Tag Archives: Technology

Why Wireless Health Matters

By Robert B. McCray, Co-Founder, President and CEO of the Wireless-Life Sciences Alliance (WLSA)

THE potential of wireless health will be realized in the effective blending of three bodies of learning: high technology; life sciences; and human factors. The last point is critical — end users (including consumers, patients and clinicians) will ultimately determine the successes and failures in wireless health.

Robert McCray

There is also a fourth factor in the creation of any convergence sector such as internet commerce, mobile data or digital music. The fourth factor is the ecosystem of innovators, executives, investors, clinicians (for healthcare) and policy makers who are creating the sector.

The following discussion is intended to level set the discussion about why wireless health is important, to provoke conversation, and undoubtedly to set myself up for some predictive failures.

What is wrong with healthcare and what does wireless health have to offer?

Societies have no choice but to change their healthcare systems in the face of exploding demand caused by aging and chronic disease. The U.S. healthcare system is already failing millions of its citizens. Wireless health offers the opportunity to satisfy this demand, thus improving life and creating shareholder value.

Nonetheless, it is apparent that some institutions and professions will resist the demand for more personalized and efficient access to care. In the face of competition and digital information, however, they will ultimately be unable to resist disruptive change any better than the automobile, music or retail industries.

Wireless health is powerful because it creates transparency in healthcare through measurable outcomes, and transparency creates accountability.

What can be done

Looking at developments in the field as a whole, and considering the global economic and social environment in which we exist, I offer the following conclusions and observations:

  • If a device or service can be connected, it should be (under penalty of malpractice, obsolescence and/or customer dissatisfaction).  How else will you be able to answer questions about how your product works in the field or why someone should buy it? If you do not take this approach and your competitor does, how will you sell against connectivity? This is why we have Merlin, CareLink and Latitude even though St. Jude, Medtronic and Boston Scientific created these wireless services without extra reimbursement.
  • In the developing world, increases in chronic disease and demand for access to health services rival or exceed our challenges in the developed world. U.S. life sciences companies should look for markets in the entire world and not just in the dwindling populations of rich and well insured in the U.S. and Europe. Five billion cell phone users constitute the largest distribution channel ever created in the world. How are you going to use it?
  • Epocrates was founded on the principal that clinicians needed on-the-fly access to accurate and up to date information via mobile devices and it has grown to establish a platform serving a majority of U.S. practitioners with several important services. It has achieved business success and its investors and founders will be rewarded. Whether Epocrates will extend this platform to the rest of the world or leave that opportunity to others remains to be seen.
  •   is moving towards free. Access to medical knowledge, including personal genomics, is being distributed directly to consumers. So far, these trends have primarily influenced a motivated minority of consumers and especially the healthy wealthy, but over time they will shift power and responsibility to patients who will have to manage more healthcare decisions for themselves and their families. Digital music ultimately reshaped the music industry. Wireless health will have a similar impact in healthcare.
  • In societies with limited access to healthcare and limited spending, wireless health delivers access to knowledge and care.  In the U.S., it is disruptive and resisted. Why? Partially because the U.S. spends too much and gets too small a return compared with the rest of the world. There is resistance to change because it is economically, culturally and legally disruptive.

Consider the combined effects of the following:

  • Professional licensure is well intended but state licensure and corporate practice restrictions shield physicians from competition.
  • The FDA operates on a laudable principle that safety and efficacy must be demonstrated, but this standard should be relaxed if the new device or service is offering a monitoring of dark space where current services leave patients unmonitored.
  • The fee for service system has created an environment where innovation depends on reimbursement which, in conjunction with device regulation, tends to freeze the innovation and impede its improvement.
  • Notwithstanding these sources of inertia, the immutable forces of population aging, rising rates of chronic disease, and the effects of global competition, mean that (1) individuals will have increasing personal responsibility for coordinating their own and their family’s care and (2) access to fully insured care will continue to decrease. These trends turn “patients” into “consumers” and “caregivers” who demand better products and services than the healthcare industry is accustomed to delivering.

