Taking Care of Mobile Patients

Roland Piquepaille writes "After a patient has been hospitalized for a surgical intervention, he usually wants to return to his normal life. But doctors would like to monitor him to be sure that the operation was successful. How can they manage this without being too intrusive? In "Health Care Monitoring of Mobile Patients," Italian researchers offer a three-layer networking solution. First, a body area sensor network would continuously record your cardiac activity or your body temperature. A second level would involve a home sensor network, including for example a PC wirelessly receiving this information. Finally, this home network would be able to alert an hospital network if needed. Right now, this whole idea is at the proof-of-concept level, but it really looks promising."

Comments

Exactly What We Don't Need

[Anonymous Coward]

Exactly what we don't need, more high tech flim-flammery for diseases that should have been prevented. More money for antismoking, better diet, better exercise, better public health, not this kind of nonsense

Re:Exactly What We Don't Need

[Tsu Dho Nimh]

"more high tech flim-flammery for diseases that should have been prevented"

Where did they mention "diseases that should have been prevented"? They could be talking about surgery for broken bones, gall stones, appendectomies, or whatever ... you leapt to the conclusion that it would be a "lifestyle" disease.

Re:Exactly What We Don't Need

[Anonymous Coward]

Is that you, James Randi?

Re:Exactly What We Don't Need

[nackrm]

There is a BIG initiative to improve people's health before they have to see a doctor. Most insurance companies are exploring ways of informing their members to get regular checkups and keep healthy.

However, they're having a hard time keeping the overweight family of 4 who you run into at Wal-Mart from eating all those Ho-Ho's and Ding-Dongs between feedings.

Re:Exactly What We Don't Need

[Zakabog]

More money for antismoking, better diet, better exercise, better public health, not this kind of nonsense

What exactly would we do with more money in these programs? We already have ad campaigns and school programs that deal with these issues, other than hiring personal trainers for everyone, what would the money be used for? You can't just throw money at problems and hope they disappear.

Re:Exactly What We Don't Need

[Anonymous Coward]

Only on /. could this be modded interesting.

Let's see. Diabetes complications, treatments for various cancers, hereditary defects, accidents. I can think of many scenarios where this technology would be helpful for the treatment of illness that has nothing to do with lifestyle. There is a far higher occurence of secondary infections in hospitals and other complications. Get us home as soon as possible and monitor us from there.

Prevention is not always the answer and anyone who gets sick because they were stupid deserves what they get. We are already bombarded with information about prevention for a myriad of diseases. Sometimes a little chlorine in the gene pool is necessary.

Re:Exactly What We Don't Need

[gl4ss]

you got a time machine?

(besides. even if you had a healthy life you would get diseases, just maybe a bit later, or with bad luck earlier. it's not like you live forever with good diet and exercise - you'll still eventually get some disease that gets the best of you. unless of course you die by some other means)

so mr. anon cow. please retain from any hightech medical nonsense so we can save some money when you die a bit earlier.

Re:Exactly What We Don't Need

[Anonymous Coward]

You already have that, it's called Disease Management. And not only is it available for commercial health plans, but the recent Medicare Modernization Act will include it for Medicare recipients as well, hopefully cutting down the costs and utilization associated with chronic diseases.

As for the remote patient monitoring, that's also already here. Many companies provide such a service TODAY, such as Viterion, Phillips Medical, and Samsung. Impantable device companies like Guidant and Medtronic can actually help heal patients post-surgery. These are necessary tools because the patient is also responsible for improving their health. Imagine if a heart attack victim leaves the hospital with a new pacemaker, but continues to eat poorly and not exercise. How would the physician know other than at the next office visit, or when it's too late and they've had another ER visit?

First Post!

[G4CubeNu]

If I have surgery, I don't want a bunch of docs hovering around me. Good idea.

Just wait

[daeg]

Just wait until his ISP kicks him off due to threats by the .*AA and he flatlines on them.

Re:Just wait

[plj]

OK, you're just joking.

But what about all possible privacy and security issues? I mean, we're dealing with personal medical data here, and the sentence "A second level would involve a home sensor network, including for example a PC wirelessly receiving this information." was already enough to get me somewhat alarmed, thinking about all the possible viruses, troijans and such that would most likely have infected this said (most likely Windows) PC. Second, the sentence "Finally, this home network would be able to alert an hospital network if needed." also made me nervous, when thinking of any system sending my medical data anywhere, unless it already has my explicit consent for that.

Now: How are all this issues solved, I'd like to ask?

Re:Just wait

[kaens]

If the computers were transmitting data that could lead to someone commiting identity theft, or using your billing/insurance info for something devious then there would be a problem.

If it's just your medical records....well then what exactly would you lose other than privacy as far as to what has ailed you in the past? Why should a hospital have to have your explicit consent to send your medical history to another hospital, or to a network of hospitals - assuming of course that they are only exchanging your medical history...not anything that could be used against you, except maybe for embarassment.

I would think that hospitals already do this, and it would seem to be a good idea - if someone at one hospital is unsure about a diagnosis, and they know of a doctor at another hospital that could confirm their opinions then they send them the data and ask about it. The problem with this would be that doctors don't seem to like working for free.

I would guess that a doctor that was a doctor for the sake of helping people, and not for the sake of making money would be a better doctor overall anyhow, as well as willing to help other doctors with their diagnosis. Diagnosii. Diagnosises...I don't know the plural...oh well.

It would seem that such doctors are few and far between though - at least from my experiences.

Hmm...I had a point there somewhere but I lost it in all my rambling. Oh well.

