Patent Publication Number: US-2007123754-A1

Title: Non-encumbering, substantially continuous patient daily activity data measurement for indication of patient condition change for access by remote caregiver

Description:
BACKGROUND OF THE INVENTION  
      The invention relates generally to health care and more particularly to patient data for patient health care.  
      A patient who has a health condition and is at home may have both formal and family caregivers who monitor the appearance of the patient. If the patient starts slowing down, sleeping in, not getting dressed, or tiring easily, the patient or caregiver may or may not report the change and get care for the patient. A delay in reporting the change or seeking medical attention may cause harm to the patient. Patient self-reporting can be inconsistent.  
      Subjectivity by the patient or caregiver may also cause the patient to request medical attention too frequently or infrequently. The requests for attention and visits to medical professionals when not needed consume resources in the health system that could deny timely care to other patients. In addition, the unneeded visits take time and effort of the patient and may expose the patient to additional dangers in making the visit. Waiting too long before receiving medical attention may result in an expensive and more dangerous acute medical event.  
      Typical measurements from in-home monitoring devices are taken once a day and may miss clear symptoms like worsening sleep or fatigue. The introduction of actual measuring devices into the home can create burdens on the daily routine of the patient. Traditional measurements often involve cumbersome equipment. Being tethered to a substantial measuring device may restrict the patient from movement that may unfortunately worsen the medical condition. The patient may feel awkward in moving and become less motivated to maintain activity. The patient may feel less agile and risk falling. If the patient is disconnected from the device while making movements, then data may be lost or monitoring of the patient compromised. The disconnection could occur by choice of the patient to allow the patient to perform a move unencumbered. The disconnection could occur by accident in movement of the patient and device creating a malfunction in connection and/or measuring.  
      It would therefore be desirable to promote a convenience and/or continuity in measurement of patient data for communication with a remote caregiver.  
     BRIEF DESCRIPTION OF THE INVENTION  
      In accordance with one aspect of the invention, an apparatus comprises a user-wearable, non-encumbering, movement sensor and an analyzer. The user-wearable, non-encumbering, movement sensor substantially continuously measures daily-activity data of a patient. The analyzer makes a determination from the daily-activity data of the patient that a change in condition of the patient has occurred. The analyzer generates an indication of the change in condition of the patient for access by a remote caregiver.  
      In accordance with another aspect of the invention, a patient is allowed non-encumbered movement at home while daily-activity data of the patient is automatically, substantially continuously measured. A determination is made automatically from the daily-activity data of the patient whether the patient needs one or more of human investigation, human diagnosis, and/or human treatment. An alert to a remote caregiver is generated automatically only upon the determination from the daily-activity data of the patient that the patient needs the one or more of human investigation, human diagnosis, and/or human treatment.  
      In accordance with a further aspect of the invention, an article comprises one or more computer-readable signal-bearing media. The article includes means in the one or more media for making a determination from daily-activity data of a patient allowed freedom of movement at home whether the patient needs one or more of human investigation, human diagnosis, and/or human treatment. The article includes means in the one or more media for generating an indication of a change in condition of the patient for access by a remote caregiver upon the determination from the daily-activity data of the patient that the patient needs the one or more of human investigation, human diagnosis, and/or human treatment.  
      Various other features and advantages of the present invention will be made apparent from the following detailed description and the drawings. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
      The drawings illustrate a preferred embodiment presently contemplated for carrying out the invention.  
      In the drawings:  
       FIG. 1  is a representation of an implementation of an apparatus that comprises a device, a base station, a plurality of databases, an analyzer, and a display.  
       FIG. 2  is a representation of an exemplary logic flow for an implementation of the apparatus of  FIG. 1 .  
