Healthcare - Telemedicine
Getting Well With the Web
More and more people are discovering the convenience of Internet shopping and online banking. Just turn on your home computer and you'll find thousands of Web stores waiting for you. And for those who would like to do something for their health, there will soon be a range of telemedicine services available on the Web as well.
A close look at the fundus of the eye can detect the first signs of damage to the optic nerve, and thus help to prevent visual impairment
The world of telemedicinehealth care over the Webis still the domain of the medical community. Physicians wanting to confirm a diagnosis, for example, can use a telephone or data link to send recorded images, lab results, or other information to colleagues. Soon, however, ordinary citizens will also be able to use this technology from the comfort of their own homes. Diabetics, for example, will be able to send their own blood-sugar readings via the Internet to a system that will immediately inform their family doctor if a predetermined value has been exceeded. Without such a system, the doctor wouldn't discover any deterioration in the readings until the next routine check.
At the heart of this system is a Web-based information and telecommunications platform known as MedStage. Developed by Siemens Medical Solutions, MedStage receives medical data from various sources, which it stores as electronic health files on a server. The platform is now being tested in a number of European pilot projects, where it forms the backbone for a range of telemedicine applications for preventive medicine, early diagnosis and patient monitoring.
Giving Doctors a Break. In Germany, MedStage servers are located at the Siemens Business Services high-security computer center in Frth. There, data is stored for DIADEM, an EU project , which is designed to stem a projected explosion in costs due to the increasingly widespread occurrence of diabetes. Studies show that a diabetic patient generally costs the health care system one and a half times as much as a healthy person. And things can get really expensive if patients start neglecting their treatment, since that's when secondary complications set in. Such complications can raise costs by a factor of 20 or 30. In Great Britain, for example, the number of diabetes cases resulting from people not taking proper care of themselves is set to triple over the period from 1995 to 2012.
Retinal blood vessels can give an early warning of the state of the vascular system. The goal of this telemedical application is to prevent strokes and heart attacks
That's where the DIADEM project comes in. The project, which was launched at the beginning of 2002 and will run until June 2003, is conducting a telemedicine study in Cardiff, Wales. Diabetic patients are measuring their blood-sugar values in the conventional manner, but are then transmitting the data to a MedStage server either by phone or via the Internet. If the server determines that any of the data seems suspicious, or that data is missing, it automatically informs a call-center employee who then contacts the patient and reminds him to regularly check his blood-sugar levels and stick to his diet. "The result is that diabetic patients only visit their doctors when it's really necessary," says Dr. Eva Rumpel, head of the DIADEM project at Siemens Medical Solutions. It is hoped that DIADEM can help reduce the long waiting lists for general practitioners that plague the UK's centralized health care system. "Early detection of illness or disease pays off in particular in countries that have a tax-funded health care system, like Great Britain," explains Dr. Volker Schmidt, who is responsible for MedStage Disease Management and Screening at Siemens Medical Solutions. "That's why we'll be stepping up our involvement in the UK and our telemedicine activities there in the future."
Keeping an Eye on Blindness. As part of the EU's TOSCA project, a screening method was developed and tested last year to help medical professionals recognize pathological changes to the retina early enough to prevent blindness. Glaucoma is the second most common cause of blindness in industrialized countries. This condition, which initially results in a severely reduced field of vision, is caused by an increase of pressure within the eyeball, which damages the optic nerve. Diabetics, on the other hand, are prone to diabetic retinopathy, the abnormal growth of retinal blood vessels that can lead to blindness. "TOSCA involves 20 partners," says project coordinator Dr. Gudrun Zahlmann from Siemens Medical Solutions. "It's a very successful alliance of clinics, research institutes, and companies. We have succeeded in bringing together the exposures of the fundus of the eye, patient information and image management systems on the same telemedical platformMedStage."
The electronic health advisor
In an age of dwindling healthcare budgets, politicians are calling on people to take on more responsibility for their own health. A useful technical aid in this context could well be the personal fitness trainer devised by Dr. Markus Jäger from Siemens Corporate Technology (CT) in Munich. The concept features a chest strap with a pulse gauge and an ECG pad that can be stuck onto the skin above the heart, and which is fitted with a reusable radio transmitter. A range of sensorsincluding, conceivably, a GPS-based positioning transmittercontinually transmit their readings or signals to a receiver, which might be integrated into a cell phone, for example. The latter transmits the data to an Internet server, which draws up an individual training plan on the basis of the values supplied. Jäger is also planning to use intelligent software agents that will automatically establish contact between the training server and other Web servers. "In this way, a special nutrition server could be used to devise a personal diet plan on the basis of the readings supplied," he explains, adding, "Other agents could check the person's smart refrigerator to determine if it already contains the right foods." Jäger is currently looking for a partner willing to bring the fitness trainer onto the market. "The concept could be up and running within just a few months," he explains. Indeed, it's probably only a matter of time before we begin conducting a whole host of health checks in the comfort of our own homes. The sensors required for this could also be integrated into smart clothing, perhaps even in pyjamas. The sensors would then monitor our state of health while we sleep and automatically transmit the readings to an Internet server.
