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`US 20080004904Al
`
`c19) United States
`c12) Patent Application Publication
`Tran
`
`c10) Pub. No.: US 2008/0004904 Al
`Jan. 3, 2008
`(43) Pub. Date:
`
`(54) SYSTEMS AND METHODS FOR PROVIDING
`INTEROPERABILITY AMONG
`HEALTHCARE DEVICES
`
`(51)
`
`(76)
`
`Inventor:
`
`Bao Q. Tran, San Jose, CA (US)
`
`Correspondence Address:
`TRAN & ASSOCIATES
`6768 MEADOW VISTA CT.
`SAN JOSE, CA 95135
`
`(21) Appl. No.:
`
`11/512,630
`
`(22)
`
`Filed:
`
`Aug. 30, 2006
`
`Related U.S. Application Data
`
`(60)
`
`Provisional application No. 60/818,260, filed on Jun.
`30, 2006, now abandoned.
`
`Publication Classification
`
`Int. Cl.
`G06Q 10100
`G0SB 5122
`G06F 7100
`G0SB 1108
`A61B 5100
`
`(2006.01)
`(2006.01)
`(2006.01)
`(2006.01)
`(2006.01)
`
`(52) U.S. Cl. .................. 705/2; 340/286.07; 340/539.11;
`707/100; 600/300; 340/539.12
`
`(57)
`
`ABSTRACT
`
`A medical system includes a network; one or more medical
`data collection appliances coupled to the network, each
`appliance transmitting data conforming to an interoperable
`format; and a server coupled to the network to store data for
`each individual in accordance with the interoperable format.
`
`PATIENT
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`208
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`APPLE 1007
`
`1
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 1 of 26
`
`US 2008/0004904 Al
`
`REMOTE SERVER 200
`
`AUTHORIZED THIRD
`PARTY <DOCTOR,
`FAMILY, EMERGENCY
`SERVICES.
`CAREGIVER, HOSPITAL,
`NURSING HOME, CALL
`CENTER, ETC.) 210
`
`BASE STATION·
`LOCAL SERVER 20
`
`90
`
`Mesh Netwol1t
`Appliances8
`
`30
`
`FIG. 1
`
`2
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 2 of 26
`
`US 2008/0004904 Al
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`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 4 of 26
`
`US 2008/0004904 Al
`
`Place a calibration sheet with known dots at a known distance
`
`and perpendicular to a camera view
`
`Take snap shot of the sheet, and correlate the position of the
`
`dots to the camera image
`
`Place a different calibration sheet that contains known dots at
`
`another different known distance and perpendicular to camera
`
`view.
`
`Take snap shot of the sheet and correlate the position of the
`
`dots to the camera image
`
`Smooth the dots to the pixels to minimize digitization errors
`
`For each pixel, draw a line from Dotl(x,y,z) to Dot2 (x, y, z)
`
`defining a cone center where the camera can view
`
`FIG. 2
`
`5
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 5 of 26
`
`US 2008/0004904 Al
`
`Find floor space area
`
`Define camera view
`
`background 3D scene
`
`Calculate patient's key features
`
`Detect fall
`
`FIG. 3
`
`Find floor space area
`
`Define camera view background 3D scene
`
`6
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 6 of 26
`
`US 2008/0004904 Al
`
`Calculate patient's key features
`
`Extract facial objects
`
`Detect facial orientation
`
`Detect facial ·expression
`
`FIG. 4
`
`7
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 7 of 26
`
`US 2008/0004904 Al
`
`Set up mesh network appliances (I 000)
`
`Determine patient position using in-door positioning system (I 002)
`
`Determine patient movement using accelerometer output ( 1004)
`
`Determine vital parameter including patient heart rate (1006)
`
`Determine if patient needs assistance based on in-door position, fall
`
`detection and vital para~eter (1008)
`
`Confirm prior to calling third party (1010)
`
`If confirmed or non-responsive, make connection with third party and
`
`send voice over mesh network to appliance worn by the patient (1012)
`
`If needed, call emergency personnel to get medical care (IO 14)
`FIG. 5
`
`8
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 8 of 26
`
`VS 2008/0004904 Al
`
`1382
`
`FIG. 6A
`
`9
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 9 of 26
`
`US 2008/0004904 Al
`
`HDTV REMOTE
`CONTROL 1399
`
`LIGHTING
`CONTROL 1398
`
`ROOM
`THERMOSTAT
`CONTROL 1396
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`HOME SECURITY
`MONITOR 1394
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`FIRE ALARMS
`1393