       FIG. 3  is a representation of a patient located in a home and illustrates an exemplary employment of the device of the apparatus of  FIG. 1  and other devices. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
      Turning to  FIG. 1 , an implementation of an apparatus  100  in an example comprises one or more of one or more devices  102 , one or more base stations  104 , one or more databases  106 , one or more analyzers  108 , and/or one or more displays  110 . The apparatus  100  comprises a device  102 , a base station  104 , a plurality of databases  106 , an analyzer  108 , and a display  110 . The device  102  comprises a user-wearable, non-encumbering device. The device  102  comprises an activity and/or a movement sensor  111  that substantially continuously measures daily-activity data of a patient  112 . The movement sensor  111  comprises a user-wearable, non-encumbering, movement sensor. The analyzer  108  makes a determination from the daily-activity data of the patient  112  that a change in condition of the patient  112  has occurred. The analyzer  108  generates an indication of the change in condition of the patient  112  for access by a remote caregiver  114 . The analyzer  108  generates an alert to the remote caregiver  114  only upon a determination from the daily-activity data of the patient  112  that the patient  112  needs medical review. The analyzer  108  generates the alert to the remote caregiver  114  only upon a determination from the daily-activity data of the patient  112  that a substantial change is taking place which may require medical review. Exemplary medical review occurs within two to three days of receipt of the indication of the change in condition. An exemplary need of the patient  112  is a need for non-emergency medical attention. The remote caregiver  114  is presented trends over days and/or weeks to verify treatment effectiveness or stabilization of condition of the patient  112 .  
      The device  102  allows the patient  112  non-encumbered movement at home while automatically, substantially continuously measuring daily-activity data of the patient  112 . The device  102  comprises the movement sensor  111  and one or more of signal processing firmware  118 , storage  120 , and/or transmitter  122 . The device  102  in one example comprises the analyzer  108 . The device  102  measures one or more of movement, acceleration, vibration, and/or change in orientation. Exemplary devices  102  comprise one or more of an accelerometer, actigraph, tilt switch, and/or motion detector. The device  102  comprises an accelerometer and/or an actigraph capable of measuring over twenty-four hour periods for a relatively long-term duration. The device  102  automatically, substantially continuously measures the daily-activity data of the patient  112 . The device  102  performs substantially continuous measurements of the patient  112  as an indirect measure of health of the patient  112 .  
      The device comprises a user-wearable, non-encumbering, in-home monitor that substantially continuously measures the daily-activity data of the patient  112 . The device  102  comprises one or more of a convenient piece of jewelry, pendant, ornament, necklace, bracelet, timepiece, watch, item suspended from the patient  112 , and/or item easily wearable by the patient  112 . The device  102  comprises a strap for attachment to a wrist of the patient  112 . The device  102  comprises a chain and/or other item for hanging the device  102  from a neck of the patient  112 . The device  102  comprises one or more of a hook, clip, pin, an item for wearing the device  102  on a belt and/or clothing of the patient, and/or an item embedded within the clothing of the patient  112 . The device  102  comprises one or more of a home-based monitor, watch, and/or pendant rather than a device pasted on the chest of a patient in a lab or hospital. The analyzer  108  makes a determination from the daily-activity data of the patient  112  that the change in condition of the patient  112  has occurred. The apparatus  100  comprises an automated system of the analyzer  108  providing the indication of the change in condition of the patient  112  for access by the remote caregiver  114 . The apparatus  100  comprises an automated system of the analyzer  108  providing an alert to a clinician as the remote caregiver  114  of only one or more patients in need of one or more of human investigation, diagnosis, and/or treatment.  
      The device  102  comprises a collector that comprises the signal processing firmware  118  and/or the storage  120 . The movement sensor  111  and the collector of the device  102  comprise a unitary construction and/or an integral formation. The collector of the device  102  receives the daily-activity data of the patient  112  from the movement sensor  111  with the signal processing firmware  118  and collects the daily-activity data of the patient  112  in the storage  120  on a substantially daily basis as daily-collection data for the patient  112 . The collector of the device  102  provides the daily-activity data of the patient  112  to the transmitter  122 . The collector of the device  102  stores the daily-activity data of the patient  112  in the storage  120  for later transmission by the transmitter  122  when the collector of the device  102  is out of range of the base station  104  that provides the daily-activity data of the patient  112  to the analyzer  108  approximately and/or substantially once per day.  
      The transmitter  122  comprises a communications resource. The transmitter  122  provides the daily-activity data of the patient  112  to the base station  104  from the collector of the device  102  approximately and/or substantially once per day. The transmitter  122  comprises a radio transmitter that transmits the daily-activity data of the patient  112  to the base station  104 . The transmitter  122  comprises a transmitter that docks with the base station  104  to transmit the daily-activity data of the patient  112 . The base station  104  involves simple zero or one-button operation to receive the daily-activity data of the patient  112  from the transmitter  122 .  
