Telemedicine vendors bank on broadband as key to home and physician marketsMore robust networks make robotics a tangible realityA variety of technological and regulatory advances are fostering an increasingly favorable environment for
More robust networks make robotics a tangible reality
A variety of technological and regulatory advances are fostering an increasingly favorable environment for telemedicine products and applications, particularly in the physician office and home markets. As high-speed broadband interconnections become more common, many online devices will be able to collect data and send it to remote servers automatically. When combined with the various patient privacy and regulatory efforts in the works, these advances should help patients and healthcare providers alike become more comfortable with the idea of conducting the business of medicine online.
At present, the fastest-growing segment of the telemedicine industry is end-user devices for home care. Although todays federal programs will not pay for home care, telemedicines market share is expected to increase in 2001 when government medical programs begin to use a new payment formula.
In another regulatory step, the Federal Communications Commission has allocated a new spectrum for wireless medical telemetry services, allowing devices to provide interference-protected wireless connections for medical equipment in potentially life-critical situations. This type of service will enable physicians to more easily monitor a patients progress anywhereat work, in the ambulance, or at home.
In addition, the increasing availability of broadband networks to the home will create adequate bandwidth for inexpensive land-line devices that facilitate remote diagnostic medical procedures. Opportunities will abound for real-time devices that offer ad hoc diagnostic modes as well as monitoring functions.
At present, one of the leading suppliers of home-based telemedicine devices is American Medical Supplies, which boasts 1700-plus installations of its telemedical devices in 41 countries. The Miami-based firm supplies everything from videoconferencing systems for physicians consulting with specialists to remote control stethoscopes for patients at home.
Right now we can give patients a dedicated device to remotely read out each of the normal diagnostic measures such as blood pressure, pulse rate, temperature, and so forth, but you have to buy the devices yourself, said Mark VanderWerf, president of AMS. Once Medicare starts paying, the device will just come as a free part of the service of monitoring you at home.
The company sells four types of remote control stethoscopes. For institutions, AMS provides complete vital sign monitors as well as remote control versions of all the normal diagnostic instruments, including otoscopes, dermascopes, and ophthalmoscopes. For home use, AMS has inexpensive models for blood pressure, weight, and various electrocardiogram monitors. They all use internal digitizers and modems to automatically send their readings to your doctor over the telephone.
The higher-priced models use two dedicated U.S. Robotics modems souped up for AMS by 3Comone at home and one at the doctors officeto transmit the real-time signal from its remote control instruments. The less expensive store-and-forward model records a vital sign, digitizes it, and then uploads it to a dedicated IP server port over standard telephone lines. The physician can then view the record of the examination when he or she is ready. The advantage of the dedicated modem route is that the doctor can direct the patients helper to move the stethoscope to specific spots. The advantage of the store-and-forward model, besides price, is that it automatically sends the readouts to the correct doctor on the Web.
Typical of the business-to-business segment is Apollo Telemedicine of Falls Church, VA. A pioneer in building diagnostic networks for hospitals, the company last month launched its eHealthStat turnkey program for individual physicians. Those who join the eHealthStat network can consult physician-to-specialist just as in a big hospital. The result, according to the company, is that a diagnosis and treatment plan take shape only hours after a patient is seen, rather than days or weeks later.
The program uses Apollos remote control microscope, which permits consultants to use the Internet to view biological samples taken from the patient. The company claims that its telepathology systems have been used in more than 3000 diagnostic case studies.
Remote control has also found its way into the surgical market. Through a contract with the U.S. Department of Defense, SRI International has developed the ultimate in remote control surgery. The Telepresence Surgery System has been installed in prototype form as a teaching tool at the Uniformed Services University of the Health Sciences in Bethesda, MD, where SRIs interconnect provides physicians with 3-D vision, dexterous robotic surgical instruments, and force-feedback so that surgeons can feel the amount of drag as the scalpel slices. The surgeon sees a virtual image while the robot on the battlefield mimics the surgeons movements.
Within the next year, Menlo Park, CA-based SRI hopes to demonstrate an updated battlefield version of the system that allows surgeons to stay safely behind the lines while medics set up the surgery tent right on the battlefield. The deployed system will replace a fiber-optic connection used for the demonstration prototype with a wireless connection between the doctors and the robotic surgery tent.
Computer Motion of Goleta, CA, has adapted the remote control surgery concept to what it calls the smart operating room of the future, where surgeons never touch the patients. Instead, the surgeon uses voice commands to instruct a robot to make the actual incisions, guaranteeing a minimally invasive surgical procedure in which each incision is exact to a precision impossible with unassisted human hands. Computer Motion announced early in July the first successful robot-assisted gall bladder removal, at the University Hospital Gasthuisberg in Leuven, Belgium.
Such robotic surgical assistants have proven the concept of remote control surgery for telemedicine. According to AMS, it wont be long before robotic surgeons will be operating over broadband remote control connections even thousands of miles away. The biggest challenge lies in merging these tools into modality-specific devices and making all of the resulting data available on fully integrated, enterprise-wide networks.
Right now, we have to require that each unit be standalone, with its own internal digitizer and modem, VanderWerf said. Plus each (medium)sound, video, and texthas to go to a different port on the Web server. But that is unnecessarily complex. What we really want engineers to design are units that put all three types of media together, interconnect with FireWire, and share a modem talking to a single IP port.