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phone-as-a-sensor technology:
mhealth and chronic disease

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eric c. larson | eclarson.com
Assistant Professor Computer Science and Engineering
iPhone 9

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Comp
Sci. & Engr.
arch

algorithms
OS

databases
& data
mining

software

Comp
Sci. & Engr.

languages

AI &
robotics
networking

symbolic
computing
arch

algorithms
OS

databases
& data
mining

software

mobile

Comp
Sci. & Engr.

languages

AI &
robotics
networking

symbolic
computing
arch

algorithms
OS

databases
& data
mining

software

mobile

Comp
Sci. & Engr.

mhealth

languages

AI &
robotics
networking

symbolic
computing
arch

algorithms
OS

databases
& data
mining

software

Comp
Sci. & Engr.

mhealth

languages

AI &
robotics
networking

symbolic
computing

mobile
what is mhealth?
the promise of mhealth:
the promise of mhealth:
revolutionize medicine
the promise of mhealth:
revolutionize medicine
eliminate doctor visits
the promise of mhealth:
revolutionize medicine
eliminate doctor visits
remote / automatic diagnosis
the promise of mhealth:
revolutionize medicine
eliminate doctor visits
remote / automatic diagnosis
equalize developing countries
the promise of mhealth:
revolutionize medicine
eliminate doctor visits
remote / automatic diagnosis
equalize developing countries
the promise of mhealth:
revolutionize medicine
eliminate doctor visits
remote / automatic diagnosis
equalize developing countries
heart rate
zombie run

fitness trainer

stress check

current mhealth

glucose buddy
heart rate
zombie run

stress check

current mhealth

43,000 apps for health on the app store

fitness trainer

glucose buddy
heart rate
zombie run

stress check

current mhealth

43,000 apps for health on the app store
96% are for calorie counting & exercise

fitness trainer

glucose buddy
heart rate
zombie run

stress check

current mhealth

43,000 apps for health on the app store
96% are for calorie counting & exercise
4% are remote monitoring

fitness trainer

glucose buddy
consider physician’s needs
consider physician’s needs
connecting with patient
consider physician’s needs
connecting with patient
tracking baselines
consider physician’s needs
connecting with patient
tracking baselines
personalized trending data
consider physician’s needs
connecting with patient
tracking baselines
personalized trending data
managing chronic disease
consider physician’s needs
connecting with patient
tracking baselines
personalized trending data
managing chronic disease

30% of all US healthcare spending
is on chronic disease
mhealth and chronic disease
management
mhealth and chronic disease
management
compliance?
cost?
doctor patient?
data reliability?
Phone As A Sensor Technology: mHealth and Chronic Disease
compliance
compliance
baseline

sensor

quantity
phone as a sensor
baseline

sensor

quantity
phone as a sensor
baseline

embedded
sensors

sensor

quantity
phone as a sensor
baseline

embedded
sensors

sensor

estimated
quantity

processing
Phone As A Sensor Technology: mHealth and Chronic Disease
accelerometer
gyroscope
magnetometer /compass
dual camera / flash
1+ microphones
proximity sensor
capacitive sensor
gps
motorized actuator
wireless antenna (s)
compliance++;
cost--;
dr_pat *= 10;

accelerometer
gyroscope
magnetometer /compass
dual camera / flash
1+ microphones
proximity sensor
capacitive sensor
gps
motorized actuator
wireless antenna (s)
accelerometer
gyroscope
magnetometer /compass
dual camera / flash
1+ microphones
compliance++;
proximity sensor
cost--;
capacitive sensor
dr_pat *= 10;
gps
motorized actuator
data reliability?
wireless antenna (s)
what can the mobile phone
sense with clinical accuracy?
lung
function

jaundice

future
research
lung
function

jaundice

future
research
spirometer ?

lung function?
lung function
evaluates pulmonary
impairments
asthma
COPD
cystic fibrosis
spirometer

device that measures
amount of air inhaled and
exhaled.
volume

flow

using a spirometer

time

volume
volume

flow

using a spirometer

time

volume
volume

flow

using a spirometer

time

volume
volume

volume-time graph

time
volume

volume-time graph

time
volume-time graph
FVC

volume

FEV1

time

FEV1: Forced Expiratory Volume in 1 second
FVC: Forced Vital Capacity
volume-time graph
FVC

volume

FEV1

1 sec.

time

FEV1: Forced Expiratory Volume in 1 second
FVC: Forced Vital Capacity
volume-time graph
FEV1% = FEV1/FVC

FVC

volume

FEV1

1 sec.

time

FEV1: Forced Expiratory Volume in 1 second
FVC: Forced Vital Capacity
FEV1% = FEV1/FVC

FEV1: Forced Expiratory Volume in 1 second
FVC: Forced Vital Capacity
FEV1% = FEV1/FVC

> 80%

healthy

60 - 79%

mild

40 - 59%

moderate

< 40%

severe

FEV1: Forced Expiratory Volume in 1 second
FVC: Forced Vital Capacity
flow

flow-volume graph

volume
flow

flow-volume graph

volume
flow-volume graph
PEF

flow

1 sec.

