Doctors @RanchoRehab Aim to Reduce Diabetes-Related Amputation with @Microsoft @Azure

This great release from the folks at Microsoft Azure detailing efforts by our Rancho team to develop next-gen technologies like Smart Boots to help people navigate their world a little better

Continuous patient monitoring is one of the newest and most innovative applications of the Internet of Things (IoT) in healthcare. Real-time patient data is transforming the relationship between clinician and patient, shifting from traditional reactive, symptom-based care toward proactive, personalized care. Whether in the hospital or in the home, continuous patient monitoring is critical for enabling timely medical interventions, reducing readmission rates, and improving health outcomes. Using Microsoft Azure IoT Central and the Azure API for FHIR (Fast Healthcare Interoperability Resources), software and wearables company Sensoria Health was able to develop a highly secure continuous monitoring solution for diabetic patients at high risk of lower limb amputations.What if you could take the best of wearable technology, the best of prosthetics and orthotics, and the best in cloud computing and create a solution that allows physicians to work on a treatment with their patients, rather than forcing it on them? That’s what we’ve set out to do at Rancho Los Amigos with Sensoria Health and Microsoft Azure. 

Dr. David Armstrong: Cofounder of the Southwestern Academic Limb Salvage Alliance (SALSA) at Rancho Los Amigos National Rehabilitation Center and USC, Coeditor of the American Diabetes Association‘s Clinical Care of the Diabetic Foot, and Professor of Surgery at Keck School of Medicine

University of Southern California (USC)

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Every 1.2 seconds, someone somewhere in the world is afflicted with a diabetic foot wound, according to Dr. David Armstrong, Professor of Surgery and Director of the Southwestern Academic Limb Salvage Alliance (SALSA) at the Keck School of Medicine at the University of Southern California. As a result, every 20 seconds, someone has a leg or foot amputated due to diabetes-related complications. Once the amputation takes place, five-year mortality is between 50 and 75 percent—similar to the most dangerous types of cancer. 

Dr. Armstrong has made it his mission to fight back against diabetes-related amputations. He’s part of a cross-disciplinary team of specialists working together with Rancho Los Amigos National Rehabilitation Center on a new approach to treating diabetes-related foot injuries. The team includes Dr. Jeff Rankin, Co-Director of Rehabilitation Engineering and Biomedical Engineer at Rancho Los Amigos National Rehabilitation Center, and the wearable technology experts at Sensoria Health.

“The gold standard for helping diabetes-related injuries heal is protecting them with a boot,” says Dr. Armstrong. “The problem is that the disease has stripped many patients of their ability to feel the pain of their injuries, so people often tend to underestimate the risk and remove their boot too soon, worsening their condition.” 

To combat this eventuality, many doctors today lock their patients in their boots or in casts. However, in the minds of the team working at Rancho Los Amigos, this option is punitive. “What if you could take the best of wearable technology, the best of prosthetics and orthotics, and the best in cloud computing and create a solution that allows physicians to work on a treatment with their patients, rather than forcing it on them?” continues Dr. Armstrong. “That’s what we’ve set out to do at Rancho Los Amigos with Sensoria Health and Microsoft Azure.”

Cloud-connected medicine

Dr. Armstrong chose organizations uniquely situated to help create a solution capable of combating the worst side effects of diabetes. Part of Los Angeles County’s Department of Health Services, Rancho Los Amigos National Rehabilitation Center is one of the largest rehabilitation hospitals in the United States and has been a leader in research and innovation throughout the majority of its 125-year history. There, sewing machines sit beside 3D printers, and both get used regularly to create new orthotics and other treatment options. “There is not a finer orthotic laboratory in the USA than the one at Rancho Los Amigos,” says Armstrong. 

Sensoria Health is a company with a single objective: to enable biometric data collection from garments and footwear. The steady stream of physiological data that the company collects thanks to its microelectronic device, Sensoria Core, gives physicians the ability to make better-informed decisions regarding the health and care of their patients. “We aim to deliver technology that clinicians can use to provide a seamless solution to patients that greatly increases their chances of healing,” says Davide Vigano, Cofounder and CEO of Sensoria Health. 