Oh yes! I was wondering...exactly what objection do you have to your medical data being sent out without your consent, other than "it's my personal data and I want to know who knows about it." By medical data I mean your medical history - allergies, broken bones, surgeries, whether or not you have cancer (etc,etc), not your insurance info/billing info/street adress (I can see why you would object to thost)

Re:Just wait

[jacksonj04]

I doubt the system would send records anywhere. The hospital monitoring you would store your records, all the computer system monitoring you would need to do is send specific signals. Sending a single, encrypted chain of values for things like pulse rate is completely different from your home PC broadcasting your medical history.

Also, if the system knows what is 'normal' it could send a single code telling the hospital everything is perfectly alright.

Still not sure about the trojans tho...

Re:Just wait

[Qzukk]

Actually, in this case these sensors would just be sending some kind of case number and whether you're dead yet to the hospital.

While it's not actually sending your medical history, the fact that it's sending anything at all gives away certain information about you, like "I might die soon so my employer might want to look at a replacement, or at least an excuse to fire me and keep the insurance premiums from going up more"

Oh Cool!!!

[AltGrendel]

Gives a whole new meaning to war driving.

Re:Oh Cool!!!

[owlstead]

Note that hacking a WiFi network does not directly mean that you can interfere with this protocol. You can always digitally sign/encrypt data units on application level. This would mean that you might have access to the network, or even internet connection, but that you would still have to hack the devices/software or operating system themselves. Of course, the advent of WiFi networks with their insecurities (insecure in practice, well thought out security *does* exist for WiFi) does not help.

Re:Exactly What We Dot Need

[Torqued]

But the problem is that we'll probably be using this sort of stuff on the baby boomers that have already done plenty of damage to their bodies by now. We are going to need this sort of technology because when all the boomers start getting sick, we're not going to have enough room in the hospitals to keep 'em all.

Similar to astronaut montioring

[Anonymous Coward]

I am not sure if they still do this today, but I remember seeing the movie Apollo 13, where they had something similar to this. They had the full heart monitor, resperator meter, etc. It would probably be a similar setup, except for the transmitter that would be used for hospital patients

Re:Similar to astronaut montioring

[cluckshot]

Being aware of Apollo stuff and some successive stuff this is just a natural progression. The really good thing here would be to get the patient out of the hospital and away from all of those nasty germs growing in that germ factory called a hospital. Your health gets in greater danger the closer you get to a hospital. They are really dangerous. Just to clarify I am an RN and I do know what I am talking about.

Hospitals have a risk of infection that is horrid. The problem is population density. In a 100 bed hospital your chances of catching something there in 3 days is about 10% or less. If the hospital has 500 beds it is about 50% Don't even think of those 2000 or so bed hospitals! What is worse your risk is of really nasty (Germ Warfare types etc) bugs getting to you like MRSA and Hemolytic Strep etc.

The best thing we could do for public health in the USA is to reduce the size of our hospitals dramatically. Following right behind that we should for the exact same reasons cut down on the size of our schools and especially get rid of or reduce daycares!

Now that I have stepped on all of the politically correct toes.. Mods get a life if you disagree.

Re:Similar to astronaut montioring

[Rosco P. Coltrane]

I remember seeing the movie Apollo 13, where they had something similar to this. They had the full heart monitor, resperator meter, etc

But but.. will the patient have to rig together an air scrubber with square bits that don't fit in round ones, held together with space duct-tape, on the doctor's instrusctions by telephone in case of respiratory problems?

Re:Similar to astronaut montioring

[ColdWetDog]

Err, umm. Aside from highly trained persons in a research environment, this appears to be a technology looking for a problem. I am a doctor and I cannot find much of a use for wiring up patients to cardiorespiratory monitors at home. We do this in the hospital because we're worried that they might do something bad sometime soon. If they're stable enough to be sent home, they're stable enough to have thier vital signs monitored by 1) the patient (weight and temperature are rather easy and low tech 2) a nurse (trained in doing vital signs, and much more importantly, a global assesement of the patient that hardware has yet to even try or 3) the extraordinarily complex technologic solution of the telephone ("Hi Mr. Smith, how do you feel today?"). If I'm so worried that the patient's heart will flat line, I'm not sending them home..... This is just another one of Roland's silly bits of "reporting". About half of the Slashdot readership should be able to cobble this up on a weekend (proof of concept indeed...). You could even use Linux. And stop worrying about all of the germs. Yes, they are out there, no they aren't jumping out of the walls to eat you. Where did you get those numbers from? Roland? Fox? The Germ Fairy? They make absolutely no sense. Just try to stay out of the ICU and you'll be fine. Put down that cigarette and for god's sake, quit sitting on your butt and reading Slashot. Go outside and play. Shoo! Shoo!

Re:Similar to astronaut montioring

[SWTP_OS9]

Actualy its very possible to do this. This group is not the only one looking at this. Its could be pulled mostly from embeded remote system tech. Not much different than monitoring a critical pipeline and checking the base line data for problems.

The most difficult part is geting sensor that are not in the way and can be left for a while. Also can be left to do the checking. Be nice to have a bed simular to Star Trek. Nothing really attached to the person. Have seen the start of this at one hospital. The monitoring was done with a wirless link. A person could get up and move around.

It would be simular to a setup for intensive care of second by second checking.

The local hospitals have outpatient groups that visit people recouping or for various reasons. Half of their visits is just spent getting the current status of the person or getting that from there caregiver. Locally their visits cost around 128 dollars for one hour! And going to fry your minds but just a person to sit there and just read a book or watch tv for a home bed bound person can average 20+ dollars with usualy a four hour minumn! And all they could do is call some one in case of problems!

