TeleMedIS A Novel MobileHealth System in Sweden

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TeleMedISA Novel Mobile-Health System in Sweden

• Presentation by RD Engineer, Sven Jonsson
• Biomedical Engineering Department, Karolinska
  University Hospital

Project co-financed by
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Agenda

• TeleMedISTM Project
• TeleMedISTM Main Sub-systems
• The Users
• Trials Program
• Potential Benefits
• Conclusion
• Reflection from the past

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TeleMedISTM Project
Wireless, anytime, anywhere, real-time
monitoring of patients vital signs
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Telehealth Monitoring Wristwatch

• The Device
• Wrist-wearable, mobile and personal
• Single unit
• Very easy to carry and simple to use
• Vital Signs
• Multi-parameter monitoring pulse rate, blood
  oxygen saturation level (SpO2), and 1-lead ECG
• Automatic measurements
• On demand measurements (local and remotely)
• Personalized for each user
• Communications
• Cellular communication
• Two-way voice data communications
• Real time messaging
• Emergency alarm pushbutton

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TeleMed Home-Care Platform

• Seamless connection of the hospital to
  patients(in and out of the hospital)
• Integrate and coordinate patients medical data
  from various resources
• Enhanced level of information in real-time for
  patients caregivers
• Common infrastructure for telemedicine
  applications
• Rapid Development of future applications
• Easier management, and greater extensibility

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TeleMedISTM System Layout
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TeleMedISTM Users

• Populations
• In-hospital patients
• Post-hospital patients (at home)
• People at risk groups (living in the community)
• Elderly people
• Diseases
• Congestive Heart Failure (CHF)
• Arythmia
• Respiratory diseases
• COPD follow-up

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Engineering Trials Program
Usability tests Communication tests Reliability
tests Security and safety tests Interoperability
tests
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Engineering Trials Results

• Usability tests
• Handling TMW through application
• Assigning TMW to patients
• Managing updates to TMW work very well towards
  end-users
• Error handling in TMW and detection by TP and
  technical staff was smooth as well.
• Note usability of TeleMedIS System will be
  conducted also during Clinical trials

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Engineering Trials Results

• Communication tests
• Sending data from 250 simulated TMWs
• Processing time took only 28 seconds for FTP
  Server Procesing time only 74 seconds for
  Ensemble.
• Conclusion
• Clinical and technical staff at Karolinska will
  be able to look at patient information of 250
  patients after 2 minutes from the time when TMW
  sends patient information to Karolinska.

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Engineering Trials Results

• Reliability tests
• 1000 Simulated users gt909 simulated patients
  OK (Test case601, Reliability, security and
  saftey test)
• If TMW wont have GPRS connectionSave
  measurements for up to 48 hours memory full.
• Red Number of users logged in, Green
  Incoming traffic (byte/s)
• Blue Outgoing traffic (byte/s), Black Total
  traffic (byte/s)

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Engineering Trials Results

• Security and Saftey tests
• Implemented state-of-the-art security solutions
  from TMW to TeleMedIS Gateway.
• All messages are sent through encrypted channels.
  
• And in addition, no names and personal
  identification numbers are sent through those
  channels.
• Therefore, even if intruder gets down to the
  information sent from TMW, he/she wont pinpoint
  the actual patient.
• Once the message is decrypted at TeleMedIS
  Gateway, it is sent to the TP in plain text. This
  is a normal practice in Karolinska, where the
  network is already secured. This is part of
  Sjunet security service.

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Engineering Trials Results

• Interoperability tests
• TeleMedIS System comprises of
• TMW
• Gateway
• TP
• Clinical and TMW Manager Applications.
• Tests have been performed to identify
  interoperability issues, and any deviations from
  current standards.
• Conclusion
• At its current state, TeleMedIS System is
  interoperable.

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Engineering Trials Results

• Back draw
• TMW Manager and Clinical applications that are
  hosted in TP were developed in early phases of
  the project and therefore lacked
  user-friendliness towards clinical staff.
• Small interoperability issues between Gateway,
  and TP, which was mostly due to software updates
  between partners. gt Once latest releases were
  integrated gt OK
• Some issues between TP and Clinical and TMW
  Manager Applications, due to incompatible Java
  Interface at TP. gt This has been solved by
  implementing new Java Interface at TP.

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Resume Enineering Trials

• The results were positive and necessary towards
  further improvement of TeleMedIS System.
• System can be used at its current stage, without
  further upgrade of hardware and software.
• Conclusion
• Therefore, the system is ready to be rolled out
  for Clinical Trials.

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Clinical Trial Objectives

• INSIDE TRIAL
• Compare the measured values with conventional
  equipment
• Testing of the TeleMedIS system in real life
  situations
• To control the usability of the TMW and the TP

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Clinical Trial Objectives

• OUTSIDE TRIAL
• Testing of the TeleMedIS system in real life
  situations
• To control the usability of the TMW and the TP

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Patient characteristics

• Male or female patient suffering from severe COPD
  
• Subjects must be enough healthy to be able to
  handle the TMW
• Subjects must have a prescribed oxygen treatment
  at home
• Subjects must sign the written informed consent

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Trial procedure Inside Hospital

• Approximately 24 hours
• Compare to conventional equipment
• Perform Pulse rate, ECG and SpO2 measurements
  once an hour
• Information will be sent to the TP at least once
  a day (Automatically, TP request or patient
  selection)

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Trial procedure, Outside Hospital

• One week
• Perform Pulse rate, ECG and SpO2 measurements
  once an hour
• Information will be sent to the TP at least once
  a day (Automatically, TP request or patient
  selection)

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Clinical Trials Program (1)

• Evaluation of Information Quality Success
• Accuracy
• Presentation
• Flexibility
• Evaluation of System Use Success
• Usefulness
• Easy of learning
• Convenience
• User support

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Clinical Trials Program (2)

• Evaluation of User Satisfaction Success
• Patients
• Healthcare professionals (HCP)
• Evaluation of Service Impacts Success
• Service quality for patients, relatives and HCP
• Monitoring accuracy

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Sweden Potential Benefits

• Government/Public
• Economical
• Possible cost reduction in healthcare systems
• Enabling process oriented healthcare services
• Assisting nurses and medical staff
• May be integrated with future systems, like
  Sjunet (the Swedish national health information
  network)
• Patients
• Better healthcare long arm of the hospital
• Increasing patients involvement
• Physicians
• Effective information for efficient medical
  treatment
• More efficient medication management

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Conclusion

• Based on the trial outcomes and the expected
  results of the clinical trials we recognized the
  potential benefits for patients, physicians,
  administrators and other stakeholders using the
  TeleMedIS system as follows
• On-line contact with medical center
• More efficient medical treatment
• Better post hospital treatment and recuperation
• Cost savings to providers and users by reduction
  the numbers of visits at the clinic
• Enhanced, timely information for physicians
  patients
• Eliminate the need to travel to clinic
  forunnecessary visits
• Enhanced lifestyle and peace in mind

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Result of TTeC 2003

• Based on face to face meetings between Tadiran
  and Karolinska at the Tromsö Telemedicine
  Conference 2003, the outcome resulted with a
  international project in the area of
  telemedicine, in the project TeleMedIS
• Banquet atForskningsparken in Breivika gt
• 15-17 Sept 2003
• 380 people 32 nations
• Network building
• Face to face meeting
• TeleMedIS project

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Questions

• Contact
• Sven Jonsson
• sven.jonsson_at_karolinska.se
• Phone[phone]
• www.karolinska.se/mta