Wireless House Calls

The latest wireless technology is saving lives and providing critical information to doctors and patients.

An apple a day may keep the doctor away, but if you need him, he soon will be no farther than your cellular phone. Doctors, nurses and hospitals are increasingly using wireless phones, PDAs and other devices to communicate with patients and save lives.

For example, physicians' e-mails to patients have tripled in less than one year, with 10% of physicians now using e-mail on a daily or weekly basis to communicate with their patients, according to a study by Medem e-health network.

Half of all physicians who responded are using the Internet daily in their offices, substantially more than a year ago, when an American Medical Association study showed that only 37% were using the Web.

Some of the newest wireless applications for the healthcare industry are providing critical information to doctors and patients, and important opportunities for wireless carriers to deliver the cutting-edge technology necessary to enable it.

"Health-care apps is the emerging wireless field, it's where wireless is going," said Marty Nee, AT&T Wireless director of corporate communications for the New England states. "Real-time information is vital for doctors, hospitals, and today the technology is there."

Wireless Helps the Medicine Go Down Each year, 14,000 Americans need liver transplants, but only about 4,000 organs are available. This year alone, more than 1,400 patients will die waiting for a new liver.

But software applications for wireless devices have been developed to keep critically ill patients on the transplant waiting list alive longer. SAS Institute's E-Intelligence software provides vital real-time data to help researchers make critical decisions during clinical trials and allows patients with acute liver failure quick access to an experimental treatment.

SAS and Synteract, a research organization, are helping biotechnology company Vitagen move its experimental artificial liver system, the Extracorporeal Liver Assist Device, through clinical trials. It contains live human liver cells and can perform a patient's liver functions for up to 10 days. This extra time may keep a patient alive long enough for a donor organ to become available or for a diseased liver to heal.

Synteract houses the clinical trial data on a secure Web site that Vitagen employees can access through a traditional Internet connection. But by using a Palm VII application, Vitagen can access real-time data at any time via a Web-enabled wireless connection, and run a program that randomly assigns patients in the clinical trial.

Before developing the wireless applications, Vitagen had to contact Synteract by phone, fax or e-mail. Dr. Patrick Maguire, Vitagen vice president of medical affairs and technology development, said he is no longer tied to his laptop.

"The patients we work with are critically ill," he said. "It is absolutely mandatory that we get the right information to the right people at the right time."

According to the National Council of Patient Information and Education, 50% of all patients taking medications, especially those on chronic or complex medication regimens, don't take their medicine at all or don't take it according to schedule. Lack of adherence to prescribed drug treatments cost the pharmaceutical industry nearly $20 billion in lost sales last year, almost 25% of the total $86 billion in U.S. retail drug sales for 1999, and results in more than 125,000 deaths.

Wireless applications help solve this problem for the pharmaceutical and patient segments. Soon, it won't be your mom who reminds you to take your medicine, it will be your wireless device.

Grey Healthcare Group and i3 Mobile are developing a personalized, lifestyle-oriented wireless healthcare-compliance service for U.S. pharmaceutical companies that will remind patients to take their medicine via SMS messages.

"We've identified one of the key wireless applications for healthcare specifically aimed at the consumer: compliance," said Michael Forbes, i3 Mobile vice president of marketing. "Over 10% of all hospitalizations are the result of patients not complying with the medication dosage that they've been prescribed."

The first application is a wireless treatment-compliance-reminder service for patients who opt to participate. This service will deliver alerts to patients on wireless devices, reminding them to refill their prescriptions and keep doctor appointments as well as providing treatment information tailored to their particular conditions.

Relevant messages can be pushed or pulled to the customer's wireless device, said Thomas J. Hardiman, i3 Mobile director of healthcare solutions. Patients with questions about their medication can communicate with their doctors using 2-way devices that feature a smart e-mail component.

As an incentive for patients to use the reminder service, it includes personalized lifestyle information. Patients can sign up with their pharmacy benefit-management organization and use a cellular phone, pager or PDA that managed-care organizations may pay for.

"A device that simply tells you when to take your medicine is not seen as all that positive; it's like a leash to the medical professional, and the users find it intrusive," Forbes said. "The inclusion of personalized content services along with the program reminders softens the experience for the user and allows them to more effectively integrate this device into their lifestyle."

Today, the healthcare industry may use PDAs predominantly, but tomorrow, more Web-enabled cellular phones will assist doctors and patients.

AT&T Wireless recently installed the technology to enable Beth Israel Deaconess Medical Center in Boston to link cellular phones belonging to doctors and nurses through its switchboard, turning handsets into "super-long-range" cordless phones.

AT&T Wireless installed the necessary low-power wiring inside seven buildings on the hospital's east campus, and will expand the service to the west campus in 2001. Within the next year, the hospital plans to add data connections up to 384kb/s through EDGE technology, which will enable doctors to use Internet-enabled wireless phones.

A Prescription for Wireless Before it installed the PBXs and wireless infrastructure, Beth Israel Deaconess conducted tests to ensure no interference would affect hospital equipment or patients. But the low-power equipment posed no problems, according to Dr. John Halamka, Beth Israel Deaconess chief information and technology officer.

Maguire said there are some areas in a hospital where you probably shouldn't use a cellular phone or a PDA because it may interfere with patient electronics. But in general, it isn't a huge problem.

The bigger challenge with using wireless devices for patient data is security. User privacy should be built into any program.

"It's one thing to remind someone to take an antibiotic for a sinus infection, it's another to use a program like this to provide information to an AIDS patient on a treatment routine," Forbes said. "It's very important to protect the privacy of the patient involved."

Maguire agreed that confidentiality is a prime concern.

"With cell phones, there will be some concerns about encryption and maintaining patient confidentiality, because that is absolutely a must," he said. "But I can't help but think that the efficiencies provided by the system are going to force people to develop the proper encryption technologies to ensure patient confidentiality."

According to Russell Holmes, Synteract chairman & vice president, security is key.

"We're in a highly regulated industry, so you have to be cognizant of electronic signatures, digital IDs, and be able to, on a validation level, make sure that people are securely transacting with the data," he said.

For Vitagen, Synteract provided an initial interface for PDAs that allows doctors and nurses to log in with an ID. That, along with their device ID, is entered into Synteract's security database so it knows exactly who users are. When users log in and make a wireless call to the security database, it authenticates them and says that particular ID has access to particular applications, Holmes said.

The prognosis for cooperation between medicine and wireless is a long, healthy one.

"(Wireless) will be very important in many aspects: It will allow ease of communication of data, especially patient data and critical data when you need to act on it," Maguire said. "Now there are various hospital systems that will be looking into wire-less applications for transmission of reports, critical patient data and laboratory data to the doctor's office and to allow 2-way communication."

So, don't stop eating apples, but keep your wireless phone handy, too.