For elderly people a trend line of medical checks could save both that person and your tax dollars before thing become a problem!

It could be use more to prevent complications as the person is being cared for. Would be good for short recouping or long term monitoring.

Last there is one huge major shortage of RN and the different groups around them. Wont replace them but would boster the group we have.

Re:Similar to astronaut montioring

[sessamoid]

What is worse your risk is of really nasty (Germ Warfare types etc) bugs getting to you like MRSA and Hemolytic Strep etc.

In my community, MRSA makes up 50% of the outpatient wound cultures. It's pretty much everywhere at this point. More worrisome are things like a bad influenza strain. We just had a flu death in our hospital--30 year old otherwise healthy female. Now that's a scary bug!

Re:Similar to astronaut montioring

[sonamchauhan]

> And stop worrying about all of the germs. ...
> Where did you get those numbers from? Roland? Fox?

BAD doctor! Stop bullying that nurse. Be humble.

The nurse is absolutely right. *Obviously*, increasing the density of sick people increases the risk of infection there. The CDC says as much:


The Impact of Hospital-Acquired Bloodstream Infections ...
Baseline Data

Population-based surveillance studies of nosocomial infections in U.S. hospitals indicate a 5% attack rate or incidence of 5 infections per 1,000 patient-days (3-5). With the advent of managed care and incentives for outpatient care, hospitals have a concentrated population of seriously ill patients, so rates of nosocomial infections are probably correspondingly higher (6). For many larger institutions, the nosocomial infection rate may be closer to 10%.

If 35 million patients are admitted each year to the approximately 7,000 acute-care institutions in the United States, the number of nosocomial infections--assuming overall attack rates of 2.5%, 5%, or 10%--would be 875,000, 1.75 million, or 3.5 million, respectively. If 10% of all hospital-acquired infections involve the bloodstream, 87,500, 175,000, or 350,000 patients acquire these life-threatening infections each year. ...
In SCOPE, 49.4% of all nosocomial bloodstream infections occurred in intensive-care units.


Yes, the article uses suspiciously grand words. But half of Slashdotters would not be able to knock up a unit in a day or even a month. I would like to, but can't. (See my other post - any move towards something like this is a good idea)

Re:Similar to astronaut montioring

[Anonymous Coward]

Lies! Damn lies! And statistics!
Wow! you included all three.

Did you actually read that article you linked to?

The attack rate of hospital acquired bloodstream infections was 5% and they speculatae that it would grow to 10% in large hospital. This is quite a bit lower than the 50% infection rate mentioned in the parent.

BTW the 49.4% number you mention out of context refers to the data that about half of blood stream infections occur in the ICU. This does not mean that half of patients coming into the hospital will get an infection!

Re:Similar to astronaut montioring

[sonamchauhan]

Whoever you are, you're an arrogant fool.

AC said:
> The attack rate of hospital acquired bloodstream infections was 5%
> and they speculatae that it would grow to 10% in large hospital.
> This is quite a bit lower than the 50% infection rate mentioned in the parent.

Was the nurse speaking about bloodstream infections? No! The nurse said:
> > > > The problem is population density. In a 100 bed hospital
> > > > your chances of catching something ... [numbers]

> BTW the 49.4% number you mention out of context
> refers to the data that about half of blood
> stream infections occur in the ICU.

I know I was speaking about the upto 10% of patients who get bloodstream infections in large hospitals (a horrendous figure). Now if 49% of these bloodsteam infections occur within the ICU, 51% of bloodstream infections occurs outside the ICU. I specifically meant to disprove what the doctor said in bold below.

The doctor said:
> > > And stop worrying about all of the germs. ...
> > > Where did you get those numbers from? Roland? Fox?
> > > The Germ Fairy? They make absolutely no sense.
> > > Just try to stay out of the ICU and you'll be fine

The doctor is obviously living in a wishful dreamland - the CDC paper backs the nurse's assertion about population density increasing risk of infection.

The nurse is right -- smaller hospitals are better for patients. I wonder if some doctors subconciously oppose this due to money. I imagine larger hospitals would be more profitable than smaller ones (economies of scale) and would pay better to a doctor in terms of money and career (while working him harder).

-1 Roland

[Anonymous Coward]

+1 No link to his bogus website.

They better have rock-solid network security

[Anonymous Coward]

Or the War Catheterizers will wreak havoc.

Farady Cage.

[Anonymous Coward]

Hopefully security, and privacy aren't at the "Proof of Concept" level.

TOO MUCH SLASHDOT

[bobdotorg]

I somehow read the title as, "Taking care of mobile patents," and immediately got bent about some organization having the gaul to patent how to take care of patients.

Ack - slashdot has turned me from a skeptic into a cynic.

I must sign off now, but of course I'll hit reload one last time just in case another interesting article has been posted. So yeah - I'll probably still be here in a our or so...

Re:TOO MUCH SLASHDOT

[Anonymous Coward]

I read it the exact same way. :(

Re:TOO MUCH SLASHDOT

[Anonymous Coward]

I must sign off now, but of course I'll hit reload one last time just in case another interesting article has been posted. So yeah - I'll probably still be here in a our or so...

right after the spelling lesson...

Patients, not patents

[neonstz]

For a minute I was wondering what mobile patents were and why they needed to be taken care of.

patient added to Two Year Transplant waiting list.

