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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
on HET Reinhold Haux 4
PLRI
on HET Reinhold Haux 5
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
on HET Reinhold Haux 6
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
on HET Reinhold Haux 7
health care and population development
on HET Reinhold Haux 8
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.
on HET Reinhold Haux 9
health care and population development
“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.
health care and population development
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
health care and population development
100
90
80
70
60
50
40
30
20
10
0
life expectancy at birth [years]
1950 2000 2050 2100
World
Germany
44,7
66,4
76,3
81,1 85,4
90,0
67,5
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
78,7
health care and population development
100
90
80
70
60
50
40
30
20
10
0
life expectancy at birth [years]
1950 2000 2050 2100
World
Germany
44,7
66,4
76,3
81,1
81,8
85,4
90,0
67,5
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
Japan
87,9 92,3
62,2
78,7
health care and population development
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
health care and population development
12
10
8
6
4
2
0
Potential Support Ratio (PSR): population 15-64 years / population ≥65 years)
1950 2000 2050 2100
World
Germany
11,7 9,1
3,9
2,7
4,2
1,8 1,9
6,9
Source: UN
health care and population development
12
10
8
6
4
2
0
Potential Support Ratio (PSR): population 15-64 years / population ≥65 years)
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
on HET Reinhold Haux 16
health care and population development
• changes in health care
• in many countries
• increase of chronic diseases
• increase of “age-related deficits”
• decrease of health professionals
on HET Reinhold Haux 17
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
health enabling technologies (HET)
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
health enabling technologies (HET)
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
health enabling technologies (HET)
• 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
health enabling technologies (HET)
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
health enabling technologies (HET)
health enabling technologies (HET)
• 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
health enabling technologies (HET)
• 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
on HET Reinhold Haux 33
some lessons learned
on HET Reinhold Haux 34
some lessons learned (1)
on HET Reinhold Haux 35
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
on HET Reinhold Haux 36
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, …
on HET Reinhold Haux 37
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