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4th September 2003

Europe : Patients enjoy full mobility and more quality of life whilst undergoing health monitoring. Furthermore quality in health care goes up at reduced costs. All this should be realized by a newly designed solution for mobile patient monitoring -- the MobiHealth system. Since the end of July field trials have started in connection with the MobiHealth system developed in the MobiHealth project funded by the European Community. First of all these trials are intended to prove the technical feasibility. The trials are run in the Netherlands, Germany, Sweden and Spain.

Already at the Medica international and medical conference and exhibition in Dusseldorf in 2002, the first live demo of the Body Area Network (BAN) -- the core element of the solution for mobile patient monitoring -- was demonstrated. Since the end of July the EC project MobiHealth has started the field trial phase with the BAN. The trials are being conducted in the areas of acute trauma care, chronic and high-risk patient monitoring and monitoring of patients in home-care settings. Each trial lasts around three months.

First of all these trials are intended to prove the technical feasibility of this system. The trials are evaluated in terms of accuracy and validity of measurements, usability of the GPRS and UMTS networks, business and market potentials and also social and ethical effects; the opportunity for medical evaluation is limited due to the short duration of the trials and the low number of participants. Rainer Herzog, project manager of the MobiHealth project, is sure that the newly designed solution for mobile patient monitoring is not only technically feasible, but also offers benefits for all parties involved: "Patients of our target groups will be given more mobility and thus be able to lead a more normal life again. Doctors will be supported in diagnosing and choosing the appropriate medical treatment and medical services in the case of home-based health care. Also, sickness-funds and health insurance will realize the potential of cost savings in health care by applying a mobile patient monitoring solution."

What is MobiHealth?

MobiHealth is the title of a mobile health care project funded by the European Commission. It is supported by the EC with 5 million Euro. The MobiHealth consortium unites 14 partners from five European countries and represents all the relevant disciplines, such as hospitals and medical service providers, universities, mobile network operators, mobile application service providers and mobile infrastructure and hardware suppliers:

PHILIPS Research Laboratories, University of Twente, Medisch Spectrum Twente (Netherlands), TMS International BV, YUCAT mobile business solutions, LogicaCMG International, HP (Netherlands), Ericsson GmbH, GesundheitScout24 GmbH (Germany), Telefonica Moviles Espana, Corporacio Sanitaria Clinic as well as Universidad Pompeu Fabra (Spain), furthermore Lulea Tekniska Universitet and Telia Mobile AB (Sweden).

The project started in May 2000 and is scheduled to end in February 2004. Dimitri Konstantas is responsible for the scientific coordination and Rainer Herzog for overall project coordination.

MobiHealth targets the introduction of new mobile value-added services in the area of health based on 2.5 and 3 G technologies, thus improving not only the quality of life of patients, but also allowing the introduction of new value-added services in the areas of disease prevention, disease diagnosis, remote assistance -- even in the case of accident or emergency, clinical research, para-health services, physical state monitoring (sports) and even clinical research. And last but not least these services should help to save costs for medical health care without a decrease in quality because they are likely to reduce medical treatment of patients suffering from chronic diseases by around 30 per cent.

The core element of the newly designed mobile solution is a Body Area Network (BAN) that the patient wears on his or her body and that can -- via a safe and mobile solution -- transmit the patient's physiological data to the doctor, the medical care center or the health call center.

What is a Body Area Network (BAN)?

A Body Area Network is based on GPRS and UMTS technologies for wireless broadband data transfer. It enables monitoring, storage and transmission of vital-sign data coming from the patient. It furthermore supports flexible personalization of services and ensures appropriate intervention in response to certain conditions or combinations detected in the vital-sign measurements.

The patient wears the BAN, which is programmed according to his/her individual health requirements, on his/her body. This BAN consists of sensors and actuators, a mobile digital box and a programmable mobile phone or Personal Digital Assistant (PDA). Small sensors fixed to the body measure vital data such as blood pressure/heart rate/pulse rate at intervals (or continuously) and wirelessly transmit these data by Bluetooth to a mobile terminal. This terminal (mobile phone or PDA) transmits the data via GPRS, later on by UMTS, to providers of health care services, e.g. health care centres, but also to hospitals. There the data will be displayed on the computer screen. The doctor monitoring these data can then decide which action to take -- from remote assistance to emergency alarm.

Overview of the field trials

Netherlands: Integrated Homecare in women with high-risk pregnancies

The trial will use the MobiHealth BAN to support Integrated Homecare for women with high-risk pregnancies.

Women with high-risk pregnancies are often admitted to the hospital for longer periods of time because of possible pregnancy-related complications. Admission is necessary for the intensive monitoring of the patient and the unborn child. Homecare with continuous monitoring of women with high-risk pregnancies, when feasible, is desirable and can postpone hospitalisation and reduce costs.

In this trial, patients are monitored from home using the MobiHealth BAN and the (maternal and foetal) biosignals are transmitted to the hospital. The objective of the trial is to evaluate if such monitoring services can be supported by 2.5-3G communications such that hospitalisation can be postponed and costs reduced.

Netherlands: Tele Trauma Team

MobiHealth BANs will be used in trauma care both for patients and for health professionals (ambulance paramedics). The trauma patient BAN will measure vital signs which will be transmitted from the scene to the members of the trauma team located at the hospital. The paramedics wear trauma team BANs which incorporate a video camera, an audio system and a wireless communications link to the hospital.