[ABeowulfCluster]

There's no cure for an unhealthy lifestyle. A heart monitor aint gonna cure that.

Go on.. Eat that cheeseburger, fries and jumbo coke and sit on your butt all day.

What about when the patient is not home

[caryw]

Expecting a patient that wants to "return to normal life" is never going to leave the house is unrealistic. Why create a home network layer for this kind of application when you can use something like Bluetooth and a GSM/GPRS cell phone to relay the information instead. This way the patient can go anywhere as long as they keep their cell phone with them and the hospital can still receive updates on the patients health. They may have to shield some of the sensetive equipment from the cell transmitter however, but that's something that they should already have looked into. The Bluetooth/GPRS combo is incredibly underrated. I bought a $30 usb bluetooth dongle for my laptop and now I have wireless internet access everywhere. Albeit not that fast but sufficient for an ssh session, or in this case, sending vital signs every couple minutes.
- Cary
--Fairfax Underground: Where Fairfax County comes out to play

Re:What about when the patient is not home

[ucdoughboy]

Well in the future, we will have sensor networks everywhere. And where ever your walking human sensors spewing wireless data goes their data will be picked up by the ever present and ever watchful sensor nets and it will be relayed back to their doctors =D

Re:What about when the patient is not home

[Bishop923]

Three big reasons I could see:
1) Signal availabilty: If you live in areas with poor or no reception you're out of luck. Also in larger-scale emergency situations cells have been known to be overloaded.

2) Reliability: Something like this needs to run 24/7 without a problem. Home networks can be hardened with good hardware and backup power sources. Accidentally breaking the phone goes from being a temporary nuisance to a possibly fatal mistake.

3) Cost: Even if it only takes 10 seconds to transmit the data most cellphone plans count that as a minute. Lets be conservative and say that there only needs to be a transmission every 5 minutes or so, thats 12 minutes an hour, or 288 a day. Depending on your cellphone contract it might be cheaper to hire a nurse to follow you around :-)

Re:What about when the patient is not home

[Aldric]

Heh, you said it about availability - I work with GPRS tracking units and one vanished for over five hours last week.

Re:What about when the patient is not home

[owlstead]

Well said, and with the advance of UMTS you would get an always on experience as well. Currently GPRS means that you need to setup a new connection all the time (which is cumbersome and very costly). At this time UMTS is pretty expensive, and not that available, but this will change rapidly. And then we will have continuous access to cyberspace from anywhere at all. Same for WiFi in some places. And there are Gbit connections just around the corner. Overlooking this kind of technology is the biggest mistake one can make.

Pulmonary Embolus

[Physician]

And how do patients expect to get their IV pain medications from home? Do they expect a PICC line and unfettered access to enough Dilaudid to stop their respirations?

Re:Pulmonary Embolus

[frenetic_wimp]

Not to mention how are hospitals going to respond to critical changes in a patient's vital signs? Once cardiovascular or pulmonary stats start going downhill, you don't have a great deal of time.

Although this is a far shot better than being sent home with no follow-up, it could also lead to a false sense of security - you just don't have stand-by nurses and operating theatres in your average home.

Re:Pulmonary Embolus

[Anonymous Coward]

The hospital will hire crack ex-army snipers who will hide up on the rooftops and automatically deliver transquilizer darts by rifle.

Encryption?

[zoharroy]

hope they don't use WAPI http://politics.slashdot.org/article.pl?sid=05/02/ 25/1321259&tid=193&tid=219&tid=218

seriously though, how would they keep this data secure, especially with all of the HIPAA requirements these days

Slashdot has gotten to me

[ICECommander]

Did anyone else read that as "Taking care of Mobile patents" ?

Yeah I can see the doctor's inbox:

[Rosco P. Coltrane]

From: superpenis@hotmail.com
Subject: MAKE YOUR PENIS HUGE!!!

From: viagra4cheap@someispinchina.cn
Subject: V14gra 4 cH4Ap

From: yourfriendjoe@spamhole.com
Subject: Jesus loves you you know!

From: cathy234@yahoo.com
Subject: Holy crap, check this out! [virus deleted]

From: hotsex12sdfsdf@bullcraponline.com
Subject: Te quiero much mi amor [virus deleted]

From: automated@healthmonitor.org
Subject: Pulse 0, patient dead

From: boss@hospital.org
Subject: WHY THE FUCK DIDN'T YOU DO SOMETHING?! YOU'RE SO FIRED!!!

Re:Yeah I can see the doctor's inbox:

[nackrm]

As someone who works for a highly electronic clinical group, I know that our doctors have seperate internal and external email addresses. This helps to ensure hippa requirements as well as keeps important work related email seperate from the rest of the crap.

However, I know that the organization I work for is not the current norm. This could potentially be a serious problem at other places which implement this.

Re:Yeah I can see the doctor's inbox:

[The Tyro]

From: superpenis@hotmail.com
Subject: MAKE YOUR PENIS HUGE!!!

Didn't you know that all doctors have access to secret penis-enlargement surgeries and drugs that are unavailable to mere mortals? (don't believe me? Watch late-night TV... if there's a conspiracy to keep effective weight-loss and cancer treatments from the general public, you just KNOW we're doing the same for our penis-enlargement treatments).

From: viagra4cheap@someispinchina.cn
Subject: V14gra 4 cH4Ap

Heh... One word: Samples.

April Fools your dying!

[bildungsroman_yorick]

If a family member had this implemented I'd hack into this network and give off false information too the sensors that they had heart palpitations or leprosy or some weird exotic symptoms.

