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In an era of increasing medical costs and inequitable access to medical care, telemedicine is growing more important. Loosely defined as the delivery of medical services through telecommunications and other video-imaging and information technologies, telemedicine programs are now tackling issues ranging from detection of breast cancer to at-home monitoring of chronically ill patients.

As a major innovator in the realms of system development and integration, real-time monitoring and information mining, IBM is strategically positioned to play a leadership role in the enablement and transformation of the telemedicine market. Through a variety of pilot programs and with a broad range of industry partners, IBM's Healthcare and Life Sciences practice is working in collaboration with IBM On Demand Innovation Services — a partnership between IBM Research and Global Business Services to help organizations leverage these sophisticated technologies for at-home monitoring and localized access to health care.

Making healthcare personal

In Denmark, the costs of universal medical care are shared by the nation and its municipalities. Aarhus, Denmark’s second-largest city, has long used visiting nurses and other professionals to monitor chronically ill persons living at home. In a three-month pilot program, Aarhus recently replaced these onsite visits with remote care monitoring enabled by IBM’s Personal Care Connect solution (PCC), a standards-based open infrastructure platform for remote monitoring. PCC consists of a data collection component designed to capture biomedical information at the point of generation (typically, in the patient’s home); a server that normalizes and stores the data collected; and an application programming interface that presents the normalized data.

PCC is built to be scalable, reliable, financially practical and protective of patients’ privacy. Important to this solution is an in-home hub that links medical devices to the PCC server. In its pilot programs, IBM has typically employed Bluetooth-empowered cell phones to act as these hubs. IBM has also used Bluetooth to provide communications between the medical devices and the hub. Although a few other companies also have brought remote patient-monitoring systems to market, IBM's PCC solution differs by employing an open-system application programming interface. This allows a broad variety of biomedical device vendors and healthcare application vendors to integrate their technologies into the PCC system platform. In addition, IBM’s solution allows the patient to be monitored during periods of travel outside the home.

In the Aarhus pilot, each patient was provided with a blood pressure cuff, scale, data collection hub and a tablet PC. They used the biomedical devices daily to measure their blood pressure and weight. They also recorded medication intake on the tablet PC. The PCC system analyzed this data to identify significant medical events, which were then forwarded to municipal medical professionals. IBM also established a separate prescription database. A medication analysis performed checks for incorrect medications and missing medications. Finally, IBM developed a Web-based application allowing patients and approved relatives and friends to access patient information.

Additional PCC pilots

Building on its success in the Aarhus study, IBM teamed with the KfH Kidney Center for Children and Adolescents at the University Hospital of Heidelberg in Germany to monitor at-home dialysis.

Dialysis performed in medical centers disrupts patients lives. It does, however, provide medical professionals with an accurate view of patients’ progress. Dialysis can be performed at home. The disadvantage is that medical personnel can then only indirectly monitor significant health issues such as the water balance in the patient’s body. IBM and University Hospital wanted to remotely monitor patients’ blood pressure and weight to help determine, during at-home treatment, whether over- or under-dialysis was taking place. University Hospital gave each patient’s family a medical device kit, including scales, blood pressure monitors, heart monitors and a Bluetooth-enabled cell phone. PCC recorded data in near real-time, allowing medical personnel to see trends in data within minutes of a measurement being taken. IBM, meanwhile, developed a system to capture information from these health indicators, combine it with time-stamp information, and aggregate and securely transfer the data to a medical server.

PCC’s capabilities are slated to be further tested during a proposed collaboration between the IBM Healthcare and Life Sciences practice and a university medical research institution to monitor asthma sufferers. Currently, these patients use an oxygen peak flow meter at home to measure lung function and a paper diary to record how they feel at the time the tests are taken. In the proposed pilot, IBM will improve monitoring by connecting pulse oximeters and peak flow meters to a PCC hub. Information will be transferred to a PCC server for review by medical professionals.

Delivering healthcare to rural areas

While PCC helps monitor the health of patients, other IBM initiatives may actually improve it. IBM has been an information technology advisor to the Arizona Telemedicine Program (ATP) in the United States, an incubator for innovation in healthcare. This program bundles telemammography, telepathology and teleoncology services that can be accessed by women living in rural areas of Arizona.

ATP was developed to deliver badly needed healthcare services to underserved populations — persons living on Navajo reservations, for example. It has since expanded to include 55 healthcare organizations in communities throughout Arizona and neighboring states.

Meeting competitive challenges with telemedicine

As the healthcare industry strives to monitor patients' health while improving access to medical care and keeping costs down, governments and medical centers increasingly are turning to telemedicine solutions to help meet these goals. Working with our partners, employing the PCC infrastructure and other telemedicine technologies, IBM's Healthcare and Life Sciences practice is helping healthcare providers deliver the kind of quality service at reasonable prices that patients have come to expect. This practice is also helping to enable the “third wave” of telemedicine. In the third wave, telemedicine will move far beyond the telecommunications-only paradigm to a fully integrated system of in-home and in-hospital monitoring, data integration, electronic health records and physician/patient exchanges.

For more information on engaging IBM expertise in telemedicine, contact On Demand Innovation Services today