As remote monitoring and interactive services involving consultants and their patients increase, today’s fast-emerging world of telemedicine is seeing some exciting developments, writes Massimo Marcotulli, Business Development Director, Southern Europe, Hughes Europe. In particular, trials underway in Italy show how satellite communications technology is proving key to enabling remote management of chronic or long-term ailments.
This builds on pioneering work already undertaken in providing small, lightweight BGAN (broadband global area network) satellite services to enterprises worldwide.
Through the use of small portable or semi-fixed satellite terminals built by Hughes, BGAN provides a flexible ‘mobile office’ which can integrate with existing corporate networks to deliver a unique end-to-end satellite broadband solution. Adapted for a medical environment, initial programmes in remote mountainous or island locations have already been successful using satellite where terrestrial communications are either inadequate or non-existent.
Here, patients with heart conditions or pneumonia, for example, have had their blood pressure automatically monitored by feeding back information on a regular basis, with remote interventions by their consultants where required. Early indications are that this is providing the medical information required to manage a patient’s condition effectively and at much lower cost.
E-care
As elsewhere in Europe, the need for home care in Italy is expanding fast, with almost one quarter of the 60 million population now over 65 years old. And this is happening at a time when the healthcare industry is under unprecedented pressure, both financially and in terms of the availability of specialist nursing and medical care.
As a result, with fewer resources available to them, healthcare providers are having to do more with less, with an ever-stronger focus on delivery quality and clinical outcomes.
It is in this environment that a number of European Space Agency-funded programmes have been launched, involving medical services provider, Telbios, satellite management services operator, Telespazio and partner satellite networks specialist, Hughes Europe. These are designed to incorporate satellite communications technologies in delivering the best possible healthcare for the whole population in a geographically diverse country experiencing tough economic times.
There are a number of other drivers impacting on how those involved in healthcare provision are tackling these immense challenges. Though keen to remain independent and live in their homes for as long as possible, increasing numbers of an ageing population are suffering from chronic conditions. Importantly, however, in playing their part in managing this they are better educated and more comfortable with technology.
One of the most successful initiatives to-date has been IGEA-SAT (Integrated General E-care Access for home care via SATellite). This aimed to supplement the existing terrestrial broadband infrastructure and put in place a telemonitoring system that met the relevant clinical protocols for each disease and targeted improvement in the quality of life for each patient.
Success would be defined in a number of ways. For example, it should meet the differing needs of the patient management community, including the public health authorities and physicians. In addition, it should support patients and their families regarding health management and also keep the general public better informed regarding disease prevention.
It was recognised that the use of satellite was the only effective way to bridge the digital divide in e-healthcare, as extending the existing terrestrial broadband infrastructure was unrealistic. Critically, improvement in the clinical outcomes of IGEA-SAT programmes would be measurable – through the reduction in the number of visits to a doctor or hospital, either on a planned or emergency basis, the daily monitoring of vital signs or ongoing assessment of the broader status of a patient’s health.
In order to achieve this, the IGEA-SAT response was to provide the patient with four key services:
– An agenda, or activity list, of daily actions to be performed and drugs to be taken
– Telemonitoring of physical parameters, through the use of portable medical devices
– Video-assistance for periodic video sessions between patients and the Telemedicine Service Centre, physicians or physiotherapists
– ‘Edutainment’ – providing treatment-related information via the home TV set
This requires a highly reliable system together with a fully integrated quality of service, including physicians’ availability. The implemented network had to include high-availability satellite and the solution chosen included VSAT terminals, allowing full-duplex communication.
This was recognised as a proven technology offering a cost-effective way to achieve the deployment of solutions specifically designed to support care management, by ensuring full interoperability with the existing network environment.
In order to achieve this, the solution had to include a central satellite multimedia service centre, with 24/7 technical support, a home terminal and an interactive TV set with an intuitive, simple-to-use remote control.
The trials took place across a number of regions, including Lombardy and the island of Elba. From a technical perspective, the results were successful in providing the network resilience and high quality demanded, in a way which was well received by patients and healthcare professionals alike. As a result, work is now underway to establish a commercial model which works for both the public sector health providers, keen to base payment on outcomes, and communications service providers used to charging on bandwidth usage.
As part of a parallel Telemedicine Pilot Project Executive initiative, TELESAL, satellite-based broadband technology has again been used, specifically to monitor and prevent cardiovascular diseases, including Type II diabetes – the leading cause of mortality in Western societies and the largest area of spending in the health budgets of developed economies. This is designed to roll out across Italy, providing:
Mobile emergency services – in remote areas not covered by terrestrial, maritime and aeronautical mobile telemedicine and screening prevention
Home care services – including tele- and video-assistance and home care medical information
Communication/information-sharing – including tele-consulting and remote training
Remote management
The emerging importance of telemedicine can be seen in a number of areas, involving both the public and private sectors. The outcome has been a number of satellite-based working solutions which have proved effective in allowing the local doctor or hospital to remotely diagnose, monitor and manage individual patient conditions.
In the military arena, for example, trials are underway in providing remote medical monitoring for troops in Afghanistan, controlled from a central hospital base.
Similarly, in specialist commercial operations such as oil and gas exploration, remote diagnosis and management of individual patient conditions can in many cases act as an effective substitute for face-to-face treatment. And, as with public sector-funded programmes, this removes the requirement for costly and time-consuming transportation of either the patient or the specialist to deal with the medical problem.
It is not only those obviously remote land-based or maritime geographies where satellite is proving to be the essential link in enabling remote medical management. Other trials involving individual patient monitoring in parts of Italy where terrestrial communications are either insufficiently robust, or indeed non-existent, are also helping to develop a revolutionary new model in which patient management is transformed – providing superior and more flexible care and at a greatly reduced cost.
Thanks to innovative satellite technologies, bringing the hospital to the patient is now proving to be a practical reality, to the benefit of the individual, the healthcare provider and the national economy. As a result, satellite communications now forms an essential part of an emerging model which is set to transform the provision of healthcare across Italy and the rest of Europe.