Fortunately, we have the technology tools to tackle these problems:

  • Nearly ubiquitous wireless connectivity to the world’s population. Cell phones are a mobile and personal permanent address.
  • Data storage, analytics and search capabilities that are declining in cost faster than the declining cost of content creation.
  • Secure cloud based access to information via the Internet.
  • Embedded wireless technology which enables wearable devices.
  • Inexpensive whole genome sequencing and rapidly advancing esoteric diagnostic services, with results reported in a digital format to enable data sharing and analysis.

The Future of Healthcare

What will we do with these tools?  What is the future of the healthcare industry in the United States, the world’s most expensive healthcare market?

  • Will it follow the trajectory of the music industry, which was controlled by a small number of companies until digital music and the Internet made access to music free, enabled free global distribution for artists, and transformed how music lovers spend their money.
  • Will it follow the course of the auto industry which tried to maintain a market for low tech low quality cars, lost its status to international companies and now has downsized, created competitive products and is regaining market share.
  • Unfortunately, elements of the U.S. healthcare industry may have more in common with the financial industry, especially its lack of transparency, high cost and government support.

In a sense, the U.S. has run the largest clinical effectiveness study in history with the Medicare program: approximately 50,000,000 patients have participated over 30 years. The U.S. is ranked last among 19 industrialized nations with respect to preventable deaths, despite outspending these nations as much as twofold (Commonwealth Fund, 2008).

The purpose of Medicare is to operate an effective health insurance program for the aged – notwithstanding clear evidence of its failure relative to the world, elements of the professions, key institutions, and consumers (as voters) resist thoughtful efforts at Medicare’s improvement. Fortunately, this problem has the attention of policy makers, entrepreneurs and some globally significant companies.

How fast will the U.S. change? How do businesses thrive and investors earn a return in the face of uncertainty? There is no guide book for this situation, but with healthcare being the largest component of the U.S. economy and with the development of middle class healthcare markets in Asia, it is certainly an area that is replete with opportunity.

Excerpted from Why Wireless Health Matters By Robert B. McCray


Diabetes Management: Killer Apps That Are Revolutionizing Diabetes Care

The advantages of the wireless world are finally being brought to use beyond socializing. For us diabetics, they’re being used as a means of communicating critical information about our health and the status of the conditions that can be mortally devastating and an expensive burden.

Of course, nothing replaces weight loss and proper diet. But, in the meantime, communications technology can be used as a means to inform, monitor and support patients.

Indeed, health care providers and medical companies are quickly learning how to leverage emerging communication and electronic technologies to make diabetes management more efficient, reducing hospitalizations and ultimately decreasing the cost of the disease to individuals and on society.

What’s more, the health care market is seeing a large influx of companies who are putting technology to use in a growing field of healthcare communications and health-record management. At a basic level, this means using technology to manage health records and share information with a patient’s physician or other approved health care providers and caregivers ‒ including family members.

But, for treating diabetes patients in particular, the use of technology has been slow. When killer apps for iPhone and iPad are out in the market days after the devices are released, it is quite ironic that given the ever-changing condition of diabetes ‒ by its very nature we could benefit from up-to-the minute capabilities that technology brings ‒ diabetes management technology remained rooted in the last century. But that’s changing.

At long last, technology is coming to the rescue of diabetics, trying to make diabetes management easier. In fact, just in the past few years, there finally has been marvelous progress in diabetes care. This isn’t just with insulin pumps and home blood glucose monitoring systems. The technologies available now and those at the cusp of development are really encouraging and exciting.

Wireless Technology Improves Patient Care For Marginalized Communities

Of my favorites is an innovative use of wireless technology will help underserved communities improve diabetes care and prevention in Tijuana. Using 3G mobile technologies, the Dulce Wireless Tijuana project helps patients in remote areas both monitor and treat their diabetic condition. The Dulce Wireless Tijuana system, announced by Qualcomm Incorporated in October last year, combines mobile applications, web applications, mobile phones, netbooks, laptops, diabetes educational content and health care worker and patient training. Service delivery is available to diabetes patients and their caregivers wirelessly through Qualcomm’s 3G technology network.

