The medium is the message, and messages such as these (and similar ones in the Policy section of this issue) suggest that the medium of remote medical monitoring devices connected to broadband communication links portends a revolution in healthcare.

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A Finnish study reported in the American Journal of Hypertension on the effectiveness of home monitoring tracked a group of 113 patients at 55 primary health care centers. Their blood pressure was measured on an automated home-use device twice daily for 7 days and then again at 2, 4, and 6 months, and the results were returned to the patients’ physicians. A comparison group of 119 patients had blood pressure measured in their primary care providers’ offices at the same time periods. The doctors in both groups were instructed to intensify treatment if the target blood pressure was not met.

Both groups experienced significant drops in blood pressure, but the effects were generally more pronounced in the home-monitoring group and significantly more patients in that group achieved their target blood pressure, though because of limitations in the study’s design, other factors may have contributed. However, an editorial writer for the Journal wrote that the study’s findings “highlight the potential role that self-monitoring of blood pressure can play in helping improve the management of high blood pressure in the community.”

Wireless Implantable Biosensors

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Taking advantage of advances in materials and miniaturization, researchers at the Academy of Finland are developing miniscule subcutaneous EKG and other sensors to provide more accurate prediction of changes in a patient’s condition. The sensors could monitor, for example, the function of the heart or prosthetic joints, even over long periods of time, and transmit data wirelessly to a physician’s mobile phone or PC.

The project involves experts in physiological modeling, biomaterial technologies, biosensors, wireless communications, and electronics packaging technologies.

Smart Clothes

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A US$145 sports bra introduced in December contains a conductive fabric that picks up the heart’s electrical pulse and a transmitter that sends the signals to a wristwatch computer that displays a digital readout of the wearer’s heart rate. The sports apparel industry is also developing clothes that monitor respiration, the proportion of lung capacity used, length of stride, and ultimately even a golfer’s swing. Such “smart fabrics,” writes Frank Greve of Knight-Ridder Newspapers, “are the next big thing in so many fields that some analysts predict that they’ll change the world as dramatically as the Internet did.”

The smart bra is not the first piece of smart apparel. Smart shirts that monitor heart rate and respiration have received medical device approval from the US Food and Drug Administration. (A current main application is in monitoring sleep apnea patients.) And smart apparel is not the only way to monitor patients at home. Greve cites a public policy economist’s recent estimate of US$30 billion a year in hospital, emergency room, and doctor costs that would be achieved by monitoring 4 million chronically ill Medicare patients at home, but he does not mention that much non-apparel-based home medical monitoring devices already exist.

MIT’s US Army-supported Institute for Soldier Nanotechnologies is developing battle dress woven with GPS, to pinpoint a soldier’s location, and vital signs to pinpoint the type, severity, and location of wounds. Future versions may even automatically alter their molecular shape when the soldier is wounded, turning into a splint or tourniquet, or even administering cardiopulmonary resuscitation.

On what Greve calls the Industrial Fabrics Association’s “wish list” are firefighter suits whose insulating properties adjust to temperature changes, fabrics that kill germs, and fabrics that detect toxic chemicals then protect the wearer from them.

Telemedicine

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A Kansas doctor seated before a video screen and watching and measuring the vital signs of a patient 20 miles away is just one example of what Paul Wenske, in an article in the Kansas City Star, calls “the latest in a quiet medical revolution in which health care is increasingly delivered through broadband technologies.” Other revolutionary examples he cites include “wristwatches that monitor the heart, cell phones that can prick the finger of a diabetic patient and send the information to a doctor, and bedroom floor sensors that can discern an elderly patient’s unsteady gait or even predict the onset of Parkinson’s disease.”

The revolution enabled by these technologies is a heady combination of more access to healthcare, higher quality healthcare, and lower-cost healthcare. “How much [lower]?” he asks; and answers: “A scholar with the Ewing Marion Kauffman Foundation and the Brookings Institution estimates savings of nearly $1 trillion,” a savings “as substantial as what the federal government is likely to spend on homeland security over the next 25 years” and that “could exceed what the United States currently spends annually for health care for all its citizens.”

But there is a problem: “Most Americans still don’t have access to broadband, smaller hospitals can’t afford the technology and current laws slow the approval process of the technology for medical use or make it hard to use across state lines. In short, … there is an urgent need for a national policy on telemedicine.” The executive director of the Center for Aging Services Technologies, which last month made a presentation at a White House conference, said it was “absolutely essential to get broadband to more citizens.” Other barriers include restrictive laws on medical devices, interstate physician licensing laws, and the perennial failure of payors to reimburse hospitals for the costs of adopting broadband telemedicine technologies.