Mobile monitoring ... the fastest way to improved health - agentur ...
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mobile monitoring ... the fastest way to improved health 1
topics
} telozo – the company behind the clue series
} general information - clue series
} clue - overview
} clue medical - overview
} modes of data transmission, modes of data access,
types of data reports
} device specifications
23
telemedicine
future} the company behind the products:
} founded in August 2008, spin-off of the privately owned Austrian
high-tech company Telovital Telemedicine
} innovates, develops and globally markets effective, high quality
brand-name telemedicine products
} main focus is cardiac, neuro and stress diagnostic via pocket sized
devices
} device can reliably transmit relevant scientific data via web or
mobile phone to central server or directly via IR or bluetooth to PCs
or notebooks
} a team of highly experienced international top experts
4Vision:
} We are recognized as leading and innovative telemedicine company
} Top people want to work with telozo and contribute to its purpose
Mission:
} We work for effective health management at any place and any time
} We develop and market telemedicine products which are:
} very versatile
} technologically highly advanced
} yet easy to operate and widely affordable
Key brands:
56
Product Focus - USP
Diagnostic devices focusing on the most common
disease area, heart disease:
Medical relevance and evidence
brillant quality
top mobility
easy to use
instant data availability, locally and world wide
State-of-the art technology, evidenced in the
participation in the inclusion into the space program
„MARS 500“
7} innovative state of the art, telemetric event recorder
} extremely light (56 grams), small and multifunctional, high quality
} mobile health measuring device – pocked sized
} capable of telemetric data transfer anytime & anywhere, worldwide
} easy to operate – one button only
} clue - lifestyle product, focused on private use
} clue medical - advanced product, focused on use by medical
professionals
8Product Portfolio
clue medical clue
Medical Device CE 0408 Health / Lifestyle Device
93/42/EWG class II a
910
11
} One measurement,
} three different representations of the same evaluation
} I. The simplified, easy for the patient to understand conversion
as a PDF, can be called up via the user’s computer or the
Telozo server
} II. The mobile assessment, can be called up at any time but
only via the Telozo server
} III. The detailed report, a complex representation which can be
read by the physician with more in-depth information, with
precise information about the recording time and duration; is
directly transmitted to the computer and evaluated there or in
a mobile manner via the central Telozo server, with
simultaneous archiving
12I. Simplified Report III. Detailed Report II. Mobile Report 13
14
} records a complete one-channel 2 minute ECG –
anytime and anywhere
} can provide you with a possible „clue“ about your current
health and/or fitness condition
} makes stress visible and can help you to optimize your
personal performance and quality of life
} instantly calculates and visualizes important stress
parameters
15clue – your personal benefits: } very economical state of the art technology without equal } is able to record up to 30 measurements between transmissions } makes stress visible } calculates your personal stress level and be warned of a possible burnout → stress management } reliably identifies your personal fitness rating } regain your balance more quickly → energy management 16
Report
HR
HRV
Balance
17Terminology Heart Rate (HR): heart beats per minute Heart rate variability (HRV): variations in the heart rate over a shorter or longer measurement period in a heart beat to heart beat analysis - a measure of the hearts ability to regulate itself („Heart Fitness Level“) Balance: balance of sympathetic to parasympathetic (vagal) actvity – a measure of stress („Stress Level“) 18
19
20
} records a complete one-channel ECG over a period of 2
minutes at a sampling rate of 1 KHz, anytime &
anywhere, in real life conditions
} is able to record up to 30 ECGs between transmissions
} analyzes heart rate variability (HRV) and
sympathicus/parasympathicus activity as well as their
balance
} transfer of data to medical centers/medical professionals
is independent of time and place, simplifying diagnosis
and monitoring
} enhances health risk prevention and fitness
improvement programs
21} monitors outpatients with cardiac or neurological risks
} for follow up of patients with heart failure and post mi
} helps in the diagnosis and treatment of stress, burn-out,
in diagnosis of rhythm disturbances never seen before
} can help evaluate different training methods in the field
of sports medicine
} instantly calculates heart rate variability & important
stress parameters
22e.g. Heart Rhythm Disturbances
The basis for the before mentioned HRV
analysis, the 2 minute high-resolution ECG, is
also an additional and important tool for the
physician when it comes to disrhythmia.