Sorry to say this

[The Tyro]

But beware the cult of data, particularly as it relates to medicine.

There is a human tendency to focus on the numbers; the objective things that we can quantify and measure. Unfortunately, numbers in medicine are fuzzy... they MUST be interpreted within the context of individual patient normals, and existing illness.

Here's a great example from my own experience (Disclaimer: I am a physician who works in Emergency Services). Home blood-pressure monitoring devices are widespread now, such that many patients maintain these devices in their own homes. I sometimes see a half-dozen patients a day who present because they got a "high" number on their blood pressure machine. These people are asymptomatic, have no signs of end-organ damage, but are concerned enough about the number to come to the ER. I usually explain the phenomenon of cerebral BP autoregulation to them, and tell them that they're actually in greater danger if I aggressively lower their high blood pressure than if we gradually lower it with some medication changes. They often leave, still anxious despite the reassurance... they're worried about that number... that concrete, objective, hard piece of data to which we're all taught to lend so much weight.

This is the problem with absolute numbers... they have to be interpreted by a clinician in the context of the individual patient. Gathering the numbers is easy... it's interpreting them that's the difficult and rate-limiting step. Every student is taugh early in training to "treat the patient, not the number." It's a cliche, but it contains a kernel of hard truth; one must recognize the importance of individualized treatment and interpretation.

This system seems like it gathers lots of data... I just wonder what they're going to do to interpret it.

Re:Sorry to say this

[Rosco P. Coltrane]

I sometimes see a half-dozen patients a day who present because they got a "high" number on their blood pressure machine. These people are asymptomatic, have no signs of end-organ damage, but are concerned enough about the number to come to the ER.

Those patients you mention *are* sick, they suffer from hypochondry. Yes, they do tend to clog up ERs, but on the other end, after one or two thorough physical examinations, they can be properly diagnosed and directed to a psychologist for treatment earlier than they would normally have, which one may argue is a benefit for them.

Re:Sorry to say this

[sessamoid]

Here's a great example from my own experience (Disclaimer: I am a physician who works in Emergency Services). Home blood-pressure monitoring devices are widespread now, such that many patients maintain these devices in their own homes. I sometimes see a half-dozen patients a day who present because they got a "high" number on their blood pressure machine.

I know exactly what you mean about these patients. The way I've started dealing with them is to take a piece of paper and draw a quick graph that shows the normal variation in various vital signs, particularly blood pressure. "See, this is when you get angry, this is right after your morning coffee hits, this is you right now because you're stuck in the ER with lots of sick people and expecting bad news, etc. Then I explain to them that they may have caught their blood pressure at one of those high peaks, even though their blood pressure is fine overall.

It can also help to draw a hypothetical line, presumably above where the patient happens to be at the moment (say 200 mmHg), at which point I would explain that it deserves immediate attention.

It's easier to counter their concern over a hard, concrete number when you visually show them the normal variation in a hard, concrete manner.

Re:Sorry to say this

[sonamchauhan]

But beware the cult of data, particularly as it relates to medicine.

There is a human tendency to focus on the numbers;
...
I sometimes see a half-dozen patients a day who present because they got a "high" number on their blood pressure machine.

Hmm, lives *have* been saved due to people being alerted by such home-based diagnosis units - these machines have a place. The correct way to combat the misinterpretation you mentioned of some limited data is to obtain better data and have better understanding all around of such data. As you mentioned, this project seems to be doing that.

> This system seems like it gathers lots of data...
> I just wonder what they're going to do to interpret it.
As far as processing huge amounts of data goes, the concept is not new. Holter monitors are used to diagnose cardiac and blood pressure problems - you wear the unit and it records BP and ECG over a day for later analysis. That data give both the doctor and the patient a better appreciate how their numbers normally vary. The only difference here, is that the data is monitored continuously. The doctors probably have set realistic monitoring alerts tailored to the patient - maybe, something like: "If blood pressures crosses, 170/110, raise alert" etc.

I once showed up in ER with a very fast heart rate (trigged by excercise). I had to wait 15 minutes for triage. By this time, my pulse should have come down near normal but when the triage nurse got a chance to do it, it showed up as 125. The nurse was concered, but I only got to see a doctor 2.5 hours later. By then I was back to normal.

I hope one day cheap Holter-style devices that record to a flash disk and interface to a computer (perhaps to retail software that analyses the data) are sold in pharmacies for $15.

Both doctor and patient gain by being better informed about the patient's condition.

After all, doctors appreciate they are fallible, and have limited resources. And patients appreciate how precious a doctor's time is.

Re:Sorry to say this

[The Tyro]

A Holter only records the data, it does not interpret it. Holter monitors most certainly DO have a place... but again, they only record the ECG data (not BP) and some give you statistics; a human cardiologist still has to interpret it in the context of that patient's individual situation, history, and pre-existing conditions.

Most ECG machines give you a "machine read" when they record a tracing... but it's very often incomplete/wrong. I don't know a single clinician who bases their treatment soley off the machine's opinion of the tracing (and most hospitals still have all ECGs reviewed by a cardiologist before they go into the permanent chart).

You do make a excellent point about life-saving machines. I prefer machines that can not only sense, but also act: probably the best example is the AICD/ICD (Automatic Implantable Cardioverter/Defibrillator). They monitor heart rhythm/rate, and can deliver a life-saving shock if an unstable or lethal rhythm is detected; they're a true lifesaver for arrhythmia-prone patients at risk for sudden cardiac death.

I'd love to have some smart machines to help me out. Believe me, as stretched and busy as I am at work, it would be great to have some digital assistance that I could trust.

