U.S. Rules for MBAN’s validate potential of mHealth.

The Federal Communications Commission (FCC) has proposed to allocate radiofrequency spectrum and establish service and technical rules for the operation of Medical Body Area Network (MBAN) systems. Why is the FCC interested in this area? They envision that MBANs would provide a platform for the wireless networking of multiple body sensors used for monitoring a patient’s physiological data, primarily in health care facilities.

MBAN’s could be used to monitor an array of physiological data, such as temperature, pulse, blood glucose level, blood pressure, respiratory function and a variety of other physiological metrics. MBAN systems would primarily be used in health care facilities, with the potential also of being used in other patient care/monitoring circumstances. Unlike traditional medical telemetry systems which rely on separate uncoordinated links for each physiological function being monitored, MBAN systems could serve to wirelessly monitor all of the desired data of a single patient, which could then be aggregated and wirelessly transmitted to a remote location for evaluation.

Using MBAN systems to eliminate much of the wired cables that typically connect patients to monitoring equipment and to facilitate the aggregation and transfer of physiological data will offer several clinical benefits, including improved patient mobility and comfort, reduced risks of infection, reduced clinical errors, and reduced patient monitoring costs.

The Notice of the FCC seeks comment on options for accommodating MBAN operations in several frequency bands, and on the amount of spectrum that should be allocated for such use. More specifically, the Notice seeks comment on the feasibility of using the 2360-2400 MHz; 2300-2305 MHz and 2395-2400 MHz; the 2400-2483.5 MHz; or 5150-5250 MHz bands for this purpose, and on various licensing schemes that would be appropriate for any of these bands under consideration. In addition, the Notice seeks comment on tentative service and eligibility rules that would be similar in many respects to those for other wireless body-worn and implanted medical devices operating in the MedRadio Service in the 401-406 MHz bands.

This action by the Commission is by Notice of Proposed Rule Making (FCC 09-57).

Sensing textiles as part of your Mobile Body Area Network system.

Sensoring your body while doing everything you are used to do. Is this possible? Comfortable smart clothes that monitor the wearer’s heart, breathing and body temperature promise to revolutionise healthcare by allowing patients to lead there normal lives.

Unlike many remote health monitoring systems that rely on sensors strapped to users’ arms or chests connected by wires to bulky equipment, a Greece team from the Sotiria General Chest Diseases Hospital in Athens, has embedded sensing devices directly into textiles, creating garments that are not only smart but also comfortable and practical to wear. Data from the biosignals collected by the clothes is then sent via a mobile connection to caregivers, allowing doctors to check up on their patients and warning if their health deteriorates.

Whereas other remote monitoring systems require different sensors linked to different transmission devices, the HealthWear system collects all the information from the sensors into a single device called a Portable Patient Unit (PPU). The embedded sensors include a six-lead electrocardiograph (ECG), respiration movement, pulse rate and skin temperature monitors, in addition to an external oximeter to measure blood oxygen saturation and a 3D accelerometer inside the PPU to measure body position. The data are then transmitted via a secure GPRS mobile connection to a central server.

“The information is stored on a patient’s electronic health record and can be accessed via a secure TCP/IP internet connection by doctors and caregivers, in either near real-time or off-line mode,” explains Alexis Milsis, a research engineer at the Sotiria e-Health Unit.

Caregivers, meanwhile, can easily access patients’ data, allowing them to visualise the patients’ progress accurately over time and even monitor their data in real time. This feature allows doctors to perform remote checkups by speaking with the patient via a videophone and instructing them to perform different exercises while they monitor their ECG and oximetry readings.

mHealth keeps them rolling.

Toyota announced that they have developed a thought-controlled wheelchair.  Honda has also developed a system that allows a person to control a robot through thoughts. Is the automotive industry coming to the health sector? Everything that’s rolling looks interesting now. See one of my last post.

Both companies continue to invest in innovation, science and engineering. The story of a bad economy and bad sales for a year or two is what you read in most newspapers. The story of why Toyota and Honda will be dominant companies 20 years from now is their superior management and focus on long term success instead of short term quarterly results.

The BSI-Toyota Collaboration Center, along with Japanese government research institute, RIKEN, and Genesis Research Institute, has succeeded in developing a system which utilizes one of the fastest technologies in the world, controlling a wheelchair using brain waves in as little as 125 milliseconds (one millisecond, or ms, is equal to 1/1000 seconds.

