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Nyberg Goodit CeBit Tele Health Germany 2007


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Mobile TeleHealth

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Nyberg Goodit CeBit Tele Health Germany 2007

  1. 1. Healthcare in Local and Global Networks Prof. Dr. Timo R. Nyberg [email_address]
  2. 2. Personal Health Record Citizen networks (Ethical and legal matters) Personal Family Community Area Country Continent Insurance networks $$$ Public health insurance Private health insurance Occupational health insurance Travel insurance Out-of-pocket Networks of care providers Primary care clinics Occupational health care providers Secondary care hospitals Speciality treatment organizations Out-patient programs Alternative care provider networks Public health & disease prevention Location based services Satelite network for GPS Cell network for positioning POI network for services RSS for interactive use <ul><li>Information networks </li></ul><ul><li>Personal Health Record PHR </li></ul><ul><li>Health Information Portals </li></ul><ul><li>Communication Networks </li></ul><ul><ul><li>Body area </li></ul></ul><ul><ul><li>Local area </li></ul></ul><ul><ul><li>Mobile networks </li></ul></ul><ul><ul><li>Internet </li></ul></ul>Clinical lab networks $ Long history of clinical chemistry Regulatory bodies Clinics & hospitals (& homes) Clinical labs (&POC) Pharmaceutical networks $$ Regulatory bodies Pharmaceutical companies Pharmacies network Health food products Networks in Healthcare Arena Other important networks Medical specialty areas Local and Global
  3. 3. KNOWLEDGE Guidelines Graded evidence Databases: drugs, laboratory, genome Images and videos for training skills Ethical summaries Patient information Patient data Genome map Database of ”all” previous patients Probably beneficial therapy Simulation Individualized prediction of the effects of treatment Patient’s values and choices Selection of treatment Selection of medical treatment in the future Decision support Doctor’s interpre- tation and experience Source: Kunnamo Paid by Insurance? Available nearby? Etc????
  4. 4. Insulin H Protaphan 32 U. Metformin 500 mg 2 x 2 Aspirin 100 mg 1 x 1 Simvastatin 20 mg 1 x 1 Enalapril 20 mg 1 x 1 Amlodipine 5 mg 1 x 1 Medication 15.6.2005 New R       R R R R R 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 diabetes 12.11.2004 Aspirin 100 mg Disperin 1 x 1 S. Miettinen Antiplatelet drug 20.06.2004 Simvastatin 20 mg Simvastatin Ratiopharm 1 x 1 I. Kunnamo Hyperlipidaemia 04.12.1999 Enalapril 20 mg Enalapril Generics 1 x 1 I Kunnamo Hypertension 26.05.2005 Amlodipine 5 mg Norvasc 1 x 1 K.Virta/KSKS Hypertension Medication used during previous month 23.6.2001 Amoksisilliini 750 mg Amoxin 1 x 2 I. Kunnamo Acute maxillary sinusitis Medications withdrawn 21.02.1998 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 R R R R R R R Always visible view Medication data
  5. 5. Data must be available at the point and time they are needed - if not, it is useless - if not, it is useless
  6. 6. <ul><li>The most common applications of mobile healthcare are for heart, diabetes, and asthma disease management. </li></ul><ul><li>The benefits of mobile healthcare include </li></ul><ul><li>improved patient’s perceived quality of life, </li></ul><ul><li>improved patient satisfaction with healthcare services, </li></ul><ul><li>improved patient compliance with treatment plans, </li></ul><ul><li>decreased hospital-based resource utilization. </li></ul><ul><li>Current applications of mobile healthcare cover the whole disease management from population level to individual care: </li></ul><ul><li>Screening, Segmentation, Intervention and Self Care </li></ul><ul><li>HOWEVER </li></ul><ul><li>Insignificant number of users compared to the problem! </li></ul>Mobile healthcare applications
