World Telecommunication Day 1999 |
Expanding high-speed telecommunications networks, increased use of information technology systems and the dramatic proliferation of the Internet all hold out the promise of cheaper, faster and more expert health care. And, in the not-too-distant future, it may be that robotic machines will be diagnosing patient ailments and even treating some of them.
The introduction of health-care services that automate labor-intensive processes or substitute a ''virtual'' presence for actual face-to-face consultation and treatment has a number of drivers.
One is cost. There is currently much debate in the health-care arena about how to cut soaring health-care spending while increasing the quantity and quality of treatment. Longer life expectancy adds to the issue in most of the industrialized nations. According to Jean-Patrick Baré, president of the organizing committee of the giant Telecom 99 + Interactive 99 trade show being held in Geneva, Switzerland, health care is currently the largest sector of the global economy. Telecommunications is the third largest, with banking sandwiched in between.
Support vs. care
In the OECD countries, expenditure on health care has been running at around 8 percent of GDP. The largest percentage of health-care activity is directed at support activities rather than direct diagnostics and treatment. A study undertaken some years ago in the County of Fyn in Denmark revealed that around 30 percent of the working effort in the area's hospitals was taken up by registration and administration, while direct patient treatment and care took 16 percent. The remaining 54 percent was spent on planning, management, transport and standby arrangements.
In countries such as Germany, a number of initiatives have been mounted to streamline support functions, improve doctors' access to patient information and reduce duplication of effort. Key elements of such telemedicine systems include the networking of digital archives and images and the creation of electronic patient files, with the Internet often playing a major role. ''Perhaps one of the most revolutionary technologies today is the Internet, which makes it possible to network everyone in health care - patients, physicians, hospitals and insurance companies,'' says Volker Schmidt, a senior researcher at the medical engineering division of Siemens AG. ''Improved communications technology means that patients are spared time-consuming trips and waiting periods, and medical treatments can be performed in the comfort of their own environment.'' Siemens itself has developed MedStage, a telecommunications networking system specifically for health care, and several pilot projects are currently testing the system.
A second catalyst for telemedicine is the use of telecommunications and IT to enlarge access to specialist expertise. This can take various forms. For example, New Bits, a Madrid-based telemedicine specialist, offers a portfolio of solutions, ranging from a product that converts a domestic television set into a system for remote psychiatric and nursing assistance for the elderly and the disabled to a tele-microscopic and consultation system linking hospitals without a local surgical pathology department to remote pathologists.
New Bits is also a distributor of satellite services for Norwegian telco Telenor, which has recently started to offer what it says is the world's first global communication service for mobile multimedia applications. Field doctors are among the target users of the Inmarsat satellite-based Global Area Network.
Access to services
Access to distant medical expertise is particularly important for developing countries such as Georgia, which earlier this year inaugurated a system giving patients with heart disease access to remote electrocardiograms for both diagnostic and emergency services. In this project, funded by excess revenues from ITU exhibitions such as Telecom 99, patients are attached to devices that record their heartbeats whenever needed. The recordings are transmitted over the telephone network to a monitoring center staffed with cardiologists round-the-clock, located at the Guli Cardiac Clinic in Georgian capital, Tbilisi.
''We expect pilot projects to serve as test beds for other developing countries interested in using telecommunications to extend and improve access to health-care services for the their population,'' says Hamadoun Touré, director of the ITU's Telecommunication Development Bureau (BDT). ''It is one of several others which we are implementing in selected developing countries as part of our strategy to use information technology to help health professionals solve some of the most acute health-care problems in developing and emerging economies.''
Says Professor T. Todua, director-general of the country's Institute of Radiology and Interventional Diagnostics: ''It is already the second telemedicine pilot project which has been successfully implemented in Georgia with the assistance of the ITU BDT.'' The first project was launched in September 1998, when the Institute of Radiology in Tbilisi was connected through the Internet to the Diagnostic Imaging Centre in Lausanne, Switzerland for medical second opinion applications.
A third factor fueling interest in telemedicine is that telecommunications and IT technologies can boost success rates in the early detection of abnormal conditions and the application of remedial procedures. Diabetes and glaucoma are the most common causes of blindness in the industrialized nations, and sufferers may be unaware that they are at risk of going blind until it is too late for treatment to be successful.
Early detection
Since May of last year, the ophthalmic clinic at the University of Erlangen-Nürnberg has been collaborating with Siemens on the Telematic Self-Tonometry project.
All participating patients in this project suffer from glaucoma and, using a portable measuring device, test their own intraocular pressure at home several times each day. The participants record the results on a Palm Pilot and transfer them via a modem to MedStage. The data can then be accessed by ophthalmologists at any time via an ISDN link or the Internet. The resulting profile of intraocular eye pressure over a period of several weeks provides important data for the treatment of glaucoma. Previously, the only way to assemble these profiles was to perform repeated tests over several days and nights after admission to a hospital. In the self-tonometry project, data are automatically preprocessed by the MedStage system, so that an alert is immediately generated if the patient's intraocular pressure rises to dangerous levels or if the data doesn't arrive.
In the next century, in addition to remote interaction with medical specialists, patients may be able to access ''intelligent'' machines for some levels of diagnosis and treatment. Studies have shown that people in some cases prefer to respond to medical questions posed by a machine rather than a human.
Far-fetched? Maybe not. After all, using the Internet to buy certain medicines and health products rather than deal with a clerk in a pharmacy is already developing into a major business.
John Williamson