Abstract:
A home-based remote care solution provides sensors including a basic health monitor (BHM) that is a measurement and feedback system. The BHM operates with low power integrated communications combined with an in-home, low power mesh network or programmable digital assistant (PDA) with cell phone technology. A cognitive system allows remote monitoring of the location and the basic health of an individual. The BHM measures oxygen saturation (SaO2), temperature of the ear canal, and motion, including detection of a fall and location within a facility. Optionally, the BHM measures CO2, respiration, EKG, EEG, and blood glucose. No intervention is required to determine the status of the individual and to convey this information to care providers. The cognitive system provides feedback and assistance to the individual while learning standard behavior patterns. An integrated audio speaker and microphone enable the BHM to deliver audio alerts, current measurements, and voice prompts. A remote care provider can deliver reminders via the BHM. The device may be worn overnight to allow monitoring and intervention. Through the ability to inquire, the cognitive system is able to qualify events such as loss of unconsciousness or falls. Simple voice commands activate the device to report its measurements and to give alerts to care providers. Alerts from care providers can be in a familiar voice to assist with compliance to medication regimens and disease management instructions. Simple switches allow volume control and manual activation. The device communicates with a series of low-power gateways to an in-home cognitive server and point-of-care (POC) appliance (computer). Alone the BHM provides basic feedback and monitoring with limited cognitive capabilities such as low oxygen or fall detection. While connected to the cognitive server, full cognitive capabilities are attained. Full alerting capability requires the cognitive server to be connected through an Internet gateway to the remote care provider.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/766,963, filed Feb. 22, 2006, copending. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    2. Field of the Invention 
         [0003]    The invention generally relates to surgery as applied to diagnostic testing and to computer assisted medical diagnostics. More specifically, the invention relates to monitoring a plurality of physiological data. An aspect of the invention relates to cardiovascular testing and to testing and detecting diverse body conditions. Another aspect of the invention relates to telemetry, such as telemetry by radio, telephone, or computer network. 
         [0004]    2. Description of Prior Art 
         [0005]    A large segment of elderly and disabled persons who would otherwise require institutional medical care are able to live independently as long as monitoring of their condition and assistance with their needs are provided. Given a trend toward greater independence and convenience of in-home healthcare, this is becoming increasingly important. Providing remote home-based care for high-risk patients typically cared for in hospitals can drive down costs and risks associated with transportation to and from points of care. This has also been shown to improve healthcare access for disabled persons, connect socially isolated individuals to their care providers, and enhance caregiver effectiveness. 
         [0006]    Home-based care as described here is not telemedicine, which has yet to fulfill the promise of remote care and appropriate intervention for disease management. European countries seem to be more advanced with the evaluation of fully integrated systems but they still have not achieved a fully deployable system. As reported by Audrey Kinsella, MA, MS Research Director of Information for Tomorrow “The idea of home telehealthcare needs a serious makeover. Even today, home telemedicine or telehealthcare is associated with high-tech, expensive devices and overall inaccessibility for the average home care nurse. We need to get past these perceptions and misunderstandings.” 
         [0007]    The term, “home telehealthcare,” is defined as clinician-driven healthcare and education services that are delivered to the home via telecommunications to patients who have already been diagnosed in a standard medical setting. As used herein, the definition further includes other informal caregivers who are interested in monitoring and maintaining the health and welfare of an interested party. The definition also includes forms of communication other than the telephone. 
         [0008]    The term, “remote healthcare,” is defined to include this extended form of telehealthcare or home-based care. Remote healthcare is an urgently needed method of caring for individuals who can experience a higher degree of self-care independence when effective monitoring and control is provided. Much of the elderly population and the disabled population fit this description. Persons undergoing transitional care for a treated condition fit this category as well. All such persons will benefit from remote healthcare. 
         [0009]    The traditional approach to caring for such individuals relies upon either relatives or care centers such as rehabilitation facilities and nursing homes. This approach is coming under ever increasing pressure due to the fact that relatives are working, thereby diminishing the time available for personal attention to care giving. Also, living in care centers is very expensive. To the extent that remote healthcare can provide an adequate level of in-home monitoring of basic health status, a more cost-effective alternative will have been created for a notable segment of this population without compromising the quality of their care. In addition, staying at home as long as possible is preferred by patients and is generally better for their welfare and spirit. 
         [0010]    Communication technologies, from well-known POTS (plain old telephone system) to the Internet, have been used for many years to monitor, diagnose and treat persons remotely. Transmission of information, such as pictures, measurements of blood pressure etc. for diagnosis and treatment is the goal. Medical literature widely reports efforts to provide medical care, remotely. Wireless technologies are starting to be employed in telemedicine as well. However, Audrey Kinsella has identified the need for specialized high-technology knowledge (e.g., rewiring households for advanced telecommunications capabilities, installing sophisticated health care workstations, and requiring a suite of engineers to wait on the doorstep, ready to assist) as impediments to the adoption of telemedicine. 
