Remote Patient Monitoring

Building on top of the topic from the last post, in this post I would like to further talk about remote patient monitoring (RPM), a term and field that is extending the boarder of telemedicine.

The fall detector discussed in the previous post belongs to the group of wireless remote patient monitoring devices, which is expected to grow at the compounded annual growth rate (CAGR) of 77%, leading to a global market size of $950 million by 2014¹. The larger category, the entire RPM industry, is also experiencing a high CAGR of 56% leading a total market of $8 billion by 2012².

An example is that in 2008 Bayada Nursing home partnered up with Ideal Life to send out internet-connected remote monitoring systems to more than 200 U.S. patients with limited mobility and chronic diseases such as congestive heart failure (CHF) and hypertension³. The benefit was tremendous – the hospitalization was reduced by 54% for these patients. It means huge savings for both the patients and the hospitals and at the same time without reducing the quality of care. These devices could send real time information to patients’ nurses and doctors to tell them the health condition of their patients. It is meaningful because for chronic diseases, many key symptoms will develop unnoticed. For example, if a patient with CHF gained more than 3 pounds over the last 24 hours, it could mean there is a fluid retention in the patient’s body³. Then the wireless body weight scale could transfer this data to the patient’ doctors and nurses, which allows the care givers to either visit the patient or make necessary adjustment in the treatment and medication³.

Besides Ideal Life, other companies, such as Philips or GE, have also developed similar products or systems to detect and transfer real time patient data from patient’s home to the care givers. The following videos are some examples.

Products from Ideal Life:

Products from Philips

Products from GE

Reference:

1.       Roy Mark, Remote Patient Monitoring Set for Explosive Growth, August 2009, http://www.eweek.com/c/a/Health-Care-IT/Remote-Patient-Monitoring-Set-for-Explosive-Growth-144720/

2.       DATAMONITOR, Homecare telehealth expected to grow despite current barriers to adoption, August 2007, http://callcenterinfo.tmcnet.com/news/2007/08/30/2897900.htm

3.       Marianne Kolbasuk McGee, Remote Monitoring Yields Healthier Patients, November 2009, http://www.informationweek.com/news/healthcare/mobile-wireless/221900414?pgno=1

Fall Detectors - Improving Senior Home Care

In this post I would like to talk about a specific technology that would significantly improve the senior home care and at the same time present a potential business opportunity in telemedicine.

The technology is a Fall Detector that is a watch-like mini size device (Figure 1). It could be attached on the wrist of a senior person or patient. The device is capable of measuring unusual pulse rate and detecting free falling¹. When there is a case of abnormal pulse or free falling motion detected by the device, it would play an alarm sound¹. If the alarm were not turned off in a pre-set time interval, a signal recording the pulse or free falling information would be sent to a GSM modem previously set up in the room where the patient was in¹. The modem after collecting and receiving the information would send a signal to the care center, ambulance, or the patient’s relative’s house wirelessly linked with the GSM modem¹. In this way medical professionals would receive the real time alerts from the device attached to the patient and would be able to respond at the earliest possible time. The implication is that for seniors living by themselves, this device could safe many lives by asking for medical services in the shortest possible time interval.

Figure 1.

The potential market for this telemedicine application is promising. The total number of older persons worldwide over 60 years old has almost tripled from 1950 to 2000 from 205 million to 606 million². In the coming 50 years this number will be tripled again to about 2 billion in 2050². The number of countries with more than 10 million people over 60 will increase from 10 in 2000 to 33 countries in 2050². In the U.S., the number of people over 60 will increase from 46 million to 107 million by 2050².  

I think it is safe to say that, according to the social structure, most of these senior people would either live by themselves or with other seniors who will be facing the similar challenge to seek for help whenever there is an emergency. This Fall Detector would become a must-have device for senior people to avoid delayed medical care and improve their life quality.

