‘Home’ Is Where the Heart Is (Part 1)
When the term “home health monitoring” was coined, the reference was not limited to the four walls we live between but rather to the monitoring of an individual’s vital signs when he or she was outside the hospital environment. Since the “home” is where we theoretically spent most of our time, the phrase “home health” was employed. However, it is the individual that is being monitored—not the environment (although the environment plays a significant role in terms of how vital signs are measured and communicated). By reclassifying “home health monitoring” as “personal health monitoring,” the walls come down, and where and how we measure vital signs becomes boundless. Part 1 of this paper will look at the revised concept of “home health” monitoring, where the “home” is where the individual’s heart is, literally.
Healthcare is changing, and our expectations of the type and level of care we will receive is adjusting to these changes. In the developed world, investments made in the healthcare industry have yielded remarkable advances in diagnostics and health monitoring. The general assumption by most has been that healthcare will continue to advance and be readily available to the developed world and will expand globally to regions historically receiving minimal support. However, with the spiraling costs of healthcare has come the realization that expectations may need to change. Across the globe, the delivery of healthcare varies greatly from region to region, and the concept of healthcare for all, whilst noble in principle, is still a long way from being achievable.
Innovative Technologies Reduce Healthcare Costs
A solution to reducing healthcare costs is to take advantage of the latest technologies and innovations that will enable patients to leave the hospital more quickly yet safely. By continuing treatment and monitoring in an environment where costs are lower, such as the home, the cost to the healthcare system is reduced. Patients have the added benefit of recuperating in a comfortable setting. To maintain patient safety and reduce recurring in-hospital stays, high performance vital sign monitoring (VSM) devices designed to support the patient environment are essential.
Out-of-hospital monitoring (excluding clinics and doctor’s offices) is generally associated with the traditional home environment. Historically, home health and wellness monitoring has been in the form of a simple thermometer, a set of bathroom scales, and in some households a blood pressure monitor. For disease management, glucose meters are the most common devices in use today, due to the escalation of diabetes cases. To some extent, heart rate monitors (HRM) for sports and fitness, defined primarily by the chest strap or handheld electrodes on treadmills in the gym, also have fallen under the out-of-hospital or remote monitoring market.
We briefly touched on the traditional monitoring devices found in the home (weigh scale, thermometer, blood pressure meter, glucose meter). These devices are generally used periodically as needed. For continuous monitoring, changes in both the design of the monitor and often the motivation of the individual are necessary.
Devices must be nonintrusive and fit seamlessly with our lifestyle — a requirement that resonates across all market sectors. Devices must be small, and since most will likely be body worn, they will need to be battery-operated (either disposable or rechargeable). The user doesn’t want to be fiddling with batteries or chargers frequently, so the devices must support low power consumption to provide uninterrupted, long term use.
Connectivity plays a significant role in remote health management. The method used to communicate information is dictated by the actual vital sign monitored and who the intended recipient of the information is. For instance, fall detection monitors require low latency, real-time communication, whereas heart rate monitors (HRMs) may require only periodic uploads. The communication trend is heading to a wireless modality. Bluetooth Smart, Wi-Fi, GPRS, and proprietary radio protocols are now mandated for new product development. There is no question that reliable, low power, wireless communication for home health monitoring devices is essential whether connection is periodic or continuous 24/7. The Continua Alliance is playing a significant role in the drive toward connecting non-homogeneous devices with third-party oversight.
Home health monitoring falls into three categories:
- Disease management
- Health and wellness
Disease management includes glucose measurement, cardiac monitoring, pulse oximetry (Sp02), continuous blood pressure, and respiration monitoring. It is expected that these devices will be prescribed following a clinical consultation. The device will require a certain level of regulatory approval (e.g., FDA), and the compliance requirements will be as high as for those devices intended for hospital environments. In addition, the devices will need to be small, portable, low power, and connected.
Products like Analog Devices’ ADAS1000-3, 3-lead ECG analog front end (AFE) provide diagnostic-quality signals to ensure regulatory compliance and support the home health prerequisites of small size, portability, and low power.
In contrast to disease management, where the motivation to connect ourselves to monitors is self-evident (i.e., consequences can be dire), health and wellness device use sometimes requires a 3rd party to provide motivation. For instance, when we stand on a weigh scale, the follow-up actions we choose to take may depend upon our emotional reaction to the result. We may feel elated that we have shed a few pounds and be motivated to keep running on the treadmill, or we may feel miserable that a lot of hard work had little effect and take solace in the comfort of our living room sofa. The converse also could be true — an evening on the sofa can be a reward for losing a few pounds.
We can all relate to the challenges of managing our own health, especially when there are no clear results or rewards. Often, third-party motivators are a necessity. There are thousands of smartphone applications directed at helping us manage our health regimen, including calorie burn and calorie intake, step counters, diet management, and exercise coaching. All are designed to provide motivation to stay on the course of better health.
Gaming consoles offer a home exercise platform that integrates motivational goals. For health and wellness in the home, the technology that resides in the monitoring device needs to be connected to a motivational coach that can provide feedback and encouragement.
Fall detectors are one of the most common devices currently deployed amongst the older population. Although these devices do not prevent a fall, they provide a remote alarm that alerts authorities of an adverse event. The key requirements of these devices are low power, small construction, and connectivity. They must also be able to discern between a person sitting down quickly and an actual fall. Extended battery life is critical because changing a battery may require a caregiver visit or a third-party visit at an additional cost to the wearer. A dead battery means a monitor is no longer active, putting the wearer at additional risk. Fall detectors use low g accelerometers to detect and distinguish type of motion. The ADXL362 is the industry’s lowest power, 3-axis MEMS accelerometer. With an operating current of 1.8 μA @ 100 Hz operating data rate (ODR), 3 μA @ 400 Hz ODR, only 270 nA when in motion activated wake-up mode, and 10 nA standby current, the ADXL362 can extend the battery life of a fall detector by many months.
Part 2 of this article will look at related areas outside the home where personal health monitoring is becoming more widespread, including sports and fitness, the workplace and military applications, as well as the expanding universe of devices being used to provide monitoring, such as the smartphone, and even the automotive environment.