Introduction to Telemedicine
Telemedicine and GPS for individuals
The Know Where Jacket
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Telemedicine enables the remote delivery of patient care using integrated health information systems and telecommunication technologies and allows scientists, physicians and other medical professionals around the world to serve more patients.
Wireless telemedecine is a new and evolving area. It involves the exploitation of mobile telecommunication and multimedia technologies and their integration for new mobile health care delivery systems.
This is an area where the technology is ahead of the ability or the will to put it into practice. Satellite telecommunications have much to offer as in remote areas, in emergencies and on planes and ships they are the best, if not the only, means of ensuring the transmission of data in real time.
Telecare: Health and social services delivered from a distance. Remote diagnostics and monitoring may have relevance both in emergency situations and in situations where mobility is a problem, either for the older or disabled person or for the service provider. Used appropriately, telecare can lead to increased autonomy and independence for older people and disabled people, and can provide important support for family carers.
Telemedicine generally refers to patient care, while telehealth incorporates a variety of health-related activities. The common thread lies in the fact that all of these activities involve the transfer of information about health-related issues between one or more sites using telecoms technology to effect the transfer.
Principal applications of telemedicine are: telecardiology, teleradiology and telepsychiatry.
Telemedicine and GPS for individuals
NASA developed the wireless LifeGuard system, a lightweight, portable device that enables physicians to monitor the health and safety of explorers in remote locations. The system allows real-time monitoring of vital parameters such as heart rate, blood pressure, electrocardiogram (EKG), breathing rate, and temperature. The LifeGuard’s button sensors stick to the skin to take EKG and breathing rate. The system’s sensors connect to the LifeGuard by wires. LifeGuard’s data logger has a transmitter that radios collected data by satellite to a base station computer. This is a good example of a system that could be used in telemedicine.
Germany’s Vitaphone has launched a handset that can record heart-activity data when pressed to a patient’s chest and transmit it to doctors. With the Vitaphone 2300 (Cardio Phone) Vitaphone is presenting a completely new innovation to the world: It is now possible for the first time to record, save, and digitally transmit 3-channel EKGs via mobile phone and without cables or adhesive electrodes. The EKG is obtained via electrodes on the back of the mobile phone. To this end, it is simply placed against the naked chest of the patient.
The EKG recording is started with the press of a button and takes place completely automatically. The same is true of the transmission of the EKG to the medical telemedicine service center of Vitphone, which is staffed around the clock with doctors and where the EKG is evaluated. The GPS receiver integrated into the Vitaphone 2300 also allows the medical service to precisely determine the position of the patient in the event of an emergency. High-risk patients in particular can be given optimal care thanks to telemedicine.
The computerized LifeShirt by VivoMetrics Inc. has been tested by the United States Air Force for its ability to monitor armed forces in the field. The Air Force will enhance the LifeShirt monitoring system with GPS and long-range wireless capabilities to create an advanced method for real-time location and physiological monitoring of military personnel in the field. Also planned are ways to improve the sensitivity of GPS localization so that it can be used to track personnel inside buildings.
The LifeShirt is a washable, mesh-like, lightweight shirt which uses embedded sensors to collect and continuously monitor over 30 physiologic indicators of health and disease including respiratory and cardiac function as well as other physiological parameters. The data is delivered via handsets for monitoring by medical personnel. Ideal for use in telemedicine.
Interactive Wear AG has developed the Know Where Jacket with integral GPS, GSM, Bluetooth and mp3 capabilities.
The Know Where Jacket
Besides a cellular phone, an mp3 player, headphones, a microphone and a water-tight and impact-resistant sleeve keypad as well as an emergency call button, all the electronics have been integrated for a terminal that is referred to as a “GPS eye,” which is used for determining and transmitting positional data that is used particularly for determining the location of people. In this way, it is not only possible to determine the location of the jacket’s wearer with GPS accuracy, but it is also possible for GPSoverIP to even enable real-time determination of the person’s location within a building. Compared to conventional solutions that are not integrated into garments, the integration of the active GPS antenna into the epaulette on the jacket’s shoulder always ensures optimum reception of GPS signals.
Scientists at the Department of Computer Science at the University of Bristol have developed the Cyberjacket, a wearable mobile computer system for telemedicine purposes. Other scientists augmented it with three purpose built sensors: an ECG, an Oxygen Saturation Monitor and a temperature sensor. This augments the standard sensors on the Cyberjacket for position sensing (using GPS), and motion sensing (using accelerometers). The Cyberjacket has a modularized architecture. This means that health researchers can easily customize a jacket for their experiment in telemedicine.