         [0011]    Current wireless technologies employing standards known as 802.11b,g and Bluetooth, used in a low power set of sensors, have significant problems. While 802.11 is successful in the home environment, it is not feasible for low power sensors due to large power consumption and is subject to coverage lapses which can only be found through use. Bluetooth has very limited range and also uses too much power to maintain a connection. The breakthrough in wireless technology known as the ZigBee standard allows devices to route low data rate information through multiple paths to ensure delivery of messages. 
         [0012]    It would be desirable to provide an improved method and apparatus for delivering remote healthcare. An improved system of care giving may be based on high technology, but must be easy to use for people without basic computer and electronic experience. A desirable system might not provide every data point to the care provider, but will forward at least events or combinations of events that represent a problem. The underlying technology may be completely hidden from the patient or user. 
         [0013]    Desirably, such a system may be enabled by recent developments in computer and telecommunications technology. Most notably, these are: a) affordable computer systems with touch screens and voice response, b) Internet, wireless communications standards of Bluetooth and ZigBee, c) low power electronics providing for long battery life, d) reliable low power GPS sensors and Zigbee triangulation technology, and e) cognitive, learning software systems. 
         [0014]    To achieve the foregoing and other objects and in accordance with the purpose of the present invention, as embodied and broadly described herein, the method and apparatus of this invention may comprise the following. 
       BRIEF SUMMARY OF THE INVENTION: 
       [0015]    Against the described background, it is therefore a general object of the invention to provide a method and apparatus that are capable of enhancing the quality of life for individuals whose mobility or self-care capabilities have been limited due to age or disease. Such an individual may be referred to as the user or patient. More specifically, an object of the invention is to enable such individuals to live in their own homes while receiving monitoring and care. An in-home care provider to monitor and assist in basic health needs may not be available. Many of these individuals are impaired mentally or are on some form of therapy such as oxygen or medication. In this case they are at risk of failure to comply with prescribed therapy, thereby potentially leading to a traumatic event such as falling, loss of oxygen, or loss of consciousness. 
         [0016]    Children and other relatives have increasing concerns for the welfare of parents or other family members with limited self-care capabilities. These concerns are becoming manifested in a desire to directly monitor those family member patients and to more actively participate in giving care. These trends create a demand for a new and innovative solution to caring. 
         [0017]    A home-based remote care solution must have the following characteristics: (1) Requires little or no understanding of the operation by the individual of the monitoring devices and system. (2) Monitors key physiological parameters relevant to the disease or disability. These parameters include activity level, falls, and key measurements such as SpO2 and consciousness. (3) Provides a determination of patient location, whether in-facility or in-home. (4) Provides cognitive understanding of situations and treatments, based on input from multiple sensors of physiological parameters coupled with interactive coaching of behavior. Inferences must be made utilizing more than one sensor. (5) Provides natural interactions employing speech and provides simple interactions with a point-of-care (POC) appliance and a wearable monitor. (6) Provides full time monitoring capability, both when the patient is in-home and when traveling. (7) Provides a link to a care provider and emergency services. 
         [0018]    The invention employs recent technological advances in low power measurements and plug-and-play wireless communications components to create a miniature measurement and feedback system that also provides location determination. Such a device may be called a basic health monitor (the BHM) or the “remote companion” that can accompany a patient throughout his day. Embodiments of the BHM include an earpiece, a pendant, a wrist-mounted BHM, a clip-on BHM for a belt, or pocket-carried BHM. The BHM has low power integrated communications with an in-home low power mesh network, a programmable digital assistant (PDA) with cell phone technology, and a cognitive system. These components allow location determination and remote monitoring of the basic health of an individual. 
         [0019]    In the preferred embodiment the BHM will be worn around the ear in the same manner as a conventional hearing aid or the recently introduced Bluetooth wireless headsets or earpieces. The BHM will be able to measure oxygen saturation (SaO2), temperature of the ear canal, and motion, including detection of a fall. A key feature is that no intervention will be required to determine the status of the individual and to convey this information to care providers. A cognitive system provides feedback and assistance to the individual while learning standard behavior patterns. 
         [0020]    With an integrated audio speaker and microphone, the BHM is able to deliver audio alerts, current measurements, voice prompts, and reminders provided by a remote care provider. The device may be worn overnight to allow monitoring and intervention both day and night. Through the ability to inquire, the cognitive system is able to qualify events such as loss of consciousness or a fall. Anticipated improvements will allow other measurements to be made such as CO 2 , respiration, EKG, EEG and blood glucose. 
