RAPID PRESENTATION 1: Designing Mobile

Shilo Anders, PhD, Vanderbilt University Prabir Dutta, PhD, the Ohio State University Thienne Johnson, PhD, University of Arizona Julie Kientz, PhD, University of Washington Yalini Senathirajah, PhD, SUNY Downstate Medical Center Jacob Sorber, PhD, Dartmouth College Gang Zhou, PhD, College of William and Mary

Shilo H. Anders, Ph.D.

Center for Research and Innovation in Systems Safety Vanderbilt University Medical Center Nashville, TN

Problem Statement
How to enhance care through interactive userfriendly mobile device technology Currently paper-based system Studying sickle cell patients initially, expanding into other patient populations Design user interface for mobile devices to monitor and coordinate their care

Future Research Interests

How to deal with health care data overload Long-term assessment of integration of increased data streams into EHR in support of clinician decision making

Development of sensors for quantitation of disease biomarkers in exhaled breath

Prabir Dutta Department of Chemistry The Ohio State University

In collaboration with Cleveland Clinic, NASA Glenn, Makel Engineering

Breath Markers in Diseased States

Disease
Oxidative Stress: - Lipid Peroxidation - Asthma, COPD, Bronchiectasis Lung Disease: - Asthma - COPD - Cystic Fibrosis - Pulmonary Allograft Dysfunction Lung transplant rejection Metabolic Disorder: Diabetes Gastroenteric Diseases: Disorders of Digestion Gastritis, Gastric Ulcer

Breath Markers
Pentane, Ethane H2O2 NO, CO, H2O2 NO, H2O2 NO, CO, H2O2 NO

Carbonyl sulfide Acetone Hydrogen

13CO, 14

CO2

Clin Chem. 52, 800, 2006

NO: Important Breath Marker for Lung Disease

Activation of NOS2 by damage to airway epithelial cells and by inflammation NO > 10-20 ppb; 90-95% predictive value for asthma (1993) American Thoracic Society/ European Respiratory Society have defined Exhaled Breath Collection Protocol (FENO) Therapy adjustment based on NO analysis NO analysis a cost effective method for screening large populations : diagnosis, compliance, drug efficacy, dosage 2003: FDA approved NO chemiluminescence analyzer (25-45 kg, $20-$45K) Significant commercial activity for developing mobile technology: hand-held device (15 million asthma patients)

20 Sensor Array: Breath samples

Sensors & Actuators, 2011, B158, 292
770 700
EMF (mV)

ON

OFF Breath Sample (8 ppb NO)

630
ON

625 620 615 610 605 30 36 Time (mins) 42

OFF

630 910 0 840 6 12 18 24 30 36 42

Breath Sample (17 ppb NO)

EMF (mV)

770 0 6 12 18 24 30 36 42
80

770 700

Breath Sample (46 ppb NO)

20 Sensor Array

60

12

18

24

30

36

42

EMF (mV)

700 630 560

Breath Sample (82 ppb NO)

40

Slope ~1.0

20

10

15

20 25 Time (mins)

30

35

40

0 0 15 30 45 NO (ppb) 60 75 90

Water as background: breath samples Impractical device, too large for mobile applications: high thermal load

Miniaturization : effort at NASA Glenn

OFF OFF 10 ppb OFF 40 ppb 20 ppb ON ON ON

J Breath Res. 5. 2011 (037111)

Breath Analyzer Second Generation Prototype: Handheld Sampler Detail (Makel Engineering)
Mouth-piece with disposable filter

Sensor manifold

Sensor array Check valve with sample port (tubing not shown)

Wireless electronics

Rechargeable battery

Spirosure, licensed OSU technology :https://gust.com/c/spirosure_inc

What Next?? Mobile Breath Detection Technology

Biologists : What are the biochemical links between breath markers and disease If volatile molecules in blood, probably in breath Mass Spectrometric analysis is advanced, so identification in breath is not an issue What will be the relevance for disease or treatment? Physical scientists: What new sensing principles are required? Development of materials/catalysts Demonstration of selectivity/sensitivity Engineers : Device Fabrication, miniaturization, ideally cell phone platforms, data handling Clinicians Are devices field applicable (point of care) ? How is the information relevant?