Dulce Wireless Tijuana patients now will have access to the system and technology, including primary care diabetes services and disease management programs. The project stands as an example of how wireless technology can improve patient care for marginalized communities — not just in Mexico, but throughout the world.

Goodbye Bariatric Surgery!

Then there is a matchbox-sized gadget called DIAMOND (Diabetes Improvement and Metabolic Normalization Device) ‒ a.k.a. TANTALUS™ ‒ developed by German medical device maker MetaCure. The system is implanted under the skin on the abdomen, and stimulates the stomach muscles when the patient is eating. This tricks brain into thinking more food has entered the stomach than the person has actually eaten. To deal with this supposedly large meal, the brain boosts insulin production as well as triggering the release of hormones that suppress appetite.

This means that the patient feels full much sooner than normal. A wireless charger system allows the patient to recharge the device at home by placing the charger over the abdomen for 45 minutes, once a week. The result is an improvement in blood glucose levels, which is often accompanied by weight loss, and reduction of blood pressure, waist circumference and blood lipid level. Goodbye bariatric surgery!

Over 200 patients are using the DIAMOND system to date, many of them for over two years, and many for over four years. Trials at the Medical University of Vienna showed the device reduced blood glucose levels by a quarter over three months and the DIAMOND has been shown to significantly reduce blood glucose levels and blood pressure levels. Goodbye bariatric surgery!

Diabetes Management System Could Be iTunes of Diabetes Care

A UK-based medical device company, Cellnovo develops and manufactures an innovative mobile diabetes management system. Comprised of a mobile connected micropump, mobile touchscreen controller, blood glucose meter and applications, the Cellnovo system provides intuitive operation, wireless Internet connectivity and real-time activity tracking – all industry firsts. Cellnovo offers extensive experience gained at the world’s premier medical device and wireless companies, including Medtronic, DuPont, Novo Nordisk, Abbott, AT&T Lucent, and other industry leaders.

The Cellnovo system’s advanced micropump technology enables people with diabetes to more efficiently manage their life-saving therapies while benefiting from greater personalization and portability.  This mobile-connected, disease management approach to diabetes removes the burden of keeping journals and pushes information to healthcare professionals so they always have a real-time view of this information

Treating High Blood Pressure With Radio Waves

The Symplicity Catheter System developed in Australia is used to perform a procedure termed renal denervation (RDN). In a straightforward endovascular procedure, similar to an angioplasty, the physician inserts the small, flexible Symplicity Catheter into the femoral artery in the upper thigh and threads it into the renal artery. Once in place within the renal artery, the device delivers low-power radio frequency (RF) energy to deactivate the surrounding renal sympathetic nerves. This, in turn, reduces hyper-activation of the sympathetic nervous system, which is often the cause of chronic hypertension. The one-time procedure aims to permanently reduce blood pressure. RDN may also allow patients to reduce or eliminate the need for lifelong antihypertensive medications.

The procedure is highly effective with 84 per cent of patients who underwent renal denervation experiencing a reduction in systolic blood pressure by more than 10 mmHg. The study also found that the therapy was safe, with no serious device or procedure-related events, no cardiovascular complications and no kidney-related complications.

Removing Pain From Diabetes Management

A quick and painless way to measure blood sugar is highly sought-after by diabetes sufferers, who currently have to prick their fingers to draw blood several times a day. Now, researchers in the US may have found a solution – a device that works by simply shining a light on skin.

An MIT team has developed an algorithm to relate blood glucose to interstitial glucose levels. “We’ve incorporated a mass-transfer model into the overall Raman spectroscopic algorithm, which allows us to seamlessly transform between blood and interstitial fluid glucose,” explains Ishan Barman, lead author of the research.

Using an early version of the device, the team tested the blood-sugar levels of some human volunteers and found that the accuracy and precision of the test was just as good as conventional finger-prick tests. In addition, the new algorithm allows the test to predict impending episodes of high or low blood sugar (hyperglycemia and hypoglycemia) by extrapolating the rate of change of sugar concentration.

