M-healthcare to be big factor in dealing with chronic disease management

In the current climate of strained health resources and cost-containment in Canada, the United Kingdom, the United States and most other Western nations, mobile healthcare (m-healthcare) will offer a solution to ease the burden of care placed on community and teaching hospitals that will inevitably rise with the aging of the baby boom generation. There is a current movement to shift the management of chronic disease states, such as diabetes, hypertension, and AIDS, from the domain of the medical specialist to the primary care practitioner or nurse, and that transition will be aided by m-healthcare, according to Robert Istepanian, director of the mobile information and network at the Technologies Research Centre at Kingston University in London UK. "The medical specialist does not need to monitor the patient’s blood pressure or glucose levels," says Istepanian, in an interview with Report on Wireless at the 5th Annual Summit on Wireless and Mobile Healthcare Technologies. "There is too great a demand on the expertise of medical specialists," he explains. "If they do not have to monitor patients with chronic disease, their time is freed up to devote to acute care cases like trauma and stroke. This way, the general practitioner or the specialist nurse can do routine tests with patients that have a condition like diabetes." Istepanian is heading a clinical trial, funded by Motorola, to use a mobile chronic disease management system at leading hospitals in the UK. The expectation is that the National Health Service in the UK and other charitable organizations will continue to fund mobile healthcare projects. And where experts are scarce in numbers because of vast geography and sparse distribution – think of much of rural Canada – employing technology that permits a nurse to perform an ultrasound remotely and have a specialist consult from a radiologist in an urban centre. For example, a radiologist in Winnipeg can then determine if a pregnant woman in The Pas MB is having any first-trimester complications, by viewing images of an ultrasound transmitted over wireless communication devices. That consult may avoid the woman from being flown to Winnipeg, a meaningful significant savings in dollars and a change for the better in patient care. Similarly, a patient is in Pickle Lake ON suffering terrible gallbladder pain, and the closest radiologist is in Thunder Bay ON. After transmitting the ultrasound image sequence over an ISDN line at 384 kpbs and using video-conference compression, the quality of the image is sufficient to make a diagnosis of gallstones. Moreover, with advances in radiology such as diffusion tensor imaging, clinicians can make more accurate clinical diagnoses when patients suffer a stroke. These scenarios sound like text book examples of efficiency and ways of optimizing patient care, given limits on human resources in healthcare and possible distances between patients and healthcare facilities. Indeed, many mobile healthcare technologies are still at a nascent stage, but once they become fully operational, the hope is that they will be both time and cost savers. With technology migrating from 2G to 3G, and on to 4G wireless within the next five years, terms like e-health and telemedicine will become not only buzzwords discussed in healthcare policy – Istepanian notes that a Google search generated 30 million hits when the term "mobile healthcare" is entered, but 800,000 hits when the term "3G wireless healthcare" is entered – but will be how much of medicine is practiced. "Many scenarios are being tested in clinical trials," says Istepanian. "There are still a lot of unknowns. We need to focus on user acceptability to make sure people in the healthcare system and the patients are comfortable using the technologies. For instance, if the specialist nurse cannot operate a mobile disease management system and enter new insulin measurements, then the system won’t be effective."With wireless medical video streaming, high fidelity is needed to avoid the loss of diagnostic information and high compression is needed for error protection, he notes. One of the unknowns is the reliability of sensors in personalized healthcare, wearable systems and body-area networks. A field of medicine such as cardiology is ideal for using devices where patients can be equipped with sensors, so their healthcare providers can monitor their vital signs such as blood pressure. Given the focus on wellness and the preoccupation of baby boomers with health, there will be an escalating demand to have portable technologies that transmit measurements of blood pressure and oxygen uptake across a 3G network, and in the future a 4G network. "This is a generation that is focused not only on disease, but on well being, so something like body area networks, where patients will wear a device like a pacemaker, will have applicability," says Istepanian. "Telecardiology is a natural fit," he states. "The current technologies have not been vigorously tested. We know that one of the current constraints however is the power consumption involved in the current interface, which is Bluetooth. Another unknown is the effect that sweat will have in the transmission of information from patient via the interface to the healthcare provider’s server unit." The challenge to progress from pilot project or clinical research trial to day-to-day implementation will be for governments, non-governmental organizations, and industry to ante up to make mobile healthcare a reality. The initial implementation of mobile healthcare systems will require big dollars upfront to purchase the technologies and train staff to use the technologies, but will prove cost-effective in the long run if they avoid unnecessary patient hospital admissions and shorten hospital stays by several days. The telemedicine business model has many stakeholders including the patient, the caregiver, the mobile service provider, the payer, and the regulator. According to Istepanian, it’s in the interest of the National Health Service in the UK – and Health Canada it stands to reason - to open the public purse to see the wide scale rollout of wireless healthcare. It remains to be seen if government will see it that way. This is the first in a series of articles to come from the 5th Annual Summit on Wireless and Mobile Healthcare Technologies. Two more articles will appear in upcoming issues of Report on Wireless.

M-healthcare to be big factor in dealing with chronic disease management

News | October 6, 2006

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