         [0021]    Simple voice commands can activate the BHM to report its measurements and to give alerts to care providers. Alerts from care providers can be given in a familiar voice to assist the patient with compliance to medication regimens and disease management instructions. Simple switches will allow volume control and manual activation. 
         [0022]    The BHM communicates through a series of low-power gateways to an in-home cognitive server and to a point-of-care appliance (the POC), which can be a computer. Acting alone, the BHM provides basic feedback and monitoring with limited cognitive capabilities, such as detecting low oxygen or a fall. While connected to the cognitive server or POC, the BHM attains full cognitive capabilities. Full alerting capability requires the cognitive server to be connected through an Internet gateway to the remote care provider. Using specialized technology within a wireless transceiver of the BHM, the relative position of the BHM within a home or facility may be determined by signal strength triangulation to the gateways. 
         [0023]    A key characteristic is the appropriate distribution of intelligence to the BHM through to the cognitive server. BHMs have limited ability to make decisions but in some cases may make decisions on their own, particularly if they are somehow not in communication with the cognitive server. Some decisions may require more information than is available from a single device in order to make decisions. The BHM contains enough sensors within a single unit that some basic decisions such as fall detection may be made standalone. Learning and trend detection require the full cognitive system to make decisions and feedback new detection parameters. 
         [0024]    The cognitive system provides high-level qualitative information and quantitative data to the caregiver. The cognitive system compresses data at the remote, in-home location into certain quantitative and qualitative states of health. Because of possible measurement errors and other uncertainties, the architecture of the cognitive system requires communication of health states and outputs as probability distributions. The cognitive system provides two levels of natural interaction with the patient: first, through a primary BHM by speech output and input; and second, through the POC in the home or care facility, by both touch screen and speech interaction. 
         [0025]    The cognitive system also contains sensors for non-health parameters that are necessary to the overall safety of the individual patient. These sensors are modular in nature and can be placed according to individually determined need. The sensors can measure multiple parameters such as ambient temperature, surface temperature (as of a cook top), motion, sounds, and infrared signals. The sensors contain a speaker for delivering audio alerts, an LCD display for displaying measurements, and appropriate buttons for interaction. These sensors communicate through a ZigBee wireless connection. 
         [0026]    The sensors may be utilized in stand alone capacity, in a network, or in conjunction with a base module in which a sensor module may be docked. Stand alone, a sensor module may interact in different modes, such as wirelessly interacting with another sensor module or with a network controller of a system. A network controller is a special case of a sensor module docked in a 10Base-T base module. 
         [0027]    By docking a sensor module into a 10Base-T base module, the sensor becomes part of a wired network of sensors to be consolidated into a set of remote objects. 
         [0028]    The POC has integrated communication capabilities along with the cognitive engine. The POC interacts with the user for scheduling activities, medication, and communications with the care provider through integrated phone, voice messaging, email, music, and graphics such as pictures and videos. 
         [0029]    The accompanying drawings, which are incorporated in and form a part of the specification, illustrate preferred embodiments of the present invention, and together with the description, serve to explain the principles of the invention. In the drawings: 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0030]      FIG. 1  is an isometric front right side view of a basic health monitor (BHM), showing representative locations of subcomponents. 
           [0031]      FIG. 2  is a view similar to  FIG. 1 , showing a BHM from the left rear. 
           [0032]      FIG. 3  is a schematic view of an overall remote healthcare system, showing a BHM and modular sensors associated with the patient and an in-home setting. 
           [0033]      FIG. 4  is a functional block diagram of the internal components of a BHM, sensor, or similar modular device, showing functional interactions. 
           [0034]      FIG. 5  is a schematic communications level diagram showing software components and a communications path from a BHM through a gateway to a cognitive server. 
           [0035]      FIG. 6  is a schematic block diagram of the cognitive operation software components of the BHM and cognitive system. 
           [0036]      FIG. 7  is an isometric view of a modular sensor device, taken from bottom front. 
           [0037]      FIG. 8  is an exploded view of the sensor of  FIG. 7 , showing suggested component locations. 
           [0038]      FIG. 9  is a view similar to  FIG. 8 , taken from top rear. 
           [0039]      FIG. 10  is an isometric view taken from front right, showing a sensor attached to a base module. 
           [0040]      FIG. 11  is an isometric view of an alternate embodiment of a BHM, taken from the front lower left side, showing a pendant or belt clip mounted BHM. 
           [0041]      FIG. 12  is a view similar to  FIG. 11 , taken from upper right rear of the alternate embodiment of the BHM. 
           [0042]      FIG. 13  is a plan view of a remote healthcare system installed in a home, schematically showing the patient and a method of determining location. 