Since many heart rhythm disturbances are
not easy possible to detect with conventional
examination methods, clue medical allows the
person concerned to record and therewith
document these events when they appear,
irrespective where and when.
Possible heart rhythm disturbances are e.g.:
• atrial fibrillation
• atrial flutter
• ventricular tachycardia
• superventricular tachycardia
• extrasystoles
• bradycardia
23In the two minute recording, the following data and values are
recorded and displayed:
} 1. The average heart period and heart rate (HR)
} 2. Absolute [SDNN] and relative [CV] heart rate variability (HRV)
} 3. A spectral analysis [FFT] including surface measures derived
from it for sympathetic and parasympathetic activity and their
balance
} 4. A tachogram of the heart period including cardiovascular
assessment
} 5. A complete 1 channel ECG section over a 2 minute period
} 6. A signal-averaged ECG with the characteristic time values
24Terminology Tachogram If you determine, for each heart action µ, within a given measurement time (e.g. 2 minutes with clue medical) the associated cardiac cycle duration TH (µ) (e.g. the applicable RR interval) and plot it as a function of the corresponding heart action, you get the “tachogram of cardiac cycle durations” as a characteristic cardiovascular function. The beat to beat variations and thus the heart rate Variability (HRV) are illustrated in a tachogram. 25
Heart Rate Variability (HRV)
From ECG to the tachogram of the heart beat periods
ECG
t1 t2 t3 t4
R R R R R
Time between R peaks
Tachogramm
Time (ms)
t1 t2 t3 t4
Number
26Terminology Spectral Analysis Calculated from the tachogram of cardiac cycle durations, made up of characteristic frequency ranges – LF, HF, VHF LF: low frequency, predominantly sympathetic cardiovascular activity HF: high frequency, typical for vagal (parasympathetic) cardiovascular activity VHF: very high frequency, a cardiac risk marker Areas under the LF and HF curves represent sympathetic and vagal activity, respectively – and their ratio is a measure of „Balance“ („Stress / Recovery“) 27
Spectral analysis: 28
References
} AKH General Hospital / Vienna, Austria
} Psychosomatic Institute (Burnout Center) /
Vienna, Austria
} Center for Sports Sciences / Frankfurt a.M.,
Germany
} Harvard University / Cambridge, USA
} IMBP / Moscow, Russia
29Project MARS 500 30 JK/09
31 JK/09
Modes of Data Transmission Modes of Data Access Types of Data Reports 32
Modes of Data Transmission
via Infrared-USB stick to PC/notebook
Recorded data can be
transmitted to the server-center
via the provided IR-USB stick
using a PC/ notebook with
internet-access as
interconnection.
This solution is usually favored
with in-patients at the medical
center, and also generally very
popular
33Modes of Data Transmission
via mobile phone with Internet-, and Bluetooth- or
Infrared-connection capability
Alternatively, recorded data can be
transmitted to the server-center for
visualization and storage via a
mobile phone, whereas the data are
conveyed from clue medical to the
mobile phone using Bluetooth- or
Infrared-Connection.
This solution is often used by out-
patients recording and transmitting
data on a regular basis at home for
supervision by physicians.
34Modes of Data Transmission 35 35
Modes of Data Access
Access with User ID and Password
To get access to the visualized
recordings is with User ID and
Password.
With these the physicians / users are
able to access via Internet all
devices / patients with its recordings,
e.g. stored in the server-center of the
hospital or telozo.
That means any medical center of a
group of hospitals has access to
certain patient recordings, if the
patient has its clue medical # filed in
his patient file.
36Modes of Data Access
Access to individual devices and recordings
By clicking on the device # of the
patient, the physician/user can see
when and at what time recordings
have been transmitted, together with
its actual reports, if clicked on the
Adobe Reader symbol.
This information allows precise
billings regarding patients, medical
centers, and health care
insurances, as applicable.
Furthermore, the stored reports can
be used as additional input for
various medical departments.
37Modes of Data Access
Further details of recordings
In addition, with clicking on
the journal #, it is possible
to see further information
like the details of a certain
recording.