      The base station  104  receives the daily-activity data of the patient  112  from the transmitter  122  of the device  102  and provides the daily-activity data of the patient  112  to the analyzer  108  approximately and/or substantially once per day. The base station  104  comprises one or more of a receiver  124 , a processor  126 , and/or a transmitter  128 . The base station  104  in one example comprises the analyzer  108 . The receiver  124  and/or the transmitter  128  comprise one or more communications resources. The databases  106  comprise one or more of a past and current patient data database  134 , a population data and rules database  136 , and/or a patient status and alert database  138 . One or more of the past and current patient data database  134 , the population data and rules database  136 , and/or the patient status and alert database  138  may be combined in a single database  106 .  
      The past and current patient data database  134  holds the activity data, past and present, for a patient  112  along with results of analysis. The population data and rules database  136  holds population models that assign meaning to activity values, shifts, and/or trends of the patient  112 . These meanings could be derived empirically from studying other patients and/or outcomes. There could also be rules written based on clinical knowledge. The patient status and alert database  138  holds trends and alerts that potentially need to be reviewed by the remote caregivers  114 .  
      The analyzer  108  is located on one or more of the device  102 , the base station  104 , and/or a network of the apparatus  100 . The analyzer  108  occupies any physical location. The data of the patient  112  is located at any physical location. The data of the patient  112  is distributed or centralized. The links in the apparatus  100  employ any type of communication.  
      The analyzer  108  performs a baseline versus substantially continuous comparison of movement and/or activity data on the patient  112  from home as an indirect measure of health of the patient  112 . The analyzer  108  is predictive of the health of the patient  112 . The analyzer  108  employs daily-activity data of the patient  112  as a predictor whether the patient  112  is in need of medical intervention and/or attention. The analyzer  108  employs the daily-activity data of the patient  112  in making a probabilistic estimate of future events related to the health of the patient  112 .  
      The analyzer  108  processes and simplifies the daily-activity data of the patient  112 . The analyzer  108  automatically identifies changes in the activity data of the patient  112 . The analyzer  108  looks for activity trends. The analyzer  108  automatically identifies changes in the activity data of a plurality of patients and picks out patients for possible attention so the remote caregiver  114  need not look at all the patients in a volume health care environment. The analyzer  108  classifies data as normal or abnormal to identify only patients who exhibit the biggest trends or shifts in activity for diagnosis by a health care professional as the remote caregiver  114 .  
      The analyzer  108  comprises an individual patient analyzer  130  and/or a patient group analyzer  132 . The analyzer  108  makes a determination from the daily-activity data of the patient  112  that the change in condition of the patient  112  has occurred. The analyzer  108  generates the indication of the change in condition of the patient  112  for access by the remote caregiver  114 . The analyzer  108  generates the alert to the remote caregiver  114  only upon a determination from the daily-activity data of the patient  112  that the patient  112  needs medical review. The analyzer  108  makes a determination from the daily-collection data for the patient  112  that the change in condition of the patient  112  has occurred. The analyzer  108  generates the alert to the remote caregiver  114  only upon a determination from the daily-collection data for the patient  112  that the patient  112  needs medical review. The analyzer  108  automatically generates the alert to the remote caregiver  114  only upon an automated determination from the daily-activity data of the patient  112  that the patient  112  needs one or more of human investigation, human diagnosis, and/or human treatment. In a further example, the device  102 , the base station  104 , the database  106 , the analyzer  108 , and/or the display  110  serve to verify that a patient  112  is recovering or stable.  
      The analyzer  108  compares the daily-activity data of the patient  112  with previous-activity data of the patient  112  to make the determination that the change in condition of the patient  112  has occurred. The analyzer  108  compares the daily-activity data of the patient  112  with previous-activity data of the patient  112  to make the determination that the patient  112  needs medical review. The individual patient analyzer  130  considers one or more health trends of the patient  112  relative to the past health data on the patient  112 . The analyzer  108  employs the daily-activity data of the patient  112  and previous-activity data of the patient  112  to look for one or more trends to make the determination that the change in condition of the patient  112  has occurred. The analyzer  108  employs the daily-activity data of the patient  112  and previous-activity data of the patient  112  to look for one or more trends to make the determination that the patient  112  needs medical review. The patient group analyzer  132  considers one or more health trends of the patient  112  relative to one or more approximately and/or substantially similar patients. The analyzer  108  employs the daily-activity data of the patient  112  and activity data of the one or more approximately and/or substantially similar patients to make the determination that the change in condition of the patient  112  has occurred. The analyzer  108  employs the daily-activity data of the patient  112  and activity data of the one or more approximately and/or substantially similar patients to make the determination that the patient  112  needs medical review.  