References:
1. http://www.owentix.com/en/ow_telemed_operator.php
2. United Nations, World Population Aging, 2002, http://www.un.org/esa/population/publications/worldageing19502050/pdf/80chapterii.pdf

Overview of Telemedicine in Europe

In this post I would like to briefly talk about the recent development of telemedicine in Europe. The telemedicine market in Europe is a fragmented and it grows at a slower rate than that of the U.S. market¹. The major hurdle of the development of telemedicine in Europe is the lack of standard regulation – each member country has its own laws and regulations regarding the practice of telemedicine¹. Some of the major restraints to the growth of telehealth markets in Europe include lack of concrete laws and regulations¹.

However, recently EU members have been striving to cooperate and collaborate to establish unified and efficient telemedicine services, aiming to deploy telehealth in every home in Europe by 2012¹. One attempt was the formation of European Patient Smart Open Services (epSOS)¹. It is a cross boarder telehealth project that linked 27 beneficiaries from 12 EU member countries¹. The goal was to build an infrastructure and framework through which patients’ health information, medical history, and prescription from different EU member states could be shared¹.

Another recent project was called the Renewing Health, a large-scale pilot project that involved nine European regions². This project was launched on February 1, 2011, with the goal to make telemedicine as a routine care for patients with chronic disease by generating data for European healthcare systems². There are 8,000 patients involved in this project including intervention groups such as cardiovascular disease (CVD), chronic obstructive pulmonary disease, and diabetes². The nine regions are Veneto region in Italy, South Karelia in Finland, Southern Denmark, Northern Norway, Catalonia in Spain, central Greece, Norrbotten in Sweden, Carinthia in Austria and Berlin in Germany².

There are more initiatives of telemedicine development in EU and the following videos illustrate these ideas and projects.

USACE Renovates Hospitals for Unique Telemedicine Program in Albania

Telemedicine Clinic in UK

eHealth - Better Health for All in Europe

References:

1.      S.Priyan, Increasing scope of Telehealth markets in Europe - A Concise Analysis, May 2009, http://www.frost.com/prod/servlet/market-insight-top.pag?docid=168892280

2.      Renewing Health, EU, http://www.renewinghealth.eu/

Progress of Telemedicine in China

Although China is growing fast in many areas, however, in the field telemedicine, it still is in its infant stage. Nonetheless, by establishing an extensive network Community Health Centers (CHC), China is building a foundation for telemedicine and telehealth, an extension of telemedicine.

With the release of the Healthcare Reform Plan in 2009, China underwent a high growth period of building CHC, each covering population between 30,000 and 100,000¹. Every CHC is created by transforming existing level I public hospitals that is designed to serve multiple communities or regions. Under each CHC, there are more Community Health Stations (CHS) ¹, which are incorporated into each community and each serves about 10,000 people¹. As of 2011, there are 8859 CHS in 36 major cities in China². The goal of this CHC system is to reduce the number of visits to the major hospitals to reduce cost to both patients and the social healthcare system. Now it usually takes 5 to 10 minute walk for a patient to visit the CHS or CHC. CHS is capable of providing primary care but more complicated cases would be transferred to its associated CHC or specialized hospitals.

Given this network of CHC and CHS, it provides the basis for implementation of telemedicine applications and technologies. If each CHS could be linked with other CHS and its associated CHC, then there would be no need for transferring patients from CHS to CHC for severe diseases, because patients could access to doctors and specialists and even perform remote operations from their CHS.

In February 2011, Ideal Life from Canada is signing a contract with Novatech Biological Pharmaceuticals in China to build a telemedicine network that provides remote monitoring healthcare to 100,000 patients, the largest in the world to date³. Ideal Life would provide wireless sensor devices that would be installed at CHS and could detect and transmit real time patients’ data to their health providers for instant feedback and consultation³.

Although this project would start at Shandong Province, with the infrastructure in other major cities in China, I believe it is scalable to the 36 cities where CHS and CHC are already in place.

