Mobile technologies for self-management of chronic diseases

Transcription

1 Mobile technologies for self-management of chronic diseases Gunnar Hartvigsen, professor Medical informatics & Telemedicine Dept. of Computer Science University of Tromsø The Arctic University of Norway Norwegian Centre for ehealth Research University Hospital of North Norway ehealth Innovation Days Flensburg, Germany Thursday 6 September 2016

2 Who am I? Ph.D. in Computer Science (AI), University of Tromsø The Arctic University of Norway (UiT) Professor, Computer Science (1994 -) Medical informatics & telemedicine (1998 -) Professor, Norwegian Centre for Telemedicine, University Hospital of North Norway (UNN) ( ) Professor, Norwegian Centre for ehealth research (NSE), UNN (2016 -)

3 Tromsø, , 9 PM Picture of Tromsø city centre taken at a workshop dinner (2 days ago), 421 meter above sea level

4 We currently experience a revolution when it comes to use and re-use of health data

5 Fundamental shift

6 Fundamental Concept New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare. -- Richard M. Satava, MD FACS, Professor of Surgery, University of Washington and Senior Science Advisor, US Army Medical Research and Materiel Command

7 The New Digital Medicine Fundamental shift in the way patients interact with their doctors. Patients are using apps and devices to work together with their providers to live healthier lives and reduce the frequency of sick visits. People have personal devises keeping them healthy. The technology allows patients to track their progress over time and potentially address issues before they become too serious

8 The New Digital Medicine Example: Twine Health focuses on forging more productive digital connections between patients and their health care providers

9 The New Digital Medicine Patients are working with their doctors to establish certain health goals, then using devices and apps to track their progress. Patients co-create action plans with goals that matter to them. They use connected devices to track their progress and to build self-efficacy and create new behaviors. 10

10 The New Digital Medicine The providers avoided the paternalistic approach common to the traditional doctor-patient relationship, in which the physician simply told the patient what to do. Instead, they mutually agreed on how to use a combination of exercise, diet, and medicine to lower their blood pressure Care teams provide timely support through tightly integrated communication tools. Patients get the attention that they deserve, seamlessly integrated into their busy lives. 6 11

11 The New Digital Medicine After that initial meeting, the patients interacted with a tablet application that displayed their daily schedules and informed them when certain actions were due to be completed. They would indicate when they took the prescribed pills, and they regularly used a smart blood pressure cuff that relayed their vital signs to the tablet and to the physician's office

12 The New Digital Medicine Patients could converse with a nurse through the tablet and receive encouragement for sticking to the regimen. The result (from one study): "One hundred percent of the patients reached their blood pressure goal."

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14 Medicine s Gutenberg moment. Much as the printing press liberated knowledge from the control of an elite class, new technology from the smartphone to machine learning is poised to democratize medicine. Patients will control their data and be emancipated from a paternalistic medical regime in which the doctor knows best. Mobile phones, apps, and attachments will literally put the lab and the ICU in our pockets. Topol, Eric J., M.D. Computers will replace physicians for many diagnostic tasks, and enormous data sets will give us new means to attack conditions that have long been incurable. 15

15 New Medicine Wireless sensors Creative Deconstruction Mobile Connectivity + Bandwidth Genomics Medical Imaging Super Convergence Internet Social Networking Information systems Old Medicine Computing power + Data universe The transformation from medicine today (old, dumbed down) to new, individualized medicine that is enabled by digitizing humans.

