Electronics Helps Foster Decentralized Healthcare

To stem the tide of escalating healthcare costs, patients are becoming more self-sufficient thanks to the latest medical electronics advances.

Rising healthcare costs, a stretched-thin number of medical providers, longer life expectancies, and a growing number of elderly and disabled patients are transforming the face of medical care. Decentralization—moving healthcare away from medical facilities and into the patient’s home—is fast becoming the new model.

In 2008, Medicaid spending for long-term care cost $99.5 billion, according the U.S. Department of Health and Human Services. The steady trend of lower-cost ICs and electronic subsystems has helped significantly in this emerging crisis.

“There’s a fundamental shift in bringing medical care to the patient’s home, thanks to high-performance and low-power ICs that are enabling portable medical devices,” says Rajesh Verma, business development manager for microcontroller units (MCUs) for Texas Instruments. “Our MSP430 mixed-signal microprocessor platform of ultra-low-power 16-bit RISC processors provides the ultimate solution for a wide range of low-power and portable applications.”

One of the latest TI MCUs for medical applications, the MSP430FG47x, extends battery life (for portable battery-operated units) to 20 years or more. It offers on-chip integration of the complete signal chain for medical applications, with two configurable op amps, a 12-bit digital-to-analog converter (DAC), a comparator, a 16-bit analog-todigital converter (ADC), a 16-bit sigmadelta ADC, and a 128-segment LCD driver. Multiple memory options are available: up to 60 kbytes of flash memory and 2 kbytes of RAM for easy programmability.

SENSORS AND IMPLANTS Bio-chemical sensors, sensors within swallowable pills, lab-on-a-chip devices, and neural implants are paving the way for a new era in healthcare diagnostics, therapy, and maintenance. Just around the corner lie even tinier and more accurate sensing devices based on carbon-nanotube (CNT) technology.

For example, the medical staff at the United Kingdom’s Southampton General Hospital uses sensors placed on the stomach to measure the impact of exercise on glucose levels for Type 1 diabetics. Patients also wear a watch-like armband to monitor their activity. The sensor can take 300 readings a day, and it’s connected to a transmitter that’s attached to the skin with an adhesive patch.

Lab-on-a-chip devices look more promising for improving healthcare. Some commercial products are available, though more development is needed to lower their costs. Still, the Caliper Life Sciences Lab Chip GX and other products offer performance advantages that mitigate their higher initial costs.

The Lab Chip GX is an advanced nucleic acid separations system that dramatically reduces the time it takes to deliver test results. It allows detection of separations at high resolution in 30 to 80 seconds, compared with hours using conventional techniques that often yield lower-quality results.

Abbott Point of Care’s i-STAT handheld diagnostic tool provides real-time laboratory-quality results for patient point-of-care monitoring within minutes. “The i-STAT results got to the doctor an average of 45 minutes faster than the lab results, and that’s a lot of time when heart muscle is dying,” points out Christopher J. Lindsell of the University of Cincinnati, an investigator who took part in a study on the benefits of patient point-of-care monitoring using the i-STAT.

Deep-brain stimulation is opening up avenues for designers of medical implants that can be used to understand and treat brain disorders. IMEC has shown that semiconductor technology helps to produce multi-electrode prototype probes with 10-µm electrodes and various electrode topologies (Fig. 1).

ADVANCED COMPUTING AT THE CORE Digital signal processing (DSP) will play a crucial role in medical diagnostics. Powerful DSP engines are already proving their mettle in advanced medical imaging, allowing providers to better identify and pinpoint maladies and ailments. With even greater processing power, future DSPs will open up new windows on the diagnosis of impending diseases. Researchers at the Electrical and Computer Engineering Department at the University of Maryland are developing what they consider “a paradigm shift” in cancer diagnosis by using DSPs at the genomic/proteomic levels. Their ensemble dependence model allows for the accurate classification of a cancer type, as its site transitions from a normal stage to a cancerous stage. These researchers hope digital testing can supplement traditional biological testing as a reliable second opinion to improve the cancer- detection accuracy rate as well as reduce false alarms.

At the University of Michigan, researchers are using SiCortex high-productivity computing (HPC) systems to predict heart arrhythmias and prevent fibrillation, ultimately saving lives. “This important initiative demonstrates HPC’s far-reaching power to solve a wide array of problems, including those directly linked to medical conditions and treatments,” says Chris Stone, president and CEO of SiCortex.

The U.S. Food and Drug Administration (FDA) is tapping computer simulation technology to help identify potential issues with the safety and effectiveness of experimental medications before the start of drug late-stage clinical trials. For example, the Cardiovascular PhysioLab developed by Entelos uses a mathematical model to simulate the function of cholesterol in the body and the development of plaque on artery walls.

