With healthcare costs rising and hospitals all over the world creaking under the strain of user demand, new and innovative approaches to diagnosis and treatment are required to maintain standards in a challenging healthcare environment.
Remote healthcare, whether in the form of innovative patient monitoring systems or new treatment options, is proving to be a valuable tool for hospitals to minimise unnecessary (and costly) re-admissions and give patients support wherever they are.
Here we profile eight promising remote healthcare trends and technologies that are bringing medical expertise into patients’ homes, on to their phones and even into outer space.
Advances in wireless healthcare technology have helped liberate costly and non-portable ultrasound technology from the hospital and bring it to smaller healthcare clinics and even the home.
In October 2011, the US Food and Drug Administration (FDA) gave commercial approval to Mobisante’s Mobius device, a compact, smartphone-enabled ultrasound scanner that uses wireless technology to transmit diagnostic scans to consultants elsewhere.
The scanner, which connects to a compatible smartphone via USB to display images, has been indicated for use in foetal, abdominal, cardiac and pelvic diagnostic imaging. Priced at less than $8,000, the device and others like it could prove a cost-effective way of increasing access to ultrasound procedures throughout the US.
Ultrasound in space
Meanwhile, the European Space Agency (ESA) has developed technology to bring ultrasound technology and expertise to a location that’s about as remote as healthcare gets: outer space.
ESA’s computer assisted medical diagnosis and surgery system (CAMDASS) incorporates an ‘augmented reality’ headset that will be able to guide astronauts through an ultrasound procedure without the need for them to have specific medical training.
ESA biomedical engineer Arnaud Runge noted that CAMDASS also has potential for more earthbound applications. "Once it reaches maturity, the system might also be used as part of a telemedicine system to provide remote medical assistance via satellite," he said.
Mobile knee-brace with motion sensors
Facing increasingly saturated markets, cellular providers are venturing into new business areas, including the eHealth market. So has Spanish operator Telefónica, which launched a new tele-rehabilitation service, called Rehabitic, in the summer of 2011.
Following a trial with 100 patients at Barcelona’s Hospital de la Esperanza, it demonstrated improved clinician productivity, with a 50% increase in patient adherence to treatment, a 62% reduction in travel and waiting lists and 96% greater satisfaction with the therapy.
"The next wave of transformation in the healthcare sector will be based on communications, and we’re the ones who know how to connect people," said Telefónica director of the global e-Health business unit Jose Perdomo.
Together with the hospital, the provider then developed a mobile knee brace. The device is co-embedded with motion sensors that allow doctors to monitor a patient’s healing process remotely after they have been discharged from the hospital.
If the patient is moving, for instance during exercise, the motion is simulated via a 3D avatar on a remote computer. This data is then sent to doctors for view on a PC or smartphone. Trials started in Spain and Chile in 2009, followed by tests in the UK, and Telefónica is now selling the service to hospitals and healthcare providers.
NHS deploys remote care for stroke patients
Effective diagnosis and treatment of strokes is a process that relies on early intervention, getting patients the treatment they need within a critical window of only a few hours.
Remote video collaboration systems have an obvious application in this field, so NHS trusts in the UK have begun to deploy Polycom’s RealPresence video system to improve stroke treatment.
Both NHS Surrey and the NHS Cumbria & Lancashire cardiac and stroke network (CSNLC) are using the system to connect hospital teams with specialist stroke consultants who can be on-call around the clock, even when at home.
NHS Surrey senior project manager Colin Lee said that with video conferencing, stroke patients can have a CT scan, be seen by triage and assessed by a stroke specialist, all in less than an hour.
"There is only a very limited window between seeing the onset of symptoms and being able to administer thrombolysis (clot busting drug)," Lee said.
"The newly installed telestroke system means vital time is saved and increases significantly the potential of patients making a full recovery and going on to lead a normal life much more rapidly. It can even mean the difference between life and death, and we are already seeing positive results from the system."
The days of dreading painful endoscopies are soon set to be over: in June 2011, Japanese scientists and medical researchers at the Osaka Medical College and Ryukoku University introduced a small, free-moving capsule camera, which is able to swim through the human digestive tract – the first of its kind.
