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Telehealth: Transforming from Sickness Treatment to Wellness Management

by: R. R. Miller, February 16, 2010

 

The term telehealth— the use of telecommunications to share healthcare services and information–encompasses multiple aspects of healthcare: teleconferencing, conversion of medical records to digital form, and collaboration among healthcare providers who all have the same information.

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Potentially more exciting is the use of telecommunications to remotely monitor patients’ health and relay medical and biometric information directly from the home to doctors and health facilities, all within seconds. Remote monitoring is possible with a new generation of small, inexpensive sensors with very low power requirements. The new sensors, benefiting from recent advances in miniaturization, are as accurate as hospital-grade equipment of just a few years ago, at a fraction of the cost.

Moreover, their low cost and small size make sensors easy to incorporate into a range of devices, providing solutions to multiple sensing applications:

  • Sensors that take direct readings of temperature, blood pressure, oxygen levels, and other vital signs to monitor and record overall health.

    Healthy people can establish a baseline profile of their heart rate, blood pressure, and other indicators. Deviations from this personalized baseline built up over time can help pinpoint health problems early.

    People with chronic health problems can more actively monitor their own conditions and know when to seek a doctor’s care. Lightweight sensors can be worn continuously to monitor chronic conditions.
     
  • Sensors incorporated into devices to sound alarms. Pill dispensers, for example, can remind a patient when pills aren’t taken at the recommended time and make sure the right ones get taken.
  • Environmental, passive sensors such as motion detectors that turn on lights when someone gets up in the middle of the night or record the timing or frequency of night-time bathroom visits. (Sleep and movement patterns are often a health indicator.)

Data collected by sensors when the patient is at home and going about normal activities can be more representative of everyday wellness than readings taken during episodic office visits when the patient may be ill or nervous. The data can be aggregated over days, months, or years to show trends over time, giving a more complete picture of a person’s health.

 

Adding telecommunications capability

Sensors can collect high-quality medical data, but the real value is relaying this information to doctor’s offices, hospitals, and other medical facilities where the data can be interpreted and acted upon. The infrastructure for transmitting medical data from the home to healthcare facilities exists now in the broadband networks built and managed by AT&T and other providers. (AT&T alone will spend over $17 Billion on capital outlays in 2010.)  Sensor-collected data can be sent over broadband and IP networks in the same way data and voice are relayed from PCs and cell phones.

Getting the sensor data from the devices to the broadband network will be done wirelessly, through a local area network set up in the home, which allows the measurements to be collected conveniently anywhere. The data flows via radio to a home gateway and is then coupled into AT&T broadband or cellular networks for transmission to where it’s needed. 

In a medical emergency, sensors could transmit alarms to hospitals or emergency rooms even as the event is occurring.

Today, wireless connectivity can be provided by the Wi-Fi and Bluetooth technologies or, more promisingly, by the new ZigBee radio standard (based on IEEE 802.15.4). Much like Wi-Fi and with similar range, ZigBee networks communicate packets, such as a temperature or glucose readings, more slowly but also using much less battery power. The radios are simple, economical, and can “sleep” for long periods when not transmitting or receiving. Wi-Fi, by contrast, is built for higher data rates and low-latency streaming. It’s ideal for voice, video, and multimedia-rich sensing “telepresence” applications, but requires more battery power, making it less attractive for devices that have small batteries that must last a long time.

ZigBee has two additional advantages over point-to-point radios such as Bluetooth: a single ZigBee “cell” can accommodate thousands of nodes, and these nodes can self-organize into a store-and-forward network in which each node can relay data on behalf of another, an important capability when data integrity must be preserved as users and their devices move about homes where RF coverage may be uneven.

Sensor data combined with telecommunications will shift the sub-clinical or health-maintenance care of patients from expensive healthcare facilities to the home. . .

This property allows ZigBee relay nodes distributed throughout the home to ensure signals reach the gateway from any room. From the gateway, the data is securely carried over AT&T’s broadband network. Away from home, a ZigBee-enabled cell phone can perform the same functions as the gateway, allowing a seamless transition from indoor local area networks to outdoor cellular networks as monitored patients go about their daily routines

With sensors able to communicate and share data, much becomes possible. In a medical emergency, sensors could transmit alarms to hospitals or emergency rooms even as the event is occurring, perhaps saving a life. Since the sensors are two-way, the hospital could send a demand-respond message to verify the information or request a series of updates in real time for more intensive information-gathering.

Sensor data combined with telecommunications will shift more post-treatment, rehabilitation, or chronic care of patients from expensive healthcare facilities to the home and allow medical conditions to be dealt with before they become acute. Eliminating trips to hospitals and doctors’ offices will reduce costs, and allow doctors more time with other patients. For the chronically ill, remote monitoring means more control over their own condition and reduces the stress of frequent office visits. 

Even patients who often require continuous monitoring in a hospital, such as women with high-risk pregnancies, could remain at home since the sensor-collected data is just as accurate as data collected in hospitals. If a dangerous situation develops, sensors could trigger an automatic alert so doctors can intervene at the first sign of trouble.

If approved by those being monitored at home, measurements can also be shared with caregivers to allow them a more active role in assisting older family members, for example, who wish to live at home independently and who may have one or more medical conditions.