The purpose of this trial is to evaluate whether use of 2.5-3G communications can improve quality of care and decrease lag-time between the accident and the intervention. When using telemetry technology, time can be saved and thus treatment and chances for patient recovery improved. Faster intervention is expected to increase survival rates and decrease morbidity.

Parameters to be measured are breathing frequency, oxygen saturation, pulse rate, blood pressure, pupil size and reactions, amount of fluids infused. Video from the scene will be transmitted assuming UMTS availability.

Germany: Telemonitoring of patients with cardiac arrhythmias

The target group in this trial are patients with ventricular arrhythmias who are undergoing drug therapy. Cardiac arrhythmias are very common, especially in elderly patients, and in many cases are related to coronary heart disease. Around one million patients suffer from coronary heart disease in Germany today.

In patients suffering from arrhythmia, ECG measurements have to be taken regularly to monitor efficacy of drug therapy. In order to save time and reduce costs, in this trial the patient is able to transmit ECG and blood pressure via GPRS from home or elsewhere to the health call centre, where the vital signs are monitored by cardiologist. The intention is that irregular patterns in these vital signs will be quickly detected and appropriate intervention can be effected. The trials are designed to determine whether 2.5-3G wireless communications can support such services.

Sweden: Lighthouse Alarm and Locator Trial

The target group involved in the trials are patients at the Lighthouse care resource centre and also clients living at home, but with the common characteristic that all have an alarm system located in their room at the Lighthouse Centre or in their home. The current system does not allow the patient any freedom related to mobility and forces the patient to be trapped at home or in their room at the Centre. By replacing the fixed alarm system with the mobile MobiHealth system the patient can move freely anywhere. Additionally positioning and vital signs are monitored and video communication is planned when UMTS is available. The main expected benefit of using the MobiHealth BANs in this trial is to increase mobility and to allow patients to lead a more normal life than they did before.

The purpose of the Lighthouse trial is to test the effectiveness of the new GPRS/UMTS-based alarm and locating device (a variant of the MobiHealth BAN) according to several determining factors: safety, convenience, empowerment of user, mobility of user and improvement in efficiency of care given.

Sweden: Physical activity and impediments for activity in women with RA

Trial subjects will be women with Rheumatoid Arthritis. The use of the BAN together with the 2.5-3 G wireless communications will enable collection of a completely new kind of research data which will enhance understanding of the difficulties and limitations which these patients face. The objective is to find solutions that will make their lives easier. By this collection of data, the scarce knowledge about what factors impede normal life will be supplemented and quality of life of RA patients may thereby be improved.

By use of the BANs, the activity of the patients will be continually monitored. Parameters measured include heart rate, activity level, walking distance and stride length.

Sweden: Monitoring of vital parameters in patients with respiratory insufficiency

The group of patients involved in the trial suffer from respiratory insufficiency due to chronic pulmonary diseases. These people need to be under constant medical control in case they suffer an aggravation of their condition. Besides needing regular check ups, they also need oxygen therapy at home, which means oxygen delivery and close supervision.

The use of the MobiHealth BANs in this trial is designed to help in the early detection of this group of diseases and also to support homecare for diagnosed patients by detecting situations where the patient requires intervention. The expected benefits are a reduction in the number of checks- ups and hospitalisations needed thus saving both time and money for the hospital. Parameters measured are pulse rate, oxygen saturation and signals from a motion sensor (accelerometer).

Sweden: Home care and remote consultation for recently released patients in a rural area

Home care services and the possibility of monitoring health conditions at a distance are changing the way of providing care in different situations. If suitable home-based services are provided, patients do not need to be in hospital when the risk is not very high or when they are recovering from an intervention. By investing in home care, hospitals have been able to significantly reduce pressure on beds and on staff time dedicated to the kind of patients named above.

This trial tests transmission of clinical patient data by means of portable GPRS/UMTS equipment from patients living at home in a rural low population density area, to a physician or a registered district nurse (RDN). The subjects are patients who have been recently discharged from hospital. The expected benefit is that this intervention will reduce the number of cases where the patient is moved to hospital unnecessarily.

Spain: Support of home-based healthcare services

This trial involves use of GPRS for supporting home-based care for elderly chronically ill patients including remote assistance if needed. Patients are suffering from co-morbidities including COPD. The MobiHealth Nurse-BAN will be used to perform patient measurements during nurse home visits and the MobiHealth patient-BAN will be used for continuous home monitoring outdoors during patient rehabilitation.

It is very important to facilitate patients' access to healthcare professionals without saturating the available resources, and this is one of main expected outcomes of the MobiHealth remote monitoring approach. Parameters to be measured are Oxygen saturation, ECG, spirometry, temperature, glucose and blood pressure.

Spain: Outdoors patient's rehabilitation

The patients involved in this trial are chronic respiratory patients who could benefit from rehabilitation programs to improve their functional status. The study aims to check feasibility of remotely supervised outdoors training programs based on control of walking speed enabled by use of the BAN. The physiotherapist will receive on-line information on patient's exercise performance and will provide feedback and advice.

It is expected that by enabling patients to perform physical training in their own local settings, the benefits, in terms of cost and social acceptance, can be significant. Parameters to be measured are pulse oximetry, ECG and mobility with audio communication between patient and remote supervising physiotherapist.