GROWTH IN MEDICAL IMAGING Medical imaging is a leading tool for diagnostics and treatment of a whole range of diseases and maladies. X-rays, ultrasound, computerized tomography (CT) scans, radionuclide imaging, and magnetic-resonance imaging (MRI) aren’t just improving in performance, they’re also being joined by many new techniques that promise to vastly boost their effectiveness. Enhanced CMOS/CCD (charge-coupled device) sensor cameras, more powerful DSPs, and sophisticated software algorithms are enabling more accurate diagnostics, treatments, and therapeutics.

InMedica, the medical research division of IMS Research, forecasts a greater than $22 billion market for medical imaging by 2012. It says that the strongest growing market segment will be hand-carried equipment, growing at a compound annual growth rate (CAGR) of 18.4% between 2007 and 2012.

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There’s no shortage of state-of-the-art imaging endeavors. Magnetic particle imaging (MPI) developed by Philips Research is one new approach for capturing real-time 3D images of arterial blood flow and volumetric heart motion.

According to the company, MPI improves diagnosis and therapy planning for major diseases like altherosclerosis and congenital heart defects. It measures the concentration of iron-oxide nanoparticles injected into a patient’s bloodstream, using sets of static magnetic-field coils for selection, oscillating field coils for the drive signal, and receive coils for measurement.

The selection field provides a single field-free point in space, while it is non-zero in all other spatial positions (Fig. 2). In the close proximity of the field-free floating point, the magnetic orientation of the nanoparticles aligns easily with an applied oscillating drive field. Meanwhile, at all other positions the magnetization is forced to align with the local selection-field direction.

FLARE (fluorescence-assistance resection and exploration) is another new method for medical imaging to illuminate cancer tumors, developed at the Beth Israel Deaconess Center in Boston. Consisting of a near-infrared (NIR) imager, a video monitor, and a computer, FLARE uses various NIR fluorophores that target cancer cells selectively when introduced into patients. Excited by appropriate LEDs, the contrast agents reveal the presence of cancer cells with high precision.

To make the cells visible to surgeons, the imaging system converts the NIR light into bright colors laid over standard images of the surgical field on a video monitor. A foot switch lets physicians control multiple viewing angles and different magnification levels.

Ultrasound imaging is receiving lots of attention. At the National Space Biomedical Research Institute, scientists are developing an ultrasound technology that will allow for the early prediction of bone disorders such as osteoporosis and a guided acceleration of fracture healing.

The objective of their scanning confocal acoustic navigation (SCAN) project is to come up with a mobile scanner that’s small, easy to use, and patient-friendly. SCAN employs noninvasive and non-destructive ultrasound for diagnosis and low-intensity pulsed ultrasound for treatment. It’s more advanced than comparable present diagnostic ultrasound scanners, since it can assess a higher number of parameters and image hard tissue such as bones.

Common, inexpensive electronic components can be used to make advanced ultrasound devices. Cornell University developed a prototype portable device that fits in the palm of the patient’s hand and can be built for about $100. The unit moves ultrasound imaging well past the diagnostic stage and into therapeutics for treatment of kidney stones and prostate tumors as well as relief from arthritic pressures. The battery-powered therapeutic unit can stabilize a gunshot wound or deliver drugs to brain cancer patients. It contains a ceramic probe transducer and creates waves so strong they instantly cause water to bubble, spray, and turn into steam.

Researchers at Duke University proved that 3D ultrasound can be quite helpful (see “3D Ultrasound Penetrates Skull To Identify Strokes And Save Lives”). They developed a helmet that could detect strokes earlier than previously possible by providing real-time images of major blood vessels for emergency medical personnel. The speed of the diagnosis and subsequent treatment can often mean the difference between life or death.

The prototype device positions ultrasound wands or transducers against the temples on either side of the head. The researchers estimate that a helmet scan can be completed in 15 to 30 minutes—far faster than a typical CT scan, which can take an average of four hours to be scheduled and performed.

Ultrasound imaging at the point of care is now possible using a smartphone as shown by researchers at the University of Washington, who developed ultrasound probes for displaying images on a handheld device. The probes couple their output into the USB port of phones that are compatible with Microsoft’s Windows platform, enabling users to view the image (Fig. 3).

Signostics has obtained FDA approval to market what it calls the world’s smallest ultrasound device. The company describes its pocketsized half-pound Signos as a visual stethoscope. Priced about $4000, Signostics hopes it will someday become as omnipresent as the signature doctor’s tool.

To make higher-quality imaging products, ultrasound equipment manufacturers are expanding the number of input channels, which in turn require higher-resolution analog-to-digital converters (ADCs) and higher frame rates for image processing. This has led to new signal-compression techniques like the patented Port Concentration and Prism technologies from Samplify Systems Inc. Incorporated into the company’s CMOS SAM1610/05/00 8/16-channel 65-Msample/s 12-bit low-power compressing/concentrating ADCs, the products are aimed at ultrasound, sonar, and other medical imaging applications.