 

Adding communications capabilities to devices

Almost any medical device can be transformed by telecommunications. AT&T Research is working with device-makers to prove the concept. Such partnerships are expanding the flexibility and convenience of today’s common health devices: scales, pill dispensers, blood-pressure meters, pulse-oximeters (combined pulse-rate and blood oxygen concentration sensors), glucometers, and other formerly stand-alone instruments,into wireless, portable Personal Health Devices (PHDs).

This is done by adding a small module containing an entire communications system, complete with CPU, memory, a ZigBee radio, and data interface (for passing data from the basic sensor to the ZigBee radio) into these devices. Devices thus augmented, become “smart”: able to detect and store readings and then communicate them automatically to a doctor, medical professional, or caregiver.

A regular pill dispenser, for example, simply sounds an alert to take a pill at a certain time. But one equipped with a sensor and telecommunications can also report to the doctor at what time the pill was removed, giving doctors much better knowledge about the relationship between the blood drug level and patient condition. Similarly, a ZigBee-embedded pulse-ox meter that clips onto a patient’s fingertip can measure pulse rate and oxygen levels in the blood (important indicators for heart and lung performance), and enter the readings in a doctor database located in a hospital hundreds of miles away.

Doctors will essentially become knowledge managers, and spend less time collecting data and more time analyzing it.

At the leading edge of research and testing is transformation of bed-stand or kitchen-table instruments that take measurements at intervals during the day to devices designed to be “wearable”, such as EKG monitors for cardiac patients. An interesting and more unconventional example is a “smart” shoe insole for combating a major health problem of the elderly: falls. For the elderly, one in three falls will require an E R visit, and one in 20 will lead to a fatal complication within six months.

AT&T Research has partnered with device maker 24Eight LLC to embed pressure sensors, accelerometers, and a ZigBee radio within cushioned insoles that can be inserted into footwear to gather continuous information about a patient’s movements and weight distribution. The work is a good illustration of how sensing capabilities have evolved. Early gait studies done in the last two decades to investigate design of mechanical prosthetics required bulky hardware cabled to the super-computers of the day. The data collected using the new insoles are almost identical to the data collected from a lab full of yesterday’s equipment.

Insole data can now be transmitted over AT&T's network, processed, and sent to a doctor’s office, where it may serve multiple purposes:

  • Predict who is most at risk of falling. Changes in weight distribution may indicate deteriorating balance or muscle degeneration, allowing doctors to recommend wheelchairs or walkers to those at risk. Parkinson’s disease progression, for example, often leads to a slow, shuffling gait that becomes more unstable over time.
  • Provide warnings of immediate falling danger, for example, due to medication effects or interactions. A change in gait might also be caused by cardiovascular difficulty, loss of blood glucose control, or dizziness. Gait instability warnings can prompt intervention by a physician or caregiver, which can be further augmented by using other remote measurements to investigate the root cause of the instability.
  • Send an immediate alert if a patient falls so that help can come quickly, even if the individual is unconscious.

The “smart” insole concept has evolved into “smart slippers” that are currently entering clinical trials at the Garrison Geriatric Education and Care Center in Lubbock, Texas, as part of a research partnership with Texas Tech University Health Sciences and TTU Electrical Engineering Schools.

And with modern telecommunications, the data can be collected from any location and transmitted to where it’s needed . . .

Communications can be added to almost any device, and AT&T Research, by building and demonstrating prototype devices, is hoping more device makers will incorporate communications into their products, making them available to all. AT&T Research has already laid much of the groundwork, creating and validating specifications that can serve as a basis for mass-producing medical devices with communications ability.

 

Remaining hurdles

Telehealth promises to fundamentally transform healthcare. The new sensors combined with telecommunications will collect a wealth of health data, giving doctors much more data to analyze, making for better and faster diagnoses. Doctors will essentially become knowledge managers, and spend less time collecting data and more time analyzing it.

And with modern telecommunications, the data can be collected from any location and transmitted to where it’s needed, allowing doctors to view the information anywhere and give a diagnosis based on a complete health record. More complete data also makes it easier to accurately track treatments and outcomes.

But there are obstacles. Standards are needed to ensure devices from different manufacturers can communicate, and that data sent from a home’s wireless network can be viewed from any doctor’s office. AT&T Research is working with standards bodies, industry groups, and device makers to create integrated solutions and help ensure that the telehealth remote monitoring future is built on a platform of solid science and good networking architectures.

One industry group of which AT&T  is a member, the Continua Health Alliance, is specifically focused on remote health monitoring. Made up of leading technology, healthcare, and fitness companies, the alliance is developing requirements and certifications for a wide range of interoperable devices, such as fitness equipment, heart monitors, weight scales.

Another hurdle is the current insurance model that compensates doctors and patients based on office visits. As telehealth becomes more pervasive, this model needs to change so doctors are not penalized for adopting the new technology and processes.

These solutions will require broad consensus across multiple industries and interest groups. This will be difficult. But as the healthcare in the US approaches a crisis point, telehealth is a solution that has the potential to improve healthcare and lower costs, and it makes sense to do all that is necessary to make it a reality.

 

 

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Preventing Falls

 

 

Telecommunications can directly transmit sensor-collected data from any location to where it's needed.

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