Telemedicine

Validation of a Real-time Wireless Telemedicine System, Using Bluetooth Protocol and a Mobile Phone, for Remote Monitoring Patient in Medical Practice.

Journal article

By: Jasemian Yousef

Date: June 22, 2005

Source: Jasemian Yousef. "Validation of a Real-time Wireless Telemedicine System, Using Bluetooth Protocol and a Mobile Phone, for Remote Monitoring Patient in Medical Practice." Abstract. European Journal of Medical Research 10 (June 2005): 254-262.

About the Author: Jasemian Yousef is a biomedical engineer and is affiliated with the Center for SensoryMotor Interaction at Aalborg University in Aalborg, Denmark.

INTRODUCTION

Telemedicine has been in conceptual development since the 1920s. At the same time that the first televisions were being developed, the engineers at AT&T Bell Laboratories were creating picture telephones (that is, telephones that would allow both sender and receiver to see one another while talking—not the digital picture-transmitting telephones of the twenty-first century). The first live demonstration of a two-way video telephone conference occurred in April 1930. Two individuals, at different geographic locations, sat in sound- and light-proof booths with their picture telephones. The images were displayed to each speaker by means of a neon lamp reflecting to a receiving disk. The speakers looked into photoelectric cells that captured and transmitted the images, and their faces were illuminated by blue light. They spoke through desk-mounted microphones, and listened through loudspeakers. Although the demonstration was considered highly successful, and it received very favorable press, AT&T did not release a video telephone product for several more decades.

Contemporary telemedicine incorporates a variety of technologies: standard and fiber-optic telephone service coupled with high-speed, wide-bandwidth transmission of digitized signals utilizing computers, fiber optics, and satellite transmission systems, enhanced by sophisticated peripheral equipment, software, and the use of the Internet. The National Library of Medicine (NLM) acts as the telemedicine clearinghouse for the United States. It collects and disseminates cutting-edge information about telemedicine, and it funds and administratively supports research and development of technology related to telecommunications applications for medicine.

The goals of the burgeoning science of clinical telemedicine are three-fold: 1) to facilitate diagnosis; 2) to provide consultation; and 3) to deliver health services in areas where there is limited access to medical care. This is of particular importance in rural and frontier areas, which may be hundreds of miles distant from specialty medical providers. The three most common ways of using telemedicine are: 1) for tele-consulting, where a patient is in a medical office with an examining provider and a distant provider is available online or by video for a real-time office visit and medical/diagnostic opinion or consultation (provider with patient to distant provider); 2) tele-monitoring (similar to care management or visiting nurse care), where a health care professional at a distant site has a visual and auditory link with a patient who is at home, and either interviews the patient or uses electronic monitoring equipment to determine health status (provider to patient); and 3) store-and-forward telemedicine, in which an electronic record is created for a specific patient, containing data and test results (often pathology, radiology, or CT/MRI/PET/SPECT scan film/data as well), and a distant health care specialist acts as a reviewer and consultant for diagnostic or treatment planning purposes. Telemedicine is also used for teleconferencing and for distance learning purposes.

PRIMARY SOURCE

This paper validates the integration of a generic real-time wireless telemedicine system utilising Global System for Mobile Communications (GSM), BLUETOOTH protocol and General Packet Radio Service (GPRS) for cellular network in clinical practice. In the first experiment, the system was tested on 24 pacemaker patients at Aalborg Hospital (Denmark), in order to see if the pacemaker implant would be affected by the system. In the second experiment, the system was tested on 15 non-risky arrhythmia heart patients, in order to evaluate and validate the system application in clinical practice, for patient monitoring. Electrocardiograms were selected as the continuously monitored parameter in the present study. The results showed that the system had no negative effects on the pacemaker implants. The experiment results showed, that in a realistic environment for the patients, the system had 96.1% up-time, 3.2 (kbps) throughput, 10(-3) (packet/s) Packet Error Rate and 10(-3) (packet/s) Packet Lost Rate. During 24 hours test the network did not respond for 57 minutes, from which 83.1% was in the range of 0-3 minutes, 15.4% was in the range of 3-5 minutes, and only 0.7% of the down-time was > or = 5 and < or = 6 minutes. By a subjective evaluation, it was demonstrated that the system is applicable and the patients as well as the healthcare personnel were highly confident with the system. Moreover, the patients had high degree of mobility and freedom, employing the system. In conclusion, this generic telemedicine system showed a high reliability, quality and performance, and the design can provide a basic principle for real-time wireless remote monitoring systems used in clinical practice.