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`HOME
`APPLIANCE(S)
`1392
`
`I
`I
`
`MEDICINE
`CONTAINER(S)
`1391
`
`BASE STATION
`OR PERSONAL t - - - - - - -1
`SERVER 1390
`
`AUTHORIZED THIRD PARTY (FRIEND, FAMILY, COMMUNITY, EMERGENCY SERVICES
`HOSPITAL, CAREGIVER, OR MONITORING CALL CENTER, AMONG OTHERS) 1194
`,
`
`FIG. 6B
`
`10
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 10 of 26 US 2008/0004904 Al
`
`Mesh
`
`4I PAM Coordinator- tFFD)
`Q Router Node (FFD)
`@ EedDewc-e IRFDor FFD)
`
`FIG. 7
`
`11
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 11 of 26 US 2008/0004904 Al
`
`FIG. 8
`
`130
`
`134
`
`132
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`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 12 of 26 US 2008/0004904 Al
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`Patent Application Publication
`
`Jan. 3, 2008 Sheet 13 of 26
`
`US 2008/0004904 Al
`
`160
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`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 14 of 26 US 2008/0004904 Al
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`174
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`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 15 of 26 US 2008/0004904 Al
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`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 18 of 26 US 2008/0004904 Al
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`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 19 of 26 US 2008/0004904 Al
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`
`FIG. 15F
`
`-----
`r.- - -
`r1 ~•,u,...,.
`:~:~p II
`
`;_ .,.
`
`11
`
`Ii 1
`r- ·;'
`... , ...
`/ . .,,,,,,.
`IL
`t.<11;•
`~ ~· r.;m,'t)'ll
`Ii
`s,c~.:,:
`y
`·j:.., ... , ...
`/·ns1'1l' -St1~111•
`I
`1!'5 •h
`:
`l,1:1 .....
`' ...
`
`:: ~
`all
`:"ti
`l!I !!'
`
`I ;; .,
`~ ••
`
`~
`
`~
`
`20
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 20 of 26 US 2008/0004904 Al
`
`Generate a blood pressure model of a patient (2002)
`
`Determine a blood flow velocity using a piezoelectric transducer (2004)
`
`Provide the blood flow velocity to the blood pressure model to
`
`continuously estimate blood pressure (2006)
`
`FIG. 16A
`
`Attach monitoring device and calibration device to patient (2010)
`
`Determine blood flow velocity from the monitoring device and actual
`
`blood pressure from the calibration device (2012)
`
`Generate a blood pressure m~del based on the blood flow velocity and the
`
`actual blood pressure (2014)
`
`21
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 21 of 26 US 2008/0004904 Al
`
`Remove calibration device (2016)
`
`Determine blood flow velocity (2018)
`
`Provide blood flow velocity to the blood pressure model to estimate blood
`
`pressure (2020)
`
`FIG. 16B
`
`22
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 22 of 26 US 2008/0004904 Al
`
`Detect weakness in left half and right half of patient body -.arms, legs,
`
`face (3000)
`
`Detect walking pattern for loss of balance or coordination (3002)
`
`Ask user to move hands/feet in a predetermined pattern (3004)
`
`Read accelerometer output in accordance with predetermined pattern
`
`movement (3006)
`
`Provide accelerometer output to a pattern classifier (3008)
`
`Check whether patient is experiencing dizziness or sudden, severe
`
`headache with no known cause (3010)
`
`Display a text image and ask the patient to read back the text image,
`
`one eye at a time (3012)
`
`Use speech recognizer to detect confusion, trouble speaking or
`
`understanding (301 4)
`
`23
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 23 of 26 US 2008/0004904 Al
`
`Ask patient if they feel numbness in the body- arms, legs, face (3016)
`
`Ask patient to squeeze gauge/force sensor to determine force applied
`
`during squeeze (3018)
`
`FIG. 16C
`
`24
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 24 of 26 US 2008/0004904 Al
`
`Left
`upper
`ann
`
`Left
`lower
`arm
`
`Torso
`
`Left
`thigh
`
`Right
`thigh
`
`Letl
`calf
`
`FIG. 16D
`
`Right
`upper
`arm
`
`Right
`lower
`arm
`
`25
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 25 of 26 US 2008/0004904 Al
`
`Compare historical left shoulder (LS) strength against current LS
