HLTHINFO 730 Lecture 13 Slide #1

HLTHINFO 730
Healthcare Decision Support Systems

Lecture 13: Monitoring

Lecturer: Prof Jim Warren
HLTHINFO 730 Lecture 13 Slide #2
Monitoring
A few different domains
Critical care monitoring reporting back to humans
who will respond quickly
Ubiquitous monitoring getting data (probably over
a long period of time) without being too obvious about
it
Participatory monitoring patients get a sense of
engagement by participating in the medical record
Coaching the interaction is mostly about
encouraging healthy behaviour
HLTHINFO 730 Lecture 13 Slide #3
Critical care systems
Classic app is ECG monitoring
See http://www.nda.ox.ac.uk/wfsa/html/u11/u1105_01.htm
P - R interval


QRS complex
duration

Q - T interval
corrected for heart
rate (QTc) QTc =
QT/ RR interval
0.12 - 0.2 seconds
(3-5 small squares
of standard ECG
paper)
less than or equal
to 0.1 seconds (2.5
small squares)
less than or equal
to 0.44 seconds

HLTHINFO 730 Lecture 13 Slide #4
Another view of the ECG
One
heart-
beat
Particularly want to look out for lengthening Q-T
HLTHINFO 730 Lecture 13 Slide #5
Amplitude, Frequency, Phase

Amplitude is displacement (a
distance) in a physical
vibration and then is usually
transformed to an electric
current and is measured in
voltage
HLTHINFO 730 Lecture 13 Slide #6
AM / FM
Can encode signals by changing (modulating)
amplitude or frequency (or phase) of a carrier signal
HLTHINFO 730 Lecture 13 Slide #7
Basics of signal processing
Sampling frequency
Must take samples frequently enough
The Nyquist
rate is
twice the
frequency of
the highest
frequency
component
of the signal
If theres something higher frequency, then youll get
aliasing an incorrect interpretation of the signal
HLTHINFO 730 Lecture 13 Slide #8
Sampling in ECG
In ECG we have a lot of concern with interval lengths
Equipment commonly samples at 100Hz (mobile devices) to
1000Hz (high resolution)
At 100Hz, due to the Nyquist rate, you miss any high-frequency
features with a period of less than 0.02s (i.e., 20ms) (Period = 1
/ frequency)
Moreover, at 100Hz, you can be up to 10ms late in seeing a rise
or fall, and thus up to 20ms inaccurate in estimate of an interval
Sampling requirements (now talking ECG or other apps)
put demands on
the speed of your equipment to process
the bandwidth of your transmission (esp. in telemonitoring)
the size of your database (esp. for long-term monitoring)
HLTHINFO 730 Lecture 13 Slide #9
Signal classification
Algorithms can classify signals based on features of the
signal
Might be straightforward (e.g., time between lowest and highest
amplitude but keep in mind all those sampling errors!)
Signal can be mathematically transformed
Fourier transform transforms from amplitude over time ->
amplitude over frequency
We can then extract features from the transformed signal
Classifiers can then use whatever machine learning
methods
Multiple regression, artificial neural networks, induced decision
trees, etc.
Can classify the system (e.g., the patients heart) as being in
any of a variety of states
And you can layer symbolic reasoning (production rules) and
fuzzy logic on top of the signal-feature-based classifiers
HLTHINFO 730 Lecture 13 Slide #10
Fourier transform results
A sine wave is the pure spike once Fourier
transformed
Square waves
and pulses
make more
complex
patterns
Time domain Frequency domain
HLTHINFO 730 Lecture 13 Slide #11
Markov model
Based on the memoryless (or Markov) property
(M either way!)
Your previous states say nothing; only need to think
about current state and probability/rate of progression
to other states from there
e.g., P(B
t+1
| A
t
) = 0.9
Can describe the system with a square
matrix, NxN, where N is the number of
states
Again, only accurate if the system is
memoryless with respect to those states
Can use a series of low probability
transitions to indicate that the system
has changed (and throw an alert)
HLTHINFO 730 Lecture 13 Slide #12
Applications
ICU (esp. PICU) monitoring
Respiration, blood glucose, etc. classify and
alert on changes
Worn heart monitors
http://www.nlm.nih.gov/medlineplus/news/fullstory_64123.html
Also, worn accelerometers for falls detection
Smart homes
Monitor usage patterns of lights, water,
refrigerator etc. and also track motion
HLTHINFO 730 Lecture 13 Slide #13
HLTHINFO 730 Lecture 13 Slide #14
Discussion
Have you experienced any good (or not so
good) automated monitors?
HLTHINFO 730 Lecture 13 Slide #15
Participatory Home Telemedcare
Home ECG, lung function, blood
oxygen saturation, glucose, weight, BP
All with feedback so patient sees their
state and their progress
Can, for instance, learn to deal with an
asthma attack (possibly on phone to
nurse) without called ambulance
HLTHINFO 730 Lecture 13 Slide #16
Reminders, life coaches
STOMP txt messaging to quite smoking
chewing gum for the fingers automated friend to
txt when
craving
Plus staged
supportive
messages
and
monitoring
Significant
quit effect
(Maori and
non-Maori
at 6 months
Other obvious apps are exercise coaches, drug administration
reminders and (esp. w. video phones) guides (e.g., for insulin dosing
or nebulizer spacer technique)