SIGNIFICANCE

In rural and frontier regions, and in typically underserved or difficult to reach areas, such as prisons, areas of military troop deployment, and commercial maritime vessels, provision of adequate health care has long been a challenge. In those settings, the medical system is often quite fragile. Providers are isolated and lack a peer community. They are often stressed due to high demands on their time with little or no back-up assistance. In addition, they often are underpaid and clinic settings are typically under-funded. (Rural and frontier communities are often poorer than more urban or suburban settings, so they may be more dependent of publicly paid health care, which typically is reimbursed to the provider at a lower rate than commercial third-party payers; in addition, community and ancillary programs for patient participation generally are lacking.) A similar situation exists for health care providers assigned to prison, military troop locations, and maritime vessels. Several access issues generally are common to each of these settings including: 1) geography (large distances between providers, between patients and providers, or between patients and health care facilities); 2) a lack of available and appropriate health care service or program options; 3) a lack of public or accessible transportation systems; 4) low or fixed income; 5) public insurance payment (and therefore limited options and lower reimbursement rates); and 6) possibly, a cultural norm suggesting that health care is not sought except in the most dire emergency.

With the advent of telemedicine, health care providers can literally be in two places at once. They can fill those service gaps without traveling great distances and can use resources with far greater efficiency and effectiveness than previously would have been possible. In each of these environments, the availability of telehealth/telemedicine services provides increased access to general and specialty health care, and provides this care with greater efficiency and effectiveness. Telemedicine can dramatically shorten the waiting time for general and specialty care. In addition, it can facilitate and enhance professional communication, support, and continuing education, and can potentially yield significant cost savings by eliminating lost revenues for transportation, emergency medical care, and missed appointments.

Along with the rapid evolution of the technology necessary to foster the advancement of telemedicine, has come the equally exponential growth and development of the Internet. Consumers are making greater and greater use of electronic technology to gather information and become educated. They use this electronic technology to do research, look up information, gather diagnostic information, order and receive diagnostic tests and protocols, and purchase pharmaceuticals. This parallel growth provides an ideal partnership for the technologically astute consumer, who is far more likely to be confident about the reliability and authenticity of telehealth resources accessed through the Internet than through other means.

There are other trends that make telemedicine a progressively more viable and potentially important tool. The population is aging and people are living longer. Older adults may not be sufficiently mobile to make frequent trips to medical offices or clinics for routine monitoring or for oversight of equipment, such as cardiac, blood pressure, and other vital sign monitors. In addition, increasing numbers of older adults live on fixed incomes. To pay for their medical care, they are dependent on Medicare, pensions, and limited health care insurance. These factors are fueling a shift in the most common sites of health care delivery. Fewer people will be admitted to hospitals, in part because of limited reimbursement, and fewer older adults will seek medical services at health care clinics and medical offices, for both economic and practical reasons (limited mobility of an aging and poorer population). The health care delivery site of choice will become the home. An additional benefit of the use of computer technology for patient monitoring will be the electronic patient record. This electronic record will facilitate consolidation of care and may prevent service duplication and over-prescribing of medications.

FURTHER RESOURCES

Web sites

The American Telemedicine Association. "ATA Newsroom." 〈http://www.atmeda.org/news/newres.htm〉 (accessed November 3, 2005).

The Changing Face of Medical Practice. "Tomorrow's Telemedicine Today." 〈http://telemed.medicine.uiowa.edu/TRCDocs/slides/ttt/sld001.htm〉 (accessed November 3, 2005).

National Laboratory for the Study of Rural Telemedicine. "Final Report." 〈http://telemed.medicine.uiowa.edu/TRCDocs/Pubs/FinalReport/nlm1final.html〉 (accessed November 3, 2005).

Office for the Advancement of Telehealth. "2001 Report to Congress on Telemedicine—Executive Summary." 〈http://telehealth.hrsa.gov/pubs/report2001/exec.htm〉 (accessed November 3, 2005).

Office for the Advancement of Telehealth. "Welcome: Imagine a World Where No Matter Who You Are or Where You Are, You Can Get the Health Care You Need When You Need It." 〈http://telehealth.hrsa.gov/welcome.htm〉 (accessed November 3, 2005).

United States National Library of Medicine. National Institutes of Health. "Fact Sheet: Telemedicine Related Programs." 〈http://www.nlm.nih.gov/pubs/factsheets/telemedicine.html〉 (accessed November 3, 2005).