The Role of Connectivity and Devices in Healthcare

Over the last few months I have discussed the role of 5G in different industries as part of various projects. Some of these discussions are part of my blog posts while others aren’t.

5G is often promoted as a panacea for all industries including healthcare. This presentation and video looks not only at 5G but other connectivity options that can be used to provide solutions for healthcare. In addition, this presentation looks at different components of the mobile network and explore the role of devices in healthcare.

Presentation and video below

Misc: Mobile Technology and Healthcare from 3G4G

You can download the slides here.

Related Posts: 

• The 3G4G Blog: 5G Remote Surgery and Telehealth Solutions
• The 3G4G Blog: 5G & AI Powered Smart Hospitals
• The 3G4G Blog: Banana and Egg gets 5G Telesurgery
• The 3G4G Blog: Real-life 5G Use Cases for Verticals from China
• The 3G4G Blog: 5G Private and Non-Public Network (NPN)
• The 3G4G Blog: Examples of 5G Use Cases & Applications 

Smartphones, Internet Trends, etc

Every few years I add Mary Meeker's Internet Trends slides on the blog. Interested people can refer to 2011 and  2014 slide pack to see how world has changed.

One of the initial slide highlights that the number of smartphones are reached nearly 3 billion by end of 2016. If we looked at this excellent recent post by Tomi Ahonen, there were 3.2 billion smartphones at the end of Q1 2017. Here is a bit of extract from that.

SMARTPHONE INSTALLED BASE AT END OF MARCH 2017 BY OPERATING SYSTEM

Rank . OS Platform . . . . Units . . . . Market share  Was Q4 2016
1 . . . . All Android . . . . . . . . . . . . 2,584 M . . . 81 % . . . . . . ( 79 %)  
a . . . . . . Pure Android/Play . . . . 1,757 M . . . 55%
b . . . . . . Forked Anroid/AOSP . . . 827 M . . . 26%
2 . . . . iOS  . . . . . . . . . . . . . . . . . . 603 M . . . 19 % . . . . . . ( 19 %) 
Others . . . . . . . . . . . . . . . . . . . . . . 24 M  . . . . 1 % . . . . . . (   1 %)
TOTAL Installed Base . 3,211 M smartphones (ie 3.2 Billion) in use at end of Q1, 2017

Source: TomiAhonen Consulting Analysis 25 May 2017, based on manufacturer and industry data

BIGGEST SMARTPHONE MANUFACTURERS BY UNIT SALES IN Q1 2017

Rank . . . Manufacturer . Units . . . Market Share . Was Q4 2016 
1 (2) . . . Samsung . . . .  79.4 M . . 22.7% . . . . . . . ( 17.9% ) 
2 (1) . . . Apple  . . . . . . . 50.8 M . . 14.5% . . . . . . . ( 18.0% ) 
3 (3) . . . Huawei  . . . . . . 34.6 M . . . 9.9% . . . . . . . (10.4% ) 
4 (4) . . . Oppo . . . . . . . . 28.0 M . . . 8.0% . . . . . . . (   7.1% ) 
5 (5) . . . Vivo . . . . . . . . . 22.0 M . . . 6.3% . . . . . . . (   5.6% ) 
6 (9) . . . LG  . . . . . . . .  . 14.8 M . . . 4.2% . . . . . . . (   3.3% ) 
7 (7) . . . Lenovo .  . . . . . 13.2 M . . . 3.8% . . . . . . . (   3.8% )
8 (8) . . . Gionee . . . . . . . .9.6 M . . . 2.7% . . . . . . .  (   3.5% )
9 (6) . . . ZTE  . . . . . . . . . 9.2 M . . . 2.6% . . . . . . . (   5.2% ) 
10 (10) . TCL/Alcatel . . .  8.7 M . . . 2.5% . . . . . . . (  2.4% ) 
Others . . . . . . . . . . . . . . 80.2 MTOTAL . . . . . . . . . . . . . 350.4 M
Source: TomiAhonen Consulting Analysis 25 May 2017, based on manufacturer and industry data

This year, the number of slides have gone up to 355 and there are some interesting sections like China Internet, India Internet, Healthcare, Interactive games, etc. The presentation is embedded below and can be downloaded from slideshare

Internet Trends 2017 Report from Kleiner Perkins Caufield & Byers

mHealth Revolution

We are living in amazing times where we can do things we could have just dreamt of 5-10 years back. I came across the following video:



This gives hope to the third world where a lot of our old non-smartphones are ending up. In fact this reminds me of Mexapixel Microscopy that can possibly have numerous applications.