      The analyzer  108  generates the indication of the change in condition of the patient  112  for access by the remote caregiver  114 . The analyzer  108  generates the alert to the remote caregiver  114  only upon a determination from the daily-activity data of the patient  112  that the patient  112  has a change in levels or patterns of activity or inactivity. The analyzer  108  makes an estimate whether medical review is needed based on an increased risk of an impending acute event for the patient  112 . The analyzer  108  generates in the alert for the remote caregiver  114  a rank from the daily-activity data of the patient  112  of a need of the patient  112  for medical review. The analyzer  108  generates the alert to a remote clinician as the remote caregiver  114  only upon a determination from the daily-activity data of the patient  112  of a need for medical review due to an increased likelihood or an impending acute event for the patient  112 .  
      The analyzer  108  makes a determination automatically from the daily-activity data of the patient  112  whether the patient  112  needs one or more of human investigation, human diagnosis, and/or human treatment. The analyzer  108  generates automatically an alert to the remote caregiver  114  only upon the determination from the daily-activity data of the patient  112  that the patient  112  needs the one or more of human investigation, human diagnosis, and/or human treatment. The analyzer  108  assigns to the patient  112  automatically from the daily-activity data of the patient  112  a ranked need of the patient  112  for the one or more of human investigation, human diagnosis, and/or human treatment in the alert to the remote caregiver  114 . The analyzer  108  employs the display  110  to one or more of show, communicate, illustrate, depict, and/or represent to a health care professional automatically a ranked need of the patient  112  for the one or more of human investigation, human diagnosis, and/or human treatment in the alert relative to one or more other ranked needs of corresponding one or more other patients for one or more of human investigation, human diagnosis, and/or human treatment. The analyzer  108  assigns automatically a priority for one or more of human investigation, human diagnosis, and/or human treatment to one or more selected patients of the patient  112  and the one or more other patients based on the ranked need of the patient  112  and the one or more other ranked needs of the corresponding one or more other patients. The analyzer  108  alerts automatically a remote caregiver  114  of the priority for one or more of human investigation, human diagnosis, and/or human treatment of the one or more selected patients.  
      The analyzer  108  makes a determination from daily-activity data of a patient  112  allowed freedom of movement at home whether the patient  112  needs one or more of human investigation, human diagnosis, and/or human treatment. The analyzer  108  generates an alert to a remote caregiver  114  only upon the determination from the daily-activity data of the patient  112  that the patient  112  needs the one or more of human investigation, human diagnosis, and/or human treatment. The analyzer  108  assigns a priority for one or more of human investigation, human diagnosis, and/or human treatment to one or more selected patients of the patient  112  and one or more other patients based on a ranked need of the patient  112  and one or more other ranked needs of the one or more other patients. The analyzer  108  alerts a remote caregiver  114  of the priority for one or more of human investigation, human diagnosis, and/or human treatment of the one or more selected patients.  
      The remote caregiver  114  views the ranked results of the patient  112  from the analyzer  108  on the display  110 . The analyzer  108  employs the daily-activity data of the patient  112  to generate the alert to the remote caregiver  114 . The daily-activity data of the patient  112  sits in storage where the analyzer  108  employed the daily-activity data of the patient  112  while the alert goes to the remote caregiver  114 . The entire dataset need not be transmitted past wherever the analysis sits. The analysis by the analyzer  108  allows clinicians as the remote caregivers  114  the efficiency of viewing only patients who have changed the most or look the worst compared to others. The efficiency saves time for the clinicians in avoidance of viewing other patients not identified as having as significant of needs as the selected patient  112 . The remote caregiver  114  views on the display  110  the ranked results of the patient  112  from the analyzer  108  along with ranked results of one or more other patients from one or more other analyzers.  
