Attacking Asthma with Advanced Telehealth Monitoring
AT&T’s prototype infrastructure provides a complete, end-to-end solution for delivering sensor data from patient to end users.
Asthma is on the rise, affecting people of all ages, particularly the young. This rise is a result of biological and chemical factors, with a main culprit thought to be airborne pollutants, smoke, fragrances and perfumes, and cleaning solvents and other volatile organic compounds (VOCs) that evaporate into the air from fabrics and carpets. With homes sealed to save energy and cut heating and cooling bills, VOCs build up in homes in high enough concentrations to trigger asthma attacks in some people.
AT&T is currently testing a portable room-monitoring device capable of detecting VOCs and then issuing alerts so those susceptible to VOC-induced asthma attacks can take preventative action.
Because healthcare is becoming increasingly data-driven as a new generation of lightweight, low-power sensors is being incorporated into a variety of new and old medical devices. Sensor-equipped heart monitors, pill dispensers, pulse-oximeters, glucometers, and other devices such as the VOC detectors will soon be sending continuous, real-time data.
Data transmitted to physicians’ offices will give physicians something they rarely have today: a long-term, comprehensive, multidimensional view of health and wellness.
This data will enable people to monitor their own health parameters and the environment around them, allowing those with chronic conditions to more carefully manage their symptoms and giving those in good health early indications of developing health problems.
But it’s the transmission of medical sensor data—to doctors, specialists, and researchers—that will do the most to transform healthcare.
Communications as a healthcare tool
Data transmitted to physicians’ offices will give physicians something they rarely have today: a long-term, comprehensive, multidimensional view of health and wellness, as well as a baseline by which to evaluate changes and anomalies. Today, physicians typically get only a snapshot of a patient’s health taken during an office visit, usually when the patient is sick. This “data” is hardly representative, and says little about what is happening in the months, or even years, between office visits. With so little data about a patient, physicians tend to focus on the specific problem or complaint, while disregarding other health indicators that provide more context for a patient’s symptoms.
Anticipating the direction healthcare was taking, AT&T started years ago looking at what would be required for relaying health data over AT&T’s existing IP net.
But sensor data, captured continuously over a long period, will give physicians a bigger picture, allowing them to see the interactions among multiple factors, such as how glucose readings change relative to weight or blood pressure. In the same fashion, data from a VOC detector may enable a physician to correlate a patient’s asthma attacks with a specific VOC trigger. With more data, physicians have more information to treat the illness rather than just alleviate symptoms.
When transmitted to medical researchers, sensor data aggregated from large numbers, perhaps millions, of people can be mined to better understand the links between diseases and their underlying causes. This is especially important for asthma and other complex diseases that are caused by a combination of environmental, biological, genetic and other factors. In the case of asthma, researchers don’t yet have a good understanding of why some people suffer asthma attacks and some do not, or why some people are susceptible to chemical triggers, and others to biological ones.
Data is key to answering these questions, but it can only be provided by individuals. Sensors make it easier to collect data. Getting the data from individuals to those that need it is the current focus.
Tying together technologies for an end-to-end infrastructure
The difficulty in transmitting medical data has always been collecting and delivering the data in a format that healthcare professionals and researchers can immediately begin using and analyzing without being concerned with the technical, low-level details of data transmission.
AT&T is now close to providing that capability. Anticipating the direction healthcare was taking, AT&T started years ago looking at what would be required for relaying health data over AT&T’s existing IP network. One key decision was choosing an appropriate protocol for transmitting sensor data from the analog device to the IP network. AT&T researchers, after evaluating different protocols, chose IEEE ZigBee wireless technology for several reasons. It has low power demands, powerful local networking M2M capability, and, like Wi-Fi, ZigBee allows devices to relay data by passing it off to nearby devices to reach more distant ones. (This contrasts with peer-to-peer Bluetooth, which does not richly network devices or provide mesh connections.) Wi-Fi and ZigBee belong to the same IEEE family of standards, 802.11 and 802.15.4, respectively.
The current step is to demonstrate meaningful use: to show that the VOC detector can be used by real people in real circumstances to avoid asthma attacks.
To transmit ZigBee-based data from sensors, AT&T Research helped create the ActuariusTM gateway, which uses a fixed broadband connection or a ZigBee-enabled smartphone to collect and securely forward measurements from Personal Health Devices standardized by IEEE 11073 and the Continua Health Alliance.
