Originally Published September 2000
Q & A: William G. Scanlon
Telemedicine Research Promises Patients Roaming Privileges
Advances in healthcare-related telemetry have the potential to enhance patient recovery and quality of life while achieving an overall reduction in healthcare costs. Studies have shown that patients consistently recuperate better from surgery and other medical procedures in their homes than in a hospital room. However, medical personnel must be able to monitor vital signs, sometimes second by second, regardless of where the patient is located. Cellular technology is poised to make precise and reliable remote monitoring of vital signs a reality. William G. Scanlon, research director at the University of Ulster's Centre for Communications Engineering, which is supported by the telecommunications company Orange PCS, has been actively involved in adapting GSM 1800-MHz cellular technology to biomedical applications. He discusses the problems surrounding the use of mobile phone technology for telemedicine and how its implementation may affect the delivery of healthcare.
Q: Can you summarize the remaining technical obstacles to capturing medical data from body-worn biomedical measurement devices?
A: Our primary focus is on the reliability of the radio-frequency (RF) link from phone to cellular base. This device will not be operated in the same way as ordinary phones. We expect the device to be worn at the hip, and it will need to provide adequate reliability under difficultcoupling and radio wave–conditions. For example, even the sensor leads will introduce a source of scattering in the near field of the device antenna. We are also investigating the effect of the user's body on the system.
Another area of concern is penetration of the cellular signal into buildings. Phone users are accustomed to losing the network signal under some circumstances, but this is unacceptable in a telemedicine scenario. Another main obstacle is the placement and maintenance of sensors such as ECG electrodes. But that is not directly a part of our interest. Coleraine General Hospital, which we are working with, has assigned a specialist nurse who will work with us to address this problem during the first clinical trials.
Q: You are working within the 1800-MHz frequency range. Higher bands are likely to emerge in the future. Is bandwidth a critical component of telemedicine?
A: Not really. Medical telemetry just involves another type of data, although the frequency and technology used will affect the RF performance, which we are currently investigating, as I mentioned earlier. Future third-generation systems will allow greater bandwidth and perhaps support a range of advanced biosignals, depending on the clinical application.
Q: How do you envision telemetry altering the practice of healthcare in the years ahead?
A: The vision that we have is of a system that is deployed when the patient leaves the hospital. The patient will be shown how to operate the device and then sent home. From this point, a trained nurse will be able to dial up a particular monitor, regardless of the patient's location, and download both current and historical records of physiological parameters. This approach does aim to reduce costs, but patient care is also improved. Another benefit is that physicians will have access to detailed records of a patient's physiological parameters during the critical first days after he or she has left the hospital. This would be beneficial in the assessment of the lingering effects of anaesthesia, for example, which are currently unknown.
Q: Beyond the technical issues, are there any other factors impeding the emergence of telemedicine?
A: Personal telemedicine applications will start to emerge, but it will require both patient and clinician acceptance before suitable market conditions are created for mass deployment. One of the key issues involves the readiness of the healthcare sector's infrastructure--the biosignal data has to go somewhere and be.
Q: Looking further ahead, what do you see as the next great leap forward in telemedicine?
A: The appropriate use of full-, or two-way, communication in advanced systems that will permit diagnosis, monitoring, and treatment. This will depend on parallel advances in such technologies as remote drug delivery and neurological or muscular stimulation.
William G. Scanlon can be reached at the University of Ulster's Centre for Communications Engineering in Jordanstown, Co. Antrim, UK; phone: +44 2890 368054; fax: +44 2890 366863; e-mail: w.scanlon@ulst.ac.uk.
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