference on Technology and Aging, Toronto, June 16–19, 2007. Available online.

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Report prepared by: James Wood
Reviewed by: Sandra Hackman
Reviewed by: Molly McKaughan
Program Officer: Albert O. Shar

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