opinion


Healthy prospects

BeingMobile

In the fourth instalment from his book Being Mobile, which is being serialised exclusively on Telecoms.com, Ofcom’s William Webb looks at the opportunities for wireless technology in the healthcare sector and the improvements it could help bring about.

Healthcare is an area of rapidly growing importance. Many studies have shown clearly how the population is aging and demand for healthcare is growing—and yet the number of people in work (and hence paying for the healthcare system) is falling. Under current extrapolations, healthcare will become increasingly unaffordable and impossible to implement, with an unfeasibly large percentage of the population engaged in caring for others. Either the quality of healthcare provided will fall, or new means must be found to care for those who currently rely on the support of others.

Wireless communications provide one possible part of the solution. Through a system of monitors, alerts and the provision of information it might be possible for electronic systems to allow people to monitor their health more effectively or to generate better information that remote medical professionals can monitor and analyse.

The benefit of both scenarios is that the user of wireless medical infrastructures would be able to stay in their homes and look after themselves for longer. A downside is that increased medical monitoring will uncover mild forms of sickness and ailments that have hitherto remained undetected, or have been dealt with by the natural defence mechanisms of the body without medical intervention. This could make individuals excessively health conscious or hypochondriacal.

Developing wireless solutions to healthcare needs might be important both to society as a whole and also to the wireless sector, where important new markets and new uses of technologies might be enabled.  In this article we look at healthcare in the home and hospital, in “Being Mobile” we also cover the ambulance and the individual as well as looking in more depth at the way ahead.

Healthcare at home

Broadly, the function of devices in the home is to monitor the individual to make sure that there is no cause for concern. Monitoring can take many forms, from fall alarms that detect a sudden change in patient orientation, to sensors in pill dispenser boxes that detect whether the daily dose of pills has been taken. Other sensors could be included in scales that chart daily changes in body weight and composition, or movement detectors to assess whether the patient is moving freely around the house.

Such monitoring essentially forms a sensor network. The sensors may be wired or wireless—for the most part wireless sensors would provide more flexibility and avoid the need for complex wiring systems to be inserted around the house.

One of the key problems for sensor networks is power, but in the home this might be eased. Some sensors might be able to use mains powering and in others (scales, for example) sufficiently large batteries could be employed to provide many years of power. Some sensors could have their power supply replaced regularly—pill sensor boxes might have a new battery inserted each time a new supply of pills was delivered, say. Because most of the sensors will be readily accessible, replacing batteries should they fail unexpectedly might not be problematic (as long as a failed battery was identified as the fault).

Because most homes are relatively small environments, a communications system based around a star-architecture might be appropriate. This would consist of a home hub providing wireless communications throughout the home. The most likely candidate for this would be WiFi, which already provides such functionality, although using WiFi in the sensors might be a heavy drain on batteries. Nevertheless, as noted above, this may not be problematic in many situations. WiFi also has the advantage of inexpensive chipsets that can readily be built into many devices.

Alternatives could be cellular-based (using femtocells), BlueTooth, Zigbee or proprietary protocols. Mesh-architectures could also be considered. Any of these could be made to work, but WiFi has the big advantage of the home hub already being available in many cases. Another approach might be a number of powered distribution nodes around the house that communicated with the home hub via WiFi or home powerline communications and communicated with sensors using a lower power and lower range standard such as BlueTooth.

A key question is how such a home healthcare system could come about. It could happen in an evolutionary fashion, as home owners gradually added various items one at a time as they found them valuable. Alternatively it could be offered as a complete “home refit”, with an entire system being installed at one time.

The complete refit offers the possibility of a single system, optimised for the task in hand, without the complexity of having to adapt to the different elements already in the home. It could be installed by professionals and might be simpler to use than multiple systems, because it could have a single combined user interface for all sensors. However, this would require central planning and likely central funding and, while not out of the question, there are many barriers to such deployments. These include issues such as the department benefiting the most (often the hospital) not being the source of funding (which is often the local authority). While it should not be ruled out, it seems unlikely.

