Pictures of the Future    Spring 2007

Happy Fish—Healthy Patients

Participants in the Fish 'n Steps game carry a pedometer. The more they move, the healthier the fish in the virtual aquarium on the computer screen become

People who live in big cities often don’t get enough exercise. Chronic illnesses are increasing, and health costs are skyrocketing as a result. "There’s a whole range of measures we can use to reduce health care costs, while improving patients’ quality of life," says Michael Mankopf from Siemens Medical Solutions. Such measures include prevention programs operated by health insurance companies and medical checkups of chronically ill patients. Such examinations can be organized on a broad scale with the help of Siemens’ Soarian Integrated Care software, for example.

In addition, self-monitoring can reduce costs, as patients can be continually cared for at home. "Here, it’s not the individual measurements that are crucial; instead, it’s measurement trends that enable doctors to recognize a deterioration in a patient’s health at its onset," says Alan Barbell, product manager for the Soarian Disease Management system.

For example, based on Siemens’ telemedicine solution, patients suffering from chronic heart failure are being cared for at home by Chester County Hospital, in Pennsylvania. Staff members can intervene early on if patients report worsening symptoms such as weight gain, swelling in their feet, or shortness of breath. Early intervention often prevents the need for visits to the emergency ward or hospitalization.

Every morning, patients call the Soarian Disease Management System using their home phones. An interactive voice response system identifies callers on the basis of a code and then asks them to provide information on their weight and overall feeling of well-being. Some programs may also collect information about blood pressure, pulse and a patient’s individual condition. The system software automatically converts the answers into computer data. Experienced nurses check the data every day and pass on advice over the phone. "Patients really like the system," says Sandra Garrison, head of the Chester County Hospital’s Chronic Heart Failure Initiative. "The system is patient- friendly, and patients like being able to ask a nurse questions at any time."

Keeping an Eye on Patient Health. One of the fastest-growing chronic illnesses is diabetes. To reduce the costs associated with treatment, the British National Health Services (NHS) established a national diabetes network in 1999. The key elements for dealing with diabetes are prevention and continual monitoring. For example, an eye examination can reveal diabetic retinopathy, which if left untreated can cause blindness. Siemens established a survey procedure for diabetics in its EU Tosca project (see Telemedicine in Pictures of the Future, Spring 2003). Studies have shown that treatment at an early stage can prevent 60 to 70 % of all cases of blindness caused by diabetic retinopathy.

In Scotland, experts predict that the number of people with diabetes will double from four to eight percent of the population between 2006 and 2015, and that more than one in ten people affected by the illness will contract diabetic retinopathy.

In response, Scotland assumed a pioneering role in 2006 by introducing the first-ever test to determine how many of its diabetics are developing diabetic retinopathy. Siemens Medical Solutions acted as a partner in this project, which involved setting up 72 cameras to perform examinations throughout Scotland. The resulting data was collated by qualified personnel and sent to five regional centers for analysis. The Soarian Integrated Care platform was used to carry out all processes, from generating and sending letters to some 300,000 patients to managing appointments and evaluating the results. "Without the software we would never have been able to manage so many patients," says project manager Andrea Schulz from Siemens.

Lena Mamykina from Siemens Corporate Research (SCR) in Princeton, New Jersey, also plans to use telemedicine to improve diabetics’ quality of life. To help doctors give patients sensible advice, she pinpoints direct connections between a diabetic’s lifestyle and his or her blood sugar levels. In an earlier project (siehe Telemedicine in Pictures of the Future, Spring 2005), Mamykina networked the home appliances of elderly people using sensors connected to a laptop. She was thus able to register every trip to the refrigerator at night, and point out to the patients the relationship between these snacks and their high blood sugar levels.

"Today, however, people in their late 30s are already being diagnosed with Type II diabetes," says Mamykina. These people lead active professional lives, and they also spend a lot of time outside the house. To ensure that such patients receive individualized treatment, Mamykina worked with Prof. Beth Mynatt from the Georgia Institute of Technology to develop an integrated communication platform. Patients measure their blood sugar levels before and after every meal. The data is sent automatically via Bluetooth to a cell phone the patient carries, and from there to a central computer. Patients also use cell phones to take pictures of their immediate surroundings. They then send the images, along with a voice message on how they feel, to the computer.

Both patient and doctor (or nurse) have access to the data, which enables participants to immediately identify any aspect of a patient’s lifestyle that’s detrimental to his or her health. The system, which can be seamlessly integrated into software such as Soarian Disease Management, is being tested for a period of three months on a group of 80 to 100 patients at a diabetes center in New Jersey. The system could also be used to monitor other illnesses, such as chronic cardiac insufficiency.

Feeding on Movement. One of Mamykina’s colleagues at SCR, Dr. James Lin, handles the prevention side of the equation. "Most patients are not able to change their lifestyles by, for example, exercising more," says Lin. But clinical studies show that 10,000 steps a day correspond to an active lifestyle. Taking a cue from the Tamagotchi virtual pets that were popular a few years ago, Lin developed a computer game called "Fish 'n Steps." The fish in a virtual aquarium are "fed" when their owners move around regularly. If they walk less, they put their fish at risk of dying. Lin tested his concept using 19 of his colleagues from SCR as subjects.

Each participant was given a pedometer that he or she had to carry around constantly for 14 weeks. If the participants took more steps than their preset target, their fish grew. If they failed to reach their target, their fish shrank, complained loudly, and in some cases died. Lin also studied the effects of peer pressure by placing four participants’ fish in the same aquarium. If one of the fish didn’t grow for a week, the water got murky. "This enabled us to get more people moving than was the case with other studies—and our success was independent of age or gender," says Lin, who is sure that Fish 'n Steps can become a successful product. "It’s an interesting approach that we’re observing closely," says Nicole Detambel, head of the "10,000 Steps" project at Siemens Health Insurance in Munich. More than 30,000 of the insurance company’s customers have already been given pedometers and are taking part in the project. Unlike Fish 'n Steps, the number of steps taken here is translated into a virtual distance that the participant covers on a map on the Internet.
                                                                                                                   Michael Lang