16 Timing of the big 6 major digital advances over the past 40 years that have set up the Great Inflection of Medicine.

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20 The Arctic cathedral MY FOCUS Patients with diabetes (Type 1 and Type 2)

21 Norwegian Centre for ehealth Research Diabetes team Cooperation Competence: Technology System development Medicine Risk analysis Statistics Security Law/ethics Economy How to be a patient

22 Årsand, E., Tatara, N., Hartvigsen, G. Wireless and Mobile Technologies Improving Diabetes Self-Management. Handbook of Research on Mobility and Computing: Evolving Technologies and Ubiquitous Impacts. Edited by Maria Manuela Cruz- Cunha & Fernando Moreira. IGI Global, Issom, D-Z., Woldaregay, A.Z., Chomutare,T., Bradway, M., Årsand, E., Hartvigsen, G. Mobile applications for people with diabetes published between 2010 and Diabetes Management, Vol. 5, No. 6, pp

23 The diabetes patients challenge

24 Living with type 1 diabetes If you have a chronic disease, you have it 24 hours a day 7 days a week 52 weeks per year The rest of your life

25 The diabetes patients challenge Nutrition Health indicators Medication Physical activity

26 BG regulation Only 35% of the patients in Norway achieve the International Diabetes Federation s goal for blood glucose (HbA1c) Only 6 % reach all treatment goals

27 Our approach: self-management systems

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29 Since April 2013

30 Since January 2014

31 Since September 2014

32 One of the users

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34 15 years of reserch on self-management of diabetes mdiabetes

35 Narrow focus: 15 years with mdiabetes BG Bluetooth adapter Smart step counter T1D, Photo Diary, Child Diabetes Diary Android versjon Diabetes Diary iphone versjon BG Bluetooth prototype T2D app ver.1 Pebble app T1D, SMS Child à parents T2D app ver.2 T2D, RCT

36 Keep the user informed - even the kids

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38 What we record

39 Main screen

40 Diary / recording

41 Insulin

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43 Physical activity

44 Blood glucose

45 Automatic BG transfer

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47 Advanced functions Similar situations BG trends Periodicities

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49 Use of Smartwatch + No. of steps are automatically recorded (App available at the Pebble s app store) 73 In the picture: Mirek (CZ)

50 Pebble smartwatch

51 Voice input Recognition takes place on a remote server (needs an internet connection to work) Supports English, Danish, Spanish, German, Portugese, Swedish, Finnish, Italian and Norwegian

52 Integration of 76

53 Child Parent Communication Traditional BGM Child with Type 1 Diabetes Works also with a CGM 77

54 Colour signalization Automatically adjusted lamp in the family s home indicates child s BG status by changing colours and blinking. Displays are also available on walls, smartwatches, smartphones, pads and computers.

55 RDS signalization Minicomputer transferring BG-values as radio signals, the FM- RDS radio announces and displays incoming BG-values. (We play with technology)

56 Motivation: Child and his/her family and friends Traditional BGM Child with Type 1 Diabetes Student project: Pietro (I) 80

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58 xdrip We have made our own!

59 A group of master student at UiT are currently adding social media features for motivation to the NightScout interface

60 Diabetes games

61 Developed by master student Alexandra Makhlysheva (RUS) 92

62 The patients can share their data with their doctor

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64 Zoome in Choose data Check factors 95

65 Set limits Statistics 96

66 Before and after: breakfast, lunch, dinner Statistics 97

67 Big data analytics The patients record a large number of data during their life-time. What can we do with these data?

68 Statistical algorithms Professor: Fred Gotliebsen, UiT Dr. S.O. Skrøvseth

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70 Food rec. surprisingly much used the most frequent user had a usage of 11.7 daily inputs average user registered 4.6 daily food and drinks

71 Physical activity step counts?

72 Documenting by phone s camera

73 Health intelligence - Electronic Disease Surveillance

74 Our mission To detect the spread of contagious diseases before the people infected know that they are infected.

75 Our system proposal: New point of detecting an epidemic outbreak Earliest point of stating an epidemic outbreak (today)

76 Early outbreak detection/surveillance Module 9/8/16 113

77 What s next?

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80 Free Book Hartvigsen, G., Pedersen, S. (2015) Lessons learned from 25 years with telemedicine in Northern Norway (405 pages) The book is freely available on the Internet and can be downloaded from:

81 Questions?