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

The First Sino-India JV for Advancement in Telemedicine

In this post I will talk about how India and China, two of the fastest growing economies in the world, are collectively working together in the field of telemedicine. The population of these two countries poses an attractive domestic market for telemedicine. At the same time, the advancement in technologies in both software and hardware positioned India and China to enter and compete internationally in the telemedicine industry.

In September 17, 2007 the first ever Sino-India Joint Venture (JV) in telemedicine research and services was formed in Kunming, Yunnan, China¹. The JV is called Sunpa Sobha Software (China) Ltd (3S) and is formed by Sobha Renaissance Information Technology (SRIT) from India and Yunnan Sunpa Image Tel Tech Co. Ltd (Sunpa) from China². With a registered capital of $1 million and more than 200 employees, 3S will be based in Kunming and have offices in four Chinese cities, Beijing, Shanghai, Guangzhou, and Shenzhen². 60% of the capital investment was from Sunpa and 40% from SRIT². However, SRIT is planning to invest $20 million in the Chinese telemedicine field in the years to come².

This JV will combine the SRIT's flagship Software Products, “Renaissance Care Magnum” and “Renaissance rChive” and Sunpa’s telemedicine peripherals and devices to benefit patients and hospitals in both India and China³. In the future, Chinese hospitals will gain access to SRIT’s expertise in Clinical, Radiological, Diagnostic and Medical Imaging software³. At the same time Sunpa’s signature tele-vital sign monitoring, tele-dermatology, tele-pathology devices will bring advancement in telemedicine to India³.

The two parties are both very optimistic about the future of 3S with projected revenue of $100 million by 2010². I believe this is a realistic goal given the population in both India and China. Also as internationally recognized software, SRIT, and hardware provider, Sunpa, in telemedicine, both companies already established extensive network both domestically in India and China and internationally in regions like South Africa and Southeast Asia⁴, this JV could also play an important role to explore international markets.

The following video provides more details about 3S and the two joinging parties.

Reference:
1. http://www.youtube.com/watch?v=L_0V5mZmXoc
2. http://www.chinadaily.com.cn/bizchina/2007-09/21/content_6125374.htm
3. http://www.renaissance-it.com/srit2/corporate/site/en/Sunpa_Sobha_Postevent_media.html

Implications from Rwanda - Mobile Technology and Telemedicine

In January 2011, I was fortunate enough to spend three weeks in Rwanda for the Innovation for Humanity project. As a Chinese native I thought I understand what emerging market means. However this trip proved me wrong not only I see more opportunities in Rwanda but also I identified areas from which China should learn.

The use of mobile technology to provide better healthcare is one of these areas. The benefits of mobile health comes in two layers - providing better quality healthcare and covering more patients in rural areas. From auditing the process of my client, a private clinic in Kigali, I learnt that all of its patients have cell phones. To better serve patients with chronic disease such as Malaria, doctors needed to keep track of the progress and conditions of these patients. One way, and the most common way, to do this is to require the patients to re-visit periodically. However every few patients do so because the time spent on traveling was too long and the cost of transportation was high. The doctors at this clinic envisioned using mobile phones as the mean to check the status of patients and deliver health care services. Upon finishing streamlining its operations, raising enough funds to cover the communication cost of using mobile technology might be a very attractive project for us next year.

Although private clinics were facing funding hurdles to realize telemedicine using mobile phones, the public healthcare system has already achieved this goal. A good example is the mHealth initiative, where communicate healthcare workers were provided with mobile phones. In Rwandan healthcare system, Community Healthcare Centers are the basic level that were supported by volunteers, called community healthcare workers. Their job is to visit rural area families to provide basic healthcare services and gather information. Enabled by these cell phones, community healthcare workers are now able to send text messages to Community Healthcare Centers or larger Referral Hospitals with the health conditions and healthcare needs of the patients. In this way needed health care services would be provided in an accurate and timely manner.

The case in Rwanda reminded us that telemedicine does not require sophisticated technology. Basic mobile technology could solve challenges faced by many developing countries.

Kicking off......with A Personal Experience

Even with limited knowledge and experiences in ICT, I did not consume too many neurons to figure out that Telemedicine, enabled by advancement in ICT, will eventually re-structure how health care services are delivered. According to American Telemedicine Association (ATA), Telemedicion is defined as the exchange of medical information from one site to another through information and communication technologies with the aim to improve the treatment of patients.

Although I have been hearing about various cases where patients' lives had been saved through the collective efforts of doctors, surgeons, and specailists via telemedicine, my first personal encounter to this method was in a cloudy day in 2007 when I went to Jinxiang Pharmacy, the largest chain in Beijing, but forgot my perscription from the doctor. Just as I was scratching my head, one of the pharmacist asked about my symptoms and told me that I could get a new perscription in the pharmacy. Noticed my confusion and hesitation, the pharmacist told me that vedioconferencing was available through which I could consult with licensed doctors. Unwilling to drive back to the hospital because of the traffic and waiting, I tried this new technology and after 20 minutes I was able to go home with the same perscribed drugs without any hassle.

Although only limited diagnose and care could be provided through this vedioconferencing technology in this pharmacy, it allowed many patients to avoid the crowdness and waiting in a regular public hospital. This service has been a good complementarity to Jinxiang's online order and free delivery services for OTC drugs.

Instead of going through all the hassle in terms of traffic and waiting as well as the risk of cross-infection at hospitals, now patients could get their medication at home or within walking distance because Jinxiang is everywhere. Using telemedicine together with other ICT technologies, Jinxiang becomes the real one-stop basic healthcare center for a large number patients in Beijing.