HLTHINFO 730 Lecture 13 Slide #17
What is a care plan anyway?
Fundamental to monitoring or health
promotion should be the notion of the care
plan for a patient
What are our objectives (specified as goals
and target values)?
What interventions do we have in place to
achieve those objectives?
How often do we monitor status?
When do we plan to re-plan?
HLTHINFO 730 Lecture 13 Slide #18
Care plan model
Weve created an information model for
care plans (Khambati, Warren, Grundy and Hosking)
HLTHINFO 730 Lecture 13 Slide #19
Model (contd.)

HLTHINFO 730 Lecture 13 Slide #20
Designing a care plan in the
model

HLTHINFO 730 Lecture 13 Slide #21
Care plan in the model (contd.)

HLTHINFO 730 Lecture 13 Slide #22
Automated interface
generation
Weve prototyped a
process for generating
multiple user interface
implementations for an
individual care plan
around the care plan
model
Model a care plan
using the care plan
visual language
Guideline Implementer
Instantiate the care plan
template for a patient
Provider (e.g., GP)
Care Plan Template
Care Plan Instance
Model a suitable visual-
isation for representing a
care plan on a specific
device
User Interface
Programmer
Care Plan Visual-
isation Definition
Generate an application
for a user to visualise a
care plan instance
Visualisation Generator
OpenLaszlo script
representing end-
user application
Create runnable
application
OpenLaszlo Compiler
Shockwave Flash
Objects
DHTML
HLTHINFO 730 Lecture 13 Slide #23
Example interfaces
Part of a diabetes monitoring care plan being tailored in
our care plan instantiation application
HLTHINFO 730 Lecture 13 Slide #24
Example interfaces
End-user Flash application compiled from OpenLaszlo
Auto-generated interfaces are still a bit
basic, but better than nothing
HLTHINFO 730 Lecture 13 Slide #25
Your plastic pal thats fun to be with
Healthcare robots (or healthbots) are being
considered to supplement human personnel
Particularly in low-intensity monitoring situations such
as aged care
Robot is from a Czech word for to work
But many practical robots are actually more focused on being
mobile sensor platforms and computer terminals
Real work robots are possible when fixed to an automotive
assembly line, but not yet practical for dealing with people
Which doesnt mean the Japanese arent trying
HLTHINFO 730 Lecture 13 Slide #26
Robots that can lift and carry
Japanese
RI-MAN
(incidentally,
thats a doll
its lifting)
still highly
experimental
HLTHINFO 730 Lecture 13 Slide #27
Tele-presence healthbot
Much more common
and further along
toward real-world use
HLTHINFO 730 Lecture 13 Slide #28
Robots for companionship
Gladys Moore, a resident at the
NHC Healthcare assisted-living
facility in Maryland Heights,
Missouri, plays with AIBO, a
robotic dog, in this undated
handout photo. Researchers
found that the robot dog was
about as good as a real dog at
easing the loneliness of
nursing home residents in a
study.
HLTHINFO 730 Lecture 13 Slide #29
UoA Health Robotics Centre
Working with ETRI (Korean Robotics Institute)
Looking at adapting an inexpensive
robot for elder care
Combination of companion-
ship and monitoring
capabilities
Strong emphasis on speech
interaction
More autonomous adjunct to
human healthcare workers, rather
than for tele-presence
Possibly supplement other
smart home equipment
Ultrasonic sensors to avoid bumping into
things
HLTHINFO 730 Lecture 13 Slide #30
Summary
Monitoring is a major class of health IT activity
It leads to the embedding of sometimes non-trivial
artificial intelligence in devices (often with reliance
on traditional signal processing)
Monitors may be overt or ubiquitous
They may engage the consumer
In fact, engaging the consumer may be the main point!
Monitoring implies the knowledge engineering of
guidelines