`
`strength (3200)
`
`Compare historical right shoulder (RS) strength against current
`
`RS strength (3202)
`
`Compare historical left hip (LH) strength against current LH
`
`strength (3204)
`
`Compare historical right hip (RH) strength against current RH
`
`strength (3206)
`
`If variance between historical and current strength exceeds
`
`threshold, generate warning (3208)
`
`FIG. 16E
`
`26
`
`

`

`Patent Application Publication
`
`Jan. 3, 2008 Sheet 26 of 26 US 2008/0004904 Al
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`Muscle site
`
`Vou: = V1-v;
`
`1mm
`
`Reference
`
`FIG. 17A
`
`HISTORICAL MEASUREMENT
`
`RECENT MEASUREMENT
`
`FIG. 17B
`
`FIG. l 7C
`
`27
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`

`US 2008/0004904 Al
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`Jan. 3, 2008
`
`1
`
`SYSTEMS AND METHODS FOR PROVIDING
`INTEROPERABILITY AMONG
`HEALTHCARE DEVICES
`
`[0001] This application claims priority to Provisional
`Application Ser. No. 60/818,260 filed Jun. 30, 2006, the
`content of which is incorporated by reference.
`
`BACKGROUND
`
`[0002] This invention relates generally to methods and
`systems for monitoring a person. The present invention
`relates to interoperability of medical devices.
`[0003] Medical devices are essential to the practice of
`modern medicine. Physiologic measurements like blood
`pressure and temperature, x-ray and ultrasound imaging,
`administration of intravenous medications, and support of
`critical life functions are all routine procedures that use
`medical devices. However, at present, each device is
`designed to stand alone as an island. It is difficult to bring
`together multiple devices into interoperable (inter-con(cid:173)
`nected) systems to improve patient care and avoid unnec(cid:173)
`essary accidents.
`[0004] To address this issue, the Institute of Electrical and
`Electronics Engineers Inc. (IEEE) is developing two new
`point-of-care medical device standards. IEEE P 1073.2.2 .0-
`Health Informatics-Point-of-Care Medical Device Com(cid:173)
`munication-Application Profile-Association Control
`Function-will provide for the establishment, release and
`disconnection of an association between a medical device
`agent and a system acting as a manager. In medical device
`communications, manager systems indicate a set of desired
`capabilities when requesting an association. Agent systems
`respond by stating the capabilities they support across the
`connection. Once an association is established, mechanisms
`must be in place to break the link. IEEE P1073.2.2.0 is
`referenced by other application-profile mode standards
`within the ISO/IEEE 11073 family. The second standards
`project, IEEE P1073.2.2.1-Health Informatics-Point-Of(cid:173)
`Care Medical Device Communication-Application Pro(cid:173)
`file-Polling Mode-will define a method for retrieving
`application data with medical devices that communicate
`through polling protocols. IEEE P1073.2.2.1 will enable
`"plug-and-play" interoperability for simple medical devices
`that use polling protocols for management systems to query
`devices for all information to be communicated.
`
`SUMMARY
`
`[0005] An interoperable health-care system includes a
`network; one or more medical data collection appliances
`coupled to the network, each appliance transmitting data
`conforming to an interoperable format; and a computer
`coupled to the network to store data for each individual in
`accordance with the interoperable format.
`[0006] The user can take his/her weight, blood pressure,
`and cholesterol measurement daily, and the data is sent from
`a health base station to a monitoring service at his doctor's
`office. Periodically, the user gets an automated health sum(cid:173)
`mary generated by a service at his doctor's office as well as
`information to help him maintain a healthy lifestyle. The
`health information can be stored in an external HIPAA
`compliant health storage database so that the user and his
`doctor can access his health information over the web. The
`
`system extends health care system into the home and can
`record personal health data on a systematic periodic basis.
