Smart Medicine: Use of Wireless and telehealth Technology in Patient Care

By Fiye

Photo by Edgar Goluch.

These days, almost everything is smart. And soon there will also be smart bandages that monitor vital signs, smart prescription bottles that remind the patient when to take the pill, and smart pedometers that count the patient’s steps and, like smart little tattletales, send the results to the physical therapist. Wireless devices and ‘telehealth’ are among the most frequently cited examples of technology that will change how healthcare is delivered. They speed up diagnosis, intervention and therapy, produce more data, lead to better outcomes, and are more efficient. It also allows hospitals to hire surgeons who are willing to perform complicated cases creating a ripple effect on the entire medical field and its culture. It changes how hospitals themselves and how the public perceive them. With theses wondrous benefits, however, also comes a concern that new device and treatments typically drive up healthcare costs.

New smart medical technologies are helping doctors take better care of their patients and efficiently so. One of these biggest technological medical developments is Nanotechnology. Nanotechnology itself is not new but there are some new medical applications. Drugs that use nanoparticles to deliver toxins directly to tumors, minimizing damage to healthy tissue, are now in trials (Poole, 2003). Nanotechnology could make imaging tools work better and more safely. Researchers at the University of Michigan and Roswell Park Cancer Institute are studying a treatment that uses nanoparticles to better visualize brain tumors during surgery, improve brain tumor resection, and eradicate residual tumor cells. To do this, they are designing tissue-staining nanoparticles that will be selectively internalized by brain cancer cells. The nanoparticles, which specifically target cancer cells, will be linked to both a dye and a therapy agent (Mousa, 2011). The dye will allow surgeons to visualize the tumor during surgery, facilitating more complete resection, according to the National Institute of Biomedical Imaging and Bioengineering. Following removal of the bulk of the tumor, the light-activated therapeutic agent would be stimulated by laser light to kill the remaining tumor cells (Poole, 2003). This will surely lead to lower reoperation rates and better treatment of cancer, where doctors can be certain if a tumor is completely gone. Hospitals who plan on investing in this technology can expect to see more cancer patients that are willing to undergo further treatment and have doctors that are more confident in relaying the progress of treatment to their patients.

Infection control is another area where nanotechnology shows promise. For example, scrubs and lab coats are being made that repel liquids as watery as wine or as viscous as ketchup. The fibers are “impregnated with Nano-sized silicone particles that change the surface area of the fabric, increasing tension and creating a barrier to fluids such as blood and vomit. The material also has antimicrobial properties with a rapid kill time—99.9% of microbes are eradicated in fewer than 10 minutes” (Panzarini, 2013). Combining the two mechanisms, the antimicrobial to kill on contact and the nanotechnology to repel liquids, shows promise for protecting healthcare workers from acquiring of nosocomial pathogens.

As minimally invasive techniques are shown to be safer and more cost-effective, hospitals are preparing for a wider variety of procedures to move to outpatient settings. And the more procedures a surgeon does outside of the hospital setting, the better the outcomes, including lower infection rates (Panzarini, 2013). Researchers have been testing a supersensitive fiber-optic probe 2 millimeters in diameter that can be passed through a normal endoscope “and can see structures as small as 1 micron, such as single cells or the nucleus within a cell. pCLE (Probe-based confocal laser endomicroscopy), could eventually reduce colon polyp removal”, their findings suggest that the virtual biopsy can replace real biopsy in several other conditions (Odagi,2007). Another use of this technology is in dermatology, where doctors can view skin abnormalities at the cellular level and “save patients unwanted, unnecessary biopsies, and in some cases it may detect a lesion which otherwise might not have been biopsied” (Basavaraj, 2012). This technology will have an important role in improving biopsy outcomes where it is more likely to locate the disease and provide immediate therapy, where it would take several days for an actual biopsy. It is a major advancement that is allowing hospitals transition into less invasive techniques while treating patients.

Healthcare organizations are already implementing some of these technologies. They are using wireless technology to remotely monitor patients and transmit large imaging files. But these devices will soon be much smaller, more convenient, and will have a better patient compliance rate. One emerging wireless technology is the smart or wireless bandage. Patients simply peel off the backing and stick it on their skin like a nicotine replacement patch. Current models connect to a phone line that send out a patient’s vitals once or twice a day, “where a patient’s compliance is met just by putting the bandage on” (Clifford, 2012). Other wireless devices are also improving patient compliance. It is a pipeline that fits onto a prescription bottle and alerts patients when it is time to take their pills. The device senses when a patient unscrews the cap and sends the information to a secure network connected to a hospital’s line (Steinman, 2011). This is a great tool, especially for elderly patients and certain medications that have a low compliance rate due to complicated dosage, as it becomes reliable and affordable.