The vision is to create a laptop-sized device that could be kept at home or carried around. Rather than having to pierce the skin to obtain blood samples, the device measures sugar levels by simply placing a scanner against the skin. Because measurement is fast and easy, it is hoped that the device may encourage people with diabetes to check their blood sugar more often, giving them better control over their condition.

This research addresses a real problem and appears to provide an important means for improving the calibration of non-invasive sensors. It may also be helpful in the development of a so-called ‘artificial pancreas’ – where insulin can be dispensed automatically in response to sugar levels.

High-Tech Tattoo For Monitoring Blood Sugar

Another MIT team has given people with diabetes one more reason to join the tattoo craze: a special tattoo under development could help them monitor their blood sugar. The team is developing a glucose “tattoo” that could give people with diabetes a visual track of their blood sugar, and reduce the need for the painful finger pricks required for traditional monitors. The glucose tattoo ink, which would be injected under the skin, would be made from a substance that can reflect infrared light back through the skin to a watch-sized monitor that the person with diabetes wears over the ink.

By having this special ink injected under their skin, and by consistently checking the small monitor worn over it, people with diabetes can get a “real-time” feed on their glucose. They can note and take action when they see their blood sugar climbing or dropping; they don’t have to wait until they can get to a convenient place to conduct a finger prick or, worse, until they start to feel ill. The device also opens up an avenue of thought: if special ink can alert people with diabetes to dropping glucose levels, could an automatic, implanted glucose dispenser or pump be far behind?

Shed a Tear to Test Blood Sugar

On diabetes forum like TuDiabetes, diabetics are forever discussing lancet devices, painful pricks, first drop of blood, and callused fingertips. Now a team of researchers at the Arizona State University in collaboration with the Mayo Clinic is developing a new sensor that could make the lives of diabetes patients much easier. The team has come up with a sensor that would enable patients to take tear fluid from their eye to test their glucose levels. The researchers claim the tear sample would give just as accurate a reading as a blood test does.

Team members assessed how current devices were working – or failing – and how others have attempted to solve monitoring problems. They came up with a device that can be dabbed in the corner of the eye, absorbing a small amount of tear fluid like a wick that can then be used to measure glucose. Because of its potential impact on health care, the technology has drawn interest from BioAccel, an Arizona nonprofit that works to accelerate efforts to bring biomedical technologies to the marketplace,

Improving Compliance

A number of companies have developed continuing blood glucose monitoring and insulin injection products with the goal of improving compliance in diabetic patients. Today’s children with diabetes also have the opportunity for better blood glucose control than any generation before.

A research study reported in Pediatric Diabetes showed that, compared to multiple daily insulin shots, children on insulin pump therapy for 12 months significantly and consistently lowered their A1C levels. In fact, insulin pump therapy has been shown to significantly decrease severe hypoglycemia in youth. Recent studies showed that adolescents and young children on insulin pump therapy had over 50 percent fewer episodes.

To encourage compliance in diabetic children, Bayer Diabetes Care recently released its Didget blood glucose monitor, which connects to the Nintendo DS and DS Lite. The meter provides children with an adventure game that rewards consistent testing with points, which can be used to unlock new game levels. The product was approved by the FDA in April.

Bioject Medical Technologies markets a needle-free injection system that is approved for delivering subcutaneous or intramuscular injections. The system forces liquid medication through a tiny opening held against the skin, creating an ultra-fine high-pressure stream that penetrates the skin. The technology can be used for a variety of applications, including diabetes, malaria and influenza.

Echo Therapeutics has developed a wireless, transdermal glucose monitoring system for patients with diabetes. The Symphony tCGM System uses a skin permeation device, called Prelude, to painlessly remove the outermost layer of skin in approximately three to five seconds, allowing the transdermal biosensor to read glucose levels through the remaining layers of skin.

OrSense has developed a noninvasive continuous glucose monitor that utilizes a patented technology called Occlusion Spectroscopy. A ring-like sensor temporarily closes off (occludes) blood flow in the patient’s finger, creating new blood dynamics that generate a unique optical signal. Clinicians can analyze the signal to obtain measurements of glucose levels and other blood parameters.