Plans are underway to utilize this technology in a wide range of applications centered on medicine and nursing care management. R&D under consideration includes increasing the number of commands given and developing more efficient dry electrodes. So far the research has centered on brain waves related to imaginary hand and foot control. However, through further measurement and analysis it is anticipated that this system may be applied to other types of brain waves generated by various mental states and emotions.

Guidelines for physicians using mHealth for clients.

Managers of Mobile Workers deal with new ways of working. Are there lessons learned for medics in relation to mHealth-patients? Just look at the lists below. It’s translated from the business-world to healthcare, just changing some roles. Does it make any sense to you?

The benefits of mHealth:

• mHealth brings a broder range of influence for the medics as they can relate to more patients.
• You gain access to a wider range of talents, knowledge and experiences, not only on better informed patients but also with co-workers.
• A vast majority of clients are more motivated in a flexible, mobile care environment than a traditional one.
• mHealth clients continue to shift doctor’s attention from activities to deliverables.
• Time gain can mean acting proactive in stead of reactive.

Possible challanges of mHealth:

• There is a risk of potential decrease in productivity.
• More influence of the client replaces positional power of the doctor.

Strategie-components for integrating and managing mHealth within the physician practice:

• Focus on building relationships.
• Streamline communications.
• Incorporate less didactic forms of communications.
• Spend more time listening.
• Let mHealth patients define communication and reporting practices they want to follow.
• Manage deliverables, not activities.
• Engage in more frequent and informal preformance management activities.
• Give complete trust until given an concrete behavioral reason to do otherwise.
• Use adaptive management styles tailored to individual clients.
• Leverage technology.

Inspiring isn’t it.

No secrets about medical service costs. Get them on the mobile.

Find out before a medical routine visit what it will cost. Did you try asking your doctor’s office? Did you get a satisfying answer? For many health care consumers, the experience of trying to figure out how much a certain medical procedure costs and how much they have to pay is kind of like this: Imagine going to a fancy restaurant where the menu has no prices, someone else orders for you and you end up with a bill.

That’s particularly true for people who have health insurance policies with high deductibles or hefty cost-sharing arrangements. But figuring how much will come out of their pocket isn’t always easy. San Francisco’s Canopy Financial has come up with what it considers is the first mobile application to help consumers figure out the cost of a medical procedure.

The iPhone app, launched today, is aimed at people who are covered by what’s known as “consumer-directed” health plans, or high-deductible policies with a savings account. It allows patients to determine the average cost of the medical procedure in their local market based on Zip code so they can know or even negotiate price before agreeing to the procedure.

”Today, if you call a carrier and ask them what the price is for a particular procedure, it’s probably going to be pretty difficult to get that,” said Vik Kashyap, Canopy’s chief executive officer. He said some insurers are more forthcoming than others, but the process is often painful for the consumer.

Mobile medical prices can also be found for free on Medzio, which has medical and first aide info on 1000’s of diseases and conditions.

The iphone medzio app can also help patients find local doctors and it provides the most accurate local medical prices from the Healthcare Blue Book. Not just procedure pricing, but also hospital, dental, lab and xray pricing.

Mobile Healthgames can be extremely effective.

Working on your health can be fun. How? Just play a game. It’s an industry starting to find a new market.

Douglas Goldstein, CEO of Games4Health talks about the importance of Health eGaming on PBS’s Nightly Business Report.

MHealth systems are growing from the inside out.

Big difference between Google Health and Microsoft‘s Healthvault is that the latter is aimt to be a platform. What’s the difference? On a platform you can built your own products and that’s exactly what’s happening now. Partners are delivering interoperable next-generation e-health solutions based on Microsoft’s platform. See their strategy unfold.

Microsoft recently released an updated version of the Connected Health Framework (CHF) and additional solution accelerators in the Connected Health Platform (CHP).  Leading healthcare solution providers Perot Systems and Philips Healthcare are supporting Microsoft’s commitment to deliver to customers e-health solutions built on the CHF and CHP strategy.

Information technology is a key asset for governments and healthcare organizations around the world facing an uncertain economic climate and needing to implement cost-effective solutions. Microsoft’s CHF and CHP are free resources that healthcare organizations and partners are using to maximize the benefits and reduce the cost to design, build, deploy and operate solutions supporting the needs of patients, families, care professionals and healthcare providers.