There was an interesting presentation recently in the Future of Wireless Conference that was very well received and had people discussing it on twitter and in the event. Its embedded below (download from slideshare)

mHEALTHCARE Opportunities, Challenges and Prospects

View more presentations from Zahid Ghadialy

Do you have any more ideas or information on this topic? Please feel free to share in the comments.

mHealth – Mobile Healthcare; consumer, doctors, healthcare providers, hardware and software tech enablers

The following is from a recent Mobile Internet SIG in the SV Forum.

You may want to get the presentations before listening to the video. Presentations available here.

Sprint, Verizon and Mobile Healthcare

In US, Sprint and Verizon are going head to head with their 4G (sic.) offering. Sprint has a WiMAX network from its Clearwire joint venture while Verizon is soon to roll out LTE.

During the ongoing Healthcare Information and Management System Society or HIMSS annual conference being held in Atlanta, the CEO of Sprint Nextel, Dan Hesse mentioned that the 4G (sic.) technology will play an important part in helping to transform healthcare to a greater height.

With wireless technology being an essential part of everyday life for nearly 277 million Americans, it is changing the paradigm of how healthcare is administered. Internet savvy consumers today expect immediate access to health information and care anytime, anyplace. Last year, 89 percent of wireless Internet users sought health information online*. Similarly, caregivers are using smartphones equipped with medical applications for instant, secure access to lab results, x-rays, vital signs, drug-to-drug interactions, and other vital medical records. These trends further validate the key role that wireless will play in shaping the future of healthcare by enabling innovative and cost-effective approaches in delivering quality care.

“If I had to pick the one industry facing the biggest gap between need for change and use of wireless to facilitate that change, it would be healthcare,” Hesse said. Most industries spend between 6 percent and 8 percent of their revenues on telecom, but healthcare only spends 2 percent or 3 percent on it, he said. Darwin said that survival of the fittest is not about the strongest or the most intelligent — it’s about the most responsive to change, Hesse explained, and consumers are beginning to drive a lot of the change in healthcare. Healthcare spending on telecom will jump from $8.6 billion to $12.4 billion in the next few years, Hesse predicted, and two-thirds of that increase in spending will be from wireless apps and services.

What if we had asked the healthcare industry to partner with the wireless industry back in 1986, Hesse asked as he held up a massive mobile phone from that year. What if I said we could monitor patients and look at EKGs on one of these? The timing couldn’t be better for healthcare and wireless to work together, Hesse said as he took out a smartphone from his pocket. Today two-thirds of physicians use a smartphone like this one and soon more than 80 percent of them will.

What use cases does Hesse see for the wireless tools his industry offers?

> E-prescribing — Physicians’ bad hand writing causes some 4 percent of errors found in prescriptions. Hesse said a doctor friend of his realized the first time he saw a Palm PDA that it was the same size as his prescription pad and once it got Internet connectivity it would eventually eliminate the handwritten prescription. Hesse said e-Prescribing could save $20 billion annually.

> Instant, secure access to vital signs – Hesse pointed to AirStrip’s fetal heart rate monitor as a perfect example of vital sign remote monitoring that is in the market today.

> Advanced mobile apps for consumers – In just a few years we have gone from going online to look up home remedies for various ailments, Hesse said, to using apps like flu radar which can tell us how many cases of the flu have been diagnosed in our area. Hesse also pointed to the app currently being researched that encourages the end user to cough into the phone’s microphone so it can compare the sound to its database of coughs and come up with a preliminary diagnosis.

> Ultrasound probe that plugs right into a cell phone — Ultrasound exams could be conducted nearly anywhere and pipe the images to doctors that could also be nearly anywhere, Hesse predicted as he showed images of an ultrasound probe that connects to a cell phone. This will not only cut costs for ultrasounds, especially in developing market but also make it easier for EMTs and other healthcare workers who are away from hospitals to have a tool to use on the go.

> Wireless video monitors for virtual, in-home visits — While this one didn’t seem to leverage the real benefits of wireless, Hesse told a story of a nurse who had gained too much weight to be able to come into work anymore. After a short while of being detached from her former colleagues she became depressed over the situation and much less engaged in our own care. She then became part of a program that used wireless video monitors to enable two-way communications between patients in their home and physicians and nurses at care facilities. After receiving frequent virtual visits using the system, she took control of her health decisions, lost the weight and made it back to work.

> Virtual coaches on your handset — Hesse described another patient who had Type 2 diabetes, a regimen of oral medications and high blood pressure. In order to adhere to our routine she participated in a program with Sprint’s partner Welldoc to track her adherence. Welldoc offered her a virtual coach application that reminded and encouraged her to stay on track.

