Telemedicine:


ROUNDUP AS OF JANUARY 2012
The FDA has cleared
MIM Software’s
mobile app for diagnostic X-ray and
ultrasound viewing. Radiation
oncologists can use medical imaging
software firm’s Mobile MIM iPhone app  
to review dose volume histograms,
isodose curves, contours, and images
for treatment plans – actions
commonly restricted to a limited
number of dedicated workstations.

The company also announced it is
working with Accuray to soon launch a
new app, called PlanTouch, that will
allow a review of a CyberKnife
interventional radiation oncology
treatment plan right on an iOS device.

MIM Software Inc. is located in
Cleveland, Ohio.



Pfizer has funded an Android app
produced by the US National Kidney
Foundation. The Manage CVD Risk in
Reduced GFR app aims to help
medical professionals reduce risk
factors for cardiovascular disease
(CVD). Its functions include an
interactive algorithm to quickly identify
high-risk patients and apply evidence-
based strategies to assess and treat
them.



The UK’s   National Institute for Health
Research (
NIHR) has launched an
iPhone app that allows pharma,
clinicians and patients to access
information about clinical trials. The
clinical trials gateway app – an Android
version of which is coming soon -
includes a portfolio of clinical trials
running in the UK that can be filtered in
a number of ways, including by health
condition, location and study sponsor.
It also allows direct contact with the
trial team for those that want to find out
more about a specific study.



Sanofi’s iBGStar has become the first
FDA-cleared blood glucose monitoring
system that directly connects to Apple’
s iPhone and iPod touch.

Developed in partnership with
AgaMatrix, iBGStar works with the
iBGStar Diabetes Manager App
(iBGStar DMA), allowing people with
diabetes to monitor their blood
glucose, analyse and track their data,
and share their readings with
healthcare professionals or caregivers.
The device can also be used
separately from an iPhone or iPod
Touch and is already available in
Germany, France, Switzerland, the
Netherlands and Italy.

The iBGStar uses the iPhone as a
beautiful visualization tool to keep
track of glucose readings, food and
insulin intake, and exercise.
The device has gone on sale in some
EU countries earlier in 2011  and
American launch is expected shortly.

A similar device comes from a small US
company
Telcare.

The device can be used independently
of the iPhone to take readings and
data will be transferred to the iPhone
once the two are connected again.

This system charts the results to
highlight trends and spot problems,
and can be accessed via a Web
browser or an iPhone app. It
automatically transmits relevant
feedback—such as whether your
readings seem high or low—and allows
doctors to respond.

Yet another company is
Entra Health
Systems
which has a meter called
MyGlucoHealth that transmits readings
via Bluetooth to a cellphone for
transmission to an online portal.


A new NHS (UK)  Android app to help
children and young people self-
manage their asthma has been
launched. My Asthma Log was
developed by North East London,
North Central London and Essex
Health Innovation and Education
Cluster
(NECLES HIEC) in partnership
of Asthma UK, Queen Mary University
London and Solar Software.

It allows patients to construct an
individual asthma plan, log
appointments and asthma attacks, and
links to Asthma UK’s Facebook and
Twitter accounts.





TELEMEDICINE WORKING EXAMPLES
IN DENMARK
Odense University Hospital is working
to build a videoconferencing network
on Denmark's existing healthcare IT
infrastructure, which includes fully
integrated EHR ( electronic health
records), ePrescribing (a prescriber's
ability to electronically send an
accurate, error-free and
understandable prescription directly to
a pharmacy), RIS and PACS, all on
secure Internet protocols.

RIS (Radiology Information System)  is
a computer system used by a
radiology department to store,
manage, retrieve, and distribute
clinical and administrative information.

PACS:In medical imaging, "electronic
picture archiving and communication
systems (PACS) have been developed
in an attempt to provide economical
storage, rapid retrieval of images,
access to images acquired with
multiple modalities, and simultaneous
access at multiple sites"
A PACS consists of four major
components: the imaging modalities
such as CT and MRI, a secured
network for the transmission of patient
information, workstations for
interpreting and reviewing images, and
archives for the storage and retrieval
of images and reports.


In addition to videoconferencing, there
are currently three clinical  focuses in  
developing telemedicine resources:

1. Home monitoring of COPD patients.
COPD sufferers are frequent guests at
hospitals, but they don't have to be.
Specialized nurses conduct
consultations while working with a
homecare staff, who can upload
patient vital signs directly to the
hospital. Odense University has
already seen positive results, including
earlier discharge, patient satisfaction
and empowerment, and fewer total
COPD admissions.