FEV1

FVC
volume

PEF: Peak Expiratory Flow
FEV1: Forced Expiratory Volume in 1 second
FVC: Forced Vital Capacity
flow-volume graph

flow

normal

volume
flow-volume graph
normal
flow

obstructive

volume
obstructive diseases

!

resistance in air path leads to reduced air flow
obstructive diseases

!

resistance in air path leads to reduced air flow
restrictive diseases

!

lungs are unable to pump enough air and pressure
restrictive diseases

!

lungs are unable to pump enough air and pressure
flow-volume graph
normal
Flow

obstructive

Volume
flow-volume graph
normal
Flow

obstructive
restrictive
Volume
clinical spirometry
home spirometry
home spirometry

!

faster detection
rapid recovery
trending
challenges with

home spirometry

high cost barrier
patient compliance
less coaching
limited integration
SpiroSmart
availability
cost
portability
more effective coaching interface
integrated uploading
Using SpiroSmart
Using SpiroSmart
Using SpiroSmart

]
Using SpiroSmart

]
Using SpiroSmart

]
Using SpiroSmart
Using SpiroSmart
flow rate
volume

airflow
sensor

lung function
flow rate
volume

airflow
sensor

sound
pressure

microphone

lung function
flow rate
volume

airflow
sensor

estimated
lung function

sound
pressure

microphone

processing
audio
audio
flow features
audio
flow features
measures
regression
FEV1
FVC
PEF
audio
flow features
measures
regression

curve
regression
Flow(L/s)

10

10

5

5
0

0

1

0
40

Volume(L) Volume(L)

FEV1
FVC
PEF

Flow(L/s)

15
15

2
Volume(L)

4

2
Volume(L)

1

3

3

3

4
2
1
3
0

20
1

2

4

6
time(s)

8

10

4
audio
flow features
measures
regression

curve
regression
Flow(L/s)

lung function

10

10

5

5
0

0

1

0
40

Volume(L) Volume(L)

FEV1
FVC
PEF

Flow(L/s)

15
15

2
Volume(L)

4

2
Volume(L)

1

3

3

3

4
2
1
3
0

20
1

2

4

6
time(s)

8

10

4
flow features estimation
amplitude

1
0.5
0
−0.5
−1
0

1

2

3

4

time(s)

5

6

7
flow features estimation
0.5
0
−0.5
−1
0

1

2

3

4

5

6

time(s)

source

vocal tract
2500

frequency(Hz)

amplitude

1

2000
1500
1000
500
0

output

7
flow features estimation
lpc8raw

amplitude

1

0.5

0.5
0
−0.5

0

flow estimation features

amplitude

−0.5

1

2

3

4

5

6

7

time(s)

0.5
0
−0.5

resonance tracking
lpc8raw

1

2

3

4

5

6

time(s)

source

vocal tract
2500
2000
1500
1000
500
0

−1 1
0

7
amplitude

−1
0

envelope detection

−1
10

frequency(Hz)

amplitude

1

output

1

2

3

4

5

6

7

time(s)

0.5
0
−0.5
−1
0

auto-regressive estimate
1

2

3

4

time(s)

5

6

7
measures
regression

8

flow(L/s)

6
4
2

ground truth

0
−1

0

1

2

3

4

5

time(s)

feature value

0.4
0.3
0.2
0.1
0

feature 1
0

1

2

4

5

time(s)

0.4

feature value

3

0.3
0.2
0.1

feature 2
0
−1

0

1

2

time(s)

3

4

5
8
6

flow(L/s)

measures
regression

7.1

4
2

PEF features

ground truth

0
−1

0

1

2

3

4

5

time(s)

feature value

0.4
0.3
0.2
0.1
0

feature 1
0

1

2

4

5

time(s)

0.4

feature value

3

0.3
0.2
0.1

feature 2
0
−1

0

1

2

time(s)

3

4

5
8
6

flow(L/s)

measures
regression

7.1

4
2

PEF features

ground truth

0
−1

0

1

2

3

4

5

time(s)

feature value

0.4
0.3
0.2
0.1
0

feature 1
0

1

2

4

5

time(s)

