on health-enabling technologies and sensor-enhanced … - sensor_haux_eng.pdf · on health-enabling...

on health-enabling technologies and

sensor-enhanced health information systems

Reinhold Haux

Peter L. Reichertz Institute for Medical Informatics

University of Braunschweig - Institute of Technology (TU Braunschweig)

and Hannover Medical School (MHH)

German Japanese Medical Informatics Symposium (GJMIS) in 2013

on health-enabling technologies and

sensor-enhanced health information systems

Reinhold Haux

Michael Marschollek and many others from PLRI, …

Peter L. Reichertz Institute for Medical Informatics

University of Braunschweig - Institute of Technology (TU Braunschweig)

and Hannover Medical School (MHH)

German Japanese Medical Informatics Symposium (GJMIS) in 2013

on HET Reinhold Haux 3

structure

• PLRI

• health care and population development

• research in the context of health-enabling

technologies (HET) and sensor-enhanced health

information systems (HIS)

• some lessons learned


PLRI


PLRI – Peter L. Reichertz Institute for Med. Informatics

Prof. Reichertz 1930 - 1987

1969

P.L. Reichertz

became professor

at MHH

(Development of

the MSH)

1974

Foundation of

the Institute

for Medical

Informatics at

MHH

1975-1988

Minor subject

medicine at computer

science program of

TU Braunschweig,

organized by Prof.

Reichertz

Prof. Pretschner 1938 - 2007

1986

D.P.

Pretschner

became

professor at

Univ. of

Hildesheim

1996

Foundation of

the Institute for

Medical

Informatics at

TU

Braunschweig

1997

Prof. D.P.

Pretschner

moved to TU

Braunschweig

2007

Foundation

of PLRI

2004

Retirement of

Prof. D.P.

Pretschner

40 years medical informatics


PLRI – Peter L. Reichertz Institute for Med. Informatics

Standort TU Braunschweig

location TU Braunschweig

location TU MH Hannover

health-enabling technologies

eLearning in der medicine and dentistry

health information systems and management

other projects

research

education

≥ 25 faculty, 3 (full/assoc.) professors

computer science

business information technol.

computer and comm. eng.

dentistry

medicine

medical informatics


health care and population development



“Population ageing is unprecedented, a process

without parallel in the history of humanity. … At the

world level, the number of older persons [persons

aged 60 years or over] is expected to exceed the

number of children [persons under age 15] for the

first time in 2045. … Population ageing … is

affecting nearly all the countries of the world.”

United Nations, Department of Economic and Social

Affairs, Population Division. World population ageing 2009.



“In 2000, the population aged 60 years or over

numbered 600 million, triple the number present in

1950. In 2009, the number of older persons had

surpassed 700 million. By 2050, 2 billion older

persons are projected to be alive, implying that

their number will once again triple over a span of

50 years.”

United Nations, Department of Economic and Social

Affairs, Population Division. World population ageing 2009.


100

90

80

70

60

50

40

30

20

10

0

life expectancy at birth [years]

1950 2000 2050 2100

World

44,7

66,4

76,3

81,1

Source: United Nations, Department of

Economic and Social Affairs, Population

Division. World Population Prospects: The 2010

Revision. http://esa.un.org/unpd/wpp/index.htm

http://esa.un.org/unpd/wpp/index.htm


100

90

80

70

60

50

40

30

20

10

0


1950 2000 2050 2100

World

Germany

44,7

66,4

76,3

81,1 85,4

90,0

67,5





78,7



100

90

80

70

60

50

40

30

20

10

0


1950 2000 2050 2100

World

Germany

44,7

66,4

76,3

81,1

81,8

85,4

90,0

67,5





Japan

87,9 92,3

62,2

78,7



12

10

8

6

4

2

0

Potential Support Ratio (PSR): population 15-64 years / population ≥65 years)

1950 2000 2050 2100

World

11,7 9,1

3,9

2,7

Source: UN


12

10

8

6

4

2

0


1950 2000 2050 2100

World

Germany

11,7 9,1

3,9

2,7

4,2

1,8 1,9

6,9

Source: UN


12

10

8

6

4

2

0


1950 2000 2050 2100

World

Germany

11,7 9,1

3,9

2,7

4,2

1,8 1,9

6,9

Source: UN

4,0

1,4 1,7

12,1 Japan



• changes in health care

• in many countries

• increase of chronic diseases

• increase of “age-related deficits”

• decrease of health professionals


research in the context of health-enabling

technologies and sensor-enhanced health

information systems

• more precise: new HET

• information and communication technologies in order to

obtain sustainable conditions for self-determined and self-

sufficient living

• sensors and sensor-enhanced health information systems

are of particular importance

overall objective:

• enhancing an individual’s quality of life as well as improving

efficiency of health care

health enabling technologies (HET)

souce: HET-lecture at PLRI


data sources – where cane be measured?

• at the human being

• in his/her living environment

• ...

what can be measured?

• physical parameters (weight, location, acceleration, ...)

• physiological parameters (respiratory frequency, skin resistance, ecg, ...)

• biochemical parameters (blood oxygen, ...)

• ...

Sources: Öberg et al. 2004, Koch et al. 2007, AGT-lecture at PLRI


for which purpose?