2. Photographic monitoring of diabetic
foot ulcers. 

Visiting nurses photograph foot ulcers
of diabetes sufferers within the
patients' homes, while a hospital-
based expert reviews the images and
provides guidance to the nurse. A
general practitioner is informed of the
patient's condition throughout the case
management.

3. ECG arrhythmia detection for heart
patients.

Nurses are doing rounds at homes of
heart condition patients while using
"ePatches" for remote monitoring.
Currently in a pilot phase, the project
aims for large reductions in costs and
time.  



STUDENT PROJECT USE
SMARTPHONE CAMERA TO
DIAGNOSE MALARIA
Imagine Cup 2011, a student contest
sponsored by Microsoft, asked student
entrants to "imagine a world where
technology helps solve the toughest
problems."

Few problems come tougher than
Malaria, which kills 1 million children a
year, mostly in developing countries
with little infrastructure and few
resources.

Tristan Gibeau and Wilson To 's
LifeLens app hopes to help reduce this
number by speeding diagnosis of the
disease by reducing the need for an
expensive and often unavailable
laboratory to spot the parasite in blood.

Gibeau said the software application,
which runs on a Windows Phone 7
handset with a special lens attached to
the phone camera, can take a picture
of a blood sample, process the data to
detect malaria parasites, quantify how
much malaria is in the sample and
point the parasites out to the phone
user. "It actually draws a red box
around the clusters of malaria, and it
actually notifies you how many it
found," Gibeau said.

Using just a drop of blood smeared
onto a slide, a photo is taken of the
sample and a phone with Lifelens
technology can visualize the blood on
a cellular level to detect the presence
of malarial parasites. It can also test an
individual's blood count to eventually
test for anemia.

Gibeau is planning to expand the
technology to allow the diagnosis of
sickle cell disease and other diseases,
and the student also hopes to
eventually make a living out of
developing the concept further.



HEART MONITORING VIA MOBILE
PHONE
Imec and Holst Centre, together with
TASS software professionals have
developed a mobile heart monitoring
system that allows users to view their
electrocardiogram on an Android
mobile phone.

The heart monitoring system,
developed by Belgian research
institutions Imec and Holst Centre with
TASS software professionals, was
recently demonstrated for Android
mobile phones at the Wireless Health
Conference in San Diego, California,
from 5-7 October.

While now in prototype form, the
technology looks like a necklace of
wires attached to a patch that would be
worn on the user’s chest. The patch
contains a sensor and two low-power
microchips for amplifying the
electrocardiogram signals from the
user’s beating heart and filtering them.
A microprocessor from Texas
Instruments processes the data and a
low-power radio wirelessly transmits
the information to a user’s mobile
phone. From there the data can be
transferred anywhere, including a
doctor’s office.

Julien Penders, programme manager
of Body Area Network at Imec/Holst
Centre, said that unlike current home
health monitoring products that
provide information on just the
average heart rate, the Imec/Holst
Centre device provides beat-to-beat
analysis.

Another feature distinguishing it from
other devices on the market, he
added, is its lower power consumption
providing seven days of constant use
between charges.

Penders said this sort of autonomy is
impossible with most mobile health
monitoring devices because of their
reliance on Bluetooth.

‘Bluetooth consumes a lot of energy
and that means the lifetime of your
sensors will drop from seven days to
one day,’ he added. ‘We want to be
low power and we don’t want to ask
people to charge their systems
everyday. We also don’t want to have
a system that weighs 100g because
you have 80g of battery.’

The team is currently awaiting results
from pilot studies monitoring patients
with epilepsy and cardiac arrhythmia.
Penders said the technology is even
being evaluated for its ability to
improve the training performance of
athletes.


CALIFORNIA TELEHEALTH NETWORK
TO  BULD UP TELEMEDICINE
Telemedicine's future took another
leap forward  with the launch of the
California Telehealth Network, the
most ambitious foray yet into the
rapidly developing field that links
doctors and patients via high-tech
tools.

Initially, just 50 clinics, hospitals and
other health care providers in
California will tap into a broadband
network that could eventually link
nearly 900 facilities statewide by the
end of 2011.

That future couldn't come soon
enough for the family of Rennee
Wilson, a young Shasta County girl
whose skull was fractured earlier this
month during a traffic accident near
Redding.

