Wearable Devices in Healthcare

8.WearableDevicesinHealthcareConstantineGlarosandDimitriosI.FotiadisUnitofMedicalTehcnologyandIntelligentInformationSystems,Dept.ofComputerScience,UniversityofIoannina,GR45110,Ioannina,Greece8.1IntroductionTheminiaturizationofelectricalandelectronicequipmentiscertainlynotanewphenomenon,anditseffectshavelongbeenevidentinthehealthcaresector.Nev-ertheless,reducingthesizeofmedicaldevicesisonething,wearingthemisquiteanother.Thistransitionimposesanewsetofdesignrequirements,challengesandrestrictionsandhasfurtherimplicationsontheiruse,astheyareoftenintendedforoperationbynonmedicalprofessionalsinuncontrolledenvironments.Thepur-poseofthischapteristointroducetheuseofwearabledevicesinhealthcarealongwiththekeyenablingtechnologiesbehindtheirdesign,withemphasisoninforma-tiontechnologies.Furthermore,itaimstopresentthecurrentstateofdevelopmentalongwiththepotentialpublicbenefitsinbothtechnologicalandhealthcareterms.Thedevicesdescribedarethoseinvolvingsomedegreeofdigitalinformationhan-dling,thusexcludingconventionalwearabledevicessuchaseyeglasses,hearingaidsandprostheticdevicesfromthediscussion.Awearablemedicaldevicecanbedescribedasanautonomous,non-invasivesystemthatperformsaspecificmedicalfunctionsuchasmonitoringorsupport.Theterm“wearable”impliesthatthedeviceiseithersupporteddirectlyonthehumanbodyorapieceofclothing,andhasanappropriatedesignenablingitspro-longeduseasawearableaccessory.Inbroadterms,thisrequiresthedevicetohaveminimalsizeandweight,functionalandpowerautonomy,tobeeasytouseandwornincomfort.Atypicaldeviceisbuiltaroundacentralprocessingunitandwillnormallypro-videadegreeofphysiologicalmonitoring,datastorageandprocessing,whichmaybecombinedwiththeuseofmicroelectronics,anelectricalormechanicalfunction,involveadegreeofintelligenceandtelemedicinefunctions.Therefore,likeanycomputer,atypicaldevicewillhaveadatainputmechanism,aprocessingunitandanoutputmechanism.Theinputmechanismsdealwiththecollectionofclinicalandenvironmentalinformationthroughphysiologicalandothersensors,thedirectdatainputbytheusers,andpossiblyotherincominginformationthroughwirelessdatatransferfromaremoteserver.Theroleoftheprocessingunitistohandletheincominginformation,ofteninrealtime,inordertogeneratetheappropriatefeedback.Thisfeedbackiseitheraccesseddirectlybytheuserinvariousformsprovidingmonitoring,alerting,anddecisionsupportfunctions,orservesasacontrolmechanismforanothercomponentofthesystemprovidingsupportingfunctions.Outputmechanismscanthereforeinvolvecombinationsof
Springer-VerlagBerlinHeidelberg2005C.GlarosandD.I.Fotiadis:WearableDevicesinHealthcare,StudFuzz184,237–264(2005)238ConstantineGlarosandDimitriosI.Fotiadisaudio,visual,mechanicalandelectricalfunctionsofasupportingdevice,oratelemetricservicetoaremotemonitoringunit.Wearabledevicesareofemerginginterestduetotheirpotentialinfluenceincertainaspectsofmodernhealthcarepractices,mostnotablyindeliveringpointofcareservice,byprovidingremotemonitoring,ambulatorymonitoringwithinthehealthcareenvironment,andsupportforrehabilitatingpatients,thechronicallyillandthedisabled.Otherdevicesaredesignedassupportingtoolsfordoctorswithinthehealthcareenvironment,suchasformonitoringpatientsduringsurgeryorforkeepingelectronicpatientrecords.Anotherdistinctfeatureistheirusebyhealthyindividuals,eitherashealthmonitorsorfitnessassistants.Thegrowingdemandinsuchproductscanbeattributedtoasignificantextenttoanincreaseofthepublic’shealthawareness,andtheirincreasingfamiliarityinusingcomputer-basedprod-uctsonadailybasis.Apartfromprovidingusefultools,thetrendtowardsthewidespreaduseofpersonalhealthassistantsisalsoseenasahelpfulsteptowardsthetransitionofhealthcaremanagementintoamorepreventativemodelratherthanthereactive,episodicmodelusedtoday.Furthermore,wearablehealthcaredevicescanhelpinchangingthepublic’sattitudetowardspersonalhealthcareinthesensethatindividualsarebothaskedandenabledtoplayamoreactiveroleintheircare.Thisprovidesastrikingresemblancetothewaythatthewidespreaduseofwearable(wrist)watcheschangedpeople’sawarenessoftheconceptsoftimeandpunctualitynotsolongago.Theincorporationoftelemetriccapabilitiesintowearabledevicesisalsoinlinewiththenovelconceptofpervasivehealthcare,wherebywirelesstechnologiesallowcitizenstotransmitandaccesstheirhealthdata,transmitandreceiveinformationabouttheircurrenthealthconditionany-whereandanytime.Wearablehealthcaredeviceshavebeenaroundforquitesometime.Themostestablishedmedicaldeviceistheholtermonitor,usedtorecordthecardiacre-sponseofpatientsduringnormalactivities,usuallyforatimeperiodof24hours.Electrodesareplacedonthepatient’schestandareattachedtoasmall,wearable,batteryoperated,recordingmonitor.Patientsarerequiredtokeepadiaryoftheiractivities,whicharelaterassessedbytheirtherapistsalongwiththerecordings,bycorrelatinganyirregularheartactivitywiththepatient’sactivityatthetime.Thenextstagewastousewearablesforrealtimeapplications,wherephysiologicalmonitoringwassupplementedwithanalertingmechanism.Suchanapplicationisthesleepapneamonitor,whichprovidesalertswhensleeppatternsdeviatefromtheexpec