           [0043]      FIG. 14  is a front isometric view of the POC, showing interface components. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0044]    The invention relates to a remote healthcare delivery system that includes a basic health monitor (hereinafter “BHM”). The delivery system further includes a network of sensor modules that enables home-based care of independently living elderly and disabled persons, who will sometimes be called the “patient” or “user.” The BHM and sensor modules are similar to one another, with the BHM being primarily adapted to be worn by the patient while the sensor modules are primarily adapted to be distributed in the patient&#39;s home or care facility. 
         [0045]    The invention contemplates that a natural network surrounds a person or patient. Such a network may include both professional caregivers and other support individuals who might provide care on an informal basis. The informal caregivers are relatives, friends, co-workers, and/or neighbors. The professional caregivers are the individual&#39;s network of doctors, nurses, emergency medical technicians, etc. 
         [0046]    Another portion of the invention for delivering remote healthcare is a cognitive system to evaluate health parameters and trends. Prior telehealthcare systems have not included this ability. A cognitive system can reduce the demands that the delivery of raw data otherwise places upon the informal care givers, thereby avoiding a portion of false alarms. A cognitive system can work together with all sensors within the remote healthcare system, especially with the BHM sensor. The BHM measures basic health function such as pulse rate, temperature, oxygen saturation, movement, acceleration, and location. The BHM also contains a speaker and microphone for speech interaction. The patient wears the BHM at all times. Through the speaker and microphone built into the BHM, the cognitive system is able to give prompts to the patient and can receive answers from the patient. This ability is crucial for implementing the cognitive, learning software included in this remote healthcare system and for enabling the prompting features of the system. 
         [0047]    A remote healthcare delivery system must fulfill three needs: a) safety, b) security, and c) social needs. Safety issues to be monitored include basic health assessments such as oxygen saturation, blood pressure, appropriate movement, and so on. Security is defined by the status of doors open/closed, appliances on/off, temperature in the house and so on. The importance of social interaction for the physical as well as emotional well being of the patients is becoming increasingly evident. Appointments for social and recreational activities and integrated communications form the basis of fulfilling these social needs. Information about safety, security, and social needs must be current, accurate and readily available both to the patient and to the person(s) involved in assisting him. 
         [0048]    A network of sensors, including the BHM, is located throughout the patient&#39;s dwelling. The sensors track and monitor the patient&#39;s health status and activities. The sensors provide input for proactive applications that will offer a variety of assistance, ranging from reminders to take medications to accessing social support. The patient will access this network through a point-of-care appliance, hereinafter called “POC,” by using a variety of familiar interfaces, such as integrated calendar, telephone, and simplified email that utilize appropriate assistive technology. The patient will not need to learn new technology to receive assistance. These proactive systems enable relatives to assess the health and well-being of the patient remotely through private, secure Internet connections and will provide social support to on-site caregivers. Such social support to caregivers is necessary to avoid burnout, which is a common problem among caregivers. 
         [0049]    The remote healthcare delivery system is distributed, which in certain circumstances might risk a full or partial loss of communications. In order to ensure that the system is robust, the cognitive intelligence also is distributed, especially to the BHM. A fusion of the data from the network sensors enables a feedback of the patient&#39;s health state. This fusion enables an adaptive intelligent assistance to the patient even when there is a communication failure. 
         [0050]    The remote healthcare delivery system employs a mesh network, which enables a new approach to care for the patient. To date, most wireless systems have employed cellular-phone-type radio links implementing point-to-point or point-to-multipoint transmissions. These prior networks are difficult to install, configure and maintain. Also, they are highly vulnerable to failure, thereby leading to dropped signals. In contrast, wireless mesh networks are multi-hop systems, where the components assist each other in transmitting signals. Signals may take several hops through different components to reach their intended destination. Mesh networks are especially well suited to adverse conditions and are easy to install, self-configuring, and self-learning. Devices can be added to a mesh network without technical knowledge and by following simple installation instructions. This makes them particularly useful for the type of care, specific application, and targeted users as identified herein. 
         [0051]    In the following detailed description, one communication path may be described for use by any particular component. Such descriptions should be understood to be representative. Many of the measurement components may follow similar communication paths. Therefore, all disclosed communication paths are applicable to each component and for communicating each measurement. In the following description, the numbers from 1-99 are elements primarily shown in  FIGS. 1-2 , numbers of the  300 ,  400 ,  500 , and  600  series refer to elements primarily shown in  FIGS. 3 ,  4 ,  5 , and  6 , respectively. Numbers of the  700  series refer to elements primarily shown in  FIGS. 7-10 . Numbers of the  800  series refer to elements primarily shown in  FIGS. 11-12  and numbers in series  900  refer to elements primarily shown in  FIGS. 13 and 14 . 
