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October 29, 2006

Telemedicine and Self Care

Worker with a PC.jpgPhysician, heal thyself with the support of remote monitoring, suggested Dr. Paul Johnson, Director of the telemonitoring service Xenetec last week at the International Healthcare Innovation Congress in London.

He pointed to a pandemic in lifestyle-related diseases exacerbated by growing levels of obesity in Western countries (in the UK 23 percent of us are now classed as obese—the highest level in Europe). As a consequence, incidence of chronic diseases—like asthma, coronary heart disease and chronic obstructive pulmonary disease—is increasing. In the UK, chronic disease apparently accounts for 65 percent of the visits to Accident and Emergency departments.

With such a pandemic, it's fortunate advances in IT and communications make 24-hour health monitoring a reality. Vital signs like respiration and heart rate are useful indicators. A healthy heart rate has a high degree of variance, showing as a spikier trace than an unhealthy one. In addition, nocturnal breathing disorder is often a co-morbidity in asthma, COPD, hypertension and heart disease. Close monitoring of such signs could assist sufferers to manage their conditions and carers to pre-empt crises.

Dr. Johnson said that multi-centre trials in Europe show such monitoring is practicable. Patients in the trials had worn a cluster of electrodes on their chests stuck on with adhesive tape that reminded me of the spaghetti at the back of my aging HiFi system—yet compliance was high. This is a good sign. If patients can tolerate being wired up like that then compliance with newer, wearable equipment should be at least as high (see future posts).

Supported by monitoring centres, self-management of chronic illness is real option. As an example of its possibilities, Dr. Johnston referred to work by Dr Dean Ornish et al on the effect of diet, exercise and stress management on heart disease. Dr. Ornish's work assessed the power of a rigourous risk management regime to arrest—or reverse—the progression of atherosclerosis.

If it's practicable (inevitable maybe), where does remote monitoring figure in NHS plans, or indeed in the NHS National Programme for IT (NPfIT)? Do the operational vision for the NHS and the technology planned to support it need revision?

October 22, 2006

Electronic Health Record: different nations, different approaches

view.jpgIn a panel session at last week's International Healthcare Innovation Congress in London speakers from Denmark and Canada spoke about how their nations are tackling the Electronic Health Record (EHR).

Hans Erik Henriksen is Healthcare and Life Sciences Industry Leader, IBM North-East Region. Hans Erik emphasised the necessity of technical and semantic standards like HL7 version 3, however also noted the heavy dependency on change.

He saw the EHR as a journey to be divided into segments. Though parts of the healthcare system have chosen different routes, Denmark has a National eHealth portal, accessed by healthcare professionals and patients; for example, patients can order repeat prescriptions from their GP online.

I was particularly struck by the evolutionary approach that the small (population of about 5m) but perfectly organised Demark has taken. Its IT first replicated the look and feel of paper-based systems and evolved using the innovation of medical practitioners.

Don Sweete is Alliance Executive, Atlantic Region of Canada Health’s Infoway programme, which seeks to address some issues of an aging population, limited funds and the boom in high-cost drugs and procedures.

The programme has $1.2 bn in capital which it distributes to the 10 provinces and 3 territories of its federation when they achieve strategic goals. The method by which they are achieved is not prescribed.

Canada expects to have implemented a basic EHR—founded on registries that include information on medications and test and imaging results—by 2009, freeing patient information from the silos in which it is now stored. It will do that by emphasising interoperability based on architecture and standards, similar to those adopted by the Danes.

Healthcare Must Ride the Wireless Wave

Picture of surfer.I used this soapbox piece as a the basis for a short introduction to the session I chaired at last week's International Healthcare Innovation Congress in London. I will also be posting on a couple of talks that caught my interest--though all of the speakers were good.

Though information is its basic currency, healthcare has been remarkably slow to embrace Information and Communications Technology (ICT). It has mostly been applied piecemeal to automate existing practice rather than transform it. As a consequence, ICT implementation has rarely dramatically improved care or the patient's experience of it.

That is about to change. While healthcare in the 20th Century was centralised and founded on disease management, in the 21st it will be devolved and founded on prophylaxis.

In the West, increasingly aged and obese populations presage more chronic illness such as asthma, diabetes and heart disease. These are better and more economically managed close to the patient's home rather than in hospital.

Fortunately, remote monitoring will make that more practicable. It is already possible to monitor basic indicators such as weight, blood pressure, pulse rate and blood sugar. But devices are becoming more sophisticated and cheaper and can be worn as armbands or less obtrusively in clothing.

Combine remote monitoring with developments in genetic testing and healthcare becomes even more proactive. DNA testing will allow us to predict propensity to disease enabling it to be prevented or at least mitigated.

Wireless applications are fundamental to this vision. Paradoxically, they will allow care to both centralise and devolve. Specialists can be centralised in monitoring and diagnostic centres, which will be invaluable to developing nations, where distances are often large and healthcare resources small. On the other hand, Generalists can be devolved and mobile. For example, in the UK the city of Norwich is experimenting with widespread free WiFi. Using this, district and community nurses can easily access and record patient information immediately before and after home visits.

Another important factor-also helped by wireless links-is greater public access to medical information on the Internet. My wife is a Physiotherapist and often spends evenings scouring medical databases to find reliable published support for her practice-a habit hammered into her by university tutors. Regrettably, only about 30 percent of medical practice is supported by hard evidence.

This shortcoming will also be helped by integrated ICT. Researchers will be able to infer best practice based on the analysis of huge populations of data about the entire process of care. Such evidence will also be available to patients on the Internet, which will alter irrevocably the clinician-patient relationship.

Propelled by a wireless wave, ICT is becoming pervasive and integrated, rather than narrow and standalone. This will give 21st Century healthcare a more solid foundation with fewer specialisms. Medical practitioners must also ride the wave or risk being swept aside.

October 11, 2006

Healthcare Innovation Congress

meeting.jpgI am chairing the first day of the International Healthcare Innovation Congress which takes place in London on 17-19 October 2006. Its topic will be health informatics and it has presenters from UK, Canada, France and Denmark. The rest of the congress examines other areas of innovation.

The healthcare innovation market is growing rapidly, with more funding and investment being added. The congress offers a forum for primary and secondary healthcare providers to share and develop strategies to address the changing nature of healthcare delivery.

The UK government is consulting on the proposed white paper Health Outside Hospitals and plans are already in place for NHS services to be contracted out to the independent and private sectors. This fundamentaly affects all healthcare stakeholders and creates fresh opportunities.

You can see a program of the event.

October 04, 2006

Closing on Remote Care

The US Defense Advanced Research Projects Agency (DARPA) seeks to investigate and exploit promising technologies for use in the defence industry. Its Trauma Pod program (see article and animation at bottom of the page)--an outgrowth of earlier telepresence surgery R&D--seeks to meet the military’s need for trauma care and autonomous surgery by 2025. It is part of the Army’s goal to remove medical personnel and all hospitals from battlefields.

This program supports immediate diagnosis, therapy and evacuation of casualties. Deliverables include advances in teleoperation and surgical procedures, mechanical movements, directed energy, software development, miniaturization and the automatic management of medical supplies in theatre.

Since 2004, DARPA principal investigators have designed and prototyped novel systems. Commercial use of Trauma Pod technologies could lead to greater medical efficiency and the better use of specialist staff.

DARPA Advanced Biomedical Technology Program.

Thanks to Lance Manning for this entry. Lance is a business consultant providing client support in research, development and implementation of emerging health care technologies.