The world’s older members of society are becoming a larger part of the population as a whole. According to the United Nations, in 2000 there were less than 600 million persons aged 60 years or over in the world, comprising 10 per cent of the world population. By 2050, this figure will triple to nearly 2 billion older persons, comprising 22 per cent of the world population. Those statistics are mirrored in the United States. Today in the US, there are nearly 40 million Americans above the age of 65. By 2050 the US Census Bureau projects that the number will grow to nearly 90 million people – about 20% of the US population. As people age, their health costs go up and the types of health care that they need becomes more intensive. These facts are behind the push by many governments to find way to control health costs.
Engaging people in their own well-being has proven to yield better outcomes both in terms of quality of life and cost containment. At-home self test kits for a variety of illnesses, including diabetes - the fastest growing chronic health problem, have slowly revolutionized the healthcare system by giving consumers direct information about their condition. There is an old engineering saying that you can only control what you measure. Monitoring health is one way to begin to control the outcome of healthcare. Now the healthcare field is poised to make a giant leap ahead by linking home-based medical instrumentation with healthcare provider databases and live on-line consultations.
Care Innovations, a joint venture of Intel and GE Healthcare’s Home Health Division, started their hardware-based product line using an Intel® Atom™ processor in a tablet-computer configuration to provide a human-machine interface including text-to-speech, full motion video, audio and low speed, and low data rate physical monitoring such as blood pressure. Data communications are via the broadband network connection. According to a company spokesperson, Care Innovations is now offering a software-only package that runs on common industry platforms. This natural evolution of the delivery vehicle for the Health Guide product was only recently approved by the Food and Drug Administration in the US. Based on the FDA clearance, Care Innovations is moving away from providing the purpose-built PHS6000 device.
The recently approved version of the Health Guide software suite can operate on a wide variety of hardware platforms. According to company Chief Executive Officer Louis Burns of Intel-GE Care Innovations, "Since the newest version of the Intel Health Guide will be available on a variety of platforms, healthcare organizations can choose from numerous portable, inexpensive options, and have the ability to scale the solution to large populations.” The new FDA approval makes a wide variety of tablet PCs able to run the Health Guide software. For example, Netbook Navigator offers two series of tablet computers that use an ATOM processor capable of running the Health Guide suite.
Aetna Insurance company has used the Health Guide PSC6000 in a trial involving older patients with chronic heart problems. Dr. Randall Krakauer, Aetna’s national Medicare medical director observed “Evidence shows that traditional nurse care management programs have improved outcomes and reduced avoidable hospital admissions among Medicare beneficiaries with CHF (chronic heart failure).” The use of the Health Guide system, and in the future the software suite, argues strongly in favor of hosting the suite on medical tablets and other medical-grade embedded hardware systems. Security of personal information used by the suite can be improved by limiting the other general computing uses of the hardware platform.
Kenton Williston published a blog on choosing a medical tablet computer last November, but the choices have since expanded signigicantly.
Members of the Intel Embedded Alliance offer hardware options. The greater range of approval means that dozens of embedded and purpose-designed systems can be use to run the Health Guide software. Asus provides the Slate computer and the Eee series, each of which can host the Health Guide. Likewise, Advantech(1) offers a series of preconfigured medical grade tablet and netbook style computers. Advantech’s POC-C series medical computing terminals were designed to save cost while providing performance. The units feature an energy-saving design that allows for low power consumption of only 28-48 watts during normal operations. The POC-C series terminals were designed for patient monitoring and computer cart applications. Emerson (2) produces a series of motherboard and other small form-factor solutions aimed at home healthcare OEMs including These qualified and open standards based platforms such as CompactPCI®, Processor PMC and MicroTCA®. Kontron(3) offers a wide variety of OEM solutions that can be configured to meet any set of needs. The product offering includes Intel® Core™ i7, i5 and i3-based products such as the ETXexpress® SC. The COM Express® basic supports pin-out Type 2 and Type 6 and the Mobile QM67 chipset. Radisys(4) also offers many options for medical computing. The company already has fielded solutions for a handheld x-ray scanner and medical monitoring equipment.
Hardware vendors and the FDA only have part of the decision about what hardware can be used for remote patient monitoring. Insurance companies may be the biggest stakeholder of all in the nascent remote patient monitoring business. Many health plans do not reimburse over-the-counter medications and devoices, even when prescribed by a doctor. To date the solution preferred by many health plans is based on equipment that serves a limited and health-related function only.
The computer is only part of the complete Health Guide solution. Asking patients to enter medical readings by hand is an error prone task that gives the opportunity to patients to “forget” to enter data. Health Guide solves this problem by allowing medical instrumentation to interface directly with the Health Guide system. Basic vital signs are an important part of monitoring the state of an individual’s health. These measurements include blood pressure and weight. For people with chronic health issues, additional measurements may be needed: blood glucose, blood oxygen levels, heart rate, and more. Towards that end, the Care Innovations Health Guide product can gather information from: A&D medical blood pressure monitors, both wired and wireless; Bayer HealthCare glucose monitors; LifeSca, a Johnson & Johnson Company glucose monitors; Microlife peak flow monitor; Nonin Medical wireless pulse oximeter; and A&D Medical weight scales, both wired and wireless.
Since the Health Guide can be used by patients to obtain medical advice and monitoring, for US use the product falls under medical devices requiring U.S. Food and Drug Administration (FDA) review. The Health Guide products are controlled by the FDA “Premarket Notification,” sometimes referenced by its origins in the Federal Food, Drug and Cosmetic Act as the “510(k) process.” The March 2011 FDA 510(k) clearance permits the Health Guide software to be marketed independent of the underlying hardware. But, market factors will likely encourage the use of low cost, low power medical certified products to host the software.
Intel was the originator of the Health Guide product and its software beginning with FDA clearance in 2008. Due to the regulatory requirements for the software-based product, Intel chose to develop the entire Health Guide software suite using traditional software development methods. The product does not employ Open Source software. The suite controls medical instrumentation measurements using various tools and presents the information for both patients and medical professionals to review. The software allows “normal” lower and upper bounds to be established for each reading type and can alert healthcare givers to out of range readings either remotely or locally if the patient is being seen in person. But perhaps the most important aspect of the new approach to healthcare is based on remote monitoring. Using the Health Guide suite professionals can be warned when readings exceed established norms. As a positive feedback mechanism for routine monitoring, frequent feedback to the patient more fully engages them in managing their own healthcare. In multiple studies, the benefits of such feedback consistently demonstrates better outcomes for patients.
Remote Patient Monitoring products like Health Guide are a sea-change in healthcare.
How can you apply these same principles of remote monitoring and reporting to your other embedded systems?
For more on extending the Internet to embedded devices, see intel.com/go/embedded-connectivity
1. Advantech is a Premier member of the Intel Embedded Alliance
2. Emerson is a Premier member of the Intel Embedded Alliance
3. Kontron is a Premier member of the Intel Embedded Alliance
4. Radisys is a Premier member of the Intel Embedded Alliance
Roving Reporter (Intel Contractor)
Intel® Embedded Alliance