         [0052]      FIGS. 1 and 2  show a basic health monitor (BHM)  303  of a form factor suited to be wearable. As suggested in these figures, a preferred configuration of the BHM  303  is as an earpiece. A BHM  303  contains subcomponents that enable various functions. Other configurations of the BHM perform similar functions and contain similar subcomponents. In a BHM of the form factor in  FIGS. 1 and 2 , many of the subcomponents are internal. Thus, various subcomponents are identified as representative locations on the earpiece  303 . The subcomponents are microphone  1 , earphone and temperature sensor  2 , dual light emitting diodes (LEDs)  3 , optical sensor  4 , accelerometer  5 , microprocessor  6 , and antenna  7 , all as shown in  FIG. 1 .  FIG. 2  shows additional components including volume controls  10 , indicator LED  11 , ZigBee radio transceiver  12 , and on/off button  13 . The LEDs  3  and optical sensor  4  are spaced apart, and the configuration of the earpiece  303  is suitable for the user&#39;s earlobe to be located between the LED&#39;s  3  and optical sensor  4  to enable measurements more fully described below. 
         [0053]    The wearable BHM  303  and other system elements in the home are shown schematically in  FIG. 3 . A boxed portion  315  of the figure represents the home or care center and shows which components are found within the home  315  or care center. Within the home  315 , a smaller boxed portion  302  represents the patient and shows devices such as the BHM  303  that the patient  302  carries or wears. Of course, the patient  302  is mobile and may leave the home, taking such devices  303  with him. This figure also shows multiple communication paths represented as ellipses. These are a Zigbee wireless path  320 , a wired or wireless 801.11 path  330 , and an Internet path  340 , which may be by wired line  341  or a wireless cellular network  344 . Lines connecting each device in the figure represent a communication path, with lines to an ellipse representing a connection to the respective network. 
         [0054]    One or more point-of-care (POC) appliances or computer terminals  301  are located in the patient&#39;s home for the patient&#39;s use. A POC  301  has full touch screen and voice interactive capabilities and communicates through a local network  330  with a cognitive server  312 . 
         [0055]    A router gateway module  300  has a USB link to the cognitive server  312 . The router gateway module  300  provides a communication bridge from the wireless Zigbee network  320  to the network  330  through the cognitive server  312 . This bridge allows communications with the patient  302  via the wearable basic health monitor  303  through a Zigbee connection. Additional wireless Zigbee modular sensors  304  are deployed at other locations in the house. As a specific example, the additional sensors  304  may include a modular surface temperature sensor  305  that is located to monitor a cooking surface or range  306 . The router gateway module  300  and sensor modules  304  are similar. 
         [0056]    The remote healthcare delivery system includes components operative outside the home  315 . When the patient  302  is outside of the home, the accompanying BHM  303  communicates through Zigbee network  320  to the optional programmable digital assistant (PDA)  313 , which the patient  302  carries with him. The PDA  313  communicates with the cognitive server, either through the link  341  or through a cellular connection to the Internet, in turn linking by connection  342  to the cognitive server  312 . The cognitive server  312  communicates through the Internet  340  to one or more desktop remote computers or patient monitors  308  located at a remote caregiver site. The remote healthcare system may include a remote PDA or remote patient monitor  307  connected through the Internet by cellular network link  344 . 
         [0057]    The general interactions and structure of BHM  303  and the similar or parallel portions of sensor module  304  and the like are shown in  FIG. 4 . A miniature accelerometer sensor  401  communicates with accelerometer signal conditioning circuitry  407 . A dual light emitting diode oxygen saturation (SpO2) sensor  402  communicates with a SpO2 signal conditioning circuitry  408 . A microphone  403  and speaker  404  communicate with speaker/earphone conditioning circuitry  409 . A preferred component to serve as or to substitute for conditioning circuitry  409  is a Sensory Inc. voice processor  409  (Sensory, Inc., 575 N. Pastoria Ave., Sunnyvale, Calif.). Temperature sensor  405  communicates with temperature and signal conditioning circuitry  41   0 . Buttons  406 , such as volume on/off buttons, control power or functionality to an integrated microprocessor  420 . The microprocessor  420  communicates with a wireless ZigBee radio transceiver  430 , which operates through an appropriate antenna  435 . The transceiver  430  contains a location engine, described below. LED indicators  431  and an LCD display  432  that is optional on some form factors of the BHM provide indications of selected modes and operations. A battery  441  provides power via appropriate power circuitry  440 . 