> Mobile enterprise for pandemic situations — During the H1N1 scare, Hesse said Sprint encouraged its workers to work from home or remotely to stem any potential spread of the flu virus among its ranks. Unlike businesses that have not adopted mobility tools for the enterprise, Sprint was able to restrict travel and encourage working from home without disrupting their employees’ workflow and progress. They had the mobile connectivity and devices to work from anywhere.

> mVisum for remote access to images, charts — Sprint partner mVisum enables clinicians to view charts, x-rays and other images right from their smartphones. Hesse said a cardiologist might be alerted through mVisum on his BlackBerry of an ambulance en route with a patient whom the paramedics suspected had suffered a heart attack. If the ambulance had wireless connectivity it could send that EKG to the cardiologist’s phone via mVisum and the clinician could prepare for the patient’s arrival knowing what needed to be done ahead of time. In those types of situations the time saved is extremely valuable.

> Intel Health Guide for remote visits and monitoring — Hesse said that moving more patients out of the hospital and back into their homes not only reduces costs overall by also improves opportunities. A woman with a high-risk pregnancy should not be moved in many cases, but she has to move in order to visit her doctor. Instead, hospitals could provide patients with Intel’s Health Guide, a tablet-like device with a touch screen that aims to make it easy for patients to track their vital signs and monitor their biometrics through peripheral devices. Physicians can make remote visits through the Health Guide.

> 4G wireless-enabled video cameras – Imagine video cameras with 4G wireless connectivity that can help patients learn how to apply their skin medication. A similar camera could be installed in an operating room to live broadcast surgeries in high definition. If it were installed in an ambulance, the EMTs could live broadcast stats, triage and more so that the clinicians at the care facility could prepare for their arrival.

> Intelligent medicine or pills with wireless embedded — “Soon i will be able to hold up a pill with wireless embedded into it,” Hesse said. The pill could also include a video camera and could send data and images straight to a doctor’s wireless device.

> 4G phones with Blu-Ray quality screens — Everyone always points to the cell phone screen’s small size or low resolution as reasons why images aren’t very useful on that platform. Hesse said HD, Blu-Ray quality resolution is coming to 4G phones.

“There are a lot of unsung heroes here today in this room,” Hesse said. “In the sometimes bitter debates on the subject of healthcare, too often we forget how important the job is of those people who deliver care.”

“To quote Yogi Berra, ‘The future ain’t what it used to be,’” Hesse said. With all the potential that Hesse pointed to and the fact that ten mobile phones are manufactured per every baby born today, the future is increasingly wireless. The future of HIMSS is wireless. And the industry can finally put the 1970s behind it.

More on the Sprint Mobile Healthcare solution at www.sprint.com/healthcare

Verizon Business has launched an information technology platform that enables the digital sharing of physician-dictated patient notes.

The Verizon Medical Data Exchange, launched Wednesday (March 3) at the Healthcare Information and Management Systems Society annual conference in Atlanta, provides a way for medical transcriptionists to share digitized patient notes detailing patients' care and treatment with doctors, hospitals and other health care providers. Until now, the lack of an interoperable, nationally available platform has made it difficult to share these notes, which primarily form the basis of electronic health records.

Verizon Business developed the platform for the Medical Transcription Service Consortium under an agreement announced last November. Founding consortium members MD-IT and MedQuist currently are using the platform. By August, when the Medical Data Exchange is expected to be in use by all of the consortium's members, 350,000-plus physicians, more than 2,700 clinics and nearly 2,500 hospitals will be supported.

The Medical Transcription Industry Association estimates that its members create and electronically archive nearly 60 percent of the more than 1.2 billion clinical notes produced in the U.S. each year. Approximately 25 percent of these records currently are shared among health care providers, including other physicians, hospitals and insurance companies.

Verizon Wireless offers customers in the healthcare industry an extensive portfolio of products and services that run on the company's reliable Evolution-Data Optimized (EV-DO) Revision A (Rev. A) network, including:

PatientKeeper® – PatientKeeper's mobility products support all operations systems while connecting physicians to patient information across inpatient and ambulatory environments. With PatientKeeper, physicians save time, increase revenue and enhance patient care. PatientKeeper enables physicians to interactively manage patient information across multiple locations, view clinical results, enter charges, sign out patients, and enter and order prescriptions, all from their smartphones.

EPOCRATES Rx for Android and Palm OS – Doctors, nurses and other healthcare professionals who use Verizon Wireless smartphones with the Android™ OS, such as DROID by Motorola or DROID ERIS™ by HTC, or devices that run on the Palm® webOS™ platform, including Palm® Pre™ Plus and Palm Pixi™ Plus, can leverage this mobile drug reference application to get prescription and safety information for thousands of brand name and generic drugs instantly. The application also offers Pill ID, which helps identify a drug based on physical characteristics such as color, shape and imprint code; table and calculators; and drug interaction information.

