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`US 20070197881Al
`
`(19) United States
`(12) Patent Application Publication (10) Pub. N0.: US 2007/0197881 A1
`Wolf et a].
`(43) Pub. Date:
`Aug. 23, 2007
`
`WIRELESS HEALTH MONITOR DEVICE
`AND SYSTEM WITH (IOGNITION
`
`Inventors:
`
`James 1.. Wolf. Conifer. CO (US):
`Thomas 1’. Walker. Morrison. {‘0
`(US): Franz Huber. Denver. CO
`(US); Robert N. Caruso.
`Evergreen. [‘0 (US)
`
`Correspondence Address:
`KYLE W. RUST
`5490 AUTUMN CT.
`GREENWOOD VILLAGE. C0 80 Ill
`
`Appl. No;
`
`111678.052
`
`l’iled:
`
`Feb. 22, 200'?
`
`Related U.S. Application Data
`
`Provisional application No. (SD/766.063. filed on l’eb.
`22. 2006.
`
`Publication Classification
`
`[51}
`
`Int. Cl.
`A618 5/00
`G06Q iii/til?
`[52) U.S. CI.
`
`(2006.01)
`(2006.01)
`600/300: 128/920: 705/2
`
`(57)
`
`ABSTRACT
`
`A home—based retnote care solution provides sensors includ—
`ing a basic health monitor (BHM) that is a measurement and
`leedbaclt system. The 1311M operates with low power inte-
`
`low
`grated communications combined with an iii-home.
`power mesh network or programmable digital assistant
`(PDA) with cell phone technology. A cognitive system
`allows remote monitoring ol‘ the location and tile basic
`health of an individual. The Iii-{M measures oxygen satu-
`ration (SaOZ).
`temperature ol‘ the ear canal. and motion.
`including detection ol‘a tall and location within a thcility.
`Optionally.
`the [311M measures (‘02.
`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 pro~
`vides thedback and assistance to the individual while learn-
`ing 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 Bl-lM. The device
`may be worn overnight to allow monitoring and interven—
`tion. 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 ttieasurements and to give alerts to care providers. Aierts
`from care providers can be iii a Familiar voice to assist with
`compliance to medication regimens and disease manage
`ment
`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-ol—cme (POC‘) appliance (mmpnter). 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 lmemet gate—
`way to the remote care provider.
`
`U.S. Patent No. 8,923,941
`
`303
`
`320
`
`Local
`Zigbee
`Network
`
`Cognitive
`Server
`
`
`
`Apple Inc.
`APL1042
`
`Apple Inc.
`APL1042
`U.S. Patent No. 8,923,941
`
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`Patent Application Publication
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`[0009] The traditional approach to caring tor such iridi-
`viduals 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 health-
`care can provide an adequate level ofin-ltome monitoring of
`basic health status, a more cost-elIectivc 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] Corrununication 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 infom'tation. such as pictures.
`measurements of blood pressure etc.
`for diagnosis and
`treatment
`is Lite goal. Medical
`literature Widely reports
`eliorts to provide medical care. remotely. Wireless technolo-
`gies are starting to be employed in telemedicine as well.
`However. Audrey Kinsella has identified the need for spe-
`cialized high-technology knowledge (cg... rewiring house-
`holds for advanced telecommunications capabilities. install—
`ing sophisticated health care workstations. and requiring a
`suite of engineers to wait on the doorstep, ready to assist) as
`impediments to the adoption of tclemedicine.
`[001]] 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 borne 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 wire-
`less 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 heallhcarc. 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
`
`016
`
`WIRELESS HEALTH MONITOR DEVICE
`AND SYSTEM WITH COGNITION
`
`CROSS-RIil’l-iRl-IENCIi TU Rlil .A'l'lil)
`APPIJFA'I‘ION
`
`[0001] This application claims the benefit of U.S. Provi-
`sional Patent Application Ser. No. 601766.963. filed Feb. 22.
`2006. copending.