      From the analysis by the analyzer  108 , the remote caregiver  114  is triggered and/or makes a decision to one or more of investigate, diagnosis, and/or treat the patient  112  and/or one or more other patients. A clinician as the remote caregiver  114  employs one or more techniques to make inquiry of the patient  112 . The remote caregiver  114  screens the patient  112  with a phone call. The remote caregiver  114  interviews the patient  112 . The remote caregiver  114  performs question and answer and changes treatment for the patient  112  based on output from the analyzer  108  on the display  110 . Based on the analysis of the patient  112  from the analyzer  108  and/or the result from inquiry of the patient  112  by the remote caregiver  114 , the remote caregiver employs traditional and/or advanced medical techniques to diagnose and/or recommend changes to treatment of the patient  112  before onset of an acute event.  
      In-home activity monitoring can be used to detect changes in CHF condition, increasing quality of chronic disease management. If a patient  112  starts one or more of slowing down, sleeping in, not getting dressed, and/or tiring easily, the patient  112  and/or a person close to the patient  112  may or may not report the change and get care for the patient  112 . The apparatus  100  automates the measurement of the patient  112 , quantifies the results of the measurement, and use the analysis to alert a professional that something is going wrong with the patient  112 . The apparatus can verify improvement after a treatment of the patient  112  and show that the improvement is maintained.  
      An illustrative description of an exemplary operation of an implementation of the apparatus  100  is presented, for explanatory purposes. Turning to  FIG. 2 , in exemplary logic flow  202  at STEP  204 , the collector of the device  102  collects activity data of the patient  112 . At STEP  206 , the transmitter  122  of the device  102  transmits the daily-activity data of the patient  112  to the base station  104 . At STEP  208 , the analyzer  108  employs the individual patient analyzer  130  and/or the patient group analyzer  132  to consider one or more activity trends of the patient  112 . At STEP  210 , the remote caregiver  114  views the ranked results of the patient  112  from the analyzer  108  on the display  110 . The remote caregiver  114  views on the display  110  the ranked results of the patient  112  from the analyzer  108  along with ranked results of one or more other patients from one or more other analyzers. At STEP  212 , the remote caregiver  114  is triggered and/or makes a decision to one or more of investigate, diagnosis, and/or treat the patient  112  and/or one or more other patients.  
      Turning to  FIG. 3 , the patient  112  is located in a home  302 . The device  102  is employable with other worn devices and/or other devices placed around the home  302  of the patient  112 . The device  102  helps identify the patient  112  when the device  102  is employed with other devices for measuring activity of the patient  112 . Pressure pads and/or sensors  304  are located in a bed  306 , chairs  308 , a sofa  310 , and/or a scale  312  of the patient  112 . Motions sensors  314  are located in the rooms, hallways, doorways, and/or stairways of the home  302 . The device  102 , pressure sensors  304 , and motions sensors  314  communicate with the base station  104  that provides the daily-activity data of the patient  112  to the analyzer  108  ( FIG. 1 ) approximately and/or substantially once per day. The analyzer  108  is located on one or more of the device  102 , the base station  104 , and/or a network of the apparatus  100 . The analyzer  108  employs daily-activity data of the patient  112  as a predictor whether the patient  112  is in need of medical intervention and/or attention. The analyzer  108  makes a determination from the daily-collection data for the patient  112  that the change in condition of the patient  112  has occurred. The analyzer  108  generates the alert to the remote caregiver  114  only upon a determination from the daily-collection data for the patient  112  that the patient  112  needs medical review. The device  102  is employable with additional medical measurements, for example, blood pressure and weight of the patient  112 .  
      An exemplary device  102  monitors and/or provides indirect measures of sleep quality and/or caloric expenditure and/or provides authentication when correlated with other sensors. Exemplary CHF symptoms correlated with measures by the device  102  comprise chest pain, coughing, difficulty breathing, shortness of breath, fatigue, and/or swollen legs. Exemplary pressure sensors  304  monitor sleep quality, sleep location, and/or information on sedentary activities. Exemplary CHF symptoms correlated with measures by the pressure sensors  304  comprise inability to sleep in one position and/or fluid retention. Exemplary motion sensors  314  monitor walking speed and/or bathroom usage. The motion sensors  314  are positioned at both ends of a passage where lingering is at a minimum, for example, at opposite ends of a hallway. Exemplary CHF symptoms correlated with measures by the motion sensors  314  comprise shortness of breath, fatigue, and/or swollen legs.  
