Thanks to advances in miniaturization and developments in sensors and measurement technologies, it is already possible to collect a considerable amount of health-related information from wearable or embedded devices, and numerous new devices are also in the pipeline (Table 32.1). Some of these devices function on a constant basis, whereas others take intermittent mea-
surements. The surrogate markers they track determine which mode is most suitable; a device that monitors the heart rate in a patient with a history of cardiac events must be constant, for example, whereas a device that monitors lipid levels in the bloodstream of a patient who has high cholesterol need only be intermittent.
But reliable, portable monitoring devices are only one element in the equation. The second is the network across which the data they collect can be sent—and here two new technologies are particularly relevant: third-generation (3G) mobile telephony and a wireless network protocol known formally as 802.11 and colloquially as Wi-Fi.
The 3G networks using the Universal Mobile Telecommunications Systems standard have been in operation for a few years now. They offer an enormous increase in bandwidth and can theoretically transmit data at speeds of as much as two megabits per second (Mbps). They are also relatively easy to use.
Miniaturization and new fabrics have massively increased the opportunities for developing devices that monitor a patient's health. Here are a few of the most promising examples.
• The GlucoWatch: In mid-2001, the first wristwatch device designed to monitor blood glucose levels in patients with diabetes reached the market. It uses a small electrical current to extract a tiny amount of fluid through the skin. A thin plastic sensor on the back of the watch measures glucose levels in this fluid every 20 minutes for 12 hours. The device sounds an alarm if the wearer's glucose reaches dangerously high or low levels.
• The clip-on pedometer: Titan Industries is developing a clip-on device that tracks various parameters, including the number of calories the wearer has burned while walking around. The company is also exploring the potential for a similar device that monitors blood pressure.
• PC in a pill: Scientists in Israel have developed a wireless digital camera so small that it can be sealed in a capsule and swallowed. It takes high-quality color images while passing through the digestive tract. The images are transmitted to a portable recorder worn on a special belt and can be downloaded on a PC.
• The smart shirt: Sensatex, a New York-based company, is developing a shirt that is used to monitor patients' vital signs. The shirt is made of an electro-optical fabric that transfers data from the wearer to the garment. A transceiver on the shirt records the data and sends it to a wireless gateway, from which it can be transmitted to the doctor.
• Smart dust: Researchers at the University of California, Berkeley, have developed smart dust—tiny, intelligent wireless sensors that can communicate with each other, form autonomous networks, reprogram themselves, and monitor almost anything. They have already been tested for various military and nonmilitary applications, but their potential in providing pervasive health care is equally huge .
Wi-Fi runs at even faster speeds; the most common standard can now transmit data at a blistering 54 Mbps, although access is limited, except in large urban areas, and the technology has suffered from criticisms of being less secure. However, both these problems are being resolved. In the US, for example, IBM, Intel, and AT&T have formed a consortium to develop a nationwide wireless data network. Companies such as T-Mobile have developed global Wi-Fi networks and have even offered cell phone subscribers the ability to add Wi-Fi hotspot access to their cell phone plans. Airports, major hotel chains, and retailers such as Starbucks have created large networks of Wi-Fi hotspots that enable high-speed network connectivity. Indeed, vendors of enterprise software such as Siebel have taken advantage of this development in Wi-Fi availability. Siebel provides a feature known as TrickleSync. This automatically synchronizes data from the laptops of mobile professionals whenever the software detects a network connection. The time when such approaches are applied to synchronizing wearable medical devices is not far away. The new and much more secure encryption standards, Wi-Fi Protected Access—WPA—and more recently WPA2, are fast replacing the Wired Equivalent Privacy (WEP), which was less secure.
The third element required for pervasive health care is a hub at the relevant hospital or doctor's office, to which the data can be sent. The frequency of collection and transmission determines whether the data are electronically filtered and programmed to trigger an alert only when they fall outside certain preset parameters or are checked by a human agent. This hub will subscribe to the stream of data coming over as HL7 messages. It will be able to retrieve the messages it has permissions for. Using this publish and subscribe approach could also enable pharmaceutical companies to receive data during in-life trials. The data recorded through the devices or diagnostics, laboratory tests, and dispensary records and the information captured by the physician in the EMR will produce a stream of HL7 messages that can have permissions defined to enable the trial sponsor to subscribe during the conduct of the study. Although this messaging approach may sound somewhat futuristic, the reality is that examples of this exist today. A project known as the Healthcare Collaborative Network (http://www-03.ibm.com/industries/healthcare/doc/ content/landing/972420105.html?g_type=pspot) aimed at improving patient care uses this publish and subscribe messaging approach. The project was launched in 2003 with the aim of improving patient care. The initial project participants are New York Presbyterian Hospitals, Vanderbilt University Medical Center and Wishard Memorial Hospital, as well as the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the Food and Drug Administration.
Another example is the Canadian government, which has purchased the same technology to run a pilot for an early warning and response system for biological agent threats. Initially limited to Winnipeg, the system's goal is to create a readiness network for front-line health care workers.
With all the technology found in the modern hospital today, the lack of coordination between other parts of health care, the pharmaceutical industry, and the agencies is outdated. A network that connects these parts together will improve patient safety, improve care, speed the development of new treatments, and support new medical breakthroughs.
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