`
`BACKGROUND OF THE INVENTION
`
`2. Field of the Invention
`[0002]
`[0003] The invention generally relates to surgery as
`applied to diagnostic testing and to computer assisted medi—
`cal diagnostics. More specifically. the invention relates to
`monitoring a plurality ol'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
`ofin-home healthcarc. this is becoming increasingly impor-
`tant. 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 indi—
`viduals to their care providers. and enhance caregiver efi'ee
`tiveness.
`
`[0006] Horne-based care as described here is not telemedi-
`cine. which has yet to fulfill the promise of remote care and
`appropriate intervention for disease management. European
`countries seetn 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 l')iroclor of Information for Tomorrow
`“The idea of home telehealthcare needs a serious makeover.
`Even today. home telemedicine or telehealthcare is associ-
`ated with high-tech. expensive devices and overall inacces-
`sibility 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 teleconnnunications to patients
`who have already been diagnosed in a standard medical
`setting. As used herein. the det‘mition 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 healthcarc.“ is defined to
`include this extended form of telehcalthcare or home-based
`
`care. Remote healthcarc is an urgently needed method of
`caring for individuals who can experience a higher degree of
`self-care independence when effective monitoring and con-
`trol
`is provided. Mitch of the elderly population and the
`disabled population fit this description. Persons undergoing
`Lransitional care for a treated condition fit this category as
`well. All such persons will benefit from remote bealthcarc.
`
`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 techno!"
`ogy. Most notably. these are: a) ali'ordable computer systems
`with touch screens and voice response. [1-] lntemet, wireless
`communications standards of Bluetooth and ZigBee. c) low
`power electronics providing for long battery life. d) reliable
`low power GPS sensors and Zigbec triangulation technol-
`ogy. and c) 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 OI’ Tilli 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
`
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`US 2007(0197881 Al
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`
`individuals whose mobility or self-care capabilities have
`been limited dtte to age or disease, Such air 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
`iii-home care provider to monitor and assist in basic health
`needs trray 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 lead-
`ing to a traumatic event such as falling. loss of oxygen. or
`loss of consciousness.
`[0016] Children and other relatives have increasing con-
`cerns for the welfare of parents or other family members
`with limited self-care capabilities. These concertrs are
`becoming manifested in a desire to directly monitor those
`family member patients and to more actively participate in
`givith care. These trends create a demand for a new and
`innovative solution to caring.
`[001 T] A home—based remote care soltttiorr must have the
`following characteristics:
`(1} Requires little or no under-
`standing ot‘the operation by the individual ofthe monitoring
`devices and system. (2) Monitors key physiological param-
`eters relevant to the disease or disability. These parameters
`include activity level. falls, and key measurements such as
`51302 and consciousness. (3) Provides a determination of
`patient location. whether in-facility or iii-home. (4) Provides
`cognitive understrutding ot'situations and treatments. based
`on input front 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-earc (POC) appliance and a
`wearable monitor. (6) Provides full time monitoring capa-
`bility. both when the patient is iii-home and when traveling.
`[7) Provides a
`link to a care provider and emergency
`services.
`technological
`recent
`invention employs
`[0018] The
`advances in low power measurements and plug—and—play
`wireless communications components to create a miniature
`measurement and feedback system that also provides loca-
`tion 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
`ofthe BHM include all earpiece, a pendant. a wrist-mounted
`BHM. a clip-0n BHM for a belt. or pocket—carried BHM.
`The BHM has low power integrated communications with
`an iii-home low power mesh network1 a programmable
`digital assistant (FDA) with cell phone teclurology. and a
`cognitive system. These components allow location deter-
`mination atrd remote monitoring of the basic health of an
`individual.
`
`017
`
`merits. 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 tirade
`such as C03. respiration. EKG. EEG arid blood glucose.
`[002]]
`Simple voice commands can activate the BHM to
`report its measurements and to give alerts to care providers.
`Alerts front 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 conununicates through a series of low-
`power gateways to an in-honre cognitive server and to a
`point-of-care appliance (the FCC] which cart be a computer.