Together with Optima Molliter in Italy, the team began to create a smart boot with Internet of Things (IoT) sensors that connect to specialized software for monitoring patient health data. But the team knew that this would require a lot of development—and the faster the development, the sooner patients and doctors could begin using the new device to save limbs. “We suddenly had four very important goals,” says Vigano. “We needed to quickly select the best patient offloading boot technology, build enterprise-class applications for both doctors and patients to use with the device, send data from the device in a way that would help people achieve compliance with HIPAA and other similar privacy-related legislation around the world, and find a way for the device’s data to easily flow from clinician to clinician across the very siloed healthcare industry. Using Microsoft Azure helped us deliver on all those requirements in a very short period of time.” 

Sensoria Health now provides a multidimensional solution, including a clinician dashboard that gives clinicians a holistic view of their patient population and treatment compliance along with a patient mobile app that displays daily treatment adherence scores, real-time behavioral feedback, and a graph of past successes and areas in which the patient can improve. Sensoria Health was able to jumpstart its cloud solution using the continuous patient monitoring template within Azure IoT Central, quickly connecting the boot and its valuable sensor data to the cloud, and taking advantage of the Azure API for FHIR (Fast Healthcare Interoperability Resources) for highly secure management of personal health information (PHI). Azure IoT Central gives the device operators the control they need to provision and manage the connectivity of millions of boots simultaneously through a straightforward, customizable device dashboard. 

“Creating a solution that combines hardware, artificial intelligence, mobile applications, and the cloud to improve the lives of patients is incredibly complex,” says Vigano. “But with Azure IoT Central, we were able to create something that will very soon be a great aid to doctors and patients alike.”

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A win-win-win solution

The resulting Optima Molliter Motus Smart connected boot is made in Italy to provide foot stabilization, mechanical offloading, and constant data to patients, their doctors, and others within their circle of care. With this information, clinicians can proactively contact their patients and address any issues that might be impeding proper treatment. This helps personalize care and increase the chances that diabetic ulcers heal fully, which in turn decreases the likelihood that people with diabetes will need to give up their limbs. “Without the Azure API for FHIR that Sensoria Health used for the clinician remote monitoring software, and without the interoperability Azure IoT Central gives us, we’d be fighting diabetic foot disease with one arm tied behind our backs,” says Armstrong. “And when you’re talking about preserving limbs and life, you need to be fighting at full strength.” 

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According to Dr. Rankin, it is estimated that patients only wear their diabetic footwear around 60 percent of the time they are moving about, greatly reducing the effectiveness of clinical treatment. The reasons for this low adherence are multifactorial and unique to an individual. “With Azure IoT Central working within the Sensoria/Optima Molliter Boot, we have the ability to provide regular feedback to both patients and caregivers,” says Dr. Rankin. “This in turn allows us to better understand patient needs and proactively collaborate with them to improve their adherence to clinical recommendations—ultimately allowing us to consistently generate positive healing outcomes.”

Adds Vigano, “We estimate that in 2019, diabetic foot ulcers and their related complications cost the US taxpayer $17.5 billion. So many people are now impacted that it is a lose-lose-lose situation, for patients, for doctors, and even for taxpayers. We want to reverse that by preventing many of these injuries, lowering the number of amputations and the costs associated with them, and helping doctors get government reimbursement for a remote patient monitoring job well done. With our ingenuity, new hardware and software, and the support of Azure, we’re beginning to make that happen.”

Find out more about Rancho Los Amigos National Rehabilitation Centeron TwitterFacebook, and LinkedIn.

Without the Azure API for FHIR that Sensoria Health used for the clinician remote monitoring software, and without the interoperability Azure IoT Central gives us, we’d be fighting diabetic foot disease with one arm tied behind our backs. And when you’re talking about preserving limbs and life, you need to be fighting at full strength.” 

Dr. David Armstrong: Cofounder of the Southwestern Academic Limb Salvage Alliance (SALSA) at Rancho Los Amigos National Rehabilitation Center and USC, Coeditor of the American Diabetes Association‘s Clinical Care of the Diabetic Foot, and Professor of Surgery at Keck School of Medicine University of Southern California (USC)

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