The 3-year-old was in need of
immediate care, and the trip from
Redding to the UC Davis Medical
Center in Sacramento would have
consumed precious hours and possibly
exposed the patient to additional
medical trauma.

Instead, using video cameras that
streamed real-time images from
Redding to Sacramento, doctors
collaborated on saving the girl's life.
From 160 miles away in Sacramento,
Dr. James Marcin, a UC Davis
associate professor of pediatrics
critical care, assisted the intensive
care physicians in Redding.

Using the latest telemedicine
technology, he consulted with his
remote partners on digital images that
revealed a fractured skull. He
recommended the drugs to administer
and even when the Redding doctors
should remove the ventilator after she
could breathe on her own.

Today, broadband technology is
allowing sophisticated instruments to
tap into the Internet's high-speed
digital currents. For example,
stethoscopes can be connected to
equipment that allows a doctor to
remotely listen to a heartbeat. Other
equipment allows doctors to examine a
wound or see into a patient's mouth,
ears and other parts of the body.



CELL PHONE USED TO DETECT
BIOHAZARDS
A tiny silicon chip that works a bit like a
nose may  detect dangerous airborne
chemicals and alert emergency
responders through the cell phone
network.

If embedded in many cell phones, its
developers say, the new type of
sensor could map the location and
extent of hazards like gas leaks or the
deliberate release of a toxin.
This technology could map a chemical
accident as it unfolds."

In collaboration with Rhevision, Inc., a
small startup company located in San
Diego, Sailor's research group at
UCSD has successfully finished the
first phase of development of the
sensor and have begun to work on a
prototype that will link to a cell phone.

The sensor, a porous flake of silicon,
changes color when it interacts with
specific chemicals. By manipulating the
shape of the pores, the researchers
can tune individual spots on the silicon
flake to respond to specific chemical
traits.

"It works a little like our nose," Sailor
said. "We have a set of sensory cells
that detect specific chemical
properties. It's the pattern of activation
across the array of sensors that the
brain recognizes as a particular smell.
In the same way, the pattern of color
changes across the surface of the chip
will reveal the identity of the chemical."


MOBILE PHONE TECHNOLOGY TO
CHECK IF THE DRUG IS GENUINE OR
COUNTERFEIT
Sproxil, Inc.’s Mobile Product
Authentication (MPA) enables
consumers to text-message an item-
unique code for a rapid response that
confirms a brand’s genuineness.
In Nigeria, for example, consumers
purchase medications with a scratch
card attached to the package. They
then scratch off the covering on the
card and text the unique numbers
underneath to a shortcode to instantly
receive a reply confirming the
genuineness or fakeness of the
product. A shortcode serves as a
“phone” number for receiving text
messages, or Short Message Service
(SMS), as they’re called. A shortcode
has five digits in Nigeria, compared to
13 for a phone number (and 10 for a U.
S. phone number). To date, the
company has coded more than
800,000 packages of Glucophage, a
product used to treat diabetes.

Both branded and generic products
are subject to counterfeiting, and no
country or therapeutic class is immune.
As a result, the existence and
distribution of counterfeit drugs poses
a public health problem that has
reached crisis proportions in many
developing areas of the world.

A recent WHO report estimates the
global value of trade in counterfeit
pharmaceuticals is about US$200
billion. Unfortunately, though, there is
a large knowledge gap in the
developed world about the emerging
markets where pharmaceutical
companies sell their products.

For example, 84 infants died last year
in Nigeria from a single batch of
teething syrup tainted with chemicals
found in anti-freeze. People can
purchase medications from a cart or
even a hand-held tray in developing
countries.




BLOOD GLUCOSE MONITOR
CONNECTED TO iPHONE
AgaMatrix, a maker of popular blood
glucose monitors, is planning on
releasing a connectivity package to
interface their Jazz Meter with Apple's
iPhone. Once the FDA approves the
firm's WaveSense Direct Connect
Cable, this may become the first fully
licensed medical device specifically
designed to work with an iPhone.
Diabetic iPhone fanatics can sign up at
the WaveSense product page for an
email update when the product comes
to market.



LENSELESS MICROSCOPE
INVENTED BY UCLA ENGINEER
Cell phones are accumulating a Swiss
Army Knife-esqe assortment of
capabilities; substituting as cameras,
providing internet access, and soon
operating as medical labs if Aydogan
Ozcan’s plans come to fruition.
This month’s cover article of the
journal Lab on a Chip features the
latest creation by the Ozcan group, a
functioning prototype of a cell phone
microscope. The lensless imaging
platform behind the cell phone
microscope is nearing readiness for
real world trials, after receiving
prestigious awards in the past month
from the Bill & Melinda Gates
Foundation, National Geographic, and
the National Science Foundation.