0.4

feature value

3

0.3
0.2
0.1

feature 2
0
−1

0

1

2

time(s)

3

4

5

0.35
0.33
8
6

flow(L/s)

measures
regression

7.1
3.2

4
2

PEF features

ground truth

0
−1

0

1

2

3

4

5

time(s)

feature value

0.4
0.3
0.2
0.1
0

FEV1 features

feature 1
0

1

2

3

4

5

time(s)

0.4

feature value

0.35
0.33

0.3
0.2
0.1

feature 2
0
−1

0

1

2

time(s)

3

4

5
8
6

flow(L/s)

measures
regression

7.1
3.2

4
2

PEF features

ground truth

0
−1

0

1

2

3

4

5

time(s)

feature value

0.4
0.3
0.2
0.1
0

FEV1 features

feature 1
0

1

2

3

4

0.12
0.17

5

time(s)

0.4

feature value

0.35
0.33

0.3
0.2
0.1

feature 2
0
−1

0

1

2

time(s)

3

4

5
measures regression
FEV1 features

PEF features
measures regression
FEV1 features

PEF features

bagged
decision tree

bagged
decision tree
measures regression
FEV1 features

PEF features

bagged
decision tree

bagged
decision tree

output

output
curve regression
feature 1

0.3
0.2
0.1

0

1

3

4

5

time(s)

0.4

feature value

2

feature N

0.3
0.2
0.1
0

...

0
−1

...

windowed machine
learning regression

feature value

0.4

0

1

2

time(s)

3

4

5
curve regression
feature 1

0.3
0.2
0.1

0

1

3

4

5

time(s)

0.4

feature value

2

...

0
−1

...

feature N

0.3
0.2
0.1
0
8
6

flow(L/s)

windowed machine
learning regression

feature value

0.4

4
2
0

0

1

2

3

4

5

time(s)

curve
output
curve regression
0.4

feature value

feature value

0.4
0.3
0.2
0.1
0
−1

0

1

2

3

time(s)

bagged
decision tree

4

0.3
0.2
0.1
0
5

0

1

2

time(s)

3

4

5
curve regression
0.4

feature value

feature value

0.4
0.3
0.2
0.1
0
−1

0

1

2

3

time(s)

bagged
decision tree

4

0.3
0.2
0.1
0
5

0

1

2

3

4

time(s)

CRF

5
curve regression
0.4

feature value

feature value

0.4
0.3
0.2
0.1
0
−1

0

1

2

3

4

0.3
0.2
0.1
0
5

0

1

2

bagged
decision tree
!

6

flow(L/s)

4

CRF

8

4
2
0
−1

3

time(s)

time(s)

0

1

2

time(s)

3

4

5

5
study design

x3
x3
study enrollment
study enrollment
study a
participants

52

18-75 years old, mostly healthy
study enrollment
study a
participants

52

18-75 years old, mostly healthy
study b
participants

10

12-17 years old, mixed healthy/abnormal
study enrollment
study a
participants

52

18-75 years old, mostly healthy
study b
10

12-17 years old, mixed healthy/abnormal
study c
participants

56

10-69 years old, mostly abnormal

enrolled by
pulmonologists

participants
measures regression results
measures regression results
curves regression results
15

6

flow(L/s)

flow(L/s)

8

4
2
0
−1

0

1

2

volume(L)

3

4

10

5

0
−2

0

2

volume(L)

4

6
curves regression results
15

6

flow(L/s)

flow(L/s)

8

4
2
0
−1

0

1

2

volume(L)

3

4

10

5

0
−2

0

2

volume(L)

4

6
curves regression results
15

flow(L/s)

6
4
2
0
−1

0

1

2

3

10

5

0
−2

4

0

volume(L)

2

volume(L)

15

flow(L/s)

flow(L/s)

8

10

5

0
−2

0

2

volume(L)

4

6

4

6
curves regression results
15

flow(L/s)

6
4
2
0
−1

0

1

2

3

10

5

0
−2

4

0

volume(L)

2

volume(L)

15

flow(L/s)

flow(L/s)

8

10

5

0
−2

0

2

volume(L)

4

6

4

6
can SpiroSmart curves be
used for diagnosis?
survey
survey
• normal/abnormal subjects curves
survey
• normal/abnormal subjects curves
• 5 pulmonologists
survey
• normal/abnormal subjects curves
• 5 pulmonologists
• unaware if from SpiroSmart / spirometer
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
results
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive
results
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive

identical
64%
results
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive

one off
10%

identical
64%
results
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive

one off
10%

identical
64%
results
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive

false positive
14%

one off
10%

identical
64%
results
false negative
4%
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive

false positive
14%

one off
10%

identical
64%
results
error
8%

false negative
4%
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive

false positive
14%

one off
10%

identical
64%
results
error
8%

false negative
4%
restrictive
inadequate
normal
minimal obstructive
mild obstructive
moderate obstructive
severe obstructive

false positive
14%

!
!

