No respectable medical clinic survives without modern computer equipment any more. But when patients left hospital they generally have had to do without high-tech care.
That is changing. In Germany, a variety of projects aimed at bringing more advanced care to the home are now underway. The goal is to improve the links between stationary and mobile medicine. The key to all the projects is the Internet.
The world-wide data network is to serve as the medium for checking on a patient’s condition. This new model could make trips to the hospital shorter or even unnecessary, according to experts.
The AOK Rheinland-Pfalz, a regional healthcare provider in Germany, is focusing its efforts on diabetic children and youths.
The programme, known as Teddi, has been organised in conjunction with the Diabetes Centre of Munich-Bogenhausen and uses an electronic blood sugar measuring device to glean the patient’s vital statistics. That data is then transferred to the attending doctor over a computer’s phone connection.
Doing so helps doctors establish proper insulin dosages, bread units, and injection points, explains Marlies Neese from AOK Rheinland-Pfalz.
The system allows for more than just reaction to acute problems. Other diabetes-related illnesses can be screened and prevented expeditiously. The first phase of the project ran until the end of the past year with more than 200 type 1 diabetics. A second phase is planned with doctors from the Rhineland Palatinate.
A similar setup is in place for the Heart Attack Teleservice Saar project, run by the Fraunhofer Institute for Biomedical Technology in Sankt Ingbert, Germany. Eighteen heart attack patients were cared for until June 2002 in conjunction with the Technicians Health Insurance Fund.
Every patient was provided with a PC and a touch screen monitor.
Medical devices for testing blood pressure, blood sugar, and blood clotting were bundled with the computer.
The patient’s data were then transferred every two or three days over an ISDN line to the attending physician. Doctor and patient also communicated via video conference.
The hope was to use constant therapeutic monitoring to reduce the chances of further stationary visits to the hospital. Patients were reminded to give constant attention to risk factors, says the project’s director, Stephan Kiefer.
A patient care system modelled on these programs remains a vision for the future. There are currently too many organisational problems, says Kiefer, who feels that these projects are only in the first stages of readiness.
Not every house has an ISDN connection, for example, and it can be difficult to bring doctor and patient together for videoconferencing. That said, the technology itself seems to pose no problem for the patients. ”In a follow-up project, we want to concentrate our efforts on speech- and memory training for heart attack patients,” Kiefer notes.
The neurosurgeons of the University Clinic of the Saarland in Homburg, Germany, currently receive x-ray and computer tomography images over ISDN lines as part of the Project Telecommunication Saarland.
In the past, these images were passed between medical facilities by taxi. Now, if the specialists detect cranial trauma or vertebral damage, they can decide on a course of action immediately.
In the past, questionable cases involved transporting the patients back and forth between clinics, says Martin Strowitzki, Chief Physician of the Neurosurgery Department. This is not only expensive, but can put tremendous strain on less stable patients.
Modern technologies for transmitting patient data are also being explored for emergency workers. In November 2001, 30 ambulances from the Munich Fire Squad were equipped with special EKG devices as part of a pilot project.
The devices send heart data from the emergency patient to the receiving clinic while the vehicle is still driving.
This means that initial therapeutic steps can be planned even before the patient arrives.
These telemedical projects are not likely to see wide release any time soon, indicates Rainer Beckers from the Centre for Telematics in Health Care (Krefeld, Germany).
The projects have not succeeded in creating market-competitive solutions. Much of the blame can be laid on a lack of standardisation of the various systems.
Incompatible data formats and innumerable databases from different manufacturers, each of which must be patched together manually by Information Technology specialists, has led to nothing but headaches. Another key issue involves finding a universally accepted and secure encryption processes for data, Beckers says. – Sapa-DPA