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Wireless technology in healthcare
The technology boom of the last few decades has left no sector untouched. As use of technology has gained wider acceptance, it is being used both by the doctors and the patients in the healthcare industry. Wireless technology has a number of advantages over wired alternatives. Recently, some forms of wireless technology such as WLAN, Bluetooth, RFID, WBAN, 3G and 4G, have made possible several advances in wireless technology. Miniaturization of medical devices to scales previously unimaginable has also made it possible for integration of wireless technology in day to day practice. Mobile medicine is another innovative use of wireless technology. An important reason for this is easy availability of high speed internet.
Uses of wireless technology in healthcare system
This is one of the more popular and more used forms of wireless technology in India. Capsule endoscope resembles a small pill, approximately 20mm in length and 10mm in width. The patient is instructed to swallow the capsule endoscope, which then transmits real time images for a period of up to ten hours. The advantage of a capsule endoscope against other forms of scopes like colonoscope or oesophagogastroduodenoscope lies in the fact that it can easily access the small intestine. It is also a non-invasive procedure, which causes almost no discomfort to the patient.
The capsule contains extremely low power utilizing circuits and physiological sensors which transmit images to sensors on the patient’s body, which are then transmitted to an external processing unit. This is known as the WBAN or the Wireless Body Area Network technology. Multiple images and videos are obtained over a span of hours, which help in making the diagnosis easier. Sometimes, a capsule endoscope is the only means of definitively and non-invasively diagnosing small-bowel ailments.
Factors which limit the use of a capsule endoscope are its cost and its diagnosis-only capabilities. Even though there has been a significant reduction in the cost of capsule endoscopy since its introduction, (a capsule endoscope cost approximately Rs 1 Lakh 3years ago, but today it costs approximately Rs 35,000) it is still out of reach for majority of the Indian population. Though an accurate diagnosis can be made, no corrective action can be taken by the capsule endoscope, as opposed to a conventional scope, which can be used for therapeutic purposes as well.
Remote patient monitoring system
In the last couple of years, there has been a lot of advancement in the remote patient monitoring systems both in the inpatient as well as outpatient settings.
Approximately 3.5 lakh unnatural deaths were reported in India in the year 2009 (Garg, 2012). Many of these deaths occur due to the lack of prompt medical services. Remote patient monitoring is a practical tool which can bridge this gap. A3 remote monitoring technology, an initiative of IIT- Bombay, a one of kind technology today in India, is an excellent example of successful application of remote monitoring of patients. This technology makes use of a portable instrument which has a 12 lead ECG and also monitors other vital parameters like blood pressure, heart rate, respiratory rate and oxygen saturation levels. The results are then sent via any of the cellular networks to the doctors. Emergency treatment can be started in the ambulance, even before the patient has reached the hospital. Patient’s data is also stored confidentially on a cloud server for future use.
Administering prompt emergency medical service is just one of the applications of remote patient monitoring. It can be used in ambulances during transit, in health camp settings, in patients’ homes, at public places like malls and to bridge the gap between primary health centres and referral hospitals.
Another UK based start-up, Isansys Lifecare systems, has also been operating in India for the last few years. The company provides web-based vital signs monitoring platform and a cardiac monitoring device that can be stuck on to the chest. The device continuously monitors the ECG rhythm of the patient’s heart and the data is transmitted to the doctor. This has been found ideal to monitor non-critical patients who need continuous monitoring. It has also been used in smaller hospitals that cannot afford expensive equipment.
Another area where wireless monitoring is becoming popular is the operating rooms. Most of the equipment required to monitor the patient’s vitals during and after anaesthesia can be replaced by wireless devices. These devices provide a surgeon better access to the patient and are also cost effective.
Use of wireless sensors for patient rehabilitation
WSN: Wireless Sensor Network has played a key role in facilitating patient rehabilitation. Many a times, even after the patient is cured of his illness, he remains bed-bound, only for the sake of monitoring as most of the monitors are wired. With WSN technology becoming more popular, the mobility of the patient improves tremendously. This translates into earlier recovery and less number of inpatient days.
Another important area for the use of WSN is facilitating recovery after surgery, traumatic injury, and stroke and neurodegenerative disorders like Parkinson’s disease. In case of stroke and traumatic injury, there are wireless devices that measure muscle activity and also provide stimulation to the muscles. For neurodegenerative disorders, the electrical activity of the brain is monitored. Several software programmes are available which can be used to store and analyze the images.
With the easy availability of high speed internet, mobile medicine has become accessible to a lot of doctors and patients.
Diagnosis of difficult cases, advice on treatment, interpretation of laboratory reports and radiographic images has become very easy. Mobile medicine has also been used for remote consultation and obtaining second opinion. Guidance during a surgical procedure is yet another application of mobile medicine.
