Nyberg Goodit CeBit Tele Health Germany 2007
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Mobile TeleHealth
Transcript of Nyberg Goodit CeBit Tele Health Germany 2007
Personal Health Record
Citizen networks(Ethical and legal matters)
PersonalFamilyCommunityAreaCountryContinent
Insurance networks $$$Public health insurancePrivate health insuranceOccupational health insuranceTravel insuranceOut-of-pocket
Networks of care providersPrimary care clinicsOccupational health care providersSecondary care hospitalsSpeciality treatment organizationsOut-patient programsAlternative care provider networksPublic health & disease preventionLocation based servicesSatelite network for GPSCell network for positioningPOI network for servicesRSS for interactive use
Information networksPersonal Health Record PHRHealth Information PortalsCommunication Networks
•Body area •Local area•Mobile networks•Internet
Clinical lab networks $Long history of clinical chemistryRegulatory bodiesClinics & hospitals (& homes)Clinical labs (&POC)
Pharmaceutical networks $$Regulatory bodiesPharmaceutical companiesPharmacies networkHealth food products
Networks in Healthcare Arena
Other important networksMedical specialty areasLocal and Global
KNOWLEDGEGuidelinesGraded evidenceDatabases: drugs, laboratory, genomeImages and videos for training skillsEthical summariesPatient information
Patient dataGenome map
Database of ”all”previous patients
Probablybeneficialtherapy
Simulation Individualizedprediction ofthe effectsof treatment
Patient’s valuesand choices
Selection oftreatment
Selection of medical treatment in the future
Decisionsupport
Doctor’s interpre-tation andexperience
Source: Kunnamo
Paid by Insurance?Available nearby?
Etc????
Insulin H Protaphan 32 U. Metformin 500 mg 2 x 2Aspirin 100 mg 1 x 1Simvastatin 20 mg 1 x 1Enalapril 20 mg 1 x 1Amlodipine 5 mg 1 x 1
Medication 15.6.2005 New
R
RRRRR
Continuous medication
05.07.2003 Long-acting insulin Insulin H Protaphan 32 U. M. Valli/KSKS Type 2 diabetes 23.6.2001 Metformin 500 mg Diformin retard 2 x 2 I. Kunnamo Type 2 diabetes12.11.2004 Aspirin 100 mg Disperin 1 x 1 S. Miettinen Antiplatelet drug20.06.2004 Simvastatin 20 mg Simvastatin Ratiopharm 1 x 1 I. Kunnamo Hyperlipidaemia04.12.1999 Enalapril 20 mg Enalapril Generics 1 x 1 I Kunnamo Hypertension26.05.2005 Amlodipine 5 mg Norvasc 1 x 1 K.Virta/KSKS Hypertension
Medication used during previous month23.6.2001 Amoksisilliini 750 mg Amoxin 1 x 2 I. Kunnamo Acute maxillary sinusitis
Medications withdrawn21.02.1998 Hydroklorothiazide 25 mg Diurex mite 1 x 1 K.Virta/KSKS Hypertension + amiloridechloride 5 mg Withdrawn 15.3.1998. Cause: Rash I Kunnamo
Detailed view
RRRRRRR
Always visible view
Medication data
Data must be availableat the point and time they are needed
- if not, it is useless- if not, it is useless
The most common applications of mobile healthcare are for heart, diabetes, and asthma disease management.
The benefits of mobile healthcare include• improved patient’s perceived quality of life,• improved patient satisfaction with healthcare services,• improved patient compliance with treatment plans, • decreased hospital-based resource utilization.
Current applications of mobile healthcare cover the whole disease management from population level to individual care:Screening, Segmentation, Intervention and Self Care
HOWEVERInsignificant number of users compared to the problem!
Mobile healthcare applications
Chronic diseases – exploding need for care
The number of chronic disease sufferers is rapidly increasing The most severe diseases are
– Asthma: 100+ million patients worldwide[1]– Cardiovascular Diseases (CVD): 200+ million patients worldwide[2]– Diabetes: 190+ million patients worldwide[3]
Related costs to society skyrocketing– Asthma: USD 14 Billion annually in the US (2002)[4]– CVD: USD 370 Billion annually in the US (2004)[5]– Diabetes: USD 132 Billion annually in the US alone (2002)[6]
1. Patients require better quality of care, more accurate treatment, and better information about they condition and needed treatment
2. Hospitals need to be more efficient, provide better care, decrease costs3. Public sector needs to decrease costs, improve public health
[1] US Lung Association data[2] US Heart Association data
[3] International Diabetes Federation[4] Trends in asthma morbidity and mortality. US Lung Association, 2004.
