First of all, the MobiHealth trials are intended to prove the technical feasibility of this system. The trials are evaluated in terms of accuracy and validity of measurements, usability of the GPRS and UMTS networks, business and market potentials and also social and ethical effects. The opportunity for medical evaluation is limited due to the short duration of the trials and the low number of participants.
There are two field trials planned for The Netherlands, one addresses integrated home care in women with high-risk pregnancies and the other constitutes the building of a tele trauma team.
Women with high-risk pregnancies are often admitted to the hospital for longer periods of time because of possible pregnancy-related complications. Admission is necessary for the intensive monitoring of the patient and the unborn child. Home care with continuous monitoring of women with high-risk pregnancies, when feasible, is desirable and can postpone hospitalisation and reduce costs.
In this trial, patients are monitored from home using the MobiHealth BAN and the maternal and foetal biosignals are transmitted to the hospital. The objective of the trial is to evaluate if such monitoring services can be supported by 2,5 and 3G communications such that hospitalisation can be postponed and costs reduced.
In Germany, the MobiHealth team will be telemonitoring patients with cardiac arrhythmias. The target group in this trial are patients with ventricular arrhythmias who are undergoing drug therapy. Cardiac arrhythmias are very common, especially in elderly patients, and in many cases are related to coronary heart disease. Around one million patients suffer from coronary heart disease in Germany today.
In patients suffering from arrhythmia, ECG measurements have to be taken regularly to monitor efficacy of drug therapy. In order to save time and reduce costs, in this trial the patient is able to transmit ECG and blood pressure via GPRS from home or elsewhere to the health call centre, where the vital signs are monitored by the cardiologist. The intention is that irregular patterns in these vital signs will be quickly detected and appropriate intervention can be effected. The trials are designed to determine whether 2,5 and3G wireless communications can support such services.
A target group in Sweden involved in the trials consists of patients at the Lighthouse care resource centre and also clients living at home, but with the common characteristic that all have an alarm system located in their room at the Lighthouse Centre or in their home. The current system does not allow the patient any freedom related to mobility and forces the patient to be trapped at home or in their room at the Centre.
By replacing the fixed alarm system with the mobile MobiHealth system the patient can move freely anywhere. Additionally, positioning and vital signs are monitored and video communication is planned when UMTS is available. The main expected benefit of using the MobiHealth BANs in this trial is to increase mobility and to allow patients to lead a more normal life than they did before.
The purpose of the Lighthouse trial is to test the effectiveness of the new GPRS/UMTS-based alarm and locating device, a variant of the MobiHealth BAN, according to several determining factors: safety, convenience, empowerment of user, mobility of user and improvement in efficiency of care given.
MobiHealth will also monitor physical activity and impediments for activity in Swedish women with Rheumatoid Arthritis (RA). The use of the BAN together with the 2,5-3G wireless communications will enable collection of a completely new kind of research data which will enhance understanding of the difficulties and limitations which these patients face.
The objective is to find solutions that will make their lives easier. By this collection of data, the scarce knowledge about what factors impede normal life will be supplemented and quality of life of RA patients may thereby be improved. By use of the BANs, the activity of the patients will be continually monitored. Parameters measured include heart rate, activity level, walking distance and stride length.
The group of patients involved in another Swedish trial suffer from respiratory insufficiency due to chronic pulmonary diseases. These people need to be under constant medical control in case they suffer an aggravation of their condition. Besides needing regular check-ups, they also need oxygen therapy at home, which means oxygen delivery and close supervision.
The use of the MobiHealth BANs in this trial is designed to help in the early detection of this group of diseases and also to support home care for diagnosed patients by detecting situations where the patient requires intervention. The expected benefits are a reduction in the number of checks-ups and hospitalisations needed, thus saving both time and money for the hospital. Parameters measured are pulse rate, oxygen saturation and signals from a motion sensor or accelerometer.
The Swedish MobiHealth team will also organise home care and remote consultation for recently released patients in a rural area. Home care services and the possibility of monitoring health conditions at a distance are changing the way of providing care in different situations. If suitable home-based services are provided, patients do not need to be in hospital when the risk is not very high or when they are recovering from an intervention. By investing in home care, hospitals have been able to significantly reduce pressure on beds and on staff time dedicated to this kind of patients.
This trial tests transmission of clinical patient data by means of portable GPRS/UMTS equipment from patients living at home in a rural low population density area, to a physician or a registered district nurse (RDN). The subjects are patients who have been recently discharged from hospital. The expected benefit is that this intervention will reduce the number of cases where the patient is moved to the hospital unnecessarily.
In Spain, home-based health care services will be supported. This trial involves use of GPRS for supporting home-based care for elderly chronically ill patients including remote assistance if needed. Patients are suffering from co-morbidities including COPD. The MobiHealth Nurse-BAN will be used to perform patient measurements during nurse home visits and the MobiHealth patient-BAN will be used for continuous home monitoring outdoors during patient rehabilitation.
It is very important to facilitate patients' access to health care professionals without saturating the available resources, and this is one of the main expected outcomes of the MobiHealth remote monitoring approach. Parameters to be measured are Oxygen saturation, ECG, spirometry, temperature, glucose and blood pressure.
The patients involved in a second Spanish trial are chronic respiratory patients who could benefit from rehabilitation programmes to improve their functional status. The study aims to check feasibility of remotely supervised outdoors training programmes based on control of walking speed enabled by use of the BAN. The physiotherapist will receive on-line information on the patient's exercise performance and will provide feedback and advice.
It is expected that by enabling patients to perform physical training in their own local settings, the benefits, in terms of cost and social acceptance, can be significant. Parameters to be measured are pulse oximetry, ECG and mobility with audio communication between the patient and the remote supervising physiotherapist.
More news on the MobiHealth project can be found in this VMW issue's articles MobiHealth Body Area Networks new promise to meet mobile health care challenges and Vodafone Netherlands starts 3G pilots within the MobiHealth project framework.