“Deep Monitoring” Chronic Disease in Underserved & Remote Populations
The “Deep Monitoring” Chronic Disease in Underserved & Remote Populations Project is a real-world effort exploring the challenges of deploying, using and assessing sensor technologies for monitoring chronic disease in millions of individual patients who are distributed over wide distances. The project’s initial results examining chronic adult diabetes are helping inform subsequent technology and implementation decisions, in a broader range of chronic diseases, and also leading to collaboration and partnerships with foundations, health systems and students globally.
Chronic diseases are the single most rapidly growing health care challenge in both the developing and developed world. The number of individuals with chronic diseases such as diabetes, kidney disease, pulmonary disease, heart disease and glaucoma, are increasing world wide — often at unprecedented rates. Monitoring chronic diseases is critical for optimizing individual treatment and sustaining long-term outcomes. In many areas, both within the U.S. and globally, direct patient contact with physicians or other professional caregivers is expensive and challenging. Travel costs for physicians and patients, together with limited time per patient for each interaction, reduce the ability of physicians to accurately modify treatment for each individual.
Measuring chronic disease status in millions of individual patients, distributed over wide distances and sampled with high frequency, is called “deep monitoring.” Deep monitoring requires: 1) the novel application of existing technologies, 2) the development of new sensor and communication technologies and 3) the analysis of large data streams for health assessment.
Chronic disease in the elderly presents the greatest technical and deployment challenge for deep monitoring. Chronic elderly conditions show extensive inter-individual and time-dependent variations. Disease conditions can persist for decades with periods of crisis and recovery.
Chronic disease in the elderly is also pervasive. Among U.S. residents over 80 years old, more than 50% of the population struggles daily with one or more serious chronic conditions. Although the most likely to be chronically ill, the elderly are the least likely to accept advanced technologies. Consequently, developing inexpensive and robust deep-monitoring strategies and technologies — that are accepted and used by the elderly population — will be essential for providing personalized disease monitoring and management where it is most needed.
This graph highlights the disconnect between “need for health care monitoring” and “the ability to afford and use new health care monitoring technologies.” Most technologies today are targeted and optimized for younger users that are technologically savvy and have disposable income. In contrast, the population demographics that need to be monitored the most are the elderly and economically disadvantaged.
During Phase 1, the “Deep Monitoring” Chronic Disease in Underserved & Remote Populations Project developed and tested sensor technologies that have both low capital costs and low recurring costs to measure, record and transmit clinically valuable physiological information from patients to their physicians, at a distance. The initial technologies were used to monitor three major health challenges of adult diabetics: 1) diabetic eye disease and blindness, 2) nerve disease leading to lower-extremity amputation and 3) end-stage kidney disease.
The four technologies consisted of:
1) A ~$5 wireless temperature sensor and smartphone application for monitoring diabetic inflammation in the foot was designed, built, tested and deployed. The device has moved from concept to patient testing at the U-M Diabetes Clinic. The system is compatible with high-volume/low-cost manufacture model and can be implemented in low resource settings.
A low cost, wireless temperature sensor being used at the U-M Diabetes Clinic to measure diabetic foot inflammation temperatures.
2) A low-cost wireless sound sensor for use as a stethoscope and as a breath sound
monitor has been designed, built and tested. The device is compatible with the wireless temperature sensor, allowing for economies of scale in manufacturing (<$10). The device is currently being tested in an approved clinical laboratory setting at the U-M Health System.
3) A first-generation urine chemistry sensor for analysis of kidney function has been designed and built. The ~$40 device is currently being tested and optimized for performance.
4) Eye-imaging systems in clinical environments in rural Jamaica and at the U-M Kellogg Eye Center have been assessed. Based on these results, a novel machine-vision system for high-resolution 3D eye imaging and measurement has been designed.
During Phase 2 of this project, these four novel technologies will be developed, tested and deployed to local U-M clinical sites, the clinical results will be analyzed and the technologies will be refined for robustness and reduction in manufacturing cost. The final technologies will then be deployed in low-resource locations in Michigan, rural Jamaica and Ghana
Potential Transformative Impact
The Deep Monitoring Project intends to build a foundation in Phase 2 that will engage and motivate students, staff, and faculty – and strengthen the University of Michigan – beyond its proposed 4-year timeframe. It includes a balance of academic research novelty and real-world implementation into the U-M Health System and the developing world.
The Deep Monitoring Project was designed to quickly and effectively establish new health assessment technologies for elderly chronic disease patients. The use of a consistent implementation and testing strategy, a defined target population and existing University of Michigan expertise in clinical research, basic science and engineering allows each of the four technologies to benefit from prior experiences. This project recognizes the wider domains of healthcare that can impact any technology, including cultural contexts, healthcare costs, business demands, patient perceptions and legal issues. We understand and value the power of the University of Michigan to bring together faculty, health care workers and students knowledgeable in these areas from across the campus. We are in contact with colleagues from the Center for Healthcare Outcomes and Policy, Institute of Social Research, School of Public Health, UMHS clinics, School of Nursing, School of Social Work, Law School and Business School and plan to reach out to this community as the project advances.
Although other research groups, nationally and commercially, are exploring sensor and communication systems for health monitoring, this project’s focus on inexpensive technology specifically designed for the elderly is unique and powerful. The investigators envision that inexpensive monitoring will fundamentally change the effectiveness of chronic disease medical care globally and locally. Its most significant impact will be on remote and underserved populations with limited financial resources. However, as these technologies progress, individualized health monitoring of all patients will be based on quantitative knowledge of changes in individual physiology, tracked densely over time at a low cost.
David Burke, Medical School
Mark Burns, College of Engineering
Crystal Holmes, Medical School
David Lorch, Medical School
Joseph Myers, Medical School
Paula Anne Newman-Casey, Medical School
Kallie Sternburgh, Taubman College of Arch. & Urban Planning
Geoff Thün, Taubman College of Arch. & Urban Planning
Kathy Velikov, Taubman College of Arch. & Urban Planning
Maria Woodward, Medical School