Medicine Central and Evidence Central – Unbound Medicine offers two applications for Verizon Wireless Android, BlackBerry®, Palm and Windows Mobile® devices.

Medicine Central is a collection of disease, drug and test information with literature tracking for mobile devices. The application features The 5-Minute Clinical Consult, A to Z Drug Facts, Drug Interaction Facts, Pocket Guide to Diagnostic Tests, and MEDLINE Journals.

Evidence Central supports effective evidence-based medical practice by integrating analysis with the latest research. Clinicians can access Evidence-Based Medicine Guidelines, Cochrane Abstracts, EE+ POEMs (Patient-Oriented Evidence that Matters from Essential Evidence Plus), and MEDLINE Journals anytime, anywhere.

Motion Computing® C5 Mobile Clinical Assistant (MCA) – Running on Windows® 7, the C5 is a hospital-grade device proven to enhance clinician satisfaction, improve point of care documentation, increase clinician productivity, and improve clinical documentation accuracy. The MCA is now available with embedded Verizon Wireless Mobile Broadband capability to stay connected to hospital information and the Internet.

More on Verizon Mobile Healthcare Solution at www.verizonwireless.com/healthcare

59p iPhone stethoscope is a life saviour

From The Independent, UK:

The stethoscope, the 200-year-old accessory without which no doctor is complete, could soon be replaced by the humdrum mobile phone.

A computer scientist who wrote a program that turns an Apple iPhone into a stethoscope has made a major advance in medical technology and created a sensation among heart specialists. The application, called iStethoscope, was developed as a "bit of fun", and has become a runaway success after being downloaded millions of times by users across the world.

Cardiologists say the software has saved lives and brought specialist expertise within reach of patients in remote parts of the world. Heart sounds can be recorded and emailed to doctors anywhere for an expert opinion.

Peter Bentley, a researcher who developed the application in the computer science department at University College, London, said he was amazed by the response.

"The idea began as an experiment," he added. "I had a new, popular science book out last year and I wanted to see if I could tell people about the book using a free iPhone application that did something useful.

"It was intended as a fun toy but to my astonishment it was downloaded by several million people all over the world in the first six months. Then I started receiving emails, phone calls and visits from cardiologists all over the world. They said it worked better than commercially available digital stethoscopes. They were tremendously excited. One flew over from the US just to discuss it with me."

The cause of the doctors' excitement was that the audio quality from the iPhone was far superior to that from digital stethoscopes. Mobile phones are a huge market compared with digital stethoscopes, and economies of scale mean they are made with better hardware.

Responding to requests from specialists, Mr Bentley extended the application to allow heart sounds to be recorded, emailed and analysed. The application costs 59p to download, but cardiologists say it does a better job than equipment costing thousands of times as much.

Glenn Nordehn, a US cardiologist researcher and specialist in digital stechoscopes at the University of Minnesota, said: "This is the best thing to come around in terms of medical equipment for a very long time. [His] closest competitor charges about 3,000 times as much"

Mr Bentley is now working on further iPhone applications, such as an electrocardiogram reader. "This is the way everyone wants to go," he said.

For more info see: http://www.peterjbentley.com/istethoscope.html

Beyond Voice: New uses for mobile phones could launch another wave of development

The Economist recently published a special report on Telecoms in Emerging markets which is available here. The following is an extract from that.

In a field just outside the village of Bumwambu in eastern Uganda, surrounded by banana trees and cassava, with chickens running between the mudbrick houses, Frederick Makawa is thinking about tomatoes. It is late June and the rainy season is coming to an end. Tomatoes are a valuable cash crop during the coming dry season and Mr Makawa wants to plant his seedlings as soon as possible. But Uganda’s traditional growing seasons are shifting, so he is worried about droughts or cash foods that could destroy his crop. Michael Gizamba, a local villagephone operator, offers to help using Farmer’s Friend, an agricultural information service. He sends a text message to ask for a seasonal weather forecast for the region. Before long a reply arrives to say that normal, moderate rainfall is expected during July. Mr Makawa decides to plant his tomatoes.

The Farmer’s Friend service accepts text message queries such as "rice aphids", "tomato blight" or "how to plant bananas" and dispenses relevant advice from a database compiled by local partners. More complicated questions ("my chicken’s eyes are bulging") are relayed to human experts, who either call back within 15 minutes or, with particularly diffcult problems, promise to provide an answer within four days. These answers are then used to improve the database.