Perot Systems is one of the largest providers of consulting, business process and technology-based solutions for global clients, including five of the top 25 U.S. health systems, more than 1,000 hospitals and 70 health insurance organizations. “Our healthcare clients expect the solutions we deliver to align with their cost and quality improvement requirements. This requires solutions that are adaptable, scalable and interoperable,” said Chuck Lyles, president of Perot Systems’ Healthcare Group. “

Philips Healthcare recently introduced the IntelliVue Clinical Information Portfolio (ICIP) Critical Care solution. The solution streamlines clinical workflow, helps improve financial outcomes, and facilitate compliance to evidence-based medicine guidelines for critical care. “Providing clinicians with timely and relevant clinical decision support solutions  is key to improving clinical and fiscal outcomes,” said David Russell, vice president of marketing Healthcare Informatics for Philips Healthcare. “Microsoft is making it easier for Philips to accelerate interoperability and ease of use by making available valuable guidance and tools that we can use and innovate upon to build solutions for our customers.”

The new version 2 of CHF contains a lot of sophisticated health care domain knowledge and is interesting learning material. It targets lifelong well-being and covers the full continuum of care, from the individual to health professionals, health institutions and payers. This version of CHF has been updated to do the following:

• Support both social care and lifelong well-being scenarios.
• Focus on the needs of families, care professionals, care providers and the funders of care services.
• Include the use of federation methods for identity management, authentication, authorization and data integration.
• Enable legacy applications to participate in the service-oriented architecture of the CHF.
• Provide more use case examples and step-by-step design guidance.

MHealth sector most promising for M2M datadelivery.

The number of mobile network connections used for machine-to-machine (M2M) communications will grow from 37.5 million in 2007 to 186 million in 2012. Vehicle telematics, also known as wireless vehicle communications technology, apps will dominate the M2M cellular market in most parts of the world, accounting for more than half of all network connections by 2012. Has healthcare anything to do with this growth? What’s  the impact?

Mobile healthcare solutions are expected to grow substantially. Similar to other type of large-scale machine-to-machine
solutions, mHealth solutions involves complete dataconnectivity services that require a new approach, new products and
expanded service levels from mobile GSM/GPRS operators.  There are 3 challanges:

• mHealth solutions involve full and automated integration of connectivity solution into different objects, terminals and machines.
• mHealth solutions will be integrated in units (mobile and fixed) indented for an international marketplace in stead of national business approach.
• mHealth solutions include large-scale deployments of machines interacting with the mobile network implying completely new requirements on reliability, security and scalability from a mobile operator perspective.

Last week T-Mobile announced the first-of-its-kind embedded SIM for Machine-to-Machine (M2M) solutions. Nearly the size of a head of a pin, the durable embedded SIM withstands challenging environmental factors such as temperature, humidity and motion to deliver reliable wireless connectivity. The embedded SIM is ideal for telematics and smart grid infrastructure solutions where environmental factors may reduce reliability and increase maintenance costs of removable SIM-based solutions. The embedded SIM differs from today’s SIMs in that it’s built from silicon, not plastic. The embedded SIM is designed to be hard-mounted onto M2M modules, accelerating deployment by allowing customers to go directly from the factory to the field without having to provide and manually insert a SIM card.

The Swedish network provider Telenor said on last Med-e-Tel conference that they creating a clear global approach for the mHealth industry, including key learnings from already deployed M2M solutions on an international level like. “We expect the Healthsector to be the third most promising for M2M mobile devices and datadelivery” said Robert Brunbäck, strategic business manager at Telenor.

Are mHealth-systems going to protect us?

Mobile Health technologies are rapidly moving towards commercialisation. They have the potential to empower patients and give them the tools and data needed to take charge of their own health. But is technology running ahead of our capacity to absorb it? Will doctors be legally obliged to act on that information? Keep in mind that technology can never be a substitute for personal responsibility and decide for yourself.

Hitachi in Japan offers a watch-like device that lets you track your pulse, skin-temperature and bodily motion. In Korea, device maker LG has the KP8400, which is a cell phone that comes with a glucose monitoring strip, giving you insulin and blood readings on the phone’s display. And there are other efforts on the iPhone, such as Proactive Sleep, which attempts to figure out your sleep cycle and then acts as an alarm to wake you up during your light sleep phase to maximize your alertness for the rest of the day.