Re:Sorry to say this

[sonamchauhan]

> A Holter only records the data, it does not interpret it.

Yes, I know that. I have a Holter scheduled early next month. :)

> Holter monitors most certainly DO have a place... but again,
> they only record the ECG data (not BP) and some give you statistics;

I was surprised to learn it, but the GP who referred me to the cardiac specialists said these Holters record blood pressure too. I asked if this was based on some sort of automated inflation, deflation of some cuff at regular intervals, but my GP said no it wasn't - apparently there is some funky optical mechanism. I hope to find out soon. :) Should be very interesting.

My main points recapped: (1) cheap sensors in the hands of patients are beneficial (2) more data is better than less data (3) machine analysis of data is better than no analysis (as your point about the ICD beautifully illustrates, the ICD must analyse it's data to allow it to act)

Isn't this just great!

[SlashThat]

Before you know it, the big brother will be monitoring your heartbeat to determine your political inclination :)

Re:Isn't this just great!

[Theosaur]

If the hospitals can monitor at-risk patients, why not just monitor everyone such that immediate response can be enacted for emergencies? And if hospitals may monitor for health emergencies, why not just let the government get in on it to monitor for crime emergencies? In fact, why not just implant trackers into citizens for easier monitoring? Wow, this would be a great way to make the world a safer place for authoirty!

Re:Isn't this just great!

[Anonymous Coward]

When you flatline you're a republican? ;P

Re:patient added to Two Year Transplant waiting li

[Anonymous Coward]

living healthy doesn't keep you from dying. this technology could benefit everyone. it sucks to be in the hospital for months.

Piquepaille

[stud9920]

more like Pissepaille am i rite...

Just wondered...

[SlashThat]

Wouldn't this kind of equipment interfere with an artificial heart stimulator? On the other hand, if the patient is flat-lining and the equipment starts transmitting, it just might bring him back! :)

Wait until your ISP hears about it

[bluGill]

ISPs are gonna love this. Suddenly your net connection is as critical as a phone connection. People will die when the net connection goes down. Suddenly telco 99.999% uptime looks small.

Even when the ISP doesn't care about you, their lawyers care because your heirs will have an easy suit if they can prove the network was down for even 30 seconds at about the time you died.

Geeks everywhere will rejoice if this happens after "fast enough" netconnections are rolled out. Suddenly the bandwidth we want will be legally 24x7, and an effective static ip address because 30 seconds is less than how long it can take to reconnect after a dhcp lease changes.

Re:Wait until your ISP hears about it

[dr_d_19]

Even when the ISP doesn't care about you, their lawyers care because your heirs will have an easy suit if they can prove the network was down for even 30 seconds at about the time you died

Well, no.

You know that combinations of words you have to agree to (by voice or signature) when you sign up for a net connection? It often states that there is no guarantee that the connection will be available at all times.

There goes the suit. And it should. If you want 100% uptime (hefty compensation when offline) you should get another type of agreement - and pay for it.

Re:Wait until your ISP hears about it

[bluGill]

Doesn't matter, the law trumps anything in a contract. The law will take very dimly to any contract that allows someone to die. In fact once this becomes common you can sue your ISP for downtime, despite that part of the contract.

Any judge who hears these words: "Your honor, they cannot know when my great aunt will come for a visit after surgery. Therefore they need to assume I always have someone visiting who needs a net connection." The judge is likely to find that the ISP must keep the net connection up in this case. If you really had a visitor with a critical need for a net connection then downtime is criminal negligence, even if nothing happened.

The phone companies already face this. On call doctors can sue the phone company if their phone goes down because they depend on the phone. There are elderly who have a monitoring system already that used the phone. They do not pay extra for service, but the phone company is expected to provide them with 24x7 service.

I am not a lawyer. Only a lawyer can give you advice on what will happen. Don't be surprised to see it happen though.

Re:Wait until your ISP hears about it

[dr_d_19]

Perhaps you are right, but then again I pity anyone living in the United States (or with your system of law to be precise).

In Sweden (where I live), this would probably not be possible. For example, it would be impossible for me to sue the seller of a microwave oven for not explicitly stating that it cannot be used to dry my cat. Heck, even if he tells me it can, I still would not be able to sue him.

People have to think for themselves sometimes.

Re:Wait until your ISP hears about it

[bluGill]

Our system of laws makes it possible for the little guy to get his day in court. It is easily abused, but despite all the stories about abuse it isn't that bad in reality.

Personally I pity you, living in a country where a faceless company can kill someone though negligence and there is nothing you can do about it, just because your contract doesn't prohibit it. Though from what I know of Swedish law (very little) my guess is that your courts are more likely to take my side of the argument than our courts in the US.

Security ?

[cyberfunk2]

Just wait until someone comes up with a good reciever for these signals...

Man goes on subway to get lunch/groceries/whatever...
another man passes him in close proximity, takes reading, privacy invaded.

Re:Security ?

[Rosco P. Coltrane]

Man goes on subway to get lunch/groceries/whatever...
another man passes him in close proximity, takes reading, privacy invaded.

The smart sick person goes get lunch/groceries/whatever..., saves the tinfoil wrapping, puts it on head immediately, another man passes him in close proximity, takes no reading, privacy maintained!

Obligatory

[Rosco P. Coltrane]

Okay, I've been waiting a while to see the Microsoft jokes come up, but none yet. Someone's gotta do it I guess:

It gives a whole new meaning to "blue screen of death"

Sorry...