Reference:

1.      Ruth Woodrow, An in – depth look at Community Healthcare Centers in Beijing, http://www.pharmachinaonline.com/admin/eWebEditor/UploadFile/2009624193513456.pdf

2.      Xinhua News, China boosts community health service, March 201, http://www.chinadaily.com.cn/bizchina/2011-03/12/content_12160857.htm

3.      Close-Up Media via COMTEX, Ideal Life and Shandong NovaTech Biological Pharmaceutical Enter into Pact, December 2010, http://medhealth.tmcnet.com/news/2010/12/03/5172811.htm

Mobile Telemedicine Vehicle

In this post I would like to introduce the application of Mobile Telemedicine Vehicle (MTV). MTV provides an effective alternative to provide medical care when accessing to hospitals is not convenient or unavailable. MTV is another area where business and ICT could come together to increase the quality of healthcare.

One example in of MTV in the use for emergency and natural disaster response is the one designed by Loma Linda University Medical Center (LLUMC) and the United States Army (the Army)¹. It is aimed to provide high quality medical care to civilians in the case where normal hospital services were not available due to situations such as terrorist attack or earthquake¹.  

The MTV from LLUMC was equipped with highly sophisticated care and telecommunication technologies and devices such as satellite system and telemedicine connectivity¹. In this way the MTV is able to provide real-time data transfer without the dependence on land-based communications¹. Also the vehicle has medical equipment, such as x-rays, vital statistics, and live video, by which doctors off-site could provide necessary care to patients whose data could be sent real-time from the MTV¹. In addition, the MTV from LLUMC also was designed to have off-road capabilities, built on the Mercedes-Benz chassis by UNICAT¹.

The following video provides more details about the MTV from LLUMC:

The second area of application of MTV is to provide easier access to high quality healthcare services. The MTV recently acquired by Kaiser Permanente (KP), a leading healthcare provider, is a good example in this field². The goal is to provide greater coverage of healthcare services to the Kaiser Permanent members on the home island of Hawaii, the Big Island².

With the installation of Kaiser Permanente HealthConnect, KP’s signature electronic health record system, the MTV is expected to serve about 12,000 Hawaii residents². It would allow KP the mobile team to access to member health care data on a real-time basis². Also, women on the Big Island would have access to the latest breast cancer detection technology, thanks to a digital mammography unit equipped on the MTV that would transfer real-time patient data to doctors in KP hospitals². In addition, residence on the Big Island could receive healthcare services such as urinalysis, gonorrhea and chlamydia testing, cholesterol, glucose and waive testing, and immunization services².

The following are the pictures of the MTV and the equipment installed on it:

These two examples imply that telemedicine could have multiple layers of technology. Traditionally telemedicine is only accessible from remote stationary health centers or from patient homes. Then one layer of telecommunication technologies, such as mobile phones and video conferences could link the patient site with doctors in distant hospitals where advanced healthcare treatment and consultation could be delivered to the patients. In the case of MTV, telemedicine was made possible by the layer of telecommunication technologies on top of mobility technologies. It even further increased the value of telemedicine in the sense that patients now do not have to travel to get quality healthcare. For example, in the case of an earthquake, patients with limited mobility could stay where they are to get quality treatment from MTVs. Also, another example would be in a flu pandemic case. Instead of going to hospitals with the potential to increase Hospital Associated Infections (HAI) cases or to risk the health of nurses and doctors, patients could stay in their homes or communities to be treated by mobile healthcare staff on MTVs. In this way, the pandemic could be better controlled because of the reduced mobility of infected patients.

The combination of telemedicine and transportation could be taken further to concepts such as “Mobile Telemedicine Helicopters”. It could be of special use in natural disasters where ground transportation is not possible.

In conclusion, the potential of telemedicine could be fully realized when creatively combined and enabled by other technologies.