  7. 7. Chronic diseases – exploding need for care <ul><li>The number of chronic disease sufferers is rapidly increasing </li></ul><ul><li>The most severe diseases are </li></ul><ul><ul><li>Asthma: 100+ million patients worldwide [1] </li></ul></ul><ul><ul><li>Cardiovascular Diseases (CVD): 200+ million patients worldwide [2] </li></ul></ul><ul><ul><li>Diabetes: 190+ million patients worldwide [3] </li></ul></ul><ul><li>Related costs to society skyrocketing </li></ul><ul><ul><li>Asthma: USD 14 Billion annually in the US (2002) [4] </li></ul></ul><ul><ul><li>CVD: USD 370 Billion annually in the US (2004) [5] </li></ul></ul><ul><ul><li>Diabetes: USD 132 Billion annually in the US alone (2002) [6] </li></ul></ul><ul><li>Patients require better quality of care, more accurate treatment, and better information about they condition and needed treatment </li></ul><ul><li>Hospitals need to be more efficient, provide better care, decrease costs </li></ul><ul><li>Public sector needs to decrease costs, improve public health </li></ul><ul><li>[1] US Lung Association data </li></ul><ul><li>[2] US Heart Association data </li></ul><ul><li>[3] International Diabetes Federation </li></ul><ul><li>[4] Trends in asthma morbidity and mortality. US Lung Association, 2004. </li></ul><ul><li>[5] Heart Disease and Stroke Statistics – 2004 Update. US Heart Association, 2004. </li></ul><ul><li>[6] Economic Costs of Diabetes in the U.S. in 2002. US Diabetes Association, 2003 </li></ul>~10% of population
  8. 8. <ul><li>Choronic disease patient today </li></ul><ul><li>Life is centered on check-ups and hospital visits </li></ul><ul><li>Dependency on care reduces ability to normal lifestyles. </li></ul><ul><li>A mobile choise for care delivery </li></ul><ul><li>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 </li></ul><ul><li>enjoy everyday life with mobile healthcare </li></ul>Mobile care benefit
  9. 9. <ul><li>The real-time data significantly improve effects of treatment . </li></ul><ul><li>Numerous ‘studies’ show economic benefits of telecare. </li></ul><ul><li>Significant economic savings and </li></ul><ul><li>quality of care improvements </li></ul><ul><li>may be expected. </li></ul><ul><li>BUT </li></ul><ul><li>More and better clinical trials on mobile healthcare are needed! </li></ul>Quality & Economics
  10. 11. <ul><li>Dibetes patient under control costs 345 €/year </li></ul><ul><li>In a city 200 000 population the cost is 5 M€/year </li></ul><ul><li>Patient with complications cost 8.300 €/year </li></ul><ul><li>10 % have complications, cost 11 M€/year </li></ul>Economic considerations City of Turku 2006
  11. 12. Source: Valle T & Tuomilehto J, 2004 1) Numbers Finland on 31.12.2004 Target value NOT in target (%) NOT in target (n) 1) T1: HbA1c < 7,5 % T2: HbA1c < 7,0 % T2: RR < 135/85 T2: LDL-kol < 2,6 Poor care quality results 72 % 167 300 82 % 190 500 69 % 139 400 79 % 26 400
  12. 13. 19 x 8 x  TK 2005 Cost of poor therapy City of Helsinki 2004
  13. 14. Mobile Phone Test result RFID reader BlueTooth etc.
  14. 15. PDA <ul><li>Mobile Clinical Studies </li></ul><ul><li>Powered by the TrialMax technology </li></ul><ul><li>Patients: 150,000 </li></ul><ul><li>Different systems: 125 </li></ul><ul><li>User sites: 7,311 </li></ul><ul><li>Countries: 57 </li></ul><ul><li>Languages: 55 </li></ul><ul><li>User complience: 95% </li></ul>
  15. 16. WEB (professional)
  16. 17. WEB (individual)
  17. 18. Lääkitys: 2.3.03 Ins Lantus, ... Allergiat: Penisiliini 20.02.98, .. Diagnoosi ja anamneesi: E11, Di.. Silmänpohj. kuvattu 21.6.02 Jalkatutkimus tehty 3.12.04 Laboratoriomittaukset: 12.02... Diabetes view Etunimi Sukunimi Ikä 73 v 7 kk Hetu 010132-xxxx Kotikatu 10, 00100 Puh. 060273849 Ilmoitukset/hälytykset Korkea HbA1C arvo ! Vuosikello & kontrollit Silmänpohjakuvaus uusittava <ul><li>Riskitekijät </li></ul><ul><li>Pvm, BMI 24,8 / 18 </li></ul><ul><li>Pvm, 140/82 mmHg </li></ul><ul><li>Tupakointi K/E </li></ul><ul><li>ASA K/E </li></ul><ul><li>Pvm, HbA1C 11,8 / 7,0% </li></ul><ul><li>Pvm fS-Col-LDL 2.49 / 2,5 mmol/l </li></ul><ul><li>Pvm fP-Gluk 5,2 mmol/l </li></ul>Verenpaine Sydämen syke EKG Lämpötila Hengitystaajuus Jalkahoito Näkötestaus Silmäpohjakuvaus Ruokavalio Elämäntapamuutos Puhe, Internet & SMS yhteys Motivointi Veren glukoosi Potilasympäristö Disease Master Diabeteshoidon asiakashallinta Doctorex MutliLab Automaattinen tiedonsiirto Mobiili yhteys Automaattinen palaute(mm. sms) e-Klinikka Sähköinen konsultaatio Omahoito & mittaukset Type 2 Diabetes care management Paino Tukitoimintoja Diabeteskeskus -paikalliskoordinaattori <ul><li>Piolottialue </li></ul><ul><li>2 lääkäriä </li></ul><ul><li>3 hoitajaa </li></ul>Effica Riskilaskuri Hoitosuositus Lähete Lisää toimintoja
