Mobile Healthcare: More on TeleHealth

There are some major developments going on in the field of Mobile/Wireless healthcare. Sometime back I happen to attend a lecture organised by IET Berkshire where Prof. Lionel Tarassenko gave an overview of what developments are going on in this area. Unfortunately I could not get hold of the presentation but there is enough info on the web about it.

Vodafone has been field-testing neurosurgical telemedicine applications using third generation (3G) technology in Germany. Scientists in Denmark have successfully used text messaging to collect diary data from asthma patients in a pilot study to determine whether increased remote support improves clinical outcomes. Previous studies using home PCs to send the same diary information proved disappointing, with users rejecting the application after a short while.

Researchers from the Norwegian Centre for Telemedicine in Tromso studied parent-child interaction using a mobile and wireless system for blood glucose monitoring, and concluded that, whether or not the health outcome is improved as a result, the peace of mind provided by such a system may make it a commercial proposition.

In Finland, Medixine has been promoting home care by integrating diagnostics and patient diaries before sending results via a PC based web-link to health professionals. The company is now offering the same functionality using hand-held mobile PCs.

Researchers in the UK have, however stolen a march. When scientists from Oxford University set out to determine whether a system based on automated transfer of data, real time analysis and immediate feedback to the patient could improve glycaemic control for young adults with type 1 diabetes, they adopted the mobile approach.

The substantive difference between their work and others cited in the literature is that, with the help of funding from the charitable Vodafone Foundation, professors Andrew Neil and Lionel Tarassenko were able to conduct randomised clinical trials.

For the first time, the use of mobile telephone technology was proved to have a significantly beneficial effect and resulted in demonstrably improved clinical outcomes.

The system involved in the trials, which has subsequently been made commercially available under the “t+ diabetes” brand, uses a glucose meter linked by Bluetooth to a GPRS-enabled mobile telephone. (GPRS allows a handset to communicate with a remote server without the user having to dial in manually.)

After the patient has taken a reading in accordance with the advice he or she has been given by a GP or practice nurse, they spend around 10 seconds adding essential diary information about diet, exercise and general health via the telephone’s keypad. The system is intuitive and easy to use.

The information, together with the reading, is sent by the handset to a central computer which responds within seconds, providing patients with personalised feedback in easy-to-read graphical format delivered to their mobile’s display.

The number crunching done by the remote computer uses sophisticated algorithms to help negate the effects of occasional rogue readings and deliver a consistently meaningful result to the patient’s mobile.

This presentation here gives the motivation for the need to have a mobile based healthcare system.

• In the UK there are 17.5 million people with a long-term condition (mainly diabetes, hypertension, asthma or Chronic Obstructive Pulmonary Disease).
• Diabetes is the fastest growing disease in the Western world as a result of poor diet and obesity.
• £5.8 billion is spent per year by the NHS on diabetes and its related complications (2002 figures).
• Asthma affects 3.7 million adults and 1.5 million children in the UK (70,000 hospital admissions for asthmain 2002).
• 80% of primary care consultations relate to long-term conditions and patients with such conditions or their complications use over 60% of hospital days.

The key to minimising long-term complications is to empower patients to take more responsibility for the management of their condition.

The economic driver is reduction in unplanned hospital admissions.

Lot of time of healthcare professionals and bed space in the hospitals are wasted for the routine procedures that can be avoided by remote monitoring of the patients

Why Mobile Phones?

• Equality of care – 90% of UK population owns a mobile phone
• Real-time feedback, with two-way information flow
• Communication with remote carer based on shared data
• Economic model based on reduction in unplanned hospital admissions makes mobile phone solution a financially viable proposition
• Interactive tool to promote self-managementRegular support from remote nurse (based on real-time data)

What kinds of problems are being looked at:

• Asthma: 3 published clinical studies, 1 recruiting for Asthma UK
• COPD: 1 trial at Bristol Royal Infirmary published in Thorax
• Diabetes Type 1: 1 RCT at OCDEM published in Diabetes Care 4 trials in progress in Dundee, Eire, Dubai and Oxford 2 studies pending with UK NHS and Singhealth in Singapore
• Diabetes Type 2: 1 published clinical study for Lloyds Pharmacy
• Cystic Fibrosis: 1 published clinical trial (data submitted to NICE)
• Cancer: 1 study at Churchill Hospital published in Annals of Oncology
• Drug Titration: 1 study at Corbeilles-Essonepresented at Alfadiem and 1 trial recruiting in Oxfordshire GP Practices
• Hypertension: 1 trial recruiting in Oxfordshire GP Practices

You can read more about the tools and applications being developed here and here.

There is also a very good and detailed study of Asthama that can be seen here. There is a diary at the end that shows how readings are entered in the phone, etc.