      Exemplary intra-patient processing by the device  102  and/or the analyzer  108  comprises a determination of a baseline for the patient  112  at hospital release, tracking of improvement in health of the patient  112 , and alerting the remote caregiver  114  when the improvement in health of the patient  112  is not sustained and/or activity of the patient  112  drops back towards immediate post-hospital activity data of the patient  112 . Exemplary inter-patient processing sub-groups patients with one or more of approximately and/or substantially similar diagnoses, activity levels, activity patterns, and/or circadian rhythms. Further exemplary inter-patient processing normalizes data on the patients to points in disease progression and/or days since and/or until next treatment for acute condition.  
      The patient  112  is allowed non-encumbered movement at the home  302  while automatically, substantially continuously measuring daily-activity data of the patient  112 . A determination is made automatically from the daily-activity data of the patient  112  whether the patient  112  needs one or more of human investigation, human diagnosis, and/or human treatment. An alert to the remote caregiver  114  is generated automatically only upon the determination from the daily-activity data of the patient  112  that the patient  112  needs the one or more of human investigation, human diagnosis, and/or human treatment. The patient  112  is assigned automatically from the daily-activity data of the patient  112  a ranked need of the patient  112  for the one or more of human investigation, human diagnosis, and/or human treatment in the alert to the remote caregiver  114 . In the alert to a health care professional as the remote caregiver  114 , a ranked need of the patient  112  for one or more of human investigation, human diagnosis, and/or human treatment relative to one or more other ranked needs of corresponding one or more other patients for one or more of human investigation, human diagnosis, and/or human treatment is automatically displayed on the display  110 . A priority is assigning automatically for one or more of human investigation, human diagnosis, and/or human treatment to one or more selected patients of the patient  112  and the one or more other patients based on the ranked need of the patient  112  and the one or more other ranked needs of the corresponding one or more other patients. A medical doctor as the remote caregiver  114  is alerted automatically of the priority for the one or more of human investigation, human diagnosis, and/or human treatment of the one or more selected patients.  
      The device  102  is employable with additional medical measurements, for example, blood pressure and weight of the patient  112 .  
      An implementation of the apparatus  100  in an example comprises a plurality of components such as one or more of electronic components, hardware components, and/or computer software components. A number of such components can be combined or divided in an implementation of the apparatus  100 . An exemplary component of an implementation of the apparatus  100  employs and/or comprises a set and/or series of computer instructions written in or implemented with any of a number of programming languages, as will be appreciated by those skilled in the art. An implementation of the apparatus  100  in an example comprises any (e.g., horizontal, oblique, or vertical) orientation, with the description and figures herein illustrating an exemplary orientation of an implementation of the apparatus  100 , for explanatory purposes.  
      An implementation of the apparatus  100  in an example employs one or more computer-readable signal-bearing media. A computer-readable signal-bearing medium in an example stores software, firmware and/or assembly language for performing one or more portions of one or more implementations. An example of a computer-readable signal bearing medium for an implementation of the apparatus  100  comprises the recordable data storage medium as the storage  120  of the device  102  and/or a recordable data storage medium of the analyzer  108 . A computer-readable signal-bearing medium for an implementation of the apparatus  100  in an example comprises one or more of a magnetic, electrical, optical, biological, and/or atomic data storage medium. For example, an implementation of the computer-readable signal-bearing medium comprises floppy disks, magnetic tapes, CD-ROMs, DVD-ROMs, hard disk drives, and/or electronic memory. In another example, an implementation of the computer-readable signal-bearing medium comprises a modulated carrier signal transmitted over a network comprising or coupled with an implementation of the apparatus  100 , for instance, one or more of a telephone network, a local area network (“LAN”), a wide area network (“WAN”), the Internet, and/or a wireless network.  
      The steps or operations described herein are examples. There may be variations to these steps or operations without departing from the spirit of the invention. For example, the steps may be performed in a differing order, or steps may be added, deleted, or modified.  
      The present invention has been described in terms of a preferred embodiment, and it is recognized that equivalents, alternatives, and modifications, aside from those expressly stated, are possible and within the scope of the appending claims.