2012 NIH MHEALTH SUMMER INSTITUTE

Thienne Johnson
Post-doctoral researcher / ECE The University of Arizona
thienne@email.arizona.edu http://www.cs.arizona.edu/~thienne

2012 NIH MHEALTH SUMMER INSTITUTE

Use case: A context-aware recommendation system platform

Context-aware system provide the user with adaptive recommendations from information available on a social application.
The use of context will enrich recommendation and personalization decisions.

mHealth intelligent platforms help users to be responsible for their own health treatment.

2012 NIH MHEALTH SUMMER INSTITUTE

Selected problems on security

Building trust relationships. A key component is to have a set of trusted users.
Trusted users are knowledgeable about food and nutrition but are not necessarily computer experts. What are good ways to build referral-based trust relationships between users and a central server without having to engage in cumbersome protocols?

Privacy: great availability of personal data (name, email, photography etc) may be used to reasonably identify a user. Its imprudent to share some info in public and it would violate most privacy legislation if release by health care professionals.

2012 NIH MHEALTH SUMMER INSTITUTE

Related solutions
Use of a central authentication server/service or ad-hoc negotiation

2012 NIH MHEALTH SUMMER INSTITUTE

Addressing the issues

Design and implementation of a trust framework (using exchange of security certificates between mobile devices and monitoring servers) to allow recommendations from trusted users.

Use of known security techniques for storing sensitive information on mobile device, server and secure communications protocols for data transmission.

2012 NIH MHEALTH SUMMER INSTITUTE

How mHealth will help?

Collaboration with health researchers to:
Engage the platform and protocols with the HIPAA security guidelines.
(but avoiding exhaustion of devices battery)

Test and define new context types

What else can we use to improve user experience and user willingness to use a mHealth system?

thienne@email.arizona.edu

Julie A. Kientz, Ph.D.

Assistant Professor University of Washington Contact:
jkientz@uw.edu http://juliekientz.com

University of Washington

About Me
Currently: Completing 4th year as Assistant Professor in Human Centered Design & Engineering

Background: Ph.D. in Computer Science from the Georgia Institute of Technology Research Focus: Human-Computer Interaction, User-Centered Design, Health Informatics

Research Mission

Computing for Healthy Living & Learning Lab

To design, develop, and evaluate applications to support individuals and families in pursing their health goals. We explore how novel technologies, such as ubiquitous and collaborative computing, can help with record-keeping, data review, and behavior change.

Current mHealth Projects

How can technology support healthy sleep behaviors?

How can technology support tracking childrens developmental progress?

Supporting Healthy Sleep Behaviors

Mobile applications for tracking sleep, promoting awareness, assessing sleep environment, and measuring sleepiness

ShutEye

sleep hygiene

PVT-Touch Lullaby
sleep environment

sleepiness test

SleepTight

insomnia CBT

Tracking Childrens Development

Baby Steps: Parents receive SMS notifications asking developmental milestone questions
Can respond to messages, which are stored and synced with online database and companion website
Can Jose throw a ball using both hands? (Reply Y for yes, S for sometimes, N for no)

Yalini Senathirajah, PhD

Assistant Professor Department of Medical Informatics SUNY Downstate Medical Center Brooklyn NY

Creating Adaptive User-composable Healthcare Information Systems

Problem: Healthcare IT
Information-intensive, complex1,2 rapidly changing Information varies Integration and aggregation of snippets of multiple information sources (e.g. a lab result, x-ray, paper, patient preference) Chronic conditions , complex multiplayer care Social, collaborative, high-stakes, security needs Different populations have different needs; unknown to designers/researchers

Historically: design by programmers/vendors

1. 2.

Vendor lock-in: monolithic systems require vendor/programmer, agreement, time, cost to change Bad fit to clinician or patient conceptions/needs Poor usability affecting MU adoption
Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. National Research Council, 2009. Wears, RL. Computer Technology and Clinical Work: Still Waiting for Godot. JAMA 2005.

