Telemedicine pops up in the most unexpected places! I was fortunate to attend the 4th International Conference on Information Technologies in Biomedicine (ITIB) in Kamień Śląski, Poland (a lovely little town northwest of Krakow which was a seat of knights and noblemen families in the past and where the castle in which St. Jacek was born is located – which is now a quaint conference center and sanatorium) and in addition to image analysis, computer-aided surgery, bioengineering, bioinformatics and signal analysis are 2 sessions dedicated to telemedicine!
The session was preceded by an invited lecture by Jurgen Zerth, PhD who compellingly discussed “Some Aspects on Effectiveness and Efficiency for Ambulatory Care Assisted by Mobile Technological Devices”. He noted what many of already see as one of the key drivers of telemedicine – the rapidly increasing population of people of 65 who are not only living longer than previous generations but doing so with more chronic conditions such as diabetes, Parkinson’s and dementia. Health care systems around the world are facing the challenges of caring for this population – and trying to do so in a manner that keeps them in their homes as long as possible.
He presented a model and data demonstrating the complex nature of the problem and showing that finding the point where mobile have an impact in terms of care and cost is challenging and needs to account for a variety of factors. The question of course is whether the findings are generalizable from one country/healthcare system to another. I would say yes but more data are required to validate the model – data we really need as this is an ever-growing problem worldwide.
The focus of the session was squarely on remote monitoring. Three of the talks (Mitas, Ridzki, Skotnicka & Lubina; Borik, Babisiak & Cap; Mitas, Rudzki, Wieclawek, Zarychta & Piwowarski) discussed activity monitoring systems (accelerometers, gyroscope and other wearable sensors) and although each were intriguing from an engineering perspective they had yet to be validated completely in an elderly sample of subjects in vivo.
The lingering question is whether people will actually be willing to wear these types of sensors. Will the potential benefits of automatic fall detection outweigh the potential nuisance of wearing the monitors? Will the false positive and false negative rates be low enough to warrant 24/7 use? Will we have the infrastructure in place that is necessary to do something once someone has fallen – can we get help to them any faster than we can now? In the long-run I think the answers are yes, but not right now.
Another talk reported on “The Application of Adapted TICS (Telephone Interview for Cognitive Status) for Diagnostics of Cognitive Function Disturbances in Elderly Patients: A Pilot Study” (Derejczyk, Stepien-Wyrobiec, Hanusiak, Bednorz, Karasek, Hornowska-Suchon, Szymszal & Pogonowska). It verified the usefulness of TICS compared to the standard MMSE and MoCA tests and found high correlations (MMSE & MoCA = 0.8170; MMSE & TICS = 0.7955). The TICS is a 19 question survey that does not use pictures or require any other materials so it can readily be done over the phone. Initial results are very promising, although further validation is required and there are, as with all tests, limitations (e.g., tester cannot tell if someone is with the person being tested and helping them). This test will surely become part of the battery of tools we have to help people in their homes as they start to experience cognitive declines. With the increasingly use of smartphones and the ability to have video conversations the potential is even higher!
There was a neat talk on “Telemetry Recording of the EMG Activity of Female Reproduction Tract” (Brzozoska, Oczeretko, Pawlinski & Gajewski). This very interesting talk had two parts. The first discussed the Monica AN24 device which attaches electrodes to a pregnant woman’s abdomen for recording fetal ECG, fetal heart rate variability, mother’