MobiHealth Health care today - Aristotle University of...

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© 2002 The MobiHealth consortium1

MobiHealthIST-2001-36006

http://www.mobihealth.org

Dimitri KonstantasVal JonesRichard Bults

Rainer Herzog

University of Twente (NL)CTIT – APS

Ericsson Consulting Germany


Health care todayProblems and issues

• Life expectancy increases• We have more chronic disease patients

(diabetes, cardiovascular, asthma etc)• Patients and non-patients seek medical

advice more often • People becoming health conscious• Hospitals face worsening resource problems

(time, space, resources, costs ..)


Scenarios for the future development of the health care sector: how to meet the challenges

PATIENTS’ ROLE

PAYERS’ ROLE

Passive

Active

ManageObserve

Empowered Managed Care? individualized, interactive

health & patient management? managed costs

Payers Rule !? pharmacoeconomics,

only cost matter

Patients Rule !? convenience, quality

of life, DTC

Nobody Cares? traditional marketing,

me-too products


Dissolving the boundaries of traditional point of care

Prescription

Diagnosis Consulting

Monitoring of patient’s status /

progression

Monitoring of patient’s status /

progression

Managing patient’s compliance

Managing patient’s compliance

Quick handling of emergency situations

Quick handling of emergency situations

Adaptation of treatment

Adaptation of treatment

Doctor’s Office

Patient’s Home


Wouldn’t it be nice ...

• To have the same level of health care while continuing a normal active life, instead of being stranded at the hospital?

• To have your health status monitored without having to go to health center?


It can be done today ...

• Available technology – Mobile medical sensors– Widely available public wireless network

• Acceptance of new services– GSM telephone based services– Internet

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The Dream ...

GPRS

UMTS


Mobile patient management :Individualized dialog in real time

Datawarehouse

Pull

Push Content

Management

Analysis

Doctor

HealthBroker

Hospital

UMTS

GPRS

SMS

WAP

e-Mail

Patient

? Sensor readings

? Data

? Reminders, questions

? Treatments? Information


Diabetes 5.000.000 500.000 1.000.000

Stroke 1.500.000 150.000 300.000

Asthma 4.000.000 400.000 800.000

Hypertension 17.600.000 1.760.000 3.520.000

CAD 1.500.000 150.000 300.000

Total potential users 2.960.000 5.920.000

Disease PrevalenceAcceptance*

10% 20%

* Estimated acceptance rates for mobile disease management programs

Disease prevalences (Germany) and acceptance rate of mobile patient management


Patient management leads to significant savings for insurers

Source: BKK, PreussenElektra, HannoverMcKinsey

Efficient patient management can save approx. 20% of yearly treatment costs and between 50-60% of costs due to late stage diseases.

Cost Basis forInsurers

Savings inTreatment

Costs

New claimsdue to PM

Costs of PMProgram

Total Costs

Net Savings forInsurers

30 - 40

100

5 -10

5 -10

70 - 90

10 - 30

EXAMPLE 1:Percentage of yearly treatment costs per patient for Asthma, (100=€5,000)

• 5% of all Germans suffer from Diabetes? 300.000 Type I diabetics? 4-5 mill Type II diabetics

• Disease related costs per patient and year:? well monitored diabetics: € 6.500

? badly monitored diabetics: € 8.500? € 2.000

• Costs caused by diabetes related late stage diseases:

? Diabetic Foot: € 1 Bil.? Renal diseases and dialysis: € 1,5 Bil.

EXAMPLE 2:Overview of disease related costs of Diabetes in Germany


Personal mobile health care

• Vital signal information to the health broker over public network

• Personalized measurements • Personalized follow-up and advice• Health record


Requirements

• Flexibility and personalization– Different persons have different needs

• Reliability– Comparable to clinical measurments

• Privacy and security• Non-intrusive – freedom of movement

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Wireless medical telemetry

Patients wear sensors which measure biosignals and transmit them in real time over wireless communications link

eg. EMG, ECG, respiration, BP…..

NB cardiac and respiratory monitoring can already be done using an ordinary mobile phone….


Application Areas

• Home care– In home and out of home health monitoring

• Post treatment follow up• Pharma research• Sports and recreation• Chronic disease research• Trauma care


Virtual Trauma Team

• emergencies, accidents, disaster sites

Mobile devices plus wireless comms to allow emergency staff to communicate with hospitals/specialists to facilitate:

- remote assessment of patient- early intervention- preparation (eg. of theatre)


theatre ER

Paramedic/patient BAN

(bluetooth, GPRS ..)