Nicknamed ‘The Mermaid’, the capsule is remotely controlled with a joystick and can provide power for up to ten hours after it has been swallowed. The magnetic field-powered fins help to the capsule to swim around, snapping two pictures each second.
The Japanese researchers said it could take another three years until the 0.4in in diameter and 1.8in long device will be used in a clinical setting, but it already promises great popularity among patients.
The mobile therapist
Serious mental health issues, such as clinical depression, tend not to mix well with traditional hospital-based treatment. Patients are often unable – financially, geographically or emotionally – to maintain a strict and geographically therapeutic regime.
Fortunately, sophisticated remote healthcare options are now being developed to support depression sufferers wherever they are, at any time of day.
A particularly promising example is Mobilyze!, a specialised smartphone developed by researchers at Northwestern University’s Center for Behavioural Intervention Technologies (CBITS) that features embedded technology to provide depression support. The phone uses a ‘machine learner’ to determine the patterns of a user’s location, mood, activities and treatment adherence.
It can then make suggestions to the user that have improved the patient’s mood in the past. In a small-scale pilot study, the phone was observed to reduce symptoms of depression.
"By prompting people to increase behaviors that are pleasurable or rewarding, we believe that Mobilyze! will improve mood," said CBITS director Dr David Mohr.
"It creates a positive feedback loop. Someone is encouraged to see friends, then enjoys himself and wants to do it again. Ruminating alone at home has the opposite effect and causes a downward spiral."
Data monitoring apps
The rise of the medical electronics sector has boosted the use of medical smartphone and tablet apps in the last couple of years. Now, Northern Devon Healthcare NHS Trust in the UK is piloting mobile devices for its community care nurses and therapists for the first time.
The two-week pilot programme, which started on 7 February 2012, includes handing out smartphones and tablets to about 60 employees, enabling them to access files, capture data and update back office systems remotely. They have access to policy and other documents held on the trust’s database and are able to update information about their visits in real time, using an in-house app.
Northern Devon Healthcare NHS Trust assistant director for health and social care Keri Storey told Guardian Government Computing: "Provided the pilot goes okay, and based on the feedback from the 60-odd staff who are using it, the plan is to move straight into our training sessions with 900 staff so that we are ready for implementation from Monday 2 April."
Mobile digital X-ray imaging
To combine well-tried X-rays with cutting-edge mobile technology, Siemens Healthcare introduced a mobile digital X-ray system with a wireless detector in 2011.
In addition to image quality comparable to that of high-end stationary systems, the Mobilett Mira also provides faster data transfer and is safer to operate.
A rotating swivel arm allows taking images from almost every angle of the body and a fully integrated cable design ensures better sterility. According to Siemens, data security is reliable, with automised anti-virus updates protecting against all common malware.
The device has one single central charging mechanism for the detector and system batteries, and an ECO-mode uses up to 25% less energy. Moreover, results can be checked on the spot, with images displaying within seconds directly at the patient’s bedside.
Improving rural healthcare in India
Throughout much of the developing world, where millions of people live in remote rural communities, mobile technologies could provide the key to improving healthcare by connecting small countryside practices with large urban hospitals for collaboration and consultation.
US-based communications corporation Cisco Systems, for example, has launched several public-private partnerships (PPPs) with regional governments in India. Around 70% of the country’s population lives in rural areas, while 80% of doctors live in and around large towns and cities, which has led to a situation where rural patients often have to travel huge distances to receive the treatment they need.
Cisco’s collaboration with the state of Madhya Pradesh is the company’s latest healthcare PPP in India. The project will introduce remote video consultation, connecting 11 rural clinics in Sehore, Datia, Gwalior and Chhindwara with their nearest district hospitals.
Local practitioners will check a patient’s vital signs while a hospital doctor provides consultation and real-time diagnosis through the video connection.
"Using networking technology we can virtualize scarce resources including doctors, nurses and paramedics and provide access to specialist consultants remotely," said Cisco Systems president, inclusive growth Aravind Sitaraman on the project’s launch in November 2011.
By Elisabeth Fischer and Chris Lo.