Data transmission is just one part of a complete, end-to-end communications infrastructure, which must also encompass cloud computing and services, big-data analytics and management, and emerging sensor-equipped devices—all areas in which AT&T maintains active and far-ranging research efforts.
AT&T has one other critical advantage when it comes to transmitting sensitive medical data: AT&T is a trusted entity, and does not use the model of “free” services where the hidden cost is the service provider’s access to and use of data.
Proving the concept
The asthma VOC detector is the first device of its kind being tested in conjunction with this infrastructure.
Last year, researchers demonstrated in the laboratory that the VOC detector can detect a range of airborne VOCs and then alert when concentrations might be high enough to trigger attacks.
The current step is to demonstrate meaningful use: to show that the VOC detector can be used by real people in real circumstances to avoid asthma attacks. Preliminary trials are now under way in conjunction with major healthcare partners. Though limited in scope now, the trials will expand next year as the number of participants increases substantially.
Even while meaningful use is being tested, AT&T is looking to make the device more useful by creating improved software and analytics so the device can discriminate among the various types of VOCs. Inserted into the VOC detector, this code will allow the detector to correlate occurrences of specific elevated VOC concentrations with other measurements (e.g., heart rate, blood oxygen, and other asthma indications) to try to zero in on the specific compound that triggers an attack in a specific individual.
This ability to personalize healthcare for the individual, to know the specific VOC triggers or know which medical indicators are anomalous for a specific person, further points to the almost limitless potential of data-driven healthcare. As more data is collected and analyzed, physicians and medical researchers will understand better how to not only help those already sick, but to maintain wellness in those who are healthy. This is something healthcare has been needing for a long time. Proving that a VOC detector can prevent asthma attacks is a step toward a healthcare system centered on health maintenance.
Results of the trial are expected in 2013.
AT&T's history with medical devices
AT&T may seem a nontraditional healthcare participant, but the company’s technology has long been incorporated into medical devices.
Metal detector (1881). Alexander Graham Bell invents a device to locate bullets lodged in Civil War survivors. Coils generate small currents of electricity, producing a signal when near a metal bullet. The detector was used in an unsuccessful attempt to locate the bullet lodged in President Garfield’s body. The metal coils in the spring mattress, an innovation of the day, interfered with the ability to find the bullet.
AT&T wireless heart monitor (1974). A miniaturized FM transmitter sends analog heart data to a nearby FM radio using early FCC unlicensed spectrum rules; the monitor’s “tunnel diode” device (used for the low-power oscillator) is now being revisited for exploration of Terahertz spectrum use.
CCD imaging technology (1970s). Developed originally as a new type of computer memory, the CCD (for charged-coupled device) incorporated light-sensitive silicon 100 times more sensitive than film or camera tubes. The technology was quickly incorporated into all camera types, including (in the 1990s) endoscopes and other medical cameras that could be used to look inside the body. The inventors of the CCD, Willard Boyle and George Smith of Bell Labs at Murray Hill, shared half a Nobel Prize for the invention.
Smart Slipper (2008). AT&T researchers embed pressure sensors, accelerometers, and a ZigBee radio into a slipper's cushioned insoles to continuously gather data about a patient’s gait and weight distribution. This data is transmitted over AT&T's network to physicians who can evaluate who is at risk of falling or to see early warning signs of Alzheimer’s or other health problems. The Smart Slipper, produced by the company 24Eight LLC (now ACM Systems), is now in clinical trials.
Actuarius Gateway (2009). Named for the honorific bestowed on physicians during the middle ages (after the physician Joannes Zacharias Actuarius), this medical gateway converts ZigBee-protocol data to IP for transmission to healthcare professionals. Invented at AT&T Research, Actuarius can use a fixed broadband connection or a ZigBee-enabled smartphone to collect and securely forward measurements from Personal Health Devices and the Continua Health Alliance. Working with the AT&T Network, VitalSpan a (cloud-based data system), and a Health Information Exchange such as AT&T’s Healthcare Community Online, the system can automatically retrieve health data from devices and make them available to medical professionals.
About the author
Bob Miller heads the Communications Technology Research Department at AT&T Labs - Research. His department develops new concepts and technologies for next-generation AT&T wired and wireless broadband packet access systems and services.
He holds a variety of patents covering wireless transmission, advanced speakerphones and acoustics, digital telephones, and advanced networking applications using IP technologies.