How a wearable wireless sensor and personalized analytics could revolutionize vital sign monitoring in Ebola Treatment Units
Throughout the West African Ebola outbreak, health care workers have been at the forefront of the battle to save lives and end the spread of the disease. An estimated 881 health care workers have contracted Ebola in Guinea, Liberia, and Sierra Leone since the start of the outbreak in 2013. More than 500 are reported to have died.[1] The loss of so many clinical staff represents a catastrophic blow to the already resource limited health systems in these countries, and highlights the extremely challenging and dangerous conditions in which health care workers conduct their life-saving work.
In November, 2014, the Ebola Grand Challenge was announced in a partnership by the U.S. Agency for International Development (USAID), the White House Office of Science and Technology Policy, the Centers for Disease Control and Prevention, and the U.S. Department of Defense. It called for pioneering ideas for new tools that will help health care workers win the fight against Ebola. The first round of grants were awarded to innovations that focus on increasing the protection and comfort of health care workers working in Ebola Treatment Units (ETUs). Among the 14 innovations chosen to receive support, was a solution submitted by a consortium of academic and industry partners, including the Scripps Translational Science Institute (STSI), which enables remote sensing of vital signs through the use of wireless sensor technology and enhanced analytics software.
Under the leadership of Dr. Steven Steinhubl, Director of Digital Medicine at STSI and a cardiologist at Scripps Clinic, this novel solution seeks to address two major challenges that health care workers in ETUs face. The first is reducing the amount of time health care workers need to spend taking Personal Protective Equipment (PPE) on and off (also known as “donning” and “doffing”), as well as minimizing the time they spend in high-risk zones inside the ETU, exposing themselves to the risk of infection by the deadly pathogen. The second challenge is removing the guesswork from correctly predicting when a patient is decompensating (in other words, when their condition is deteriorating) by arming the health care workers with individualized patient vital sign data, enabling more precise monitoring and personalized care. The solution described here is being developed by the STAMP2 (Sensor Technology & Analytics to Monitor, Predict and Protect Ebola patients) consortium, a partnership between STSI, PhysIQ, and Rhythm Diagnostic Systems.
For health care workers, there are multiple benefits to remote sensing of vital signs. Conventionally, patients admitted to ETUs have their vital signs recorded every 6 to 8 hours. To obtain these metrics, health care workers have to cover themselves head-to-toe in PPE, risking heat stress, which can lead to mistakes in infection control measures. Some low resource health care facilities in West Africa also have limited stocks of PPE, which can lead to health care workers not being able to take the proper precautionary measures. There is also the hugely time consuming task of donning and doffing PPE, a process where a single error can result in the health care worker becoming infected.
The solution developed by STAMP2, enables health care workers to obtain important information regarding critical changes in patients’ physiological parameters, all without setting foot into the ward. The MultiSense sensor (developed by Rhythm Diagnostic Systems), utilizes Bluetooth to continuously stream a patient’s physiological data to a computer, smart phone, or other mobile device, allowing for real-time monitoring by the health care workers. The sensor consists of a disposable, battery-powered, waterproof patch, which is placed on a patient’s chest like a band-aid. It continuously monitors the patient’s heart rate, pulse synchronized oxygen saturation, temperature, respiratory rate, depth of respiration, and motion/position.
STAMP2 combines this cutting-edge sensor technology with analytics software that helps address a need for Personalized Physiology Analytics (PPA). Rather than comparing a patients physiological parameters against population based “norms”, which can be incredibly broad, physIQ’s PPA allows health care workers to measure them against the patient’s own baseline. This enables them to more accurately identify if and when changes in a patient’s physiologic status occur, even before symptoms manifest, allowing health care workers to administer potentially life-saving interventions at the right time.
“It’s remarkable how we’re able to leapfrog a generation of health care, in low resource settings such as Sierra Leone, because of what mobile technology allows you to do.” – Dr. Steven Steinhubl
In July 2015, Dr. Steinhubl conducted a three week field-test of STAMP2’s solution, during which he monitored suspected Ebola patients at an ETU run by the International Medical Corp in Makeni, Sierra Leone. “It’s remarkable how we’re able to leapfrog a generation of health care, in low resource settings such as Sierra Leone, because of what mobile technology allows you to do,” says Dr. Steinhubl. “And there’s so much more that can be done by leveraging the advances that have been made in genetic sequencing, diagnostics and monitoring capabilities.”
“It’s an exciting opportunity to show what can be done because of mobile technology,” says Dr. Steinhubl. “We’re able to take sophisticated monitoring that up until now would require an intensive care unit in a brick-and-mortar hospital, and deploy it in a tent facility, in extremely rural settings with a generator for electricity, and no internet.”
And applying STAMP2’s solution to Ebola patient care is just the beginning. “The whole vision is that in any low resource setting, or even a high resource setting such as a hospital here in the U.S., this technology can be used to develop an automated alerting system that notifies clinical staff when there are signs of decompensation in a patient”, explains Dr. Steinhubl. This will help save health care worker time, and ultimately result in better health outcomes. Based on their recently completed successful pilot study, a much larger scale and longer field test is being developed with the results to allow for continuous monitoring to be broadly scaled to all settings where limited resources and health infrastructure are common, such as in disaster responses or epidemics.
Learn more about the STAMP2 consortium’s work and how the technology described here is being implemented by reading “Remote Sensing of Vital Signs: A Wearable, Wireless ‘Band-Aid’ Sensor With Personalized Analytics for Improved Ebola Patient Care and Worker Safety” published in Global Health: Science and Practice in September 2015.
[1] http://apps.who.int/ebola/current-situation/ebola-situation-report-2-september-2015
Related links –
Learn more about the Ebola Grand Challenge
Learn more about the International Medical Corp
Learn more about physIQ
Learn more about Rhythm Diagnostics Systems