  18. 19. 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 6 Other Intervention Therapy concepts Path 5 Combi Path 3 Insulin Path 2 Oral Path 4 Excercise Path 1 Diet 1 ½ hour 3 1 month 2 1 week Segmentation based on a) 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
  19. 20. Cost-Justification <ul><li>Screening 10000 á 50e 500000e </li></ul><ul><li>Monitoring 2000 á 150e 300000e </li></ul><ul><li>Intervention 500 á 400e 200000e </li></ul><ul><li>Self care 5000 á 60e/year 300000e </li></ul><ul><li>Total 1.3 million € / 1st year </li></ul><ul><li>(1300000/10000=130 avoided complications i.e. 1,3%) </li></ul><ul><li>Next years 300000€ or less - cost very low </li></ul><ul><li>Compare cost to 5M€/a and 11M€/a </li></ul><ul><li>10% i.e. 1100 compl. because 2/3 not in care balance </li></ul>
  20. 21. Technology Choises x Mobile Phone x PDA x Internet Technical functionality Cost effectiveness Easyness of use Notes Screening xx xxxx xxxxx xx xxx xxxx x xxx xxxxx Cell Phone, PDA and Internet ok Segmentation & Monitoring xxxx xxxx x xxxx xx xx xxxxx xxx xx Cell Phone and PDA work well Intervention xxx xxxxx xx xx xxxxx xxx xxx xxxxx x Cell Phone & Internet OK PDA best Self Care xxxxx xxxxx xxxxx xxxxx xx xxxx xxxxx xxx x Cell Phone is the best choise
  21. 22. <ul><li>Mobile healthcare systems are easy and fast to install, </li></ul><ul><li>operate and carry. </li></ul><ul><li>The systems can be made functionally ready at the service </li></ul><ul><li>provider’s location and easily taken by the user to home, office </li></ul><ul><li>or anywhere he/she goes. </li></ul><ul><li>For long-term use, only charging is required and the system is </li></ul><ul><li>ready to run. </li></ul><ul><li>There is no need to connect the system to internet, telephone </li></ul><ul><li>modem or any other system; it is always connected. </li></ul><ul><li>Remote downloads are possible and the systems may be </li></ul><ul><li>updated without returning the device to the provider’s location. </li></ul>The most of technology
  22. 23. Body area network <ul><li>BlueTooth is the BAN which is currently preferred by the most medical technology industry. </li></ul><ul><li>BT is a standard in most modern mobile handsets. </li></ul><ul><li>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. </li></ul><ul><li>Alternative technologies include Zigbee and radio frequency identification (RFID) technologies, which are simpler and have lower power consumption. </li></ul><ul><li>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. </li></ul>
  23. 24. Wireless local area network <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Many mobile healthcare applications exploit the WLAN systems, including locating applications, VOIP and connectivity between portable devices such as laptops. </li></ul><ul><li>WLAN is wireless local, not mobile . </li></ul>
  24. 25. Mobile network <ul><li>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. </li></ul><ul><li>Often the SMS data transfer capacity is sufficient, but the time delay is an issue in medical emergencies. </li></ul><ul><li>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. </li></ul><ul><li>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 . </li></ul>
  25. 26. Wide area network (Internet) <ul><li>Now almost ubiquitous, the internet serves as an excellent platform base for mobile healthcare information systems. </li></ul><ul><li>Internet allows all necessary data transfer economically, like voice and video consultations almost anywhere in the world. </li></ul><ul><li>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. </li></ul>
  26. 27. <ul><li>Technology exists, many applications exist. </li></ul><ul><li>Systems often conflict with existing organization structures. </li></ul><ul><li>The integration of mobile health services with old electronic medical records will present challenges. </li></ul><ul><li>More evidence (clinical studies) of the benefits are needed. </li></ul><ul><li>Mobile healthcare can be delivered without using all connectivity options but in many cases several are in use. </li></ul><ul><li>KISS - especially in the beginning  </li></ul>Conclution
  27. 28. . Thank You for Your Attention [email_address]