         [0058]      FIG. 5  shows software and communications function of a BHM  523  or similar sensor, through functions of a Zigbee gateway module  525 , interacting with functions of a cognitive server  312  through a ZigBee gateway. The BHM  523  includes a microprocessor that executes a main operating program  504  from firmware. The main operating program  504  causes periodic measurements to be taken at preselected times or intervals, without requiring external polling from the cognitive server. The preferred microprocessor is a Chipcon (trademark of Chipcon AS, Gaustadelléen 21, No-0349, Olso, Norway). A measurements software subroutine  501  provides measurement signal conditioning. A power control subroutine  503  controls power and switches. 
         [0059]    An audio input and output subroutine  502  executes on a separate Sensory Inc. (575 N. Pastoria Ave., Sunnyvale, Calif.) speech recognition microprocessor and provides audio signal conditioning, speech recognition, and output. The Sensory, Inc. voice processor  502  is linked via a serial digital interface to the Chipcon microprocessor  504 . 
         [0060]    A Baysian Object server  505  provides standard interfaces to the remote system, which includes the remote patent monitors  307 ,  308  and POC  301 . The Baysian Object server  505  includes a ZigBee and 801.15.4 communications stack  506 . A Chipcon (trademark of Chipcon AS, Gaustadelléen 21, No-0349, Olso, Norway) wireless transceiver  507  in the Baysian Object server intercommunicates by an appropriate subroutine with another Chipcon wireless transceiver  510  in a ZigBee gateway  525 . 
         [0061]    The ZigBee gateway  525  includes a ZigBee and 801.15.4 communications stack  511 , a microprocessor  512  operating a main program for the gateway, and a USB interface  513  providing interface to a PDA or desktop computer such as the cognitive server  527 . The USB interface  513  preferably provides intercommunication with a desktop computer  527  with an EmWare (trademark of EmWare, Inc., 6322 S. 3000 E, Ste 250, Salt Lake City, Utah 84121) distributed object controller or equivalent, which includes a USB host controller  520  that provides an interface to the subroutine in the desktop or PDA. In addition, the PC server or cognitive server  527  includes a Baysian object access server  521  that carries out Baysian object interface subroutines to the cognitive server  522 . 
         [0062]    Cognitive operation software components of the various devices and system are shown in  FIG. 6 . An upper block  630  is the BHM software block diagram. A lower block  632  is the PC software block diagram showing the cognitive server. BHM software routines include SpO2 measurement subroutine  601 , a motion measurement subroutine  602 , a body position measurement subroutine  603 , and a temperature measurement subroutine  604 . The subroutines communicate through Baysian filters  605 , consisting of statistical filter subroutines, with a level one multi-parameter inference engine  606  within the BHM. A probability object server  607  carries out Baysian probability distributions object server subroutines and communicates through a wireless link  608  carrying out wireless communications subroutines inclusive of the ZigBee software stack  506  and the Chipcon wireless ZigBee transceiver  507 . 
         [0063]    The ZigBee gateway is a wireless link from BHM or similar sensor module to the server  527 , inclusive of elements  510 - 513 , and intercommunicates with the wireless link  608  of the BHM. Included software components are remote interface link subroutines  620  such as Sharepoint (trademark of Microsoft Corporation, One Microsoft Way, Redmond, Wash. 98052) services, a level two multi-parameter inference engine outside device  621 , speech input processing subroutines  622 , speech output processing subroutines  624 , Basian Object interface subroutines  625 , a database  626  for storing inference expertise and learning, and a Basian Object server link  627 . 
         [0064]      FIG. 7  shows details of a modular device  304  used as gateways to the BHM device or as part of the location triangulation feature. Such a device is battery powered and is equipped with a battery compartment within battery cover  701 . A liquid crystal diode (LCD) display  702  provides selected readout. A photo sensor  703  provides useful determination of day or night conditions or the state of a lamp or light. Function keys  704  provide input and selection of functions. Indicator LEDs  705  confirm settings and operation. A microphone port  706  and speaker port  707  enable input and output of audible communications. 
         [0065]      FIGS. 8 and 9  show component locations of a modular device  304 . Front cover  715  and back cover  716  contain a main printed circuit board (PCB)  717  that carries input buttons  718 , accelerometer  719 , microphone  720 , and speaker  721 . The PCB  717  also carries batteries  722 . As best shown in  FIG. 9 , the PCB carries a microprocessor  730 , a radio transceiver  732 , an on board antenna  733 , and a connector to LCD display  731 . The PCB may carry a daughterboard  734  with interface connector  735 . Back cover  716  carries a base connector  736 . 
         [0066]      FIG. 10  shows the modular device  750  attached to a wall-mount base  751  having buttons  752  which operate device functions and provide the same functions as buttons  704 . 