• getting feedback on a person's health status (for the person, relatives/close persons, nurses, ...)

• health management of chronic diseases (activity analysis, fall prediction, ...)

• detecting emergency situations/ generating alarms (falls, ...)

but also

• communication and social interaktion

• supporting activities of daily living

• entertainmant, information and education, wellness

Souces: Gietzelt et al 2011, Haux et al 2008, Ludwig et al 2012, AGT-Vorlesung des PLRI


• potentials: see e.g.: Spitalewsky et al. Methods Inf Med 2013

among others singificantly improved efficiency of health cate

as outcome of the WSD-study Steventon et al. BMJ 2012

• Cochrane-meta-analyses on telemonitoring for heart failure

patients: telemonitoring • reduces mortality and • reduces hospital readmissions

Inglis et al. Cochrane Database Syst Rev 2010

• but: be careful (a German saying: the devil lies in the detail) Black AD et al. PLOS Medicine 2010, Chaudry SI et al NEJM 2010,

Marschollek M IHSC 2009, Powell LH et al. JAMA 2010


Lower Saxony Research Network Design of Environments for Ageing (GAL)

Information and Communication Technologies for Promoting and Sustaining Quality of Life, Health and Self-sufficiency in the Second Half of Life



• Project started in 2008

• Objective: quality of life in the ageing society

• Independence within one’s own residence

• Development of systems for assisting elderly people, relatives and

caregivers

• Identification of threats

• Support of care structures

• Approach: interdisciplinary research

• Synergy of geriatrics, gerontology,

economics, computer science,

engineering, medicine, nursing science

and special needs education

• Survey of requirements and resources

• Development, evaluation and assessment of exemplary assisting systems

• aim: individual optimized training in unsupervised

environments, COPD

• monitoring of vital signs and

adaptive load control

• Song et al. Meth Inf Med, 2010

• Schulze et al. Inform Health Soc Care, 2010

monitoring in rehabilitation training

• measuring of individual fall risiks

• (long term) use of sensors at the body in

everyday life

• several prospective studies, prediktion models

• Marschollek et al. Meth Inf Med, 2011

• Marschollek et al. BMC Med Inf Dec Mak Med, 2011

sensor-based fall risk assessment

low risk high risk

• use of HET for the assessment of risk

profiles of patients with movment

restrictions (e.g. after fracture of the femoral

neck)

• 3 geriatric centers in lower saxony (BS,

LIN, OL)

• n=30 patients, temporal installations of

HET for 3 months

GAL-NATARS-study

GAL-NATARS-Study

MONitoring, treAtment and pRediCtion of bipolAr

Disorder Episodes

Marcu G, et al. Bipolar Disorders, 2011

MONARCA (EU FP7)

• Cue-Exposure and psychophysiological

Monitoring at Alcohol-Craving

• aim: early identification of craving episodes on

the basis of psychophys. parameters,

preventing fall-backs

• phase 1: controlled, prospective study

• phase 2: long term measurement of risk

patients

CEPMAC-projct

• aim: reduction of fall frequency for high risk

patients in clinical environment through HET

• randomised prospective controlled

intervention study (n=98)

bed-exit-study

1885 nights

falls at

night

all wards 23

intervention 0

control 5

not participated 18


some lessons learned


some lessons learned (1)


some lessons learned (2)

• activities of persons (also) at home are increasingly getting correlated to health care

• developments on ambient assisted living and smart homes, not considering this, may be limited

• developments in health care (diagnostics, therapy, financing, …), not considering this, may be limited

• basic research is needed in many fields

• early translational activities and joint projects with those institutions, providing technology and services is needed


some lessons learned (3) – HET

• in the sensor-enhanced environment ‘classical’ standards for the electronic health records have limits

• analysing (e.g. acceleration) sensors for e.g. fall risk prediction is getting advanced and methodology from signal processing can well be used

• existing methods for analysing data from multiple different sources are not yet satisfactory

• in addition to data protection and privacy issues, legal matters on such sensor systems as ‘medical products’ have to be solved

• considerable research is still needed for appropriately connecting homes (and home-based services) to those of hospitals, …


some lessons learned (4) – (sensor-enhanced) HIS

• although the need for collaboration of health care organizations is unanimously seen, the organizational framework is still fragile

• also, some services needed, do not fit well to a certain institution

-> foundation of the Lower Saxony Bank of Health

• information management concerning multiple independent organization is different

• HIS architectures can well benefit from IHE approaches, which are meanwhile in practise and are able to consider existing “legacy systems”

• education of craftsmen and other professions involved in the context of home care is crucial

(also) through HET...

• ... a person's living environment will become the future place

for diagnosis and therapy as well as for (nursing) care

• ... new diagnostic and therapeutic opportinities exist for

many clinical disciplines

• ... save(‘intelligent‘) living/ AAL, medical and nursing care

will more and more overlap

• ... with conseuqnces for new combinations of outpatient and

inpatient care

some lessons learned (5) - perspectives

Good medicine and good healthcare demand good information!

new forms of care through research on

HET & sensor-enhanced HIS!

? ? ? ?

Peter L. Reichertz Institute for Medical Informatics University of Braunschweig and Hannover Medical School

www.plri.de

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