Pictures of the Future      Spring 2005

Readings from Home

An important trend in healthcare is home monitoring via mobile radio or the Internet. Readings of vital signs taken at home will mean fewer trips to the doctor and shorter hospital stays. Software solutions from Siemens are helping medical professionals evaluate, interpret and manage the data.

Overcrowded doctor’s offices may soon be a thing of the past. Many patients could be taking routine measurements at home and transmitting the data via a mobile phone or fixed-line network. Not only would this cut costs; it would also free up medical personnel for patients with more urgent conditions. According to a 2004 study conducted by Frost & Sullivan, the European telemedicine market is ex­pected to grow by an average annual rate of 42 % by 2011. And in the U.S., tele­medicine is already helping several service providers reduce costly home visits by healthcare workers. "The tele­medicine solution we developed as part of the Soarian health information system can receive measurement data from many devices," says Michael Mankopf of Siemens Medical Solutions in Erlangen.

The core of the system is a small central unit to which a range of special measuring devices can be connected. Voice instructions help the patient make measurements. People with cardiovascular complaints, for example, can record their body weight, blood pressure and pulse. And there are other measuring devices for diabetics, coronary patients and people suffering from chronic obstructive pulmonary disease (COPD). The data is then transmitted via mobile radio to a Soarian system in a healthcare center, where it can be accessed by authorized medical professionals. Soarian is an advanced soft­ware system developed by Siemens to make processes in hospitals more transparent and efficient (see  Facts and Forecasts). It administers medical records, coordinates the stages of treatment and features analytic programs that assist doctors with decision-making. The system is available in a range of modules such as Soarian Cardiology, which is designed to help diagnose cardiac complaints; Soarian Clinical Access, which administers medical records and is designed for the forthcoming introduction of electronic patient files; and Soarian Integrated Care, a telemedicine application that supports the exchange of data and medical images.

The German healthcare system still doesn’t have an accounting model for tele­medicine services, but several projects are evaluating the potential of remote medical care. In a Bavarian pilot project, medical care for COPD patients is combined with a psychological evaluation. Patients at home measure their pulmonary function, before and after medication, and answer questions on their well-being. "We can’t cure COPD patients, but we can certainly improve their quality of life," says Dr. Bernhard Werner of the Clinic for Respiratory Diseases in Donaustauf, near Regensburg. Since the measuring device is connected to a modem, the data can be sent to the Soarian database in the clinic at the press of a button. To access this data, general practitioners and medical specialists also use a modem.

Healthcare via Mobile Phone. "In five to ten years, mobile radio will be the standard means for transmitting this data," predicts Mankopf. Among his partners in the U.S. is the South Carolina Heart Center, where a direct-communication installation featuring a Siemens CX65 mobile phone, weighing scales and a device for measuring blood pressure was tested for eight weeks. Patients suffering from hypertension and cardiac problems used the system at home to monitor their weight, blood pressure and heart rate. The CX65 automatically received the readings via a power-saving version of Bluetooth—thus ensuring that batteries in the measuring devices would last for up to three years—and then sent the data to the Soarian system in the hospital.

Prof. Bernhard Wolf, who holds the Heinz-Nixdorf Chair of Medical Electronics at the Technical University of Munich, is also working in this field. His company, Sendsor, performs a range of such services around the clock, including lung capacity measurements and automatic blood-pressure readings. "Using a mobile phone means you only need a simple measuring device without an expensive display," he explains. "On the basis of the data, we can determine if a patient consistently suffers from hypertension or only has a high reading at the doctor’s." This information is valuable since the stress of being in the examination room can sometimes distort the picture. For other continuous measurements, Wolf has also developed sensors that can be mounted on the inside of a bracelet or a ring. These sensors monitor things like pulse rate and skin moisture and transmit the data to a mobile phone by means of Radio Frequency Identification (RFID) technology. The world’s industrialized nations are about to see a drastic increase not only in cardiovascular diseases but also diabetes. Excessive weight, lack of exercise and poor diets are the highest risk factors for metabolic dysfunctions. To cut healthcare costs, it’s hoped telephone-based supervision will reduce visits to the doctor.

For the newly diagnosed, however, this kind of care is often not enough. "When patients are diagnosed with diabetes, they have to radically change their habits and diet overnight," explains Lena Mamykina from Siemens Corporate Research in Princeton, New Jersey. Mamykina wants to help patients make this change by demonstrating how their lifestyles and blood sugar levels are interrelated. Her project is aimed at older people who mostly stay at home and have regular daily schedules. With the patients’ permission, Mamykina installs motion sensors in their homes, and the patients wear Glucowatches manufactured by Cygnus, a California-based company. At ten minute intervals, this measuring device creates a weak electric current next to the skin to measure the concentration of glucose in the tissue between the skin and the blood vessels. The blood-sugar readings and the diabetic’s location are then transmitted via radio to a laptop, which combines these two pieces of information. The system provides patients with direct feedback as to how their diet is affecting their blood-sugar levels. Mamykina is modifying the program for PDAs and mobile phones so that general practitioners can access the data via mobile radio.

Pilot Project for Dementia. Intel has developed a similar system to help care for Alzheimer patients. It allows relatives to continue going to work despite the obligations of caring for such patients. Sensors that measure pressure, noise and motion, for example, can determine if a patient is sleeping or has perhaps fallen out of a chair. The information is evaluated using a database maintained by Soarian Disease Management. "The big challenge is how best to process the data," says Keith Crownover, head of Siemens Residential Health Solutions in Altoona, Pennsylvania. To test the sensors, Crownover will run a nine-month pilot project later this year, together with healthcare specialist Meridian.

Given the sophistication of the software that automatically evaluates patient measurements and monitoring data, it’s tempting to wonder if physicians will still be needed in the future. "Telemedicine will radically reduce trips to the doctor, but it will never do away with them completely," says Kai-Uwe Schmidt of Siemens Medical Solutions. "Whoever takes the reading can easily be held liable." Ultimately, though, it’s the doctors who are responsible for their patients.
                                                                                                                     Michael Lang