References:
1. http://lomalindahealth.org/medical-center/for-health-professionals/center-for-prehospital-care/care/mobile-telemedicine-vehicle.page
2. http://xnet.kp.org/newscenter/pressreleases/nat/2009/061109hawaiimobilehealth.html

More on the Telemedicine Application in Patient Transportation

Here I would like to add a supplementary case to further illustrate the application of telemedicine in patient transportation. In this case, not only we see how telemedicine could improve patient care, but also the business implications, especially for telecommunication devices companies.

At Cincinnati Children's Hospital Medical Center (CCHMC), sophisticated telecommunication devices have been installed on the ambulances. This idea was originated by Dr. Hamilton Schwartz at CCHMC from the use of webcams to talk to his family¹.

In order to allow his critical care transport teams to provide quality care from the pick-up site to the hospital room, Dr. Schwartz chose GlobalMedia to design and develop an in-transit mobile telemedicine solution called Transport AV Telemedicine System². This system combined the TotalExam camera, a high-resolution handheld video camera, with a digital stethoscope, microphone and headset². It is then connected to the Internet via 3G, 4G, or 802.11 networks².

Using this system, the critical care team would be able to transmit real-time patient data through live video and freeze-frame images from the ambulances to the doctors at CCHMC².

What’s better was that the Transport AV system not only is used inside the ambulance, but also is able to travel with the patients by attaching to the gurney in the ambulance. It allows uninterrupted communication between care givers on-site with patients and doctors in CCHMC to give continuous monitoring and care delivery². In addition to prepare and set up necessary operation rooms, the Transport AV system also enable hospital administrators to register for the patients before their arrival, saving critical time for treatment².

This case is a great example how telecommunication providers and device manufacturers could work together to provide state-of-the-art health services to patients. Frequent conversations and interactions between patients, doctors, and care givers and telemedicine technology and service companies is an efficient way to design and develop customized telemedicine products and solutions.

The following is the picture of TotalExam from GlobalMedia

The following is the picture of the Transport AV Telemedicine System

References:

1.       http://www.informationweek.com/news/healthcare/mobile-wireless/showArticle.jhtml?articleID=220600778

2.       http://www.globalmedia.com/newsletter/Volume1-page5.html

Mobile Telemedicine: Transiting Patients

In this post I am going to talk about the importance of telecommunication technologies in ambulance during the process of patient transportation. This application of telemedicine have significant benefits to patients and care givers and present great opportunities for hospitals.

First let’s look at the application of telemedicine in emergency care. Patients who had to be transferred to hospitals by ambulance usually require instant care by care givers and doctors. However without doctors and specialists on the ambulance, emergency care givers could only provide basic life-sustaining cares. Many lives had been lost in the ambulance on the way to hospitals. To give the needed care at the earliest possible time, University of Maryland Medical Center and University of Maryland School of Medicine in Baltimore established the first ambulance equipped with video and computer technology to assess and treat stroke patients¹. This invention was partnered with TRW Inc. and partially funded by National Library of Medicine¹.

 Providing two-way audio and video communication between ambulance and a computer in a doctor’s office, the new system had successfully transported 12 stroke patients in test runs¹. There would be more sophisticated equipment installed in this system, allowing doctors to examine patients before they reach the hospital to determine which treatment would be required¹.

According to the American Heart Association, Stroke is the leading cause of disability for U.S. adults¹. Every year about 750,000 Americans suffer from a stroke¹. However, only a small percentage of them were able to get the drug they needed within a 3-hour window. By using this now telemedicine system on ambulance, more stroke patients would be benefited from real-time diagnosis and treatment from doctors even before they were transported to hospitals.

Stroke patients will more likely to choose hospitals with such services. Embracing telemedicine in ambulance would signficantly increase the quality of services provided by hospitals and thus increase the competitive advantages of hospitals with such technologies.

Reference:

1.       http://www.umm.edu/news/releases/telemedicine.htm