Virtual Home careThe “patient” is equiped with a

personalized set of sensors/actuators and is connected (via UMTS/GPRS) to a health center.– Intensive care at home– Sports and recreation– Medical follow up– Medical research


Mobile Health Body Area Network

ECGGlucowatch

EEG

headsetBlood pres/pulse

services

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Mobile Health Operational Overview

Health broker

Wireless data services

Public Operator

Hospital

UMTS

Call centerGeneral practitioner


Issues for Mobile Health BAN

• Quality of service– Security, privacy, performance, network

segmentation• Social acceptance

– Health risks, economic issues• Legal issues

– Accreditation of the devices and applications– Legal restrictions for health care – Hospital responsibilities for patient treatment


Why UMTS ?

• Bandwidth – Need more than 9 kbps – 13 kbps

• Data transmission delays– No connection delay

• Cost – per KB instead per minute


Why UMTS - bandwidth as the basis for mobile applications

DATA QUANTITY TRANSMISSION SPEEDS

photo 100 KBweb 30 KBmovie 3000 KB

EDGE 384 Kbps UMTS 2 Mbps

GSM 10 Kbps HSCSD 58 KbpsGPRS 115 Kbps

2G wireless(GSM)

Basic wireline(analog )

Enhanced wireline(ISDN)

HSCSD

Enhanced wireless(adding GPRS )

3G wireless

1 hour1 min 10 min10 sec

E-mailWeb

PhotoVideo clip

TRANSFER TIME


? The successor of present day mobile standards

? Main advantages:

? better utilisation of the frequencies

? high data transmission rates of up to 2 Mbs

? always connected, always on-line

? charging of data volume, not connection time

? Enables the simultaneous transmission of pictures/videos,

speech and data in multimedia applications

? UMTS creates new distribution channels as well as new

competitive advantages for innovative companies

Why UMTS - more convincing advantages


The MobiHealth ProjectIST 2001-36006

• Overall objective The development and trial of new services and applications in the area of mobile health, promoting the use and deployment of GPRS and UMTS.

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MobiHealth targets

• Development of new m- health services and methodologies for their evaluation

• Integration of a generic m- health Body Area Network (BAN)

• Validation of GPRS and UMTS networks for m- health services via large scale trials

• Validation of the accuracy of measurements and data capture

• Validation of medical, social/ ethical and economic advantages of the new m- health applications


MobiHealth BAN

MBU

internalcommunication

links

sensor

0...n

actuator

0...m

externalcommunication

link


MobiHealth architecture\

Home care Home

Pharma Testing

Sports

Hospital patient management system

BAN Operating System

Communications Management

IP Interface

2.5G 3G 4G

Traumacare


MobiHealth Trials

• 4 trial sites– The Netherlands, Enschede– Spain, Barcelona – Sweden, Lulea – Germany

• Trials will start in late spring 2003 • Multiple scenaria will be trialed


Trial Scenaria

Examples of potential trial scenaria (to be finalized end of June 2002, the list is not complete)

• Home care and follow up for chronic patients

• Virtual trauma team• High risk pregnacies• Monitoring of respiratory insufficiency


MobiHealth organization

• Project start : May 1st 2002• Project Duration : 18 months• Project Budget : 8.2 MEU• EU contribution 4.9 MEU• 6 partners – 8 members

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The MobiHealth Consortium

• Ericcson Consulting GmbH (DE)– Gsout

• Telia (SE)– University of Lulea

• University of Twente (NL)– MST, TMSI, Compaq, Yucat

• Telefonica moviles (ES)– Consorti Sanitari Clinic, University Pompeu Fabra

• Phillips Research (UK)• CMG Wireless Data Solutions (NL)


Contactshttp://www.mobihealth.org

Mr. Rainer HerzogSenior Consultant

Maximilianstr. 36D-80539 MünchenGermanyTel.: +49 89 25543713Mobile.: +49 178 534 0067mailto: rainer.herzog@ ericsson.com

Ericsson ConsultingUniversity of Twente

Prof. Dr. Dimitri Konstantas Dr. Val JonesMr. Richard Bults

CTIT – APSP.O.Box 217 NL-7500 AE EnschedeThe NetherlandsTel.: +31 53 489 3784 / 4018mailto: [email protected]: [email protected]: [email protected]


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