abnormal vs normal
one off
96%
identical
10%

64%
appropriate for
trending and screening
global health non-profit
global health non-profit

patient and doctors
global health non-profit

patient and doctors

pharmaceutical drug trials
lung
function

jaundice

future
research
lung
function

jaundice

future
research
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
Phone As A Sensor Technology: mHealth and Chronic Disease
neonatal jaundice in the US
kernicterus:
21

hazardous
jaundice: 1158
extreme jaundice:
2,317
severe jaundice: 35,000

phototherapy: 290,000
visible jaundice: 3.5 million
births/year: 4.1 million
Method

Accuracy

Disadvantages

TSB

Gold standard
(r=1.0)

Painful, costly,
inconvenient, delayed

Accurate
(r= 0.75 -0.93)

Meter = $7000
tips $5
unavailable in most
physician offices

TcB

Visual assessment
(provider or parent)

not accurate
(r= 0.36 - 0.7),
underestimates
severity

No standardization
lighting, pigmentation
bilirubin
level in blood

blood
draw

jaundice level
bilirubin
level in blood

blood
draw

yellowness

camera

jaundice level
bilirubin
level in blood

blood
draw

estimated
jaundice level

yellowness

camera

processing
Phone As A Sensor Technology: mHealth and Chronic Disease
bilicam
Phone As A Sensor Technology: mHealth and Chronic Disease
study A
participants

48 newborns

0-4 days old, collected in nursery
3 hospitals in Washington & Philadelphia
study A
participants

48 newborns

0-4 days old, collected in nursery
3 hospitals in Washington & Philadelphia
bilicam
Color
Linearization
• Camera Settings
Adjustment
• Light Source Estimation

Image
Segmentation
• Quality Control for Distance,
Lighting, and Shadow
• Sternum, Forehead, Card
Segmented

Color
Calibration
• Dynamic Least Squares
Regression
• Automatic Feature
Selection

Neonatal Skin
Response to
Bilirubin
• Skin Independent Color
Transformations Applied
• Multivariate Machine Learning
Regression
bilicam initial results
bilirubin level

20
15
10
5
0

r=0.91
mg/dl

20
5
10
15
bilicam estimation
bilicam initial results
bilirubin level

20
15
10
5
0

r=0.91
non
white
mg/dl
white

20
5
10
15
bilicam estimation
bilicam initial results
bilirubin level

20

TcB = 0.85

15
10
5
0

r=0.91
non
white
mg/dl
white

20
5
10
15
bilicam estimation
bilicam initial results
bilirubin level

20

TcB = 0.85
BiliCam = 0.84

15
10
5
0

r=0.91
non
white
mg/dl
white

20
5
10
15
bilicam estimation
bilicam future work
bilicam future work
• near term: screening
bilicam future work
• near term: screening
• medium term: more data
bilicam future work
• near term: screening
• medium term: more data
• long term: developing world
bilicam future work
• near term: screening
• medium term: more data
• long term: developing world
“in many resource poor nations,
hyperbilirubinemia is the second or
third leading cause of infant
mortality and disability”
lung
function

jaundice

future
research
lung
function

jaundice

future
research
future research

oxygen volume, VO2
cardiac output and blood pressure
intra ocular pressure
intra ocular pressure

PressCam
eclarson.com
eclarson@lyle.smu.edu
> slide to unlock
@ec_larson

Thank You!
phone-as-a-sensor technology:
mhealth and chronic disease

eclarson.com
eclarson@lyle.smu.edu
> slide to unlock
@ec_larson

eric c. larson | eclarson.com
Assistant Professor Computer Science and Engineering

collaborators:
!
Joseph Camp
Shwetak Patel
Jim Stout, MD
Jim Taylor, MD
Margaret Rosenfeld, MD
Gaetano Boriello
Mayank Goel
Lilian DeGreef
phone-as-a-sensor technology:
mhealth and chronic disease

eclarson.com
eclarson@lyle.smu.edu
@ec_larson

eric c. larson | eclarson.com
Assistant Professor Computer Science and Engineering

collaborators:
!
Joseph Camp
Shwetak Patel
Jim Stout, MD
Jim Taylor, MD
Margaret Rosenfeld, MD
Gaetano Boriello
Mayank Goel
Lilian DeGreef

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