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Mon 8 Mar 2010 04:00 AM

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Healthy technologies

With many countries facing the twin problems of ageing populations and soaring healthcare costs, telecoms technology is taking a central role in the medical and healthcare sectors.

Healthy technologies
Ericsson’s Rainer Herzog says the vendor will work with its traditional client base of telecom operators as well as healthcare providers.
Healthy technologies
Tandberg’s Steve Woollett says that video conferencing is making a big difference in healthcare by improving communication.

With many countries facing the twin problems of ageing populations and soaring healthcare costs, telecoms technology is taking a central role in the medical and healthcare sectors.

Healthcare now accounts for a significant and growing slice of the global economy, with healthcare spending in the US alone reaching an unprecedented $2.5 trillion in 2009, accounting for 17.3% of the US economy.

While the US may be a very different market from the Middle East and Africa, many of the chronic illnesses contributing to the country's ballooning healthcare costs, such as diabetes and heart disease, are also common in the Gulf.  The figure also points to a global trend of rapidly increasing healthcare costs, particularly in more developed markets.

Furthermore, with a rapidly ageing population in many parts of the world including Europe and the US, and fast growing populations in other regions including Middle East and Africa, a wide range of telecoms technology looks set to take a central role in improving all areas of the healthcare sector.

From communication between doctors and patients, training of healthcare professionals and the remote monitoring of people recently released from hospital, solutions such as mobile broadband and high definition video conferencing are increasingly playing a role in driving efficiency across the sector.

Rainer Herzog, director of strategy and business development for e-health at Ericsson, points to a number of healthcare solutions that have been developed from wireless technologies for the remote monitoring of patients.

"Probably the most important solution that we are developing in telemedicine is what we call Ericsson Mobile Health, which is an end-to-end solution with which you can perform patient monitoring," he says.

The system, which is in the latter stages of development, is able to remotely measure various body parameters such as blood pressure, lung function, ECG, body weight and pulse rate and then transmit the data wirelessly to a server located in a hospital or another location where the doctor or healthcare professional can retrieve it.

The system allows the doctor to see data in real time, and send back certain alarms based on certain thresholds. The person assessing the data can also look back at historical data, and the system can also be automated to detect and alert the relevant people when certain thresholds are breached or in an emergency.

Ericsson expects to have a commercially and medically certified version of the system available in April, which will give the company the opportunity to start medical trials, according to Herzog.

"We have two pilot phases in the framework of a European Union project called Health Service 24 where we used the system with people with lung diseases, pulmonary disease and heart disease," Herzog says. "These are small scale trials with 20-30 people, lasting five months. If you look at the larger scale implementation - that has not been done yet."

The system, which has been in development for about three years, consists of a small mobile device, about the size of a small mobile phone, which collects the data wirelessly from special sensors on or in the patient's body. The device contains a Sim card which collects from the one side and sends it over the wireless network to the server, via GSM or 3G. "It is just switch on, switch off - there is not much the patient has to fiddle around with," Herzog says.

In terms of path to market, Ericsson is "applying a two-way approach" according to Herzog. The company is looking to work with its traditional client base of telecom operators, as well as healthcare providers and healthcare insurance companies.

"On the operator side, there are more and more who are looking into healthcare because they are in search of meaningful applications," he says. "This is reflected by the tendency to set up their own e-health departments, which Vodafone, Telefonica and Orange have done. There is growing interest from the operators to work with us.

"The other route to market is to go directly to the healthcare players so there we are approaching mostly hospitals and health insurers. The hospitals are interested in how can they save money by discharging people earlier and monitor them while they are at home - which gives a better quality of life for the patient and less cost for the hospital," he says.

He adds that health insurers are also interested in making savings by improving patient management, particularly with people suffering from chronic illnesses, through remote monitoring.

But remote monitoring does not just allow hospitals to save money. It also benefits patients and their families and employers, by allowing them to continue to go about their everyday activities. Ericsson's idea was to mobilise people who may otherwise have been confined to their homes or a hospital ward, according to Herzog.

"There are people getting chronic diseases at the age of 40-45, and you can't leave these people at home, so we wanted to give them the opportunity to leave home, go to work, shopping, do sports and lead a normal life, and our system allows them to do that because it is fully wireless."

But with the system being central to the well being of patients, Ericsson has been busy ensuring the security and reliability of the solution. "The complicated thing is to make it waterproof, in terms of registration consistency of communication and data security," Herzog says.

"You have to work with data buffers whenever communication breaks down, so that communication is not lost, you put it into a buffer and then when the system reconnects again that data is automatically there and broadcast to the servers."

While many people might expect such systems to be targeted at wealthy nations, Ericsson has already seen significant interest from healthcare providers in developing markets. Part of the reason is that remote monitoring holds much potential for communities in remote areas that are far from healthcare services, and also because of the cost savings and efficiencies it can create.

Leading edge

One reason that many countries in the Middle East could benefit from new advances in healthcare related technology such as remote monitoring is that they have newer network infrastructures than many more developed markets.