Re:Obligatory

[drxray]

Well, what do you expect if you insist on overclocking your organs...

Re:Obligatory

[fyrewulff]

I've added 6 new pipelines to my heart and overclocked to 2000BPM.

Needless to say, I wrote this post in .3 milliseconds.

Warning

[oKtosiTe]

Warning, a critical heart failure has been detected, would you like to restart your computer?

Get them OUT of the hospital ASAP!

[Tsu Dho Nimh]

""After a patient has been hospitalized for a surgical intervention, he usually wants to return to his normal life. But doctors would like to monitor him to be sure that the operation was successful. How can they manage this without being too intrusive?"

Even if they only go to a convalescent care center, the faster they get out of the hospital and into a place that is more like a home envoronment, the better for all concerned. Hospitals are no place to try to rest and recover from anything (and I speak as an ex-Med Tech).

Being able to monitor blood pressure, temp and pulse, perhaps with a "store and send" technology, would be a big step, because the firsat sign of a complicating infection is usually shown when one or more of the three goes off the patient's usual pattern.

Brave new world.

[ramblin billy]

I can just imagine it now...

Sensor modules are located in the appropriate places - cardiac, temperature, blood oxygen level - all connected by bluetooth to the hub of your Body Sensor Suite - your cell phone. The phone stores 2 hours worth of telemetry at the maximum collection rate. It runs the input data through gates, constantly checking for pre-loaded alert triggers. If it detects a problem it can react with a variety of responses, from warning you in a kindly caretaker voice (maybe recorded messages from your 3 daughters) to take it easy, activating a medpak release, automatically connecting with your doctors office, up to sending a mayday on the 911 channel with automatic integration to the nearest EMT unit. The EMTs and your doctor receive real time sensor feeds as well as a GPS upload from your phone. Your doctor can remote activate medpaks, adjust your pacemaker, or use your phones camera to check pupil dilation. The EMTs have your complete medical history as well as treatment instructions from your doctor before they reach the scene. Your phone handshakes with the infotags embedded in the EMT's drug deliver system - verifying doses and checking for allergies.

If you don't have any problems every two hours your phone links with your PC at home. Data is downloaded. Your complete records are available to your doctor (or his Virtual Physicians Assistant) via internet. He can monitor trends and modify the alert trips and actions. These new settings are uploaded to your phone during regular updates. Lifestyle information linking time, place, and physical condition are available for diagnostic evaluation. Your phone calls you and says "you are entering the first phase of an allergic reaction, what are you touching?" Sensors are available for environmental contaminants, radiation, air quality, even electromagnetic and sonic energy. Your phone won't let you drive drunk or fall asleep at the wheel. There's a hack available that masks cannabis detection. There's a lot of hacks available - recreational, performance enhancing, popular supplements. To refill your medpaks you just insert them into the AutoScript at your favorite store - yes - hacks are available. Of course if your phone indicates you have been deviating from your doctor prescribed regimen your co-pays go up. And there is that nasty rumor about the NSA...

And of course.....it runs linex.

More important: people vary

[wowbagger]

The other thing to remember is that people vary.

For example - I always have a bitch of a time donating blood, because I usually run a little hot - 99.2 F. That's my normal temperature - and too many health professionals forget that the original studies that determined body temp were done in Celcius, and were accurate to a degree ( have you ever wondered why 98.6 F = 37.0 C? Because the measurement was done in Celcius first, then converted).

You have to have the background data - what is normal for the patient - in order to really judge what is going on.

This is ALSO why it is SO important to NOT go doctor-shopping - the new doc won't have the accumulated data on you.

Another example - my 94 year old great-aunt has "high" blood pressure - and every doc she sees feels it is his sworn duty to lower it. Of course, when they get her BP where they want it, she is unsteady on her feet, will get dizzy standing up (postural hypotension), and will lose what little mental acuity she has (Alzheimers is a bitch!). These docs seem to forget that it is not unnatural for a 94 year old to have a higher pressure than a 30 year old!

Re:More important: people vary

[RobertLTux]

Every doctor should have tattoed to their arm (under the medic alert stuff) Always Treat Who not What!! The numbers will vary due to who (marathon runner, dancer, cumputer tech, gardener) even when you limit to a given age range

in socialist Canada

[Anonymous Coward]

Why would any surgeon want to actually monitor a patient? What's in it for them?

And The 4th Part

[nate nice]

The doctors are able to electrocute you to death when you fail to make payments.

About those numbers

[The Tyro]

All of us hospitalists and hospital-based docs deal with drug-resistant nosocomial infections... but I've never heard the numbers you're espousing. They're interesting if true... I'd appreciate a reference.

In my area MRSA is rampant out in the community... people walk in the door with MRSA abscesses and skin infections all the time... many of them are young people with no sick relatives who have never spent a day in a health-care facility.

Hospitals already do this

[Anonymous Coward]

For three years now, the hospital I work for has had a wireless telemetry system much more sophisticated than anything used on Apollo 13 (if not quite so long-range). But as cluckshot says, the object is to get away from the nasty germs. It'd be simple to adapt the receiver to a home PC environment. The hard part is ensuring reliable communication with the hospital over the Internet. I'd hate for my vital signs to have to compete with my neighbor's kid's pr0n download.

Someone call a doctor!

[Anonymous Coward]

This guy just failed it!

Re:Exactly What We Dot Need

[mbsurf]

But are baby boomers going to be the best patients for this type of treatment? It seems as if they are going to need more urgent care than most. Granted, this will be a case by case basis, but I'm speaking on average.

