Wireless World: Text messaging for meds


By Gene J. Koprowski
UPI Science News

Chicago, IL, Jan. 7 (UPI) -- Physicians now have a technological solution to an all too common scenario -- a cardiac patient forgets to take his heart medication and winds up in the emergency room.

Doctors are sending text-message reminders to patients, via mobile phones and personal digital assistants, telling them it's time to take their prescribed angiotensin converting enzyme or ACE inhibitor, like Prinivil, or other medications.

"One of our major thrusts is going to be moving healthcare related applications to technologies that are more familiar to the patients," said Dr. Joseph Kvedar, vice chairman of dermatology at the Harvard Medical School, and a director of Partners Telemedicine.

"Many of the technologies that have been deployed in the home look like they should be in a doctor's office, Kvedar told United Press International's Wireless World. "But people are more likely to change their routines if we use technologies, like mobile phones, that they have already adopted."

Harvard Medical School is a leader in the emerging niche of telemedicine via text messaging. During the 1990s, doctors started to embrace telemedicine, using computer networks to link specialized medical practitioners across the country or around the globe.

Now they realize that rather than just linking doctors, they can connect with patients in this way, too, and reduce the time spent on routine in-office visits, cutting overall healthcare costs.

"As a tried and true academic center, our whole model has been based on patients coming here," Kvedar said. "But now we're looking at ways of taking care of patients without them coming here. The hand-in-glove technology combination is messaging and monitoring."

Other medical centers -- even those in remote rural areas -- are eyeing the same technological trend. At MCG Health System in Augusta, Ga., which runs a number of hospitals and clinics, neurologists are working with patients through the Remote Evaluation of Acute Ischemic Stroke or REACH program.

"There's a wireless component to this," Danielle Wong Moores, a spokeswoman for MCG, told UPI. "On the rural hospital end, the computer has wireless Internet access so it's easy to move to the patients. On the neurologist end, it's the same deal.

"So when they (neurologists) get a page for a stroke consult, if there's WiFi access, they can turn on the computer right away and start the exam," Moores said. "This is particularly important since a three-hour window exists in which the clot-busting drug can be administered to reduce side effects of stroke."

The doctors can offer consultation to patients without ever actually having to be at their side. They can evaluate physical symptoms and signs, and even receive the patient's vital signs, wirelessly.

"This medium will offer a direct communications method for doctor-patient relations and will temporize advice and information between the two before the patient is actually able to be seen by the physician," Elizabeth Downing, a spokeswoman for Dr. James Rosser, director of the Advanced Medical Technology Institute at Beth Israel Medical Center in New York City, told UPI.

The wireless collection of vital signs is possible because of the development of sensors that transmit health data, such as blood pressure, to doctors, according to a study by the Royal Society of Medicine in the United Kingdom. The study said that long-term, the new technology could keep elderly patients out of hospitals and in their own homes. A first phase of the study was completed in 2003 and research is ongoing.

"The project will look at ways of bringing this telecare into mainstream service delivery," according to the Royal Society of Medicine.

Some applications for more routine medical and dermatological examinations already are regularly available via telemedicine technology.

In New York City, the State University of New York Downstate Medical Center has been conducting a telemedicine project with homeless patients. With the aid of a digital camera and a computer, 28 patients have received free dermatological care in the last year.

"Dermatologists are trained by using slides, so looking at images and making a diagnosis over the computer comes naturally to us," said Dr. Daniel Siegel, head of the pilot program in New York and a spokesman for the Skin Cancer Foundation.

"This technology will allow us to treat and very possibly save lives of people who don't see a dermatologist regularly," Siegel told UPI.

New software also has been developed to help facilitate the in-field examinations, he said.

Health insurance companies often pay for the services, too, Erin Mulvey, a director at the Skin Cancer Foundation in New York City, told UPI.

"There are approximately 38 states practicing teledermatology," Mulvey said, "with many of them being covered by insurance -- mainly by third party payers."

Kvedar said wireless technologies have the ability long-term to change the way medicine is practiced and enable doctors to be more productive information workers. Most of the time today, clinicians collect data during a patient office visit or a hospital setting.

"They talk to you; they listen with a stethoscope," Kvedar said. "Then they communicate with you about what is being done and what will happen. But the data gathering can be better done by technology. A physical exam is a great tool for bonding, but not for gathering information."

Telemedicine Partners is conducting a trial with wireless technology developer Motorola Corp., creating a communications hub to monitor critically ill patients in the home. The patients are provided with a Nextel mobile phone handset equipped with a Java applet and a scale and a blood pressure cuff. The blood pressure cuff sends data wirelessly by Bluetooth software to a Web site, where it is viewed by physicians.

"This is going to be a tool to monitor congestive heart failure," Kvedar said. "Weight is an indicator of health here. These patients tend to collect fluid and get short of breath, and wind up in the emergency room. But if you track their weight, can determine if they are getting sick, you can keep people out of the institution and take care of them in a higher-quality way."

Ultimately, the information gathered remotely at a patient's home and transmitted wirelessly may be even more accurate than what has been accumulated, historically, in the doctor's office, due to the anxiety a patient may feel when visiting the physician for a chronic illness.

"Text messaging is not the same as sitting across from the person," Kvedar said. "But not every interaction with your provider needs to be highly emotional. The blood pressure check is an example. We've put up with this over the years, but it probably is highly inaccurate in the doctors office and inconvenient for you."

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Wireless World is a weekly column that examines the technological and social and cultural trends generated by wireless technology. Contact: Gene J. Koprowski, sciencemail@upi.com.