Healthy returns

Systems that monitor patients remotely look set to help create huge savings in the healthcare sector. For example, on average, a stay in a hospital in Germany costs about 450 Euros ($606) a day, and remote monitoring systems save an average of 3-4 days in hospital for the patient.

If deployed across German hospitals, this could amount to 4.5 billion Euros of savings, just from earlier patient discharges, according to Rainer Herzog of Ericsson.

Meanwhile, a person with a problem such as obstructive pulmonary heart disease costs an average of 200,000 Euros a year in Europe, just on care costs. Herzog estimates that savings of about 30% could be made on this sum by using remote monitoring.

Thierry Zylberberg, executive VP in charge of strategic partnerships at Orange Healthcare, says that countries or cities that are "starting from a blank sheet of paper" in terms of ICT infrastructure might be able to build a health infrastructure which is less fragmented than in some of the more developed countries.

He adds that this is especially the case in some of the Gulf countries which are relatively small and can therefore focus on developing modern telecoms networks tailored for sectors including healthcare. This is in contrast to more mature markets that often have legacy systems that can lead to a more fragmented network.

"The challenge in many developed countries is that you have to deal with the legacy of a system which is today extremely fragmented. Whereas in the smart cities case [cities connected by fibre and other leading-edge infrastructure], it is more a green field operation and you could really try to organise things more rationally and more efficiently," he says.

Orange created a healthcare division about three years ago to cover developments and potential from ICT in healthcare, and the company has developed a strategy "in three different directions," according to Zylberberg, head of the division.

One part is to develop products and services for all the professionals in the healthcare sector, from doctors and nurses to hospital administration and governments. The second part is focused on providing products and services for patients outside the hospital, and the third part is about "wellness and assistance for the general public," Zylberberg says.

In the first category, one of Orange's main initiatives that it is currently deploying is called ‘Connected Hospital'. This is a multi media infrastructure for hospitals which includes a portable terminal that can be placed at the patients' bedside. The device allows the patient access to the internet, a telephone line, and also allows the medical professionals access to all of the patient's medical records. "This is already deployed in France and we have some installations in Poland and we are starting in Spain," Zylberberg says.

Zylberberg points to patient records as an area where technology is likely to play an increasing role. Orange Health has been working on a project tender with the French government to store peoples' health records securely in a large data warehouse, hosted by Orange Business Services. While Zylberberg admits the service is fulfilling a basic storage requirement at the moment, he adds that it is likely to become more elaborate in future, possibly allowing healthcare professionals and patients to access the records wirelessly.

Ever present

Another area where telecoms technology is creating a sea change in the way medical professionals interact with each other and with their patients is video conferencing. From doctor's meeting with their patients, to students interacting with surgeons performing complex operations in real time, high definition video conferencing is starting to move into the mainstream of healthcare in a number of areas.

Steve Woollett, EMEA head for the public sector at video conferencing specialist Tandberg has an insider's view of the difference the technology is making in the healthcare sector. He says that Tandberg has seen steady year-on-year growth for the last eight years in healthcare for a variety of reasons. The main benefit is that the technology, as in other sectors, improves the way people communicate.

But the combination of seamless high definition video and superior sound quality make many modern video conferencing systems from the likes of Tandberg and Polycom are particularly useful for healthcare professionals, who often need to attend meetings or stand in on operations in other hospitals while completing a busy schedule at their own base.

It is now becoming common for various people including senior surgeons and medical students to watch operations taking place remotely, whether for support, peer review or education.

"Medical students may be watching from another location, asking the surgeon questions while he is operating," Woollett says. "In the UK, clinicians are using it for peer review in endoscopy because the nature of endoscopy is very visual."

A professional performing peer reviews can save significant time by watching operations live from a desktop, rather than commuting to another hospital in a different city. This practice is being adopted more readily in the US, but is also becoming more common in most developed countries.

Training tool

The systems are also particularly useful for training medical students, as it gives them the opportunity to interact with surgeons while they are carrying out operations, allowing them to see the whole process. "When medical students are being trained, it is important to have that two-way communication and be talked through the procedure and see the kind of decisions surgeons are making as they progress," Woollett says.

Video conferencing is also proving to be a powerful tool for clinical meetings where specialists in different fields need to meet up to discuss a specific patient's case. Such specialists could be in different parts of the country, and they are all likely to have busy diaries, making video conferencing a no-brainer.

The high-definition part of the technology is also important, as it allows the specialists to look at MRI scans and the like, and to be able to make reliable diagnosis from them, Woollett says.

Ageing population

For Orange Healthcare's Thierry Zylberberg, another major market for remote monitoring will come from ageing populations in Europe and the US. "There will be one European out of four over the age of 60 in 2010. In France, a new born baby has a life expectancy of 100," Zylberberg says.

This poses some tough questions as to how to deliver care to so many people. "It would be impossible to build enough care homes to deal with so many people, so you have to be able to take care of these people in their homes, and to do that you need to deploy an infrastructure where they can get assistance, emergency services and some monitoring of what is happening to them," he says. "This will be a major issue in the coming years in many countries."

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