Farmer’s Friend is one of a range of phone based services launched in June by MTN, Google and the Grameen Foundation’s "Application Laboratory", or AppLab. As well as disseminating advice in agriculture, provided by the Busoga Rural Open Source and Development Initiative, the new services also provide health and market information. The Clinic Finder service points people to nearby clinics, and the Health Tips service explains the symptoms of common diseases.

Lastly there is Google Trader, a textbased system that matches buyers and sellers of agricultural produce and commodities. Sellers send a message to say where they are and what they have to offer, which will be available to potential buyers within 30km for seven days. Mr Makawa says his father used the service to look for a buyer for some pigs, which he sold to pay school fees. These services cost 110 shillings ($0.05) a time, the same as a standard text message, except for Google Trader, which costs double that. In their first five weeks the services received a total of more than 1m queries.

As with the Village Phone project, Grameen is trying to establish a model that can be scaled up and replicated in other countries. Offering agricultural and health information is more diffcult than offering a phone service, however, because such information must be localised and must take cultural di?erences into account.

Grameen’s collaboration with MTN and Google in Uganda is just one of dozens of services across the developing world that offer agricultural, market and health information via mobile phones. In India, for example, farmers can sign up for Reuters Market Lite, a textbased service that is available in parts of India. Its 125,000 users pay 200 rupees ($4.20) for a threemonth subscription, which provides them with local weather and price information four or five times a day. Many farmers say that their profits have gone up as a result.

Tata Consultancy Services, an Indian operator, offers a service called mKrishi which is similar to Farmer’s Friend, allowing farmers to send queries and receive personalised advice. "The rural population is willing to pay substantial subscription fees to get this information multiple times a day", says Kunal Bajaj of BDA. There have been lots of pilot schemes in the past, he says, but commercial offerings are now beginning to gain ground.

Nokia, the world’s largest handsetmaker, launched its own information service, Nokia Life Tools, in India in June. In addition to education and entertainment, it provides agricultural information, such as prices, weather data and farming tips, that can be called up from special menus on some Nokia handsets. The basic service costs 30 rupees a month, and a premium service which provides detailed local crop prices in ten states is available at twice that price. "It is in its early stages, but it has resonated extremely well with its target audience," says OlliPekka Kallasvuo, Nokia’s chief executive.

Services to help farmers have been most widely adopted in China, where China Mobile offers a service called Nong Xin Tong in conjunction with the agriculture ministry, as part of its push into rural areas. It has already signed up 50m users and is aiming for 100m within three years. The service provides news, weather information and details of farming related government policies.

China Mobile also runs a website, 12582.com, that sends farmers information about planting techniques, pest management and market prices. The service, which costs two yuan ($0.30) a month, sends out 13m text messages a day and has over 40m users. There are dozens of other examples across the developing world.

TradeNet, launched in Ghana in 2005, now links buyers and sellers of agricultural products in nine African countries; CellBazaar provides a textbased classified ads service in Bangladesh.
Mobile phones are also being used in health care. Oneway text alerts, sent to everyone in a particular area, can be used to raise awareness of HIV; sending daily text messages to patients can help them remember to take their drugs for tuberculosis or HIV. Mobile phones can be used to gather health information in the field faster and more accurately than paper records and help with the management of drug stocks. Cameraphones are used to send pictures to remote specialists for diagnosis.

Quantifying the benefits of agricultural and health services is hard, and such services are still in their early days in much of the world. The mobile service that is delivering the most obvious economic benefits is money transfer, otherwise known as mobile banking (though for technical and regulatory reasons it is not, strictly speaking, banking). It has grown out of the widespread custom of using prepaid calling credit as an informal currency.

Suppose you want to send money from the city back to your family in the country. You could travel to the village and deliver I’m not selling for that the cash in person, but that takes time and money. Or you could ask an intermediary, such as a bus driver, to deliver the money, but that can be risky. More simply, you could buy a topup voucher for the amount you want to transfer (say, $10) and then call the villagephone operator or shopkeeper in your family’s village and read out the code on the voucher. The credit will be applied to the phone of the shopkeeper, who will hand cash to your family, minus a commission of 10-20%. In some countries, where airtime can be transferred directly from one phone to another by text message, the process is even simpler: load credit onto your phone, then send it to someone on the spot who in return gives cash to your intended recipient.

These methods became so widespread that some companies decided to set up mobile payment systems that allow real money, rather than just airtime, to be transferred from one user to another by phone. Once you have signed up, you pay money into the system by handing cash to an agent (usually a mobile operator’s airtime vendor), who credits the money to your mobilemoney account. You can withdraw money by visiting another agent, who checks that you have su?cient funds before debiting your account and handing over the cash.