Philips has developed bedsheets with metal strands woven into them to allow a patient’s heart to be monitored as he sleeps. Dozens of firms, from clothing and shoe manufacturers to consumer-electronics firms, are developing other “body-computing” tools. Companies are working on applications that monitor all of our six vitals: temperature, heart rate, heart rhythm, respiration rate, blood pressure and the amount of oxygen your blood. All can soon be tracked with a single sensor, which can be synced to a phone and generate information and signals 24×7. If you drink too much caffeinated coffee on an empty stomach, your phone might be able to alert you. Or your doctor might call you befor you have a heart attack, responding to an alarm sent out by monitoring systems in your body.

A new type of diagnostic toolkit is emerging. Portable and rapid diganostics thanks to the fusion of genomics, proteomics (which analyses specific proteins) and information technologies. One firm has produced a cheap testing kit that can be thrown away after use. Diagnostics for All has developed a range of diagnostic tests using micro-fluidics technology, directing a sample (say, a drop of blood) through tiny grooved channels to various chambers. Chemicals then react with the sample, providing rapid diagnostic results.

Medtronic, a large medical-devices firm, talks about targeted drug delivery. Old-fashioned pills were swallowed and absorbed through the gut, but that does not work for biotech drugs because stomach acid would wipe them out. The firm is investing in implanted pumps, precision devices and other clever ways of putting medicine where it is meant to go. Philips has developed a way for drugs to be encapsulated in bubbles made of biodegradable polymers that can be delivered to a tumour like a guided missile. Selecta BioSciences, an American firm, is testing biodegradable nanoparticles to target lymph nodes. MicroCHIPS, also in American, made a specially designed silicon chip that is able to store and release drugs on demand. When a remote wireless signal is sent, a tiny electrical current zaps the chip to release the desired quantity of the drug. Future applications will include chips that monitor patients at home for signs of a heart attack or hypoglycaemia and can release the appropriate life-saving drugs. John Santini, the boss of MicroCHIPS, believes that over the next decade devices will increasingly interact with the body and communicate medical data directly to portable devices or EHRs, thus helping patients to manage their own chronic diseases.

In three locations in England the NHS is now running one of the largest trials of “telecare”, which aims to monitor and offer remote medical care to the elderly in their homes. The Scottish Centre for Tele-Health has set up video kiosks offering medical consultations in remote areas. Dr Tomazou of Imperial College believes the future belongs not to medical devices enhanced by consumer electronics but to ubiquitous and user-friendly devices like personal digital assistants and mobile phones. These are “very useful for hiding medical monitoring” and for displaying data in ways that enable patients to act on that information. Qualcomm, which makes wireless-communications equipment, thinks of a good way to do this is by integrating advanced sensors and short-range wireless networks (known as “femtocells”) to create “home health hubs”. Tim Brown of Ideo, a design consultancy, goes further, arguing that in future “medical devices for the home will simply disappear into our built environment, our consumer products, our clothing or even our bodies.”

Signs are strong that these apps will be entering our lives in a big way within the next five years. Experts say they’ll give you a visualization of your daily rhythm of life and will encourage you to eat and sleep the right amounts at the right times in order to enjoy your life to the fullest.

The mHealth Value Chain.

Developing a mHealth service comes with some specific characteristics. What about the value chain? A model with knowledge management insights gives perspectives,

The initial investment in a mHealth service is independent of the number of users. Reproduction and possible earnings of the service is controlled by the customers, not by the producer. That’s one of the reasons that production cost greatly exceeds the reproduction cost and most of the spendings are accumulated at the front-end of production.

Building a mHealth service means creative use of components like: databases, statistics, collections, publications, documents, correspondence, photographs, diagrams, presentations, speeches, lectures,recorded experiences, stories, laws, regulations and procedures.

The client engages the service with his own experience and self-learning, influenced by beliefs, perspectives and values.The mHealth user competences are: awareness, skills, mental models, expertise, judgement, wisdom and memory.

The health decision process of users is a combination of mHealth-components, -competences and the interfacing in between.

The value of a mHealth service is very difficult to measure. It’s extracted when the service is used. Sharing increases the value of the service. While judging the value in advance is very hard to do. Value can be added by offering the right service at the right time.

So we can look at the value chain from two perspectives: the user and the service provider.

On basis of his sensing, the user starts a process building up his knowledge about a specific situation to make his decision and adopt new behavior. The service provider develops a picture of his customers in order to deliver his product.

A mHealth service adds value by linking the product of the provider, in a meaningfull way, to one of the chains of the user value chain. A qualitative high mHealth service supports the development of the usercapacity and -process to collect and preserve inputs, sharing and integrating newly created information in order to support learning and adaption of health related competences.