`Appointments can be automatically scheduled with provid(cid:173)
`ers. Long-term data for medical baseline can be collected.
`The system can also provide predictive alerts for high-risk
`conditions. The system can perform initial triage utilizing
`biosensors, images, e-mail/chat/video.
`[0007] Advantages of the system may include one or more
`of the following. The system empowers people with the
`information they need to better manage their health and the
`health of their loved ones. The interoperability enables
`disparate industries to work together to combine their prod(cid:173)
`ucts and services through connectivity standards and provide
`millions of people with the tools they need to better manage
`their health and the health of their families. The system can
`perform chronic disease management, monitoring the health
`and healthcare needs of aging people and proactive health
`and fitness. The interoperable system can address the data
`storage requirements for health and wellness management,
`chronic disease management or patient recovery, medication
`management, and fitness and workout
`tracking. For
`example, using a blood pressure sensor, a weight scale or a
`cholesterol monitor, the user regularly collects health data
`that is then reviewed by the patient's caregiver for remote
`monitoring and health management of the patient. The
`system can provide remote monitoring of multiple patients,
`seamless device replacement and support for clinical trials.
`The Medical Device Profile will be compliant with the US
`Health Insurance Portability and Accountability Act
`(HIPAA) and other international data privacy requirements.
`[0008] By enabling a network of readily connected health
`and medical devices, people with diabetes or other chronic
`diseases will be able to share vital sign information such as
`blood pressure and glucose level with their doctors. Adult
`children will be able to remotely watch over their aging
`parents and proactively help them manage safely in their
`own homes. Diet and fitness conscious individuals will also
`be able to seamlessly share their weight and exercise data
`with fitness consultants through the Internet.
`[0009] The above system forms an interoperable health(cid:173)
`care system with a network; a first medical appliance to
`capture a first vital information and coupled to the network,
`the first medical appliance transmitting the first vital infor(cid:173)
`mation conforming to an interoperable format; and a second
`medical appliance to capture a second vital information and
`coupled to the network, the second medical appliance con(cid:173)
`verting the first vital information in accordance with the
`interoperable format and processing the first and second
`vital information, the second medical appliance providing an
`output conforming to the interoperable format.
`[0010] The appliances can communicate data conforming
`to the interoperable format over one of: cellular protocol,
`ZigBee protocol, Bluetooth protocol, WiFi protocol,
`WiMAX protocol, USB protocol, ultrawideband protocol.
`The appliances can communicate over two or more proto(cid:173)
`cols. The first medical appliance can transmit the first vital
`information over a first protocol (such as Bluetooth proto(cid:173)
`col) to a computer, wherein the computer transmits the first
`vital information to the second medical appliance over a
`second protocol (such as ZigBee prototocol). The computer
`can then transmit to a hospital or physician office using
`broadband such as WiMAX protocol or cellular protocol.
`The computer can perform the interoperable format conver(cid:173)
`sion for the appliances or devices, or alternatively each
`
`28
`
`

`

`US 2008/0004904 Al
`
`Jan. 3, 2008
`
`2
`
`appliance or device can perform the format conversion.
`Regardless of which device performs the protocol conver(cid:173)
`sion and format conversion, the user does not need to know
`about the underlying format or protocol in order to use the
`appliances. The user only needs to plug an appliance into the
`network, the data transfer is done automatically so that the
`electronic "plumbing" is not apparent to the user. In this
`way, the user is shielded from the complexity supporting
`interoperability.
`[0011]
`In another aspect, a monitoring system for a person
`includes one or more wireless nodes and a stroke sensor
`coupled to the person and the wireless nodes to determine a
`medical problem, for example a stroke attack. The stroke
`monitoring system is interoperable with emergency vehicle
`and/or hospital systems and provides information to quickly
`treat stroke once the patient reaches the treatment center.
`[0012]
`In one aspect, a monitoring system for a person
`includes one or more wireless nodes and an electromyogra(cid:173)
`phy (EMG) sensor coupled to the person and the wireless
`nodes to determine a medical issue such as a stroke attack.