Online Diabetes Resources

Then there are new computer programs that support the analysis of home blood glucose data. Insulin pens are finally the norm and diabetes sufferers are using not just more convenient and expedient methods of insulin administration ‒ they are now using more accurate methods because of technologies that provide improved measurement and monitoring. The idea of subcutaneous glucose sensors were a dream only a decade ago and now they’re an everyday part of diabetes care.

Bethesda-based Telcare, a Bethesda-based company that has developed blood glucose monitoring technology that combines a glucose meter with wireless connectivity to Telcare’s “cloud” server. The electronic device keeps an open two-way communication between a patients and caregivers ‒ those that are loved ones and those that are professionals such as the nurses and doctors.

Telcare monitor users can access all of their glucose data, as well as offering additional electronic logbook capabilities such as manual recording, nutrition recording, weight management, exercise regimens, medication amounts, and blood pressure statistics. Most impressive is that Telcare provides a cross-platform social community where people with diabetes and healthcare professionals can interact, share stories, discuss the diabetes technology that they use, and learn from one another.

Many diabetes-related health problems ‒ such as eye, kidney and heart disease ‒ are the result of high levels of blood glucose affecting organs over time. So doctors are encouraged that today’s young diabetes patients can achieve consistent, lower blood sugar levels from an early age that can continue for a lifetime. For example, Roche makes the ACCU-CHEK® Spirit insulin pump system.

These pumps are milestones above the traditional method of treating fluctuating glucose levels. These pumps can deliver 480 basal doses of insulin each day. But here’s where technology comes in: A Palm device and the ACCU-CHEK Pocket Compass software with a bolus calculator determines a patient’s bolus doses and even creates pie charts and other graphs to track a patient’s progress. This software application can be loaded onto smartphones.

Another company is PositiveID Corp, a growth-stage micro-cap known for their digital personal health records technology. The company unveiled its new ‘iglucose’ technology at the Cellular Technology Industry Association (CTIA) annual conference in Orlando, Florida last week. It is a wireless communication device for the automatic transmission of blood glucose readings from market leading, data-capable glucometers to the iglucose database.

PositiveID’s iglucose technology is making great strides in the advancement of diabetes management and control by allowing patients to wirelessly track blood glucose levels. It connects to the patient’s existing glucometer and, using M2M (machine-to-machine) technology, collects, records and transmits a patient’s blood glucose data to the iglucose database.

From there, it can be shared automatically via text message, email or fax with family members and health care professionals in real-time. In doing so, iglucose helps eliminate the burden of keeping journals and empowering individuals with diabetes to be more engaged in the self-management of their condition.

Cure for Diabetic Neuropathy

Neuropathy is typically measured by taking skin biopsies from the foot and running a series of specialized tests that can take up to a week to complete. In many cases, this debilitating condition is not identified until serious, and irreparable, damage has already been done.

But in a profound and important breakthrough, Nathan Efron, an Australian optometrist, has discovered that the nerves affected by neuropathy are an exact match to nerves found in front of the eye, and is testing whether looking at their level of degeneration in these nerves over a period of time would match the nerve degeneration found in arms and legs.

Quick and non-invasive eye tests would deliver results in a matter of minutes. In short, the importance of Efron’s discovery lies in the fact that since the eye is a transparent structure, it is the only place in the body where you can look directly at nerves and their degeneration over time.

There are multiple benefits of being able to measure the onset of neuropathy, one being that there are drugs in development that aim to cure diabetic neuropathy. When these drugs are ready to come onto the market the method would be able to detect nerve degeneration early and then hopefully cure it.

For the tests, patients would receive a drop of anesthetic in the eye. A corneal confocal microscope would then capture a 20 second “movie” of their eye for analysis. Two more eye tests will look at the effect of nerve degeneration on the retina.

Efron hopes his discoveries will lead to early testing for diabetic neuropathy that will motivate sufferers to better manage their disease. Testing could be carried out at the same time as diabetes patients are tested for other eye problems caused by the disease. The test has been used to monitor nerve regeneration in patients who have undergone kidney and pancreas transplants, and it could help track the effects of new treatments.

