I take this opportunity with Forum Nokia blog and discuss about harnessing Symbian devices for telemedicine and eHealth purposes. 

For those whom telemedicine and eHealth are strange words: 

Telemedicine (defined by medterms.com): The use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care. Telemedicine includes consultative, diagnostic, and treatment services.  

eHealth (defined by HIMSS’ eHealth SIG): eHealth (or E-health) is defined as the application of Internet and other related technologies in the healthcare industry to improve the access, efficiency, effectiveness, and quality of clinical and business processes utilized by healthcare organizations, practitioners, patients, and consumers in an effort to improve the health status of patients. 

There are lot of solutions for personal use and amusement as well as for enterprise but as always special sectors like healthcare are not first-in-line when thinking about Symbian applications. It’s quite interesting since there are lot of healthcare (or medical) applications for PDA devices like Windows Mobile and Palm. Why Symbian is avoided in this context?  

Surely there are some applications for Symbian like medical dictionaries, personal diet calculators and fitness planners available for Symbian but not so many when talking about using the device in serious way e.g. to monitor your vital signs and to transfer them to the healthcare staff when needed or for the professional use. 

Just think of one of the most common scenarios: you have some problems with your blood pressure and you are given orders to take blood pressure measurements at home for certain follow-up period. You take the measurements, write them down to your paper diary and take them to your doctor for feedback on the results. Are you starting to get the picture? Why not use your phone for storing the information? Of course, it is no problem to implement suitable application to store and display the information. But when adding the direct connection to blood pressure meter to collect results automatically and the information transfer directly to the doctor and even to use phone to receive feedback from the doctor, we are starting to talk eHealth and telemedicine (or should I say tele-HomeCare).  

Thinking this way, there are vast amount of possible uses for this kind of solutions that can collect, store and transfer vital signs. I have been working with this kind of solutions for some time and as a developer there are some intriguing issues to think of. But I’ll get back to these later... 

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Bluetooth has finally found its way to medical devices as well (especially POC, Point-Of-Care). There are still lot of measurement devices out that just gives the measurement result to the device screen, no connections to outside world whatsoever. Then majority of devices that has output connections uses serial communication, either using RS-232 or serial-to-USB conversion. Minority of connectable devices uses Bluetooth, infrared or other wireless communication channel. However it seems that Bluetooth has got manufacturers’ interest since new medical measurement devices with Bluetooth are coming. Even Bluetooth SIG has special medical devices working group.

Even though medical devices are bound by very strict regulations it is quite surprising to notice the variations between Bluetooth implementations between devices. First of all what comes to my mind when talking about medical device and Bluetooth is security. Health care sector and medical industry have always been very straightforward with the security issues when it comes to dealing electronic patient records. So, personally I would take granted that medical devices uses the highest Bluetooth security level (level 3), but that’s not the real world case. For example, there are devices as follows:

• devices without any kind of security
• devices with fixed PINs like 0000 and 1234
• devices that has PIN code hard coded to its friendly name like MEAS_DEVICE_123456
• devices that blindly tries to find first available Bluetooth SPP service around and then tries to send information to that service

The common thing for all the above cases in my opinion is the attempt to ease the device users work e.g. by bypassing Bluetooth paring process so that the user does not have to input the actual PIN code.  This is very awkward when comparing to other health care security regulations regarding electronic patient data. For some cases this kind of solutions might be suitable, e.g. for cases where there is some kind of dedicated “black box” whose only job is to listen and collect data from specific devices. But when these measurement devices are used with Symbian, developers have to think twice before implementing working connectors.

Stay tuned for more…

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What does bluejacking to do with medical measurement devices?

Let’s take closer look for the case where measurement device is active in creating connection to other device to deliver measurement results. In this case device functioning is as follows:

• After person has taken measurement device activates Bluetooth communication automatically (person can not affect to this)
• If there is no previously paired target in the memory, device starts to look Bluetooth targets that provide SPP service.
  • Device tries to create connection one after one to found Bluetooth targets with SPP service
  • When some Bluetooth target responds with correct PIN, device sends measurement results.
• If there is previously paired target in device memory, it tries to connect and send measurements automatically.
  • If for some reason target is not available, or transmission fails. Device begins again Bluetooth inquiry for new possible target.
• And all this happens “under the hood” without any indication to the measurement device user.

Here is one case that might happen when person is taking measurements at home and no initial pairing has been done. There isalso one PDA device and one PC with Bluetooth SPP service available in the next door neighbours (isn't wireless fun!). So the initial communication might not go as expected.

Not so nice Bluetooth planning from the measurement device manufacturer, eh? Neighbouring devices gets connection attempt notification from some obscurely named measurement device.