Public Web user control & participation

Web 2.0 Is a core philosophy and set of principles & practices Framework or platform, not application

MedWISE3

Metadesign = design to let others design

Widgets can be plots, notes, RSS, alerts, timelines, any web-enabled program

Expected & Found Benefits

Better task-technology congruence HCI/cognitive/usability efficiencies: decreased back and forth navigation; decreased work and time due to aggregation, sharing; cognitive ease Users do use new affordances to solve problems, develop new things that fit their needs User acceptance/satisfaction great enthusiasm Mashups - accommodate rapid change (e.g. H1N1) Problems unknown by designers can be solved by users; evolutionary development Christensen - Disruptive Innovation: Bring a different value proposition to the market Initially under perform established products in mainstream market Superior in ways that are not valued by the established market more reliable, easier to use, or cheaper

Why mHealth?
Accessible, low-cost, BYOD policies give user control devices improving - disruptive innovation? Consensus (NIHI-Canada); in future you will mix and match your apps Wheres the framework for this? Advantages for patients, clinicians, researchers:
Design in a flash, change in a flash Access, control, rapid updates, fit to task Inferior now but rapidly increasing power, screen res, functions Ubiquitous, where you are App is existing paradigm; composability intuitively understood App Frame with medical vocabularies, hooks, data specialization, visualizations Special populations can design their own; unpredicted

Recent History- letting users do it

Wordprocessing anyone can print GUI anyone can use a computer Graphical browser anyone can use internet Framework + MedAppInventor ? Anyone can program?

2012 NIH Mobile Health Summer Institute

Gang Zhou
Assistant Professor Computer Science Department The College of William and Mary Web: www.cs.wm.edu/~gzhou

What is the problem? How to provide:

P1: practical body sensor networking? P2: sensing performance assurance? P3: communication performance assurance? P4: energy efficiency for battery powered devices?

ZigBee Bluetooth etc. WiFi/3G/4G + Internet

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College of William and Mary

P1: Practical Body Sensor Networking?

E.g., for activity recognition, Requirements: Portable and user friendly

Our Solution (ACM SenSys11)

TinyOS-based motes + Android phone Activity recognition approach appropriate for phones (no servers) Identify redundant sensors to reduce training costs Classify difficult activities with nearly 90% accuracy Retraining detection without ground truth
College of William and Mary

Computationally lightweight

Accurate

Not Invasive
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P2/P3: Sensing/Communication Performance Assurance?

P2: Need to ensure sensing performance
We accurately characterizing and exploiting sensing diversity
Sensing diversity is defined as: the sensing capability differences among individual sensors or sensor clusters, no matter heterogeneous or homogeneous ones, in a specific deployment.

Compared with existing model-driven approaches that depend on modality specific sensing models for data fusion
They need to mitigate sensing diversity, but we utilize sensing diversity for our benefit: IEEE INFOCOM11

P3: Need to ensure sensing performance over multiple heterogeneous hops:

ZigBee, Bluetooth, WiFi, 3G/4G, etc.

We use a radio-agnostic MAC/PHY abstraction to support platform portability

IEEE INFOCOM11, ACM TOSN11, INFOCOM08
47 College of William and Mary

P4: Energy Efficiency for Battery Powered Devices?

Energy savings for both sensors and smartphones
Opportunistically sharing sensing and computing resources among multiple body sensor networks
Under submission to ACM TOSN

More energy savings for smartphones

Classify applications into high/low priorities, put WiFi radio to power save model for delay-tolerant applications.
ACM Ubicomp12, up to 56% energy savings in Android smartphones compared with adaptive PSM

For real-time applications like VoIP, sense silence data packet and put WiFi radio to power save mode.
ACM Ubicomp11, about 40% energy savings in Android smartphones compared with adaptive PSM

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College of William and Mary

How will mHealth help?

New applications that can use our smartphonecentered, performance-ensured, body sensor networks New hardware that can be integrated into or collaborate with our smartphone-centered body sensor networks New research partners New funding opportunities

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College of William and Mary