You can also send money to other people, who will be sent a text message containing a special code that can be taken to an agent to withdraw cash. This allows cash to be sent from one place to another quickly and easily. The biggest successes in this field so far have been Gcash and Smart Money in the Philippines, Wizzit in South Africa, Celpay in Zambia and, above all, MPESA in Kenya, which has become the most widely adopted mobile money scheme in the world.

Launched in 2007 by Safaricom, Kenya’s largest mobile operator, it now has nearly 7m users. Not bad for a country of 38m people, 18.3m of whom have mobile phones. MPESA’s early adopters were young, male urban migrants who used it to send money home to their families in the country. But it has since become wildly popular and is used to pay for everything from school fees to taxis (drivers like it because it means they are carrying less cash around). Roughly $2m is transferred through the system each day, with an average amount of $20. ?In markets in Kenya, stallholders are happy to take MPESA payments.

"It’s pretty dramatic," says Bob Christen, head of the "Financial Services for the Poor" initiative at the Bill & Melinda Gates Foundation.

MTN’s launch of a mobile money service in Uganda in March 2009, in partnership with Stanbic Bank, provides further cause for optimism. MTN backed up its launch with a huge marketing campaign based around the simple idea of sending money home, as Safaricom had previously done in Kenya. After three months 60% of the population had heard of the service, a level of awareness that MPESA took a year to achieve, according to MTN. After four months the service had signed up 82,000 users. Of the $5.1m transferred in that period, half was in the fourth month, indicating a rapid take-off. MTN plans to increase the number of outlets that can handle mobile money to 5,000 by early 2010. MTN’s apparent success in Uganda seems to suggest that Kenya may not be a one-off after all. After fine-tuning its technology and procedures in Uganda, MTN plans to introduce the service in 20 other African and Middle Eastern countries; it has already launched in Ghana. Meanwhile Zain, which operates in several African markets, has started its own mobilemoney service, called Zap. According to CGAP, there will be over 120 mobilemoney schemes in developing countries by the end of 2009, more than double the number in 2008. By 2012, it predicts, some 1.7 billion people will have a mobile phone but no bank account, and 20% of them will be using mobile money.

Operators do not expect to make much money from mobile banking, says Mr Okoudjou, but it can help keep customers from defecting to rivals and cut costs by allowing people to top up their airtime directly on their phones, as well as providing wider social and economic benefits that reflect well on operators. Most importantly, he says, mobile banking can help the industry repeat the huge impact made when mobile phones were first introduced. "This is a second wave that can unleash the potential of mobile phones again," he says. "So we need to do this, and we need to do it properly, and we need to do it all over."

mHealth and keeping fit Apps for Blackberry

From Brian Dolan, Mobile Health news:

When Fraser Edward joined Research In Motion (the company behind BlackBerry) four years ago, the device maker had only three partners for mobile healthcare applications, Edward said during a panel session at the American Telemedicine Association in Las Vegas. Today, Edward is RIM’s business manager of market development for Health & Life Sciences, and the company has 30 healthcare applications in its recently launched BlackBerry App World store.

During his presentation, Edward showed a slide of 12 mobile health companies that are “BlackBerry Solutions Partners,” which means they are clients of RIM to take advantage of the company’s marketing channels, developer know-how and more. Here’s a rundown of the 12 companies Edward counted as Solutions Partners and the mHealth buckets he put them in:

Fitness

AllSportGPS — powered by Trimble — GPS-enabled mobile application for coaching on cycling, mountain biking, running, walking and other sports activities.

BonesInMotion – GPS-enabled app targeting those participating in outdoor activity 3 or more times a week: fitness walking, running, cycling, hiking, mountain biking, GeoCaching, and other outdoor activities.

BodyMedia – Wearable, “fashionable” body monitors that record and transmit a variety of physiological data to the BodyMedia’s website.

Healthy Lifestyle

Myca - Enables nutrition professionals connect with their clients through video consults, messaging, a personalized website, and a picture food journal.

Sensei - Makes mobile health applications for a wide variety of handsets, but most recently launched a couple of iPhone applications, including one for diabetics.

Personal Health Records

Tolven - Open source healthcare solutions developer of PHRs, clinician health records and health informatics.

CapMed - Offers PHRs for families to keep track of their own health data.




Corporate Wellness/Chronic Disease Management

t+Medical - Offers disease management and remote monitoring services that work with most mobile phones and also does some work with clinical trial management.

Medtronic - Develops medical devices and services to help people better manage chronic diseases.

Healthanywhere - Offers applications that let users monitor their health from a smartphone, PC or from a “dedicated Healthanywhere supplied platform.”