 

This does not end to this with this device. Let’s think about simpler case where there is only measurement device and correct target device in the range. But the target device is advertising two SPP services, both from different applications. Only one application is waiting for measurement results, other application is for some other purposes. Let’s see what could happen.

 

This case is hard reality with older Series 60 models (e.g. Nokia 6600). There is one Bluetooth SPP service advertised by system (for unknown reason). So it is impossible to get these Series 60 models to communicate with this measurement device, since the connection is always tried with system SPP service.

 

How could this multiple service problem be handled?

• Measurement device should look for devices with SPP service and with specific service name -> service name separates multiple SPP services from each other. Of course this would need modifications to device itself…
• One not so elegant solution could be that listening application could try to be the first application to register to SDP database with SPP service. This way it would be most likely the first service reported in SDP inquiry.

 

Let’s look how this “named service” principle works for these two presented problem cases.

 

 Now everything seems to work better…

And if you are wondering if this kind of measurement device could even exist, yes it does and the device is also quite a lot used with different kind of target devices.

 

Stay tuned for more…

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With the release of Nokia 5500, there has been lot of discussion how to utilize the integrated motion sensor. This integrated sensor is excellent for certain type of applications but would it be better not just to monitor phone motion but the actual person muscle activity and other bio-signals?

You could have integrated sensors built in to your clothes (e.g. sports wear) that does not monitor only motion but also muscle activity and heart rate automatically. Sensor information can be collected directly to your mobile. With this kind of smart monitoring of human motion you can monitor your exercise, daily activities and fitness development very easily and accurately.

So, what do you need for this?

• Mobile device (preferably, Symbian) with Bluetooth
• Monitoring application
• Clothing that has built in smart monitoring technology (e.g. Smart wear, active clothing)

Just put on smart wear, clothes similar to normal skin tight sport wear that has “built-in” sensors for muscle activity, motion and heart rate, and start monitoring with your Symbian device.

This would be ideal solution for personal wellbeing as well as for professional athletes to monitor their exercises. Even more, the results could be transferred using 3G network to the personal trainer or coach for further analysis.

Ok, do you think this sound like the future? No, these advanced solutions already exist but sadly are not very widely known like other professional healthcare/wellbeing related smart phone solutions. For example, a company called Mega Electronics Ltd (www.megaemg.com) is specialized in bio-signal monitoring devices and technology.

My previous blog “Symbian and smart monitoring of human motion” seemed to inspire a lot of people, so I decided to go deeper into this subject.

In this blog I present a real world working case for controlling your mobile using your muscles.

Case setup:

• Series60/Series80 mobile phone
• Small battery-operated Bluetooth enabled two-channel EMG monitoring device (MultiTrainer by Mega Electronics Ltd)
• MuscleMonitor application. This application was built specifically for this case and it monitors muscle activity (EMG) with two channels, so two different muscles (biceps in this case) can be monitored, one channel for each muscle.

Imagine the case where your doctor has prescribed you to take e.g. blood pressure measurements at home regularly for some time period. You should write down all the measurement results and bring the result log to the doctor after monitoring period.

Ok, you take the measurements and write them down. Few times you perhaps forgot to write measurement down and you write it down later trying to remember what the measurement result was. Then you take them to your doctor. Doctor looks results and perhaps types them into clinic information system and then gives you a feedback.

So, what’s the point here? This is just normal routine to do.

I would like to introduce alternative way to do this using today’s smart phones.

In my opinion, the combination of self-monitoring devices with mobile technology offers several advantages in comparison with traditional monitoring methods. In personal health monitoring with smart phones accurate measurement results are available to health care professionals in almost real time regardless of your location. Your personal treatment can be monitored and quickly adapted to a change in health status. Furthermore, by being able to follow the progress of your own treatment, you are more motivated to follow the prescribed therapy.

Smart phones can offer mobile solutions to collect measurements results automatically and wirelessly from the measuring devices and seamlessly transfer the collected data to the healthcare personnel for further analysis. Since smart phones today have well enough storage and processing capabilities they can be used to collect, store and transfer information from different measuring devices at a same time. For example, a blood pressure monitor, a weighing scale and a glucometer can be used to collect and register key information in diabetes care.

Results from different measurement devices are linked together and immediately forwarded by using mobile networks like GPRS and 3G to the healthcare provider, where they are available for review. Following the analysis, the healthcare professionals can send feedback back to your mobile phone. As a result, you not only remain informed about your health status via the information displayed on your mobile, but you can also quickly adapt your treatment, diet or exercise programme in response to the medical advice you receive from your healthcare provider.

In addition to this, you can even view the results on a list or have them displayed in a clear graphical form directly on the screen of the mobile device. This gives you an immediate overview of your treatment progress.