Targeted Queries. Another project group at Siemens Corporate Technology is focusing on the topic of artificial intelligence and, in particular, self-learning causal networks. "Our first project based on causal networks was HealthMan," explains project coordinator Dr. Joachim Horn. Once fed with patient information by the doctor, this software program autonomously conducts a dialog-query regarding the patient's previous medical history. Just as in an authentic physician-patient consultation, the choice of each subsequent question depends on the answer previously supplied. The HealthMan program runs on a notebook and is currently being used to help families deal with very young children who are ill. A further development, known as "HeartMan," is now being tested by Hamburg, Germany-based Pro Consilio. The program is designed to help people suffering from cardiac insufficiency. Once a week, a counselor calls the patient to see whether an appointment with a doctor is required. Before the advent of the HeartMan, counselors would merely run through a fixed list of questions, such as whether the patient had an urge to urinate at night or was suffering from shortness of breath. Today, the self-learning software guides the dialog and helps the counselor formulate targeted questions as to the patient's precise condition. "The system decides for itself which information is relevant to an analysis of the patient's state of health," explains Dr. Volker Tresp, head of an associated center of expertise at CT. If, for example, it is known that a patient suffering from cardiac insufficiency is also asthmatic, HeartMan will assign a completely different significance to the symptom of shortness of breath. HeartMan can thus concentrate on the essentials rather than wasting time asking for information that is already known.
In two subprojects, individuals insured by Siemens health insurance provider SBK in Munich were screened for glaucoma, while 2,200 diabetics in Cardiff were checked for diabetic retinopathy. The images were then sent to the MedStage server via the Internet and assessed by experts using image software. "10 % of the cases required further medical clarification," says Zahlmann. What's more, abnormalities were observed in the group of 30 to 40-year-olds, although glaucoma is typically regarded as a condition affecting people over the age of 55. To reduce the burden on medical professionals, the plan is to have MedStage software automatically evaluate the images in the future. Doctors would then only see the suspicious cases. Experts hope that in Britain TOSCA will lead to a major reduction in the number of cases of blindness due to diabetic retinopathy. Moreover, today's technology already enables those particularly at risk from glaucoma to use a tonometer to measure eyeball pressure and send the readings to a doctor via the Internet. Another example of the trend toward increased automation of medical screening is a pilot project called t@lkingeyes. SBK conducted a program in the Erlangen region of Germany that involved photographing the retinas of over 7,000 people with a special camera. By examining the state of the blood vessels, specialists from the University Hospital in Erlangen were able to determine the probability of the person suffering a stroke. "The project generated enormous interest," says Dr. York Dhein, a specialist in contract and health care management at SBK.
The procedure lasted ten minutes. Each patient was required to complete an extensive questionnaire to determine his or her personal risk profiles. The data was then sent to Erlangen via the Internet and evaluated using special software. On the basis of an analysis of the images, plus the responses in the questionnaire, the program automatically calculated each person's risk of suffering a stroke. The program determined a very high risk among 11.2 % of those examined, while 9.2 % had an increased risk of which they were formerly unaware. Those identified as being at risk were asked to contact their family physicians. Given the huge positive response, SBK will be running t@lkingeyes in four more cities with Siemens locations beginning in April 2003.
Certain aspects of telemedicine, such as tests that can be performed at home, could make it possible to reach people who don't get regular checkups because they are reluctant to go to the doctor. Moreover, the new technology will benefit medical professionals, since telemedicine will simplify many procedures in the area of routine and preventive diagnosis, as well as in the preventive care area.
The Internet is also a highly useful tool for identifying target groups and arranging appointments for screening tests. Finally, telemedicine applications will help experts analyze results and make diagnoses. Such software will not entirely relieve doctors of many routine tasks in the foreseeable future, however, since a number of legal issues still remain to be resolved.
Michael Lang