`[0013]
`In another aspect, a health care monitoring system
`for a person includes one or more wireless nodes forming a
`wireless mesh network; a wearable appliance having a sound
`transducer coupled to the wireless transceiver; and a bio(cid:173)
`electric impedance (BI) sensor coupled to the wireless mesh
`network to communicate BI data over the wireless mesh
`network.
`[0014]
`In a further aspect, a heart monitoring system for a
`person includes one or more wireless nodes forming a
`wireless mesh network and a wearable appliance having a
`sound transducer coupled to the wireless transceiver; and a
`heart disease recognizer coupled to the sound transducer to
`determine cardiovascular health and to transmit heart sound
`over the wireless mesh network to a remote listener if the
`recognizer identifies a cardiovascular problem. The heart
`sound being transmitted may be compressed to save trans(cid:173)
`mission bandwidth.
`[0015]
`In yet another aspect, a monitoring system for a
`person includes one or more wireless nodes; and a wrist(cid:173)
`watch having a wireless transceiver adapted to communicate
`with the one or more wireless nodes; and an accelerometer
`to detect a dangerous condition and to generate a warning
`when the dangerous condition is detected.
`[0016]
`In yet another aspect, a monitoring system for a
`person includes one or more wireless nodes forming a
`wireless mesh network; and a wearable appliance having a
`wireless transceiver adapted to communicate with the one or
`more wireless nodes; and a heartbeat detector coupled to the
`wireless transceiver. The system may also include an accel(cid:173)
`erometer to detect a dangerous condition such as a falling
`condition and to generate a warning when the dangerous
`condition is detected.
`[0017]
`Implementations of the above aspect may include
`one or more of the following. The wristwatch determines
`position based on triangulation. The wristwatch determines
`position based on RF signal strength and RF signal angle. A
`switch detects a confirmatory signal from the person. The
`confirmatory signal includes a head movement, a hand
`movement, or a mouth movement. The confirmatory signal
`includes the person's voice. A processor in the system
`executes computer readable code to transmit a help request
`to a remote computer. The code can encrypt or scramble data
`for privacy. The processor can execute voice over IP (VOIP)
`code to allow a user and a remote person to audibly
`
`communicate with each other. The voice communication
`system can include Zigbee VOIP or Bluetooth VOIP or
`802.XX VOIP. The remote person can be a doctor, a nurse,
`a medical assistant, or a caregiver. The system includes code
`to store and analyze patient information. The patient infor(cid:173)
`mation includes medicine taking habits, eating and drinking
`habits, sleeping habits, or excise habits. A patient interface
`is provided on a user computer for accessing information
`and the patient interface includes in one implementation a
`touch screen; voice-activated text reading; and one touch
`telephone dialing. The processor can execute code to store
`and analyze information relating to the person's ambulation.
`A global positioning system (GPS) receiver can be used to
`detect movement and where the person falls. The system can
`include code to map the person's location onto an area for
`viewing. The system can include one or more cameras
`positioned to capture three dimensional (3D) video of the
`patient; and a server coupled to the one or more cameras, the
`server executing code to detect a dangerous condition for the
`patient based on the 3D video and allow a remote third party
`to view images of the patient when the dangerous condition
`is detected.
`[0018]
`In another aspect, a monitoring system for a person
`includes one or more wireless bases; and a cellular telephone
`having a wireless transceiver adapted to communicate with
`the one or more wireless bases; and an accelerometer to
`detect a dangerous condition and to generate a warning
`when the dangerous condition is detected.
`[0019]
`In yet another aspect, a monitoring system includes
`one or more cameras to determine a three dimensional (3D)
`model of a person; means to detect a dangerous condition
`based on the 3D model; and means to generate a warning
`when the dangerous condition is detected.
`[0020]
`In another aspect, a method to detect a dangerous
`condition for an infant includes placing a pad with one or
`more sensors in the infant's diaper; collecting infant vital
`parameters; processing the vital parameter to detect SIDS
`onset; and generating a warning.