Sounds quite far fetched? Not really, this is actually reality today and the presented eHealthMonitor application exists commercially for the Series40, Series60 and Series80 devices.

I visited the Smartphone in London and it was very interesting event indeed.

Along with the device manufacturers, there was good cross-section of companies working with the main stream applications. For my surprise there was even one healthcare related application (ECG monitoring) present in the Symbian stand. Or at least there should have been. When I asked about the healthcare application from the ladies at the Symbian stand, they were very confused. They pointed me to the each corner of the Symbian stand one after the other but still I didn’t manage to see the presentation (I just wonder if the application was present at all?).

Anyway it was very interesting to see people’s reactions when they asked what kind of business I am with. When I told that I am developing healthcare and personal wellbeing related applications almost everyone looked like they are going to ask: “Come again?” I was expecting this. Healthcare and personal wellbeing solutions with mobile devices are not part of the main stream development today and therefore these solutions are not very well known. But when I finished explaining and demonstrating, everyone thought that the use of mobile devices with health related applications is justified indeed. Especially the muscle control (bicep control) demonstration seemed to interest everyone I demonstrated it.

One particularly memorable event in London was as follows. I had the bicep control demonstration with me (this time with the Bounce game and with the 3D Snakes game for Series60 3^rd edition). At the Forum Nokia Pro evening reception I literarily hooked up one Nokia guy for the muscle control demonstration. I placed EMG electrodes to his both biceps and explained him how the MuscleControl application works. You should have seen the reaction when he played the Bounce game with his biceps. The genuine enthusiasm he presented as he played was the best feedback I needed to be convinced that this kind of “health entertainment” would be really accepted in general public as well.

As it seems that the healthcare solutions are strange for smart phone community, you might think that in the healthcare community smartphone solutions are widely known; not exactly. In November I will be participating world’s largest medical event Medica 2006 in Düsseldorf, Germany (15^th – 18^th November). Medica is really big event. The event takes 4 days and there are over 3600 exhibitors and over 136000 visitors (year 2005 statistics). Last year I got almost the same response in Medica for the healthcare applications with smartphones than in the Smartphone show. So based on my experience, healthcare applications utilizing smartphones are somewhere between the smartphone community and the healthcare community. This is one issue that makes this area so interesting. Every time I discuss with people about these solutions, I get different point of view to think of.

As said this much, I must say that I have really enjoyed talking with people about the “health visions” and all.

Oxygen saturation can be measured with a pulse oximeter. Pulse oximeter tells you basically what percent of your hemoglobin molecules are carrying oxygen, commonly referred to as blood oxygen saturation (%SpO2). Pulse oximeters measure blood oxygen saturation in a non-invasive fashion usually from the fingertip.

 

 

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Ever thought that your bio-signals could be monitored when you are at sleep? This is another interesting case where your mobile can bring great help and simplicity to everyday health problems. Sleep apnea, as the case here, can be defined as public health problem (more commonly present on men than women).

First some background for this case. Sleep apnea or sleep apnoea is a sleep disorder characterized by pauses in breathing during sleep. These episodes, called apneas (literally, "without breath"), each last long enough so one or more breaths are missed, and occur repeatedly throughout sleep. The individual affected with sleep apnea is rarely (if ever) aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes, or is suspected because of its effects on the body (sequelae) [wikipedia].

Since this disorder is related to your unconscious sleep period, you can just imagine that there is really need for a simple user-friendly test to cope with the problem. I’m pretty sure that I can say that you would like to sleep at your own bed instead of hospital to determine if you have tendency for sleep apnea.

Pulse oximeters, which measures blood oxygen saturation (%SpO2) and heart rate, can be used as the simple first level tool for determining the tendency to sleep apnea. In addition to this I encourage you to read my previous blog to see how pulse oximeter can be used for determining acute mountain sickness as well. However, to be useful as a diagnostic tool in the home, a pulse oximeter should have a memory storage capability to store measurements overnight.

As a simple, easy to use and effective setup is the combination of Bluetooth enabled pulse oximeter and smart phone. Pulse oximeter can be without any storage, just measuring and forwarding results to mobile phone. Basically, you would just wear the small battery-operated pulse oximeter overnight and have your mobile collecting the measurements wirelessly. This is very convenient setup since there is no uncomfortable large devices and wires involved that might interfere person’s sleep.

In essence, you just wear the pulse oximeter and start the monitoring application from the mobile (it could be could idea also plug the mobile to charger). Then just sleep..zzzz…

In addition to just storing the results, smart phone can analyze measurements in real-time and detect and mark sudden drops in %SpO2 level automatically. After monitoring period (e.g. when you wake up), you can see the results immediately from your mobile phone’s screen. Even more, you could forward the results to the doctor for further analysis when needed using phone’s GPRS/3G access. Convenient also for the health care professionals, no need to separate data extraction procedure from the pulse oximeter since the data is already available at the database.

