Development of a mobile medical application for imaging and analysis of arthritis of the hand: Nicholas MacKinnon, Shanil Gunasekara, Fartash Vasefi eTreat Medical Diagnostics Inc., Vancouver, BC, Canada This project introduces a new smartphone and tablet deployable mobile medical application that utilizes device sensors, internet connectivity and cloud-based image processing to document and analyze physiological characteristics of hand arthritis. The application facilitates image capture and performs image processing that identifies hand fiduciary features and feature metrics to report and quantify the progress of arthritic disease. In addition to describing this process, we discuss the technical issues and regulatory challenges related to development and deployment of mobile medical applications with reference to the 2013 FDA Final Guidance on Mobile Medical applications, HIPA requirements, and compliance with the ISO/IEEE 11073-10201 Domain Information Model (DIM) standard for integration with personal or institutional health records. Presented at The Canadian Medical and Biological Engineering Society Conference CMBEC 37 in Vancouver Canada May 21 2014

1. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
Nicholas MacKinnon, Shanil Gunasekara, Fartash Vasefi
May 2014
©2014 eTreat Medical Diagnostics Inc.
www.etreatmd.com
Corresponding author: nmackinnon@etreatmd.com
DEVELOPMENT OF A MOBILE MEDICAL
APPLICATION FOR IMAGING AND
ANALYSIS OF ARTHRITIS OF THE HAND
eTreat Medical Diagnostics Inc.

2. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
Outline
• eTreat Mobile Health Approach
• Hand Arthritis
• Image transfer and security
• Image Analysis
• Reporting and Tracking
• Arthtrac Market
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3. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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eTreat Mobile Health
• Mobile apps and cloud computing to manage
chronic health problems throughout the world

4. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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Global Demand for Mobile Health Applications
• By 2017 mobile health revenue to reach $23 billion
• 70% will be chronic disease management.
• eTreat is focused on apps directed to chronic diseases
such as arthritis, diabetic ulcers, chronic wounds, skin
conditions and muscular/skeletal disorders.

5. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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• App captures data from camera and sensors of phone
• App captures user input from prompts
• Data upload for analysis and cloud health record
• Information and reports go to users, clinicians, etc.
eTreat Mobile Health Concept

6. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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Specific Apps for Specific Conditions
• App provides a report like a lab test
• Asks questions and logs data
• Provides useful information and reminders to user
• Info stored securely in cloud Electronic Health Record

7. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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Secure Cloud Processing and EHR
• Every App has a cloud processing engine and database
• EHR captures and logs user encounters with App
• Data and analyses captured by EHR
• EHR is a full clinical record system ( HIPA, HL7 compliant)
• Data owned by the user
• Can send to medical practitioners and other EHR systems

8. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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First Chronic Disease App – Hand Arthritis
• Common chronic health problem affecting
articulating joints
• Causes pain, deformity and moderate to
severe disability.
• Symptomatic OA has inflammatory
episodes that result in joint swelling and
tenderness
• Irritation of nerves and blood vessels of
synovial membrane (encapsulates and
lubricates the joint)
Disease Africa The Americas
Eastern
Mediterranean Europe
South-East
Asia
Western
Pacific
Population 857 939 605 899 1830 1808
Hand Arthritis 58 64 41 61 124 123
Foot Arthritis 54 59 38 57 115 114
Hand and Foot Arthritis Prevalence (millions) by WHO region, 2004
Radiographic
Arthritis
Symptomatic
Arthritis

9. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

10. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

11. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

12. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

13. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

14. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

15. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

16. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

17. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com
ArthTrac: Procedure overview and Screenshots
 User log-in/registration
 Instructions for image capture
 Capture image of the subject hand on white
letter/A4 size paper
 Verify Image is OK
 Send image to cloud for image analysis (patent
pending method)
 Store data to cloud electronic health record
(EHR)
 Receive processed image from cloud
 Receive measurement data analysis report

18. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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Image Processing :
Distortion removal
Spatial calibration
Background removal
Anatomical analysis
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19. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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A
B
C
D A’ B’
C’D’
216mm
279 mm
ArthTrac: Distortion correction and calibration
–Letter/ A4 Paper is
identified
–Distortion is removed
–Image is cropped and
scaled

20. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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ArthTrac: Image processing identifies hand
– Image processing software
processes and segments image
– Hand is separated from
Background
– The image is analyzed and
converted to a binary format
– The binary image is analyzed and
the boundary determined
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0 200 400 600 800 1000 1200 1400 1600 1800
400
600
800
1000
1200
1400
1600
1800
2000
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21. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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ArthTrac: Boundary information is analyzed
• Boundary image can now be
analyzed to provide arthritis
metrics
• Analysis algorithm identifies
key fiduciary feature
coordinates
• Tips and vertexes of fingers
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22. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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ϴ
ArthTrac: Features located on boundary data
– Fiduciary features of hand are now
identified
– Boundary image can now be
analyzed to provide arthritis
metrics
– Distances, angles, widths can
become features for analysis
– From analysis can identify
anatomical irregularities
– Anatomical characteristics can be
compared over time
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23. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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(1) (2)
(3) (4)
Analysis of Normal and Arthritic Hand
• Normal Hand • Osteoarthritic Hand
(5) (6)
(7) (8)

24. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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(1)
100 200 300 400 500 600
140
150
160
170
180
100 200 300 400 500
140
160
180
200
Finger #3
Thickness
Finger #2
Thickness
Analysis of Phalange Width

25. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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Analysis of Phalange Angular Deviation
• Normal Hand • Osteoarthritic Hand

26. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
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ArthTrac: Secure Transfer to Servers and EHR
• Regulatory Compliance
– HIPAA compliant to ensure confidentiality
– CEN ISO/IEEE 11073 standard
– HL7 compliant data to effectively
interface with electronic health record
– ISO 13485 / GMP compliant as medical
device
– Fingerprint blurring for additional
security
– Cloud based app and image processing
server
– Cloud based EHR database server
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27. 2014 CMBEC37 Conference
Vancouver, BC
May 21 – 23, 2014
etreatmd.com27
Conclusion
• eTreat is focusing on chronic disease apps for
arthritis, diabetes, chronic wounds, skin
conditions and muscular/skeletal disorders.
• Our prototype of our first app for hand arthritis,
using cloud image processing has been
demonstrated
• The scientific basis of our patent pending image
analysis software has been described
• Questions?
Website: etreatmd.com
Tel: 1+ 604.836.5482
nmackinnon@etreatmd.com