The wearable system consists of an ADS `bitsy’ processor unit (based on the StrongARM), with a custom 9-wire bus embedded in the fabric of the jacket. The bus provides sensors with power, ground, and communications via three serial links. Two links run at RS-232 levels, and are for dedicated RS-232 devices. Any commercially available device that runs RS-232 (such as a GPS) can be connected to one of these busses. The third bus runs at TTL level, at 4800 baud, and is used as a drop-link bus on which tens of devices (e.g. medical sensors) can be connected. In addition, the bitsy offers stereo sound I/O that can be used to give feedback to the wearer.
TAM-Télésanté comes with the V-TAM medical T-shirt for telemedicine use. It was developed by four laboratories and an equal number of manufacturers in France. By pooling their skills, they created a T-shirt that’s arrayed with small physiological and medical measurement sensors. It’s then linked via GSM mobile communications network to a specialized monitoring center. Heart rate, respiratory rhythm, and skin temperature are all recorded.
If the doctor at remote distance wants to communicate with the patient, he or she can do so through a microphone-loudspeaker that’s incorporated into the garment. If necessary, an ambulance can be quickly dispatched to the patient’s location. The patient is easily found with the built-in GPS receiver. To complete this project, TAM-Télésanté faced many unusual issues. For instance, it was vital that the cotton T-shirt or undergarment retains its traditional functions. It had to absorb perspiration and provide comfort and ergonomic qualities. The company also wanted the garment to be dry-cleanable.
The V-TAM T-shirt is particularly aimed at older people. Using it, they could regain their independence or continue living at home with the security of permanent medical assistance. The people who will benefit the most from this T-shirt are patients with an unstable cardiovascular pathology following real or suspicious episodes; persons presenting symptoms of temporal-spatial disorientation, such as those suffering from Alzheimer's; and even competitive athletes whose heart rate is being monitored. Professionals in high-risk industries, such as fire protection or the military, also could benefit from its use.
Medical Intelligence from Quebec has devised a portable telemedicine cardiac alert system that will automatically detect a heart attack up to eight minutes before an individual even gets any symptoms. And because the device, called the Vital Positioning System (VPS), is connected to a cell phone or pocket computer containing a global positioning system (GPS), it will alert designated emergency services that the person is having a heart attack and pinpoint where, geographically, he or she is.
The Vital Positioning System contains self-learning artificial intelligence software that detects the advance signs of a cardiovascular incident and calls for an ambulance before the attack develops. The GPS tracks the exact location of the patient and the patient does not have to do anything.
This telemedicine device is a three-in-one combination of artificial intelligence, a digital wireless ECG and a telecommunications system. The digital ECG is worn at the waist on an elastic belt. The belt also contains cardiac activity sensors, a small GPS and a transmitter that sends data to a cell phone or pocket personal computer. The phone or PC is inserted into a base that holds the VPS software, and the belt can operate up to about 90 m away from the phone.
In addition to being able to locate the patient, the emergency telemedicine services will be able to monitor the patient's heart activity remotely on screen and talk to the patient through the system's two-way microphone.
This summer(2005) hospitals and health care units in Sweden will have access to a new and unique service. Using GPRS in the mobile network, hospital and health care staff can remotely monitor patients with sicknesses or diseases that do not require hospital treatment or other types of medical care. The service, called BodyKom, has been developed by TeliaSonera Sweden in association with HP (Hewlett Packard) and Kiwok, a Swedish software company. BodyKom functions by means of a communications device that is connected wirelessly to a number of sensors on a patient's body. The communications device communicates with health care personnel over TeliaSonera Sweden's nation-wide mobile network and constantly monitors the patient's health status remotely. If the sensors detect any changes in the patient's health, or if the patient notices changes to his or her body functions, the system can automatically dispatch an alarm to an on-call doctor or to members of the patient's family. The unit receiving the alarm will also be informed of the geographic position of the patient through the use of GPS technology.
On June 3, 2005 Canadian company Medical Intelligence in collaboration with telecommunications operator Orange and Medidep, one of France's major private companies specializing in dependent care-giving solutions, unveiled a major technological innovation for Alzheimer's patients. To prevent any disappearance, the Columba bracelet automatically detects any departure from a security zone surrounding the residence or nursing home. The "zone" is pre-determined by the patient's family or caregiver. The Columba then alerts a medical assistance centre that promptly contacts the family or caregiver to coordinate assistance efforts. If required, the medical assistance centre, which operates 24-7, can accurately geoposition the bracelet wearer and establish audio communication using Columba's "handsfree" feature. The Columba has a GPS-Assisted positioning system, a GSM/GPRS transmitter/receiver with a SIM card for voice and data, and an intelligent alert detection system.
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