“The trend in medical imaging is to use thousands of input channels, a phenomenally challenging task. It requires generically integrating on silicon high-speed DSP with highperformance analog functions while dissipating low power, instead of conventionally using fieldprogrammable gate arrays (FPGAs). Our experience in mixed-signal processing has enabled us to meet this challenge,” says Allan Evans, vice president of marketing for Samplify.

Smartphones and PDAs are becoming essential to healthcare. More physicians are turning to them in clinical care. According to Manhattan Research, 54% of U.S. physicians own a smartphone or a PDA, and more than half consider them to be an integral part of their practice. Physicians can use these devices to view and manipulate X-rays and ultrasound images, as well as access pharmaceutical libraries.

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“Companies are spending a lot of time on improving the user interface to medical devices, making for a more comfortable and intuitive experience,” says Mark Nadeski, global marketing director for TI’s medical imaging group. “They’re even embedding video processors into the medical devices to show patients how to use a device like, say, an ultrasound probe.”

Most recently, TI introduced an ultrasound development kit that enables medical device manufacturers to deliver clearer images, more accurate diagnosis, and cost-effective healthcare directly to patients. The embedded process software toolkit (STK) leverages the performance of TI’s C64x+ DSP platforms and speeds up a design’s time-to-market.

TERMINALS, CARD READERS PROLIFERATE Medical terminals and card readers are becoming more common in many healthcare facilities. Recently, California’s Kaiser Permanente Center tried out a portable computer, Intel’s Motion C5, to help nurses document patient medical indications and other assignments (Fig. 4). The Center is also testing out Intel’s Health Guide, designed to be connected to blood-pressure monitors, glucose meters, weight scales, and other medical equipment to transmit data to physicians regularly (Fig. 5).

Gemalto, based in the Netherlands, has launched the Sealys e-health terminal, specially designed for the German market (Fig. 6). The product was approved by Germatik, the German national health IT body that sets the stringent security requirements of the country’s e-healthcare system. It has all of the necessary features needed to operate in an online mode in connection with Germany’s “Telematik” infrastructure, due to be implemented next year.

The issue of medical data security is a key factor in the slow adoption of wide-scale medical-records exchanges between healthcare providers, patients, insurance companies, and other legitimate parties. Sending medical records over the airwaves and via the Internet somewhat limits how far smartphone and PDA usage can spread in the medical healthcare field. Privacy laws about medical data and storage must be established to ensure such data is safe and can’t be accessed by unauthorized people.

Progress is being made, though. Health record storage or “banking” continues to gain traction in many regional projects worldwide. In the U.S., three pilot projects were launched in Washington. There’s also a statewide bank in the formative stages in Oregon, and citywide projects are underway in Louisville, Ky., Kansas City, Kan., and Ocala, Fla.

Healthcare consumers in the U.S. now have expanded telephone access to more affordable, high-quality medical care as a result of a strategic relationship between telehealth company TeleDoc Medical Services and Healthagen, a developer of healthcare information software that launched its iTriage application for the iPhone.

Google has partnered with IBM to develop an online personal health record system. And, Lifespan Inc. offers medical information technology that it claims is a breakthrough in the integration of operating-system software and hardware to manage electronic medical data.

PATIENT ASSIST DEVICES ON THE RISE Patient-assist devices are becoming more widespread as electronic and mechanical technologies find applications in the medical field. This is particularly true for the rapidly growing elderly population and for the handicapped.

American Honda Motor Inc. recently demonstrated a prototype to support the elderly and those who suffer from weakened leg muscles but can still walk on their own. The Stride Management Assist is a lightweight wearable device that obtains information about the user’s walking motion from hipangle sensors (Fig. 7).

Based on this information, a CPU applies cooperative control and calculates the amount and timing of the assistance to be provided. As a result, the user’s stride is lengthened compared to a normal stride and the walking pace is regulated, making it easier to walk. The device was inspired by Honda’s advanced humanoid robot, ASIMO.

Ideal Life recently introduced the first Bluetooth-enabled chair scale for home use. The FDA-approved Body Manager Plus is designed for individuals who are too frail or obese to use conventional scales. The company also offers a line of FDA-approved products for assisting patients with chronic conditions such as hypertension, congestive heart failure, asthma, diabetes, and chronic obstructive pulmonary diseases.

Care Track International’s Mobile Locator wrist transmitter tracks and locates patients with Alzheimer’s disease, dementia, autism, and Down syndrome as well as elderly patients with disabilities who are likely to get lost. The SafetyNet from LoJack Corp. provides similar services. These products cost about $25 to $30 a month to use, and they can be provided free in cases of urgent need.