Dick Cheney

[krikat]

I wonder if Dick Cheney has one of these with like a "Hit Counter" so he knows how many heart attacks he has.

It's been done. Devices are on patients now.

[LordByronStyrofoam]

Cardionet makes an ambulatory cardiac patient monitor with a chest-worn sensor that transmits heartbeat waveform data to a belt-worn unit over ISM band (range is actually up to 30 feet - useful for when the belt-worn unit is in it's recharger on the nightstand and the patient gets up to use the restroom down the hall).
The belt-worn unit, running VxWorks, continuously analyzes the waveform, comparing results with physician-defined thresholds. When a threshold is exceeded the unit communicates with the monitoring center using it's built-in cell phone. It the patient is outside, the built-in GPS tells the ambulance where to find him/her. The monitoring center can contact the physician. The system is in active use today in Philadelphia.

Too Late Professor

[Anonymous Coward]

I fond this kinda funny, I work for an At home telemetry lab. Oddly enough we got FDA 150 clearance back in november of 98. Take a look http://www.cardiactelecom.com

Already Being Done

[Anonymous Coward]

This kind of stuff is already being done at the medical automation research center, university of virginia. They have some systems installed in a Volunteers of America facility that does this kind of in-home monitoring and vital signs monitoring.

from the summery

[rob_squared]

"How can they manage this without being too intrusive?"

Step 1: No rectal thermometers at work.

Uh Oh,,,

[tyman]

Now I'll have to line my organs with tin-foil before surgery to prevent those medical government-controlled hacks from trying to control me!

Not new

[mmu_man]

This French company manufactures intelligent health monitoring clothing that can be setup to connect remotely...

Dr Clippy

[Linker3000]

Looks like you're having a heart attack, do you want me to:

1. Restart your heart
2. Email your doctor and mark it 'urgent'
3. Fax a copy of your will to $group_benefactors
4. Play the file mylifeflashingby.mpg
5. Switch to 'tunnel of light' wallpaper
6. Turn on webcam and the ftp feed to www.seemedie.tv

Re:patient added to Two Year Transplant waiting li

[gl4ss]

how original. copy the first post.

don't you realise that no matter how healthy you live you will get some (semi)'lifestyle' disease sooner or later that kills you. because you won't live forever - you WILL have problems with your heart, lungs, brains, muscles or something else, regardless of how healthy you have lived(it might take some healthy years later than if you had eaten unhealthy.. but you wont live forever).

Not just proof of concept

[Anonymous Coward]

Matt Welsh, one of the great figures of the early Linux days, has implemented this type of system already as part of his systems research at Harvard:

Code blue

I've had a chance to play with it, and it's a great system with huge promise in triage situations. Welsh is a brilliant guy - if you're interested in this kind of stuff, keep an eye on his work.

Brings new meaning too

[Cylix]

BSOD

Re:Exactly What We Dot Need

[Anonymous Coward]

I think the goal is to make quadruple-bypass-and-sensor-install an outpatient surgery.

Another thought - metrology...

[wowbagger]

I am NOT a physician, but I do design test equipment - so metrology (the science of measurement) is something near and dear to me.

I have a thermometer at home (old-school, alcohol filled glass tube). I also have a sphygmomamometer (one of the old-school types - cuff, dial, stethoscope).

Now, if my thermometer shows me running a bit hot, or if my sphygmomamometer shows me running a bit high, am I going to get terribly excited?

No, because I have NO IDEA what the calibration states of those instruments are - they could be dead nuts on, or wildly off. The only thing I will even REMOTELY trust is relative measurements - if the themometer shows me a degree higher than it normally does, then that may be significant. If my BP is 10mmHg higher than normal (controlling for situation), that may be significant.

But then again, while I have an idea how to run a sphygmomamometer, I am not trained to run one - and so my measurements have a built-in error factor.

I would trust one of those Wal-Mart sphygmomamometers about as far as I could throw it for absolute accuracy - I'd want to talk to my doc (or more likely his nurses) to find out how they calibrate their gear, and check the calibration.

But like I said - I build test equipement for a living - metrology is my livelihood.

I though the idea was

[Jozer99]

I thought that the whole idea was that the patient was there in case their heart suddenly stopped after surgery. While a home sensor system like this would TELL the doctors it happened, there would not be much they could do about it for the 5 minutes that it takes an amublance to get there. If the patient is in the hospital, someone with a defibulator would be there in seconds.
Can't people take a day or two off for a triple bypass anymore? IT isn't like you are isolated from the world. Many hosipitals now have computer terminals that you can use, and free WiFi if you want to use your own. Not to mention telephones.

Bad idea from experience

[kbielefe]

My daughter was born last June 3 months premature, spent 3 months in the hospital, and then 4 months on a home heart/apnea monitor because complications with her hydrocephalus cause bradycardia (low heart rate).

I think wireless transmission to the hospital would be a bad idea for the following reasons:

• If you are bad enough off to need a monitor you need someone at your home trained in CPR and the interpretation of the monitor alarms anyway in order to respond fast enough.
• Those things go crazy with false alarms. Our daughter had about 300 alarms a month, only a couple of which were actually cause for concern, and none of which required medical intervention. Every time our daughter breathed a little shallow when she was eating, wiggled a little too much, or got a little upset when her diaper was changed, the alarm went off. A human must look at the person to verify if the alarm is valid, even in the hospital. It was pretty fun to have the battery get low after a 4 hour plane flight and set off the ear-piercing alarm in the terminal.

Now a real innovation would be making these the size of a cell phone instead of that VCR we were hauling around.