It’s interesting to ponder how technology – much of which already exist for other uses – can help us maybe not cure diseases like diabetes, but at least treat them in a way that takes the burden off the patient. There’s more to come…What ideas do you have?

With inputs from Huffington Post

3G Wireless Technology Delivers Diabetes Health Care In Innovative Project

An innovative use of wireless technology will help underserved communities improve diabetes care and prevention in Tijuana. Using 3G mobile technologies, the Dulce Wireless Tijuana project helps patients in remote areas both monitor and treat their diabetic condition.

In less than four decades, diabetes has become the U.S.-Mexico border’s most prominent public health problem, affecting over 1.2 million inhabitants. A bi-national and multi-sector alliance thus chose to focus on diabetes care with 3G wireless applications and services. The resultant effort is a pilot project.  Participants will determine if this approach might work as a regional model.

The Dulce Wireless Tijuana system, announced by Qualcomm Incorporated earlier this month, combines mobile applications, web applications, mobile phones, netbooks, laptops, diabetes educational content and health care worker and patient training. Service delivery is available to diabetes patients and their caregivers wirelessly through Qualcomm’s 3G technology network.

Dulce Wireless Tijuana patients now will have access to the system and technology, including primary care diabetes services and disease management programs. The project stands as an example of how wireless technology can improve patient care for marginalized communities — not just in Mexico, but throughout the world.

Delivery of health care through wireless technology assists providers and patients in a variety of ways. It allows promotores (health care workers) the real-time ability to locate and receive confidential access to patient information, to manage patient appointments and to review training curriculum. Patients benefit because they can review diabetes information —such as instructional videos— online, participate in interactive surveys that help their providers learn how they are managing their diabetes and receive notifications from an alert system.

“This project is a significant step forward in increasing patient access to proper diabetes care in Tijuana,” said Dr. Paul E. Jacobs, chairman and chief executive officer of Qualcomm.

“The use of mobile technology has the potential to improve health outcomes, bring down costs and provide more people with access to care.”

An equally significant aspect of the project is the cooperation it engendered among a variety of public, private and nonprofit organizations across two nations. The diverse groups collaborated to empower diabetic patients to take control of their health.

The project operates from IMSS Clinic #27, the largest IMSS (Social Security) clinic in Mexico. But the project’s impact could extend far beyond the bounds of the Mexican border. Should it prove successful, this approach to the public health problem of diabetes could “scientifically prove the positive impact of this innovative solution on the public health problem of diabetes in order to provide this alternative as an effective model of care for all of Mexico and the world,” according to Pablo Contreras Rodriguez, IMSS regional delegate for Baja California.

Bringing health care to marginalized areas entails specific challenges, according to Marcela Merino, director general of Fronteras Unidas PRO SALUD, a nonprofit organization serving Tijuana communities.

“One of the greatest issues that these communities face is that —because of distance, public transportation challenges and lack of time— it is extremely difficult to visit doctors and nurses. With this project, patients are now connected to their health care providers, including promotoras, wirelessly via their mobile devices, which will enable them to obtain care they could not receive in the past and help them to live healthier lives.”

The Scripps Whittier Diabetes Institute of San Diego provided background and expertise in training and developing peer educators to deliver a clear and understandable message for diabetes patients. They train peer educators south of the border helping Mexicans implement programs similar to Project Dulce activities in San Diego.

“Diabetes is exceedingly prevalent along the border region so it makes perfect sense for us, if we are going to treat the disease, to treat it in similar ways across both sides of the border,” explained Dr. Athena Philis-Tsimikas, vice president of the SWDI.

The organizations collaborating with Wireless Reach to provide technical assistance, program management, evaluation, in kind and monetary support are:

• the International Community Foundation (ICF) and its sister organization, the Fundación Internacional de la Comunidad

• Iusacell

• the Social Security Institute of Mexico (IMSS)

• the Medical School at the Autonomous University of Baja California (UABC)

• the Scripps Whittier Institute (SWDI)

• Fronteras Unidas PRO SALUD

Thank you Billie Greenwood

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