Another new dimension of mobile medicine has been the ability of the patient to instantly communicate with the doctor via instant messaging services. Several start-ups in India offer a platform for the patients to directly interact with the doctors. With virtually all the people owning smart phones, these platforms are widely accessed. Patients can easily post their queries and get a diagnosis over the phone! These platforms are immensely popular with the patients as they offer instant solutions to their problems and the patient is saved the hassle of waiting in the crowded waiting rooms. He also gets the consultation free of cost!
Mobile medicine has been integrated into many of the Hospital Information Systems. The clinicians received automated SMS on their mobile phones if certain critical parameters of the patient are deranged. They also receive the patients’ laboratory reports, which help them to decide prompt treatment plan.
Other commonly used technologies
RFID has been used for tracking and monitoring the patients. Patient details can also be uploaded on to the chip for easy access. Though it is not yet widely used in India, there are numerous benefits of using RFID. RFID operates on radio frequency. The earlier versions had an obvious drawback that they could be used only in a limited area and the patient had to be close to the detectors to be tracked. This drawback has been overcome and now tracking and monitoring of patients over long distances is possible.
One benefit of RFID technology is during mass casualties. The patients can be tagged during such scenarios for easy tracking. Triaging can also be done, which helps in deciding immediate treatment.
Another unique use of RFID technology is in tagging the medical equipment like wheel chairs and trolleys which can be easily tracked. This limits the loss of hospital equipment.
The RFID technology is widely used today in hospitals across India for restricting access to certain areas.
Advantages of wireless technology
Wireless technology has several advantages over wired technology. It is safer, cost effective, reduces the risk of infection in many cases and is patient friendly.
Only certain technologies like the capsule endoscopy are out of reach of the common man today. The use of wireless technology, in most cases, translates into significant monetary savings for the hospitals. Quality of patient also improves with the use of wireless technology, as monitoring becomes easy and the discomfort caused to the patient is reduced. There is better communication between the patients and the clinicians and also the other staff members like nurses. The risk of infection which is always present with invasive procedures is significantly reduced by using wireless technology. Since most of these devices are light-weight, portable and easy to use, they afford maximum comfort to the patient as compared to bulky, wired devices. They reduce the burden on health care providers and also reduce informational errors which can lead to patient mismanagement.
Challenges in using wireless technology
It goes without saying that wireless technology needs sound infrastructure. Strong network communication, continuous power supply and data integrity are just some of the factors that need to be addressed before a hospital successfully implements wireless technology. It is of immense importance that wireless technology be totally reliable, especially in critical care units and operating rooms. Consequences of technical glitches in these scenarios, for example an exhausted battery, can be disastrous. Since most of these devices are battery operated, care should be taken to see that the devices are always charged. When a change of battery or recharging a battery is required, alternatives should be in place so that continuous monitoring can be carried out.
One of the most important things to be taken care of while uploading patients’ data is security. Patient data has to be totally confidential and access needs to be restricted, yet authorized personnel should easily be able to access the data.
In India, wireless technology is being used only in larger cities as the infrastructure that is required is found only in these cities, that too in larger hospitals. Many rural locations in India are deprived of a sound mobile network and WiFi networks are only available widely in larger cities. Many areas struggle with power-cuts and irregular power supply. We still have a long way to go before the benefits of this technology are appreciated widely everywhere. Existing technology itself is not fully utilized till date. Devices which are used for rehabilitation of neurodegenerative disorders need to be designed with special care, so that the patient co-operates in using them.
Some knowledge of technology is essential in operating these devices. Clinicians who are comfortable with using wired devices and patients with lower education levels might not be convinced to use these devices.
Air Ambulance Apps
Hi Flying - Air Ambulance International the First Air Ambulance service in India which was fully operational in 1990 - embarked on International patient transfers in 1996 plans an app for easy access to its services in times of emergency patient transportation for state to state transfers for tertiary care centers and International transfers across different countries by both Commercial and Charter flights.
The App is the first of its kind and has received very positive response from doctors across the country.
Summary and conclusion
Wireless technology has become an important part of the healthcare system today. In some form or the other, majority of the hospitals are using wireless technology. Remote monitoring of patients, continuous monitoring during surgeries and during mass disasters, triaging and patient rehabilitation are just some of the many uses of wireless technology. Capsule endoscopy is a widely used diagnostic modality which uses wireless technology. Instant access to physicians via mobiles is possible today because of wireless technology.
In most of the cases, wireless technology has many advantages over wired technology. It is patient friendly and reduces costs to the hospitals. However, wireless technology is still in its infancy in India. There is still a long way to go before the required infrastructure becomes commonplace.
Air Ambulance India