`Acting alone. the BHM provides basic feedback and moni-
`toring with limited cognitive capabilities, such as detecting
`low oxygen or a fall. While connected to the cognitive server
`or POL“, the [311M attains full cognitive capabilities. Full
`alerting capability requires the cognitive server to be con-
`nected lhrottglr 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 tnake 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 mat-re decisions.
`The BHM contains enough sensors within a single unit that
`some basic decisions such as fall detection may be made
`standalone. Leaming and trend detection require the full
`cognitive system to make decisions and feedback new
`detection parameters.
`[0024] The cognitive system provides high~level qualitaw
`tive information and quantitative data to the caregiver. The
`cognitive system compresses data at the remote,
`iii-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 FDIC in the borne or care facility, by botlr 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 deter—
`mined need. The sensors can measure multiple parameters
`such as ambient temperature. surface temperature (as of a
`cook top). motion. soturds, 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
`
`the BHM will he
`In the preferred embodiment
`[0019]
`wont around the ear in the same manner as a conventional
`hearing aid or the recently introduced Blue-tooth wire-legs
`headsets or earpieces. "the BHM will be able to measure
`oxygen saturation ($2102). temperature of the ear canal. and
`motion. including detection ofa 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 teaming standard behavior patterns.
`[0020] With an integrated audio speaker and microphone.
`the lit-1M is able to deliver audio alerts. current measure-
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`
`018
`
`times 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‘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 inihrmal basis. The infon'nal
`caregivers are relatives. friends. coworkers. and/or neighw
`bors. The professional caregivers are the individual’s net-
`work ofdoctors. 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
`alamts. 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. move—
`ment. acceleration. and location. The BI-IM 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 1311M. the cognitive system is able
`to give prompts to the patient and can receive answers from
`the patient. This ability is crucial
`for impletnenting the
`cognitive. learning sofiware included in this remote health-
`care system and for enabling the prompting features of the
`system.
`[0047] A remote healthcare delivery system must fulfill
`three netxls: a) safety. 11) security. and c] social needs. Safety
`issues to be monitored include basic health assessments such
`as oxygen saturation. blood pressure. appropriate move-
`ment. and so on. Security is defined by the status of doors
`opetulclosed. appliances on/olf. 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 recre-
`ational activities and integrated communications form the
`basis of fulfilling those social needs. Infonnation about
`safety. security. and social needs must be current. accurate
`and readin available both to the patient and to the person(s)
`involved in assisting him.
`is
`including the BHM.
`[0048] A network of sensors.
`located throughout the patient‘s dwelling. The sensors track
`and monitor the patient's health status and activities. The
`sensors provide input for proactive applications that will
`ofier a variety of assistance. ranging from reminders to take
`medications to accessing social suppon. The patient will
`access this network through a point-of-care appliance. here-
`inafier called "‘POC." by using a variety of familiar inter-
`faces. such as integrated calendar. telephone. and simplified
`email
`that utilize appropriate aSsistive technology. The
`patient will not need to leam new technology to receive
`assistance. These proactive systetns enable relatives to
`assess the health and well-being of the patient remotely
`through private. secure Internet connections and will pro-
`vide 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 distrib-
`uted. which in certain circumstances might risk a full or
`
`module may interact in dili'erent 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 IOBase-T base module.
`[0027] By docking a sensor module into a IOliase-‘l‘ base
`module. the sensor becomes part of a wired network of
`sensors to be consolidated into a set of remote objects.
`[0028] The FCC has integrated communication capabili-
`ties along with the cognitive engine. The POC interacts with
`the user for scheduling activities. medication. and commit-
`nicalions with the care provider through integrated phone.
`voice messaging. email. music. and graphics such as pic—
`tures and videos.
`[0029] The accompanying drawings. which are incorpo-
`rated 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
`
`FIG. 1 is an isometric front right side view of a
`[0030]
`basic health monitor (BHM). showing representative loca-
`tions of subcomponents.
`[003]]
`FIG. 2 is a view similar to FIG. 1. showing a Bl—IM
`from the lefl rear.