[5] Heart Disease and Stroke Statistics – 2004 Update. US Heart Association, 2004.[6] Economic Costs of Diabetes in the U.S. in 2002. US Diabetes Association, 2003
~10% of population
Choronic disease patient today
• Life is centered on check-ups and hospital visits
• Dependency on care reduces ability to normal
lifestyles.
A mobile choise for care delivery
• For people with diseases such as diabetes, cardiac
arrhythmia, COPD or asthma, and for others in
need of frequent medical care outside the clinical
environment, it is easier to
enjoy everyday life with mobile healthcare
Mobile care benefit
• The real-time data significantly improve effects of treatment. • Numerous ‘studies’ show economic benefits of telecare.
Significant economic savings and quality of care improvements
may be expected.
BUT
More and better clinical trials on mobile healthcare are needed!
Quality & Economics
• Dibetes patient under control costs 345 €/year• In a city 200 000 population the cost is 5 M€/year
• Patient with complications cost 8.300 €/year• 10 % have complications, cost 11 M€/year
Economic considerations
City of Turku 2006
72 %72 % 167 300167 30082 %82 % 190 500190 50069 %69 % 139 400139 400
Source: Valle T & Tuomilehto J, 2004Source: Valle T & Tuomilehto J, 2004
1)1) Numbers Finland on 31.12.2004 31.12.2004
Target valueTarget value NOT in NOT in target (%)target (%)
NOT in NOT in target (n)target (n)1)1)
T1: HbA1c < 7,5 %
T2: HbA1c < 7,0 %
T2: RR < 135/85
T2: LDL-kol < 2,6
79 %79 % 26 400
Poor care quality results
1014
8212
534
10331
0
2000
4000
6000
8000
10000
Type 1 Type 2
No Complications With Complications
€ / patient / year
19 x8 x
TK 2005TK 2005
Cost of poor therapy
City of Helsinki 2004
Mobile Phone
Test resultRFID reader
BlueTooth etc.
PDAMobile Clinical Studies
Powered by the TrialMax technology
Patients: 150,000 Different systems: 125 User sites: 7,311 Countries: 57 Languages: 55 User complience: 95%
WEB (professional)
WEB (individual)
Riskilaskuri Lääkitys: 2.3.03 Ins Lantus, ...Allergiat: Penisiliini 20.02.98, ..Diagnoosi ja anamneesi: E11, Di..Silmänpohj. kuvattu 21.6.02Jalkatutkimus tehty 3.12.04Laboratoriomittaukset: 12.02...
Diabetes viewEtunimi SukunimiIkä 73 v 7 kkHetu 010132-xxxxKotikatu 10, 00100 Puh. 060273849
Ilmoitukset/hälytyksetKorkea HbA1C arvo! Vuosikello & kontrollitSilmänpohjakuvaus uusittava
Riskitekijät1. Pvm, BMI 24,8 / 182. Pvm, 140/82 mmHg3. Tupakointi K/E4. ASA K/E5. Pvm, HbA1C 11,8 / 7,0%6. Pvm fS-Col-LDL 2.49 / 2,5 mmol/l7. Pvm fP-Gluk 5,2 mmol/l
Hoitosuositus
Lähete
Lisää toimintoja
Verenpaine
Sydämen syke
EKG
Lämpötila
Hengitystaajuus
Jalkahoito
Näkötestaus
Silmäpohjakuvaus
Ruokavalio
Elämäntapamuutos
Puhe, Internet & SMS yhteys
Motivointi
Veren glukoosi
Potilasympäristö
Disease MasterDiabeteshoidonasiakashallinta
DoctorexDoctorex
MutliLab MutliLab
Automaattinen tiedonsiirto
Mobiili yhteys
Automaattinen palaute(mm. sms)
e-KlinikkaSähköinen konsultaatio Omahoito & mittaukset
Type 2 Diabetes care management
Paino
Tukitoimintoja Diabeteskeskus-paikalliskoordinaattori
Piolottialue•2 lääkäriä•3 hoitajaa
EfficaEffica
City of 200000 population, target group about 30000 over 40-year-old men in occupational health care system
Screening with Internet or PDA 30000 men
Path 6Other
InterventionTherapy concepts
Path 5Combi
Path 3Insulin
Path 2Oral
Path 4Excercise
Path 1Diet
1 ½ hour
3 1 month
2 1 week
Segmentation based ona) risk screening, b) life style, and c) Motivation 10000 men
4 continuous
Self care
Self measuremets
Mobile phone
Intelligent support system
FEED BACK
ACT
MEASURE
Cost-Justification1. Screening 10000 á 50e 500000e
2. Monitoring 2000 á 150e 300000e
3. Intervention 500 á 400e 200000e
4. Self care 5000 á 60e/year 300000e
Total 1.3 million € / 1st year
(1300000/10000=130 avoided complications i.e. 1,3%)
Next years 300000€ or less - cost very low
Compare cost to 5M€/a and 11M€/a