Evolutionary deployment is much easier to envisage. A simple example of a home healthcare element that could readily be implemented now is a set of scales that measure weight and body mass composition (these are widely available for around $50 – $100) with in-built WiFi which records the daily measurements and then supplies them to the home computer via the home hub. If the home already had a WiFi system and home PC then, with the download of a simple software program, the scales could provide information both on the weight of the patient and also on the fact that they had weighed themselves at the usual time of day (and hence were active).

There might be a gradual increase in the number of such sensors over time, with end users buying them directly, making use of subsidies where available or building on functionality already provided in devices such as the Wii.

Healthcare in the hospital

Key applications fall into:

  • Monitoring the location and movement of people, equipment and drugs.
  • Removing wires.
  • Facilitating access to information.

The monitoring function is valuable because items can go missing in hospitals. Valuable equipment can be moved by one person resulting in their colleagues being unable to locate it later. Drugs can be misplaced, or given to the wrong person. Even patients can go missing if they choose to move around without informing the staff. Tracking these items can save time, costs and, in some cases, result in better care.

Tracking is generally performed by placing a passive sensor or tag onto devices or in the wrist bands worn by patients. Whenever these devices pass through a controlled point such as a doorway where an active reader is located, the reader notes their presence and records it. Such tagging is already widely used in department stores at the store exit to detect stolen goods and in business premises to open doors with an employee pass. The technology is often known as RFIDs and is well established. Installing it in a hospital would involve some cost but little else.

The removal of wires allows patients with body sensors to move about freely and for equipment to be wheeled from bed to bed without needing to be plugged in. This is all relatively straightforward, making use of either short range standards such as BlueTooth (for example to connect body sensors to nearby monitors) or longer range standards such as WiFi (to connect monitoring equipment to central databases).

Facilitating access to information allows healthcare workers in the hospital to access patient records, central databases and communicate with each other while moving around the hospital.

One concern over implementing these applications using wireless is that most envisage using unlicensed spectrum, often at 2.4GHz. There are no guarantees of freedom from interference in this spectrum, although it might be possible in a hospital environment to control the devices within the hospital to some extent. If the hospital were to become reliant upon unlicensed spectrum to the extent that it could not function properly without such wireless connectivity then the consequences of interference might be severe. Indeed, the possibility of congestion or interference is one that affects much more than hospitals, with the potential to impact WiFi hotspots, home hubs and much more. It is still very much an open question as to whether interference will occur and, if it does, whether there will be acceptable solutions.

Difficulties in introducing new solutions

On the face of it healthcare would seem an excellent place to introduce new wireless services and technologies. There is a strong need for new solutions and many worthwhile concepts can be envisaged that would improve the lives of patients and save money for healthcare authorities. Some of these services might then be further developed into other areas of our lives.

However, there are barriers caused by the manner in which healthcare is provided in many countries of the world. Institutional arrangements are often such that there is little budget for new ideas and the benefits often fall to different budget holders than those who would fund the deployment. Healthcare is also often a conservative world that is difficult to change both because of the entrenched self-interests and also the risk of harming patients, or of legal challenge, if a deployment is not successful.

In addition to this, the benefits that continuous monitoring provides might not be as great as benefits derived from greater investment in more traditional forms of medical infrastructures. Health organisations may need to choose between more operating theatres and wireless systems, just as they might have to choose between wireless devices and more general practitioners.

There are many areas where harmonisation would be very valuable, for example in the standards that sensors use to communicate so that individuals could have one monitoring device and healthcare professionals could link into the sensors when needed. But there is little evidence of harmonisation of this sort taking place, despite the fact that it would not be unduly difficult since many appropriate standards exist already.

These concerns make it most likely that wireless healthcare solutions will be introduced piecemeal, often by individuals. It is much simpler for an individual suffering from a particular condition to purchase a sensor or device that will assist them and link it to their home system than it is for a central agency to supply appropriate technology. Self-purchase works better in a market economy and seems likely to happen in the health sector over the coming years.


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