`[0021] Advantages of the system may include one or more
`of the following. The system detects the warning signs of
`stroke and prompts the user to reach a health care provider
`within 2 hours of symptom onset. The system enables patent
`to properly manage acute stroke, and the resulting early
`treatment might reduce the degree of morbidity that is
`associated with first-ever strokes.
`[0022] Other advantages of the invention may include one
`or more of the following. The system for non-invasively and
`continually monitors a subject's arterial blood pressure, with
`reduced susceptibility to noise and subject movement, and
`relative insensitivity to placement of the apparatus on the
`subject. The system does not need frequent recalibration of
`the system while in use on the subject.
`[0023]
`In particular, it allows patients to conduct a low(cid:173)
`cost, comprehensive, real-time monitoring of their vital
`parameters including blood pressure. Using the web services
`software interface, the invention then avails this information
`to hospitals, home-health care organizations, insurance com(cid:173)
`panies, pharmaceutical agencies conducting clinical trials
`and other organizations. Information can be viewed using an
`Internet-based website, a personal computer, or simply by
`viewing a display on the monitor. Data measured several
`times each day provide a relatively comprehensive data set
`compared to that measured during medical appointments
`separated by several weeks or even months. This allows both
`
`29
`
`

`

`US 2008/0004904 Al
`
`Jan. 3, 2008
`
`3
`
`the patient and medical professional to observe trends in the
`data, such as a gradual increase or decrease in blood
`pressure, which may indicate a medical condition. The
`invention also minimizes effects of white coat syndrome
`since the monitor automatically makes measurements with
`basically no discomfort; measurements are made at the
`patient's home or work, rather than in a medical office.
`[0024] The wearable appliance is small, easily worn by the
`patient during periods of exercise or day-to-day activities,
`and non-invasively measures blood pressure can be done in
`a matter of seconds without affecting the patient. An on(cid:173)
`board or remote processor can analyze the time-dependent
`measurements to generate statistics on a patient's blood
`pressure (e.g., average pressures, standard deviation, beat(cid:173)
`to-beat pressure variations) that are not available with con(cid:173)
`ventional devices that only measure systolic and diastolic
`blood pressure at isolated times.
`[0025] The wearable appliance provides an in-depth, cost(cid:173)
`effective mechanism to evaluate a patient's cardiac condi(cid:173)
`tion. Certain cardiac conditions can be controlled, and in
`some cases predicted, before they actually occur. Moreover,
`data from the patient can be collected and analyzed while the
`patient participates in their normal, day-to-day activities.
`In cases where the device has fall detection in
`[0026]
`addition to blood pressure measurement, other advantages of
`the invention may include one or more of the following. The
`system provides timely assistance and enables elderly and
`disabled individuals to live relatively independent lives. The
`system monitors physical activity patterns, detects the
`occurrence of falls, and recognizes body motion patterns
`leading to falls. Continuous monitoring of patients is done in
`an accurate, convenient, unobtrusive, private and socially
`acceptable manner since a computer monitors the images
`and human involvement is allowed only under pre-desig(cid:173)
`nated events. The patient's privacy is preserved since human
`access to videos of the patient is restricted: the system only
`allows human viewing under emergency or other highly
`controlled conditions designated in advance by the user.
`When the patient is healthy, people cannot view the patient's
`video without the patient's consent. Only when the patient's
`safety is threatened would the system provide patient infor(cid:173)
`mation to authorized medical providers to assist the patient.
`When an emergency occurs, images of the patient and
`related medical data can be compiled and sent to paramedics
`or hospital for proper preparation for pick up and check into
`emergency room.
`[0027] The system allows certain designated people such
`as a family member, a friend, or a neighbor to informally
`check on the well-being of the patient. The system is also
`effective in containing the spiraling cost of healthcare and
`outpatient care as a treatment modality by providing remote
`diagnostic capability so that a remote healthcare provider
`(such as a doctor, nurse, therapist or caregiver) can visually
`communicate with the patient in performing remote diag(cid:173)
`nosis. The system allows skilled doctors, nurses, physical
`therapists, and other scarce resources to assist patients in a
`highly efficient manner since they can do the majority of
`their functions remotely.
`[0028] Additionally, a sudden change of activity ( or inac(cid:173)
`tivity) can ind