`[0032]
`FIG. 3 is a schematic view of an overall remote
`healthcarc system. showing a 1311M 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 Bl-IM. sensor. or similar modular device.
`showing functional interactions.
`[0034]
`FIG. 5 is a schematic communications level dia—
`gram showing software components and a communications
`path fmm a BHM through a gateway to a cognitive server.
`[0035]
`FIG. ti is a schematic block diagram of the cogni—
`tive operation sofiware components of the BHM and cog-
`nitive 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
`rean
`
`FIG. 10 is an isometric view taken from front right.
`[0039]
`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 lieaithcare
`system installed in a home. schematically showing the
`patient and a method of determining location.
`[0043]
`1“ IG. 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 deliv-
`ery 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 indepen-
`dently living elderly and disabled persons. who will some-
`
`018
`
`FITBIT, Ex. 1042
`
`

`

`US 2007f0197881 A1
`
`Aug. 23, 2007
`
`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
`multipie communication paths represented as ellipses. These
`are a Zigbee wireless path 320.51 wired or wirelesr; 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 conununication 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's home for
`the patient’s use. A FCC 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 pro—
`vides a communication bridge from the wireless Zighee
`network 320 to the netwurk 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.
`
`O19
`
`partial loss of communications. In order to ensure that the
`system is robust. the cognitive intelligence also is distrib-
`uted. especially to the BHM. A fusion of the data from the
`network sensors enables a feedback of the patient‘s health
`state. This fusion enables an adaptive intelligent assistance
`to the patient even when there is a conununication failure.
`[0050] The remote healthcare delivery system employs a
`tuesh 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—muhipoint transmissions. These prior networks
`are difficult to install1 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 trans-
`mitting signals. Signals may take several hops through
`diflerent components to reach their intended destination.
`Mesh networks are especially well suited to adverse condi—
`tions and are easy to install, self-configuring. and self—
`leaming. 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.
`
`In the following detailed description. one commu—
`[0051]
`nication 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 conuuunication paths. Therefore. all dis—
`closed colnmunlcation paths are applicable to each compo-
`nent and for communicating each measurement. 1n the
`following description. the numbers from L99 are elements
`primarily shown in FIGS. 1-2. numbers ufthe 300. 400. 500.
`and 600 series refer to elements primarily shown in 1" IGS. 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.
`
`FIGS. 1 and 2 show a basic health monitor (BI-1M)
`[0052]
`303 of a form factor suited to be wearable. As suggested in
`these figures. a preferred configuration ofthe 1311M 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 subcompo—
`nents. In a Bl—IM of the form factor in FIGS. 1 and 2. many
`of the subcomponents are internal. Thus. various subcom—
`poncnls are identified as representative locations on the
`earpiece 303. The subcomponents are microphone 1. car-
`phone and temperature sensor 2. dual light emitting diodes
`[[EDs} 3. optical sensor 4. accelerometer 5. microprocessor
`6. and anterura ‘7. all as shown in FIG. 1. FIG. 2 shows
`additional components including volume controls 10, indiw
`cater LED 11. ZigBee radio transceiver 12. and on/ofi button
`13. The LIEDS 3 and optical sensor 4 are spaced apart, and
`the configuration ol'the earpiece 303 is suitable for the user’s
`earlobe to be located between the LED's 3 and optical sensor
`4 to enable measurements more fully described below.
`[0053] The wearable Bl-IM 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
`
`[0056] The remote healthcare delivery system includes
`components operative outside the home 315. When the
`patient 302 is outside of the home. the accompanying Bl [M
`303 corrununicates through Zigbee network 320 to the
`optional progranmiable digital assistant (PDA) 313. which
`the patient 302 carries with him. The PDA 313 communi-
`cates with the cognitive server. either through the link 341
`or through a cellular connection to the Internet.
`in tum
`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 moni—
`tors 308 located at a remote caregiver site. The remote
`healthcare system may include a remote PDA or remote
`patient monitor 30'? connected through the Internet by
`cellular network link 344.
`
`[0057] The general intemctions and structure ol'Bl IM 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 acceler