Confidant - Provides a mobile-phone based service that includes feedback, coaching and context to a patient’s chronic disease management routine, while simplifying and automating the flow of information between patients and their healthcare providers.

RIM also partners with chipmaker AMD for Corporate Wellness and Chronic Disease management.

More healthcare/fitness apps for Blackberry can be seen here.

Mobile Healthcare: EpiSurveyor saving lives

DataDyne's EpiSurveyor program, funded by the United Nations Foundation and the Vodafone Foundation, has been implementing mobile technology to track and contain disease in developing nations since 2007.

In a recent and potentially devastating polio outbreak in Kenya, EpiSurveyor's new mobile platform was used to track virus carriers and immunize affected children. The campaign targeted around 2 million Kenyan children. Mobile tech will be used exclusively for new nationwide initiatives in children's healthcare, and the World Health Organization has made EpiSurveyor the standard for data collection in sub-Saharan Africa. Screenshots and video included below.

"mHealth" is a recent term for medical and public health practice supported by mobile devices, such as mobile phones, PDAs, and other wireless devices, especially in areas where Internet access via computers is lacking. Related programs allow health officials to quickly gather and assess data regardless of location or access to more traditional resources, permitting immediate mobile response to health crises. Users can create forms, view records, and share data with others.

The EpiSurveyor program began using donated Palm Pilots to gather health data in Kenya and Zambia less than two years ago. Currently, DataDyne is migrating the program to Java-based platforms for mobile phones. Beta testing began in April 2009 with Nokia S40 series devices and will expand to support other devices in May.

There's an interesting and rather basic tutorial video for field workers here which demonstrates some of the uses of EpiSurveyor's data collection tools. Much more interesting is this video, an interview with an EpiSurveyor mobile developer in Kenya who had been working through the night to prepare a stack of phones for data collection in the field:



Datadyne founder, pediatrician and CDC epidemiologist Dr. Joel Selanikio, also recently won this year's $100,000 Lemelson-MIT Award for Sustainability for his contributions to public health and international development.

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.

Mobile healthcare named 2009 tech pioneer

The World Economic Forum on Thursday named Japan-based Mobile Healthcare Inc (MHC) as a 2009 Technology Pioneer. The company, which develops real-time mobile health solutions for preventing and managing diabetes, obesity and other lifestyle-related illnesses that can be accessed over mobile phones, became one of the 34 technology visionaries to be honored at the 2009 World Economic Forum.

MHC Founder & CEO James Nakagawa said, “We have aspired from the outset to be pioneers, exploring the life-changing potential of mobile technology and finding solutions that empower people to tackle their own health issues affordably and easily via their personal cellular devices and the Internet. I was at once ecstatic and humbled by the news that our work had gained disciples from amongst the venerable body of global business and financial leaders put forth by the World Economic Forum.”

The company’s flagship product, Lifewatcher, is a mobile phone-based health management application for people with so-called ‘lifestyle diseases’ such as diabetes and obesity. Users can monitor their own conditions by logging blood sugar levels, calorie intake, exercise and many other variables into their ‘always on’ mobile device, creating a one-glance health portfolio, which collates daily, monthly and even yearly data. It also delivers vital medical information, reminders and alerts with escalating alarm-levels if goals are not met.Using real-time cellular technology, diabetics and lifestyle illness sufferers can also be in constant dialogue with medical practitioners to ensure health measures are in check or, if not, to spark intervention that could save lives. With the dramatic rise of diabetes and obesity to pandemic levels in countries like Japan and the U.S., doctors have been welcoming this self-directed management tool that affordably and easily increases drug, nutrition, exercise and monitoring compliance for sufferers.

Motohisa Furukawa, a high-ranking Japanese politician and long-time participant at Davos said: “Japan is particularly proud this year to see Mobile Healthcare accepting this honor. It is my hope that government representatives attending Davos this year will recognize the particular relevance of innovative technologies like Lifewatcher, as a universal low-cost healthcare solution that is also environmentally sustainable, as we move forward in these tough economic times in a resource-constrained world.”

SMS Rocks! Long distance shoulder amputation by text

We have heard of dumping and divorce through SMS, betting through SMS but none can beat this one. A surgeon carried out an operation in Democratic Republic of Congo by following instructions received over SMS.

A British surgeon volunteering in the Democratic Republic of Congo saved the life of a teenage boy by amputating his shoulder using instructions texted by a colleague in London.

David Nott, 52, a general and vascular surgeon at Chelsea and Westminster hospital, was working with the charity Médecins sans Frontières (MSF) in the town of Rutshuru when he came across the badly injured 16-year-old in October.