“Cell phones present a tremendous
opportunity in Global healthcare,”
remarked Ozcan, an assistant
professor of electrical engineering at
the UCLA. “We can leverage the fact
that eighty percent of the world’s
population lives in areas covered by
cell phone networks to bridge the gaps
left by a lack of health care
infrastructure in developing countries.”

That lack of health care infrastructure
includes not only buildings, but also
trained personnel. For telemedicine
tools to effectively fill in for hospitals,
the devices have to meet several
criteria. They must be cheap enough
for widespread use in poor areas, be
simple enough for a minimally trained
person to correctly operate, and be
able to easily transmit information over
existing cellular networks. Optical
microscopes, a key diagnostic tool in
hospitals, are too bulky for
telemedicine applications.
Images are captured through a
process called diffraction, or shadow-
based, imaging. An ordinary light-
emitting diode (LED) from the top
illuminates the sample, and the
detector array already installed in cell
phone cameras captures the image,
recording the patterns created by the
shadows resulting from the LED light
scattering off of the cells in the sample.
Because cells are semi-transparent,
enough information is obtained from
this type of imaging to detect sub-
cellular elements, and to produce
holographic images. By using an
inexpensive LED light instead of a
laser as typically required for
holographic imaging, the size and cost
are further reduced.

The cell phone microscope is also
easy to use, and versatile. Samples
(blood smears or saliva) are loaded
into single-use chips that easily slide
into the side of the microscope.
Because the microscope uses the
entire detector array to capture an
image and has a relatively large
aperture, it has a wide imaging field-of-
view. Samples do not need to be
precisely aligned for images to be
captured, and the chance of debris
clogging the light source is lessened.
Alternate uses of the technology
include testing water quality in the field
following a disaster like a hurricane or
earthquake.



MOBILE HEALTH CARE: EYE TESTING
MIT's  Media Lab will soon start clinical
trials on a mobile health care
innovation that can transform a cell
phone into a sophisticated eye-testing
device, using an inexpensive snap-on
plastic accessory. Preliminary testing
of Netra suggests it compares well to
the standard aberrometer test, making
it especially suitable for remote,
developing-world locations that lack
these expensive systems.

Uncorrected refractive errors are the
world's second-highest cause of
blindness, affecting 2 percent of the
world's population, according to the
World Health Organization. Manuel
Oliveira, one of the developers,
believes the mobile vision-testing
device 'has the potential to make
routine refractive eye exams simpler
and cheaper, and, therefore, more
accessible to millions of people in
developing countries.'

All the system requires is the cellphone
software and the plastic device, which
could cost only pennies per unit if
produced in large quantities. The
patient looks into a small lens, and
presses the phone's arrow keys until
various sets of parallel green and red
lines just overlap. The test takes under
two minutes, and at the conclusion, the
software provides the prescription data.

The group intends to launch
production as the company
PerfectSight, initially targeting
locations in Africa and Asia.  There
may also be a more advanced version
of the device which could be marketed
in the developed world.


HANDHELD ELECTROCARDIOGRAM
MACHINE
The ecg@home, a handheld
electrocardiogram machine, small
enough to fit in the palm of a
hand, can record a 10-second ECG
(electrocardiogram) rhythm strip
without electrode cables, made by
Healthfrontier and Italian partner;



OTHER  DEVELOPMENTS

LATITUDE cardiac patient home
monitoring device by Boston Scientific;

UnitedHealth Group Inc., a US health
insurer, and Cisco Systems Inc., a
maker of computer networking gear,
will build a network of virtual clinics;

ARTIS project by European Space
Agency for remote control ultrasound
scan;

Portable telemedicine workstation by
MEDESSAT Company;

Intel Health Guide, a two-way, video-
enabled device with a computer
installed in homes allows physicians to
videoconference with patients and
check vital signs online by Intel and
General Electric;

Boston Scientific’s Latitude remote-
monitoring program for heart-failure
devices and defibrillators;

Medtronic's system monitors fluid
levels automatically, Boston Scientific's
system can monitor patients' weight
and blood pressure, St. Jude plans to
use its system for its pacemakers;

INTOUCH HEALTH
InTouch Health provides a network of
stroke experts remotely to a chain of
about  300 hospital locations.