The biggest effect of these new smart technologies is on clinical quality. Navigational tools allow surgeons to make the smallest possible incision, resulting in faster recovery time, especially for fragile patients. Screw malposition rates are another example of how the technology is improving outcome (Bledsoe, 2009). If medical screws used to stabilize the spine are not positioned correctly, the results can be fatal, so most patients must undergo a second surgery to fix poor placements. A report in Advanced Materials and Processes, after studying Sacred Heat Hospital in Eau Claire, WI, stated that, “The average screw malposition rate is about 5%. Thapar’s [doctor of neurosurgeon at Sacred Heart Hospital] freehand screw malposition rate was about 2.5%. After the hospital started using the smart technology, the screw malposition rate dropped to less than 0.1%” (Bledsoe, 2009). It has a profound impact on patient care. It also allows more surgeons to do more daring procedures like this that treat patients more efficiently but lead to fewer lawsuits due to complications in reoperation.

Affordability is one of the major concerns as more and more technological developments are made in medicine. Unlike in other industries, where advances in technology reduce costs (self-check-in kiosks at airports, for example), new devices and treatments typically drive up healthcare costs (Clancy, 2006). Feinberg a doctor at UCLA states, “Someday colonoscopies will be performed by a pill you swallow. But that means there will be more diagnoses of colon cancer, that those people will need further treatment, and that costs will go up” (Clancy, 2006). One the other hand, technology is going to be part of the answer for healthcare costs because it will lead to quicker diagnosis, early disease intervention and treatment, and better safety. The benefit to patient care is obvious, but there is a the question of the dollar value of preventing an error, infection, and other problems when healthcare cost without the implementation of these technologies is already high. “Every design solution that reduces or eliminates a problem has a cost, and finite resources make design. You have to consider cost in the context of the benefit of improved outcomes and of the improvement in people's lives,” UCLA's Feinberg says. Hospitals need to consider several factors when weighing these technological investments; its clinical impact, if healthcare worker are willing to adopt, if insurance companies will pay for the procedures and tools, and if patients can afford it (Mandl, 2009). Another concern is that new devices are ahead of doctors that have not been trained to use them and an inexperienced doctor or surgeon may do more harm than good (Clancy, 2006). Thus eliminating all the major benefits of this technology. The solution is not simple. Major healthcare policy decisions in collaboration with healthcare leaders and lawmakers are needed because the benefits of increasing medical technology investments are immeasurable.

Investment in medical technology is will lead to better innovations and discovery that improve the way patients are treated and how the medical field advances to better treat and interact with the public. The benefits of new technological advancements in medical tools are endless. However, the cost of implementing and investing in these technologies seems just as large. As the world keeps on creating ‘smart’ things, however the real cost is not keeping up and lacking in medical treatments that better serve the public. Why not invest in new technologies that will lead to better hospitals, health care workers, and treatments and that will change the culture structure of medical care for the better? All it takes is smart policies and smart investments.

Works Cited

Basavaraj, K. H. (2012). Nanotechnology in Medicine and Relevance to Dermatology: Present Concepts. Indian Journal Of Dermatology, 57(3), 169-174. doi:10.4103/0019-5154.96186

Bledsoe, J. M., Fenton, D., Fogelson, J. L., & Nottmeier, E. W. (2009). Accuracy of upper thoracic pedicle screw placement using three-dimensional image guidance. Spine Journal, 9(10), 817-821. doi:10.1016/j.spinee.2009.06.014

Clancy, C. M. (2006). Getting To 'Smart' Health Care. Health Affairs, 25w589-w592. doi:10.1377/hlthaff.25.w589

Clifford, G. D., & Clifton, D. (2012). Wireless Technology in Disease Management and Medicine. Annual Review Of Medicine, 63479-492. doi:10.1146/annurev-med-051210-114650

Mandl KD, Kohane IS. No small change for the health information economy. N Engl J Med2009;360:1278–81. [PubMed]

Mousa, S. A., & Bharali, D. J. (2011). Nanotechnology-Based Detection and Targeted Therapy in Cancer: Nano-Bio Paradigms and Applications. Cancers, 3(3), 2888-2903. doi:10.3390/cancers3032888

Odagi, I., Kato, T., Imazu, H., Kaise, M., Omar, S., & Tajiri, H. (2007). Examination of normal intestine using confocal endomicroscopy. Journal Of Gastroenterology & Hepatology, 22(5), 658-662. doi:10.1111/j.1440-1746.2007.04837.x

Panzarini, E., Inguscio, V., Tenuzzo, B., Carata, E., & Dini, L. (2013). Nanomaterials and Autophagy: New Insights in Cancer Treatment. Cancers, 5(1), 269-319. doi:10.3390/cancers5010296

Poole CP, Jr., Owens FJ. Introduction to Nanotechnology. Hoboken, NJ, USA: John Wiley; 2003.

Steinman, M. A., Handler, S. M., Gurwitz, J. H., Schiff, G. D., & Covinsky, K. E. (2011). Beyond the Prescription: Medication Monitoring and Adverse Drug Events in Older Adults. Journal Of The American Geriatrics Society, 59(8), 1513-1520. doi:10.1111/j.1532-5415.2011.03500.x

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