The teenager's left arm had been so badly damaged - either in an accident or as a result of the fighting between Congolese and rebel troops - that it had already had to be amputated. But the flesh and bone that remained had become badly infected and gangrenous.

"He was dying" said Nott. "He had about two or three days to live."

The doctor realised the boy's best chance of survival was a forequarter amputation which requires the surgeon to remove the collar bone and shoulder blade. The only problem was that it was an operation Nott had never performed. But he remembered that one of his colleagues at home had carried out the procedure.

"I texted him and he texted back step-by-step instructions," he said.

"Even then I had to think long and hard about whether it was right to leave a young boy with only one arm in the middle of this fighting.

"But in the end he would have died without it, so I took a deep breath and followed the instructions to the letter."

Such an operation, if performed in the UK, would require careful planning with every sort of modern medical product on hand if things went wrong.

But in Congo Nott had just one pint of blood and an elementary operating theatre.

Despite the basic conditions, the operation was a success and the teenager made a full recovery.

This news could not have come at a better time because the inventor of SMS, Matti Makkonen, received this year's Economist Innovation Award for Computing and Telecommunications.

If I remember my stats correctly, there are 3Billion+ users or SMS worldwide with 1Billion+ SMS exchanged daily and its nearly 20 years since SMS has been launched.

Healthcare using BWA (Broadband Wireless Access)

Came across this paper entitiled "IEEE 802.16/WiMAX-based broadband wireless access and its application for telemedicine/e-health services". While it is common sense that any prehospital diagnosis and monitoring can be very helpful it is important to make sure that the information is updated properly and with correct QoS.

Ambulances and other medical emergency vehicles travel at extremely high speeds. This would require that the technology in place is able to handover between different cells and keeps the equipment connected to the server. The nurse should concentrate on the patient rather than worry about the link being maintained electronically. This also necessitates a quaranteed QoS being maintained for this setup to work effectively. The figure above shows the QoS that is required in different situations.

In the above mentioned paper, the authors argue that WiMAX/802.16 networks can be engineered for telemedecine/e-health services. The main focus should be on Radio Resource allocation and admission control policy. Other important thing is to remember while implementing to use TCP for loss sensitive data and UDP for delay sensitive (but loss in-sensitive) applications.

I am sure the healthcare industry is already looking in these kinds of options and its just matter of time before we will hear about some new related application.

Qualcomm and Healthcare

Qualcomm is diversifying its portfolio by starting a MVNO focussed on healthcare. An article that appeared on Wireless Week has some interesting information on this.

Qualcomm is preparing to launch a standalone mobile virtual network operator (MVNO) company focused on healthcare, although designed to have a broad consumer appeal.

The new company, which was incorporated recently under the name LifeComm, was created by Qualcomm and several other, unnamed, partners. Don Jones, who is vice president of business development for QUALCOMM's' health and life sciences unit, says the MVNO likely will launch commercially sometime in the second half of 2008.

Although the MVNO will have a healthcare focus, Jones says it plans to have applications and services designed to help consumers maintain their personal health as well as more specialized medical uses.
"We don't see it as just health care," he says, because the MVNO also will offer services for wellness, fitness, and health maintenance.

The specific applications and services the MVNO will offer have not been determined, but Jones says the company wants to establish a brand known to provide services for anyone interested in his or her health. The target audience, he says, is predominantly going to be women ages 40 to 65 because they are "influencers" when it comes to health.

Services could involve fitness, weight management or reduction, diabetes management, and monitoring heart health, including hypertension and congestive heart disease.

LifeComm already is talking to handset manufacturers about designing phones with consumer appeal but with the capability of linking to the MVNO's special applications and services, Jones says. One of the plans is to have handsets that would create a personal area network that could communicate with medical devices such as heart and blood pressure monitors. They also could connect to consumer devices like pedometers. Some of Qualcomm's partners in the MVNO are medical device manufacturers.

Jones also talks about using innovative devices like "wireless Band-Aids," which stick to the skin and monitor some bodily functions. Such devices are in use now for mobile health care, as well as wireless pacemakers, remote electrocardiograms and wireless blood glucose meters.

LifeComm expects to close on a bridge loan in the next few weeks to provide initial funding as a separate company. Jones says the company will then start pulling together an executive team and will do additional market research.

LifeComm has an agreement with a CDMA wireless carrier to provide network services for the MVNO, although Jones says he cannot announce which carrier. He did say the MVNO expects to use Qualcomm's BREW platform, which is the platform used by Verizon Wireless. The MVNO also will use assisted-GPS for location services.

This isn't the first time that Qualcomm has spun off a separate company to take advantage of technology it has developed. The latest example was MediaFLO USA , which is building a nationwide network for mobile broadcast TV services.