         [0067]    In greater detail, wearable BHM  303  fits on the ear of an individual patient  302 . The BHM device measures oxygen saturation SpO2 and cardiac pulse through the dual led  3  and optical sensor  4  across the patient&#39;s ear lobe membrane. The BHM is reversible so that it can operate on either ear. The measurements are made periodically under timing control of the microprocessor  6 , which has been given instructions from the cognitive server  312 . The period of measurement is optimized for low power consumption and necessary physiological needs by cognitive server  312 . 
         [0068]    The BHM measures inner ear temperature through a sensor within earpiece  2 . Also within the earpiece  2  is an earphone for delivering speech and audible alerts from microprocessor  606 ,  FIG. 6 , through the speech microprocessor  409 ,  FIG. 4 , which incorporates firmware  502 ,  FIG. 5 , implementing a speech playback system  612 ,  FIG. 6 , through output amplifier  610  through the combined speaker and earphone  404 ,  FIG. 4 . Speech input is recognized and communicated through the microphone  1 ,  403 ,  806  ( FIG. 11 ) to a speech input amplifier  609  and a Baysian speech filter  611  serving as a speech input decoding system that operates within the speech microprocessor  409  with firmware  502  and through to the cognitive server  312 . 
         [0069]    The cognitive system is partially contained in the BHM and partially in remote server  312 . Sufficient capability to deliver emergency commands to the patient in the event of disconnection from the cognitive server  312  is contained with the BHM utilizing the Sensory, Inc. speech microprocessor  502 . The speech input is normally forwarded to the cognitive server  312  for full voice recognition. The level one cognitive server may recognize a few key words through the BHM&#39;s Baysian speech filter  605  for requesting simple information such as current SpO2 readings. 
         [0070]    A miniature three-axis accelerometer  5  is contained within the BHM to measure the position of the patient&#39;s head, motion from normal activities, and motion from extraordinary events such as a fall. Input from this sensor is processed by accelerometer circuitry  407  to the microprocessor  6 . Subsequently the input is processed to the cognitive system through a two-way wireless ZigBee communications path that includes the transceiver  12 ,  430 , antenna  7 , 435 , and the gateway router  300  to a mirror image transceiver  623  in the gateway. Firmware in the BHM will quantify the three-axis orientation of the individual and the relative motions of the head. These motions and position will feed into a Baysian filter  605  to determine a first level inference as to activity level and fall detection. This inference may be used on the BHM, if it is not connected to the cognitive server, to deliver emergency alerts to the individual. When connected to the cognitive server through the wireless communication path, the information about position and activity is forwarded to the cognitive server&#39;s inference engine  621  for a more complete determination of the importance of the current values of these measurements. 
         [0071]    Similarly, the temperature measurement and oxygen saturation (SpO2) of the individual are processed through the system. 
         [0072]    The cognitive server  632  has full multi-parameter inference engine  621 , meaning some inferences as to the current health of an individual must be made by using multiple measurements and relating them through the Baysian inference filters. For example, the inference engine  621  determines a fall from multiple measurements, which may include the position from which the individual started and ended, and the relative accelerations in between. These and other measurements may be necessary for determining the difference between lying in bed and falling on the floor. Additional measurements such as pulse rate and oxygen level may qualify the fall with a determination of expected consciousness. 
         [0073]    A significant event detected through the cognitive system may cause the delivery of an interactive session with the individual to further refine and learn the appropriateness of the determination. For example, a detected fall may deliver a question in the form of voice message to the individual, “Have you fallen?” If no answer is given the determination probably is: The person has fallen and is unconscious. Or if an answer of yes is given, this will validate the Baysian filter coefficients. If the answer is no, then a correction to the Baysian filters will be made and forwarded to the BHM for future fall detection. Thus a key feature of this system is the use voice and other interactions to update its ability to provide correct detection of different health related incidents. Many of these events may evidence themselves over a long period of time, such as SpO2 deteriorating through lack of oxygen availability. One of the functions of the cognitive server inference engine is to evaluate these trends to determine if there is cause for an alert or alarm. 
         [0074]    Upon detection of a significant health risk, the system may alert the appropriate monitoring caregiver through the remote POC interfaces  307 ,  308 , and  920  ( FIG. 14 ). 
         [0075]    Other sensors may include a modular sensor  304  and, as a specific example, a modular surface temperature sensor  305 . Such modular sensors may be used within a monitored environment such as a home to monitor various ambient situations to ensure the safety of the individual. These sensors incorporate the same basic design of electronics, microprocessor, firmware and audio wireless communication as previously described. For example, the temperature sensor  305  may monitor a cook top  306 , which is a leading cause of fires within the home of an elderly person who may forget to turn off the cook top. Upon detecting of a rise in cook top temperature, the cognitive system will begin monitoring the appropriateness of the length of time that the cook top is on. Upon a determining an inappropriate behavior, the cognitive system issues an alert to the individual followed by an alert to the caregiver. This alert may be made through a BHM wireless module, another wireless sensor module  304  in the same room, or the POC appliance  301  in the kitchen or other convenient location. The alert may be issued in the form of a voice message, “Did you intend to leave on the cook top.” Once again through a voice interaction through the BHM, a module or the POC appliance or GUI on the POC appliance, an improvement will be made in the Baysian algorithms determining this event. 
