January 26, 2008

Remote Health Monitoring: big brother or big help?

Picture of workers using PCs.UK law firm Eversheds reports Microsoft has applied for a patent for workplace monitoring software. It could remotely monitor a worker's wellbeing, productivity and competence using metabolic measures like heart rate, temperature and movement and relate them to their psychological profile.

Trade unions are concerned that such software could be used to support cases for dismissal, but Eversheds reminds us of its double edge. Workers may equally be able to claim they were subject to undue stress, which might entitle them to reasonable adjustments to their job and working conditions.

I attended a healthcare CIO conference at Microsoft in Reading UK last week. Fellow blogger Dr. Bill Crounce showed a short clip of a vision of future healthcare that made use of remote monitoring and also surface computing. Cabinets next to a patient's bed could indicate to a patient or a carer when it was time for medication to be to be taken by coloured rings around the drug containers, for instance.

November 13, 2006

Long Term Care Demonstrators

Hand holding a walking cane.That will teach me to ask rhetorical questions at the end of posts.

In a previous post on management of chronic conditions I asked where remote monitoring appeared in the vision for the NHS and in its NPfIT. The DoH has announced its intention to fund up to three Whole System Long Term Care Demonstrators covering a population of one million. The pilots will run for up to two years.

It will be interesting to see how the pilots are organised and their technical solutions. The DoH wants the NHS and Local Authorities to partner. The workings of such partnerships--which could include contributions from the primary and acute care in the NHS as well as the private, voluntary, charitable and private sectors--will be key to their succeess. And where will organisations like NHS Direct fit in, I wonder? All in all, we should gain insight into the structure of future healthcare and the technical, human and organisational dynamics needed to support it.

Partnerships will be able to draw upon offerings from 15 suppliers from a pre-competed Telecare National Framework Agreement.

November 01, 2006

Healthcare on Wireless Waves

Toumaz device being used.My previous post discussed the reality of remote health monitoring. I noted the high compliance of study participants monitored using large arrays of stick-on sensors. Such discomfort may now be unnecessary.

Toumaz Technologies has developed new, small, low power, wireless sensors that can be attached to the body with sticking plasters. These devices enable non-intrusive, continuous monitoring and analysis of ECG, temperature and at least one other vital sign, such as respiration or activity level. Vital signs are transmitted to a PDA or mobile phone and monitored with software that includes an arrhythmia detection algorithm for real-time monitoring of ECG.

You may also be interested in an article I wrote for an IT innovation magazine about real-time remote health monitoring (well, everyone likes to back a winner sometime) though I was thinking of a wristband.

Visit the Toumaz site for more on their device.

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?

September 16, 2006

Remote Testing for Influenza?

Picture of clinician using microscope.Scientists from the University of Colorado at Boulder and the Centers for Disease Control and Prevention (CDC) have developed a microchip-based test that may allow more labs to diagnose influenza infections and learn more about the pathogenic viruses.

The FluChip successfully distinguished among 72 influenza strains - including the H5N1 avian influenza strain - in less than 12 hours. Bichip can be used at lower levels of biosafety, which may increase the number of labs that can determine critical details of a virus's origin.

FluChip is constructed by a robotic arm dropping thousands of spots of DNA and RNA onto a microscope slide in a known sequence. The spots are exposed to sample material and scientises can then compare gene sequences to identify the virus.

It seems to me that this technology could be the basis for remote diagnosis, maybe using the silicon biotechnology I talked about in this FHIT post.

July 16, 2006

Brain Training--and monitoring?

Like 1.4m Japanese, I have applied myself to Dr. Kawashima's Brain Training on the Nintendo DS. After 2 months I reduced my brain age to more than 20 years below my biological age--not bad I guess.

Using Magnetic Resonance Imaging (MRI) Dr. Ryuta Kawashima (a neroscientist at Tohoku University in Sendai, Japan) has selected numerical and verbal tests that most activate your brain's hemispheres. Surprisingly, the tests are not sophisticated. You solve a range of simple arithmetical and verbal puzzles quickly and your memory is also tested.

The handwriting and speech recognition are good--but it's still frustrating sometimes when the software misreads my handwriting scrawl giving me a red cross instead of the green tick I should have had!

I bought Nintendo's Big Brain Academy which was released recently in the UK. It also tests mental agility with another series of puzzles. I will let you know how I get on.

Devices like this could be used to remotely monitor cognition and perhaps give an early warning of its decline.

Nintendo's UK site for Brain Training.