So, is this kind of applications available today? Yes they are and many more. Just stay tuned for more…

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I attended the Medica 2006 fair (International Trade Fair with Congress World Forum for Medicine) on 15^th to 18^th November. It was so exhausting to see 17 really big exhibition halls full of different medical related “things” ranging from software to equipment that I cannot even explain.

Anyway it was very good experience in overall. I thought that mobile phone usability in medical applications, especially in mobile telemedicine solutions, would be questioned a lot. But actually the acceptance of mobile devices in personal wellbeing and professional healthcare related solutions was really good. I was so busy presenting all the possibilities smart phones could offer that I did not even notice the 8^th hours passing by each day.

I was really amazed to notice that also big medical device manufactures (producing small homecare devices) are coming to notice mobile telemedicine applications as an important business area. There were so many exciting Bluetooth equipped medical measuring devices presented that they got my mind mixed up with all the possibilities they present with smart phones.

But as every coin has its counter side, also this event. I met people from companies that were working closely with Symbian devices (at least in their opinion) and trying to establish something (I’m not really sure what) with healthcare. As I came to understand, they were there just to sneak out all the possibilities others have invented. They even promised almost everything between earth and sky to get working applications at will to their mobiles. This was very strange experience indeed.

But in overall this event exceeded all my expectations. It truly seems that medical industry is beginning to accept mobile devices like smart phones. Since mobile phones are so common, they are also perceived as natural way to communicate health related information to caring personnel. Just the way I like to think.

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Let’s imagine situation where there has been big accident or some natural disaster like hurricane. There could be many injured people around and paramedics/rescuing personnel trying to retrieve as much of information from injured vital sings as quickly as possible. Could smart phones be useful in this kind of scenario? Surely!

I can just imagine the scenario that there are no even landline communication possibilities in disaster site due to damaged cables but there might be mobile network working (and of course satellite communications). Paramedics/rescuing personnel could use their smart phones to rely first hand information to the health centre for further decisions and information.

Of course the first advantage that comes to mind is relying information by talking with the health centre. Second and more advanced usage is the imaging and positioning possibilities of the modern smart phones. But I like to go beyond of these obvious functionalities and present some ideas to extend smart phone usage in this kind of scenario. Following picture will compact my ideas together.

I must say that I think this is so simple technical setting compared to the help it might provide in the disaster site I wonder why it has not been around already.  Basically for this scenario you need just a suitable smart phone “off-the-shelf” with add-on software and few small-sized Bluetooth enabled medical measurement devices.

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It has been studied that falls are one of the leading causes of fatal and nonfatal injuries to older people. This leads to case where fear of falling forces many otherwise healthy persons to leave their own home to live in an assisted-care environment. The fear of falling has been studied by the researchers and they describe this as a cycle in which after a fall elderly become so afraid of falling again they limit their activities. This in turn decreases their fitness, mobility and balance and leads to decreased social interactions, reduced satisfaction with life and increased depression. Even more this fear cycle is a “driver” to increase the risk of another fall. This might sound quite unbelievable but it is the reality.

As we know the amount of elderly citizens is constantly rising in many countries and the need for more efficient and cost effective caring methods are needed. One aim is to provide elderly citizens the means to stay at home longer than previously. However, the fear of falling effectively drives elderly to seek even more care from the health care providers.

So how could this kind of situation helped? One effective approach is to provide tools (technology) for the elderly to guide and to give more secure feeling to cope in their daily life. Nokia 5500 provides excellent feature for this: the 3D accelometer.

Nokia 5500 has built-in 3D accelometer that can be used as fall sensor to detect falling automatically with suitable algorithms. Fall sensor again can be used to create applications that automatically provide fall monitoring and alerts dedicated caring personnel if the person does not recover from the fall in set time frame. You could think the application as an “emergency button” that is automatically activated when you have felled and you are not standing up in certain time frame. This gives persons more confidence since they get the knowledge they are not alone if something happened and medical help will be coming when needed.

This is again very simple and effective example how smart phones can be harnessed to enhance personal wellbeing and health.

As you know, there is a Sensor API plug-in to Series 60 3^rd edition SDK at the Forum Nokia. You just need to download the plug-in and install it over the existing Series 60 3^rd SDK and you are ready to start developing accelometer aware applications for Nokia 5500. I warmly recommend you to try!

For deeper insight to the algorithms needed for fall detection using accelometer I suggest you to read e.g. paper “An Optimum Accelerometer Configuration And Simple Algorithm For Accurately Detecting Falls”.

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