         [0076]    While the patient  302  is outside of the home environment, a programmable digital assistant (PDA)  313  cellular device with a ZigBee wireless transceiver and global positioning system (GPS) will maintain the BHM device and other body sensors to the cognitive server and inference engine. A portion of the cognitive functioning of the cognitive server will be duplicated in the PDA such that a more immediate response and speech interaction is possible. When the primary link to the cognitive server is not possible, a backup link to POC appliances can be made for alerts. 
         [0077]    Various alternative embodiments of the BHM are contemplated. In certain situations the BHM may not be worn long-term on the ear and may alternatively be manufactured in the form of a wristwatch or pendant with a clip for attaching to a belt.  FIGS. 11-12  show health monitor  800 , which is the size of a small cell phone, and is suitable to be carried or worn as a pendant or clipped to a belt. Similar components are contained within the pendant device  800  as in the ear mounted BHM. Components include microphone  806 , speakers  807  and  821 , LCD display  801 , function buttons  802 ,  803 ,  809 , function toggle button  808 , USB interface connector  805 , and external SPO2 sensor connector  822 . A port  810  for an external speaker and microphone enable the use of an external, hands free headset, as desired. Ports  804  and  811  allow connection of individual external microphone or speaker, respectively. A mounting  820  for a belt clip is located on the rear face of the health monitor  800 . 
         [0078]    Internal components not shown are similar to the ear-mounted device. These include a microprocessor, a Zigbee RF transceiver, an antenna, a speech processor, accelerometer, a temperature sensor, a battery, and support electronics. Some measurements will not be able to be made solely by this device but will require other sensors on the patient&#39;s body to be wirelessly linked to it. 
         [0079]    Other wireless sensors on the body will form a wearable sensor network connected to the cognitive server and BHM. Additional sensors may include, but are not limited to, SPO2, electrocardiogram, blood glucose, and respiration. 
         [0080]      FIG. 13  represents a typical home with an individual  302  wearing or carrying a BHM companion  906 , illustrated to be a BHM of any form factor. The individual is able to move freely about while maintaining communications through the fixed location gateway modules  901 , 902 , 903 , 904  and  905 . These gateway modules may be selected from gateway  300 , sensor module  304 , or sensor module  305 . Each of these modules, including the BHM companion  906 , contains the CC2431 Chipcon Zigbee RF Transceiver  430 ,  507 . This Chipcon transceiver contains Chipcon&#39;s proprietary circuitry for determining the relative position of BHM  906  to gateway modules  901 , 902 , 903 , 904  and  905  through RF signal strength and triangulation, suggested by the dashed lines between the gateway modules and the position of patient  302 . This position is communicated through the gateway modules to the cognitive server. 
         [0081]    Modular sensors  304 ,  305 , and the like include those for motion, infrared, light levels, occupancy, ambient temperature, door position including garage door, and medication delivery. The modular devices also have the capability to be wired into control circuits such as garage door openers and thermostats. 
         [0082]      FIG. 14  shows in more detail the key components of the integrated communications appliance  301  (POC) in the system diagram of  FIG. 3 . The POC  301  is a customized Intel based computer optimized for use as an appliance. The LCD screen  920  is utilized to display the pertinent activities for the individual under care. The LCD screen also contains a touch interface to eliminate the need for a mouse. The activities calendar, phone, email, voicemail, and graphics such as pictures are presented for the individual  302  to view on screen  920 . Stereo speakers  929  and  923  are utilized for audio alerts, delivery of voice prompts, voice mail, email, music and the integrated speakerphone output. An integrated microphone  922  is likewise utilized for voice input and detection of sounds. 
         [0083]    Proximity sensor  921  is utilized to determine the presence of an individual in front of the POC. The detection of an individual&#39;s presence is utilized to trigger certain interactive activities such as the notification of email, voicemail and reminders. Buttons  924 - 928  are utilized as quick entry into different screens such as phone, email and calendar. An integrated camera  930  views activities within its field of view. A key feature of this device is software that is completely integrated and optimized for easy use and cognitive capabilities. 
         [0084]    The foregoing is considered as illustrative only of the principles of the invention. Further, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described, and accordingly all suitable modifications and equivalents may be regarded as falling within the scope of the invention.