10% i.e. 1100 compl. because 2/3 not in care balance
Technology ChoisesTechnical
functionalityCost
effectivenessEasyness of
useNotes
Screening xxxxxx
xxxxx
xxxxx
xxxx
xxxx
xxxxx
Cell Phone, PDA and
Internet ok
Segmentation & Monitoring
xxxxxxxx
x
xxxxxxxx
xxxxxxxxxx
Cell Phone and PDA work well
Intervention xxxxxxxx
xx
xxxxxxx
xxx
xxxxxxxx
x
Cell Phone & Internet OK PDA best
Self Care xxxxxxxxxxxxxxx
xxxxxxx
xxxx
xxxxxxxxx
Cell Phone is the best
choise
x Mobile Phone x PDA x Internet
• Mobile healthcare systems are easy and fast to install, operate and carry. • The systems can be made functionally ready at the service provider’s location and easily taken by the user to home, office or anywhere he/she goes. • For long-term use, only charging is required and the system is ready to run. • There is no need to connect the system to internet, telephone modem or any other system; it is always connected. • Remote downloads are possible and the systems may be updated without returning the device to the provider’s location.
The most of technology
Body area network
BlueTooth is the BAN which is currently preferred by the most medical technology industry.
BT is a standard in most modern mobile handsets. However, in mobile medical equipment the amount of
information transmitted is typically small and the equipment is personal, so there is no need for either the large data transfer capacity or the open network connectivity of BlueTooth.
Alternative technologies include Zigbee and radio frequency identification (RFID) technologies, which are simpler and have lower power consumption.
Often the wired connection to the mobile handset is a good choice for body area networking and the short wire does not make the system any less mobile.
Wireless local area network
WLAN technologies are widely used in hospitals, but WLAN devices are seldom suitable for true mobile applications, as they require relatively big batteries to support the power needs and their roaming is limited.
As for BlueTooth, they offer more data transfer capacity than is needed for simple monitoring applications. The benefit of WLAN systems is the well-established standards in this area.
Many mobile healthcare applications exploit the WLAN systems, including locating applications, VOIP and connectivity between portable devices such as laptops.
WLAN is wireless local, not mobile.
Mobile network
Most mobile networks are capable of conveying medical data, even the old GSM data 9.6 kBits is enough for transferring a good quality 12-lead ECG signal.
Often the SMS data transfer capacity is sufficient, but the time delay is an issue in medical emergencies.
With the WDMA and GPRS networks it is possible to transfer MMS messages, small pictures and video clips and continuous data. They are preferred for many mobile healthcare applications today.
In practice the new 3G network will make it possible to have video consultation over the mobile network, but it is not yet fully operational or competitively priced.
Wide area network (Internet)
Now almost ubiquitous, the internet serves as an excellent platform base for mobile healthcare information systems.
Internet allows all necessary data transfer economically, like voice and video consultations almost anywhere in the world.
With the advent of digital TV or IPTV, it is anticipated that TV type interface will become the an important portal to the web services.
• Technology exists, many applications exist.• Systems often conflict with existing organization structures.• The integration of mobile health services with old
electronic medical records will present challenges.• More evidence (clinical studies) of the benefits are needed.• Mobile healthcare can be delivered without using all
connectivity options but in many cases several are in use.
• KISS - especially in the beginning
Conclution