38Modes of Data Access
Device details
In addition, with clicking on the
device #, it is possible to see
additional information like the
latest transmission, total number
of transmitted recordings, plus
e.g. the e-mail address, the
visualized reports are sent to.
The conveying of reports via e-
mail is an additional way of
obtaining recordings to be
evaluated.
39Modes of Data Access
List of all devices
List of all devices within a
user account
40Data Reports
General
The Output: Data Reports
Privacy protection of personal vital data is fully guaranteed, since all
recordings/visualized reports in the server-system are anonymous and
only handled by the device number.
The allocation of the outputs to a person/patient takes place only during
print-out.
An earlier allocation is disallowed by the system.
41Data Reports - Standard
Reports for each recording
1 - The average heart period and
heart rate (HR)
2 - Absolute [SDNN] and relative 6
[CV] heart rate variability (HRV)
3 - A spectral analysis [FFT] 1
including surface measures
2
derived from it for sympathetic
and parasympathetic activity and 4
their balance
4 - A tachogram of the heart
period including cardiovascular
assessment 3
5 - A complete 1 channel ECG
section over a 2 minute period
6 - A signal-averaged ECG with
the characteristic time values
4243 JK/09
Data Reports - Standard Reports for each recording: 120 seconds of ECG data (in 3 pages) 5 44
45
46
Data Reports – Special Analysis
It is also possible to provide the physician additionally with a trend analysis over
certain periods of time, whereas the basis for it is continuously updated
Example: Trend-Analysis over a period of 24 days
Sympathicus/Parasympathicus Activities
Changes of sympathetic and parasympathetic activities of the cardiovascular
system under prescribed medication (35 year old patient) during 24 days
(averaged values per daily measurings)
600
Parasympathetic Activity
Sym pathetic-
Sympathetic - and
500 Activity LF Parasym pathetic-
400 Activity HF
[ms 2]
300
200
100
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
day
47Data Reports – Special Analysis
Balance Sympathicus/Parasympathicus Activities
35 year old patient under prescribed medication, recorded during 24 days, average value per day
Changes in cardiovascular balance
2
1,5
Balance
1
0,5
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
day
48Data Reports
Heart Rate
35 year old patient under prescribed medication, recorded during 24 days, average value per day
Changes in average heart frequency
75
]
70
-1
heartrate [min
65
60
55
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
day
49Data Reports
Heart Rate Variability (HRV)
35 year old patient under prescribed medication, recorded during 24 days, average value per day
Changes in Heart Rate Variability (HRV)
5
Heart Rate Variability CV [%]
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
day
5051
General Summary
clue medical are state-of-the-art systems for
one-channel recording of application-specific
ECG sections for the purpose of determining
heart rate variability (HRV) as well as the
activity of the autonomic nervous system
(sympathetic and parasympathetic activities) as
indicators of cardiovascular stress, recovery
and its balance.
The recorded data can be sent telemetrically
using a PC/ notebook with internet-connection
or mobile phone to a server-center
5253
Device Specifications Measurements L/D/W 76 mm x 72 mm x 15 mm Weight with battery 56 g Weight without battery 49 g Operating temperature range 10°C to 45°C Storage temperature range -20°C to 60°C Transport temperature range -20°C to 60°C Relative humidity 10% to 95% non-condensed Operating time w/o change of battery >400 measurements Risk class II a Degree of protection BF / IP 20 ECG lead 2 x 1 channel ECG recording bipolar and neutral electrodes Input voltage 10 mV p-p DC offset correction < 300 mV Frequency range: adhesive electrodes3 0.05 – 40 Hz (-3dB) Frequency range: fixed electrodes 0.1 - 40Hz (-3dB) Scanning rate 1000 Hz Resolution of AD conversion 12 Bit Memory 30 recordings max. Battery type AAA alkaline (1,5V), rechargeable types allowed (NiMh 1.2V) Battery display Optical Electrode monitoring Yes IrDA Transmission Modem (IrComm) to central server over Internet connection IrDA Transmission Obex push (PDF file) directly to recipient Method of heart rate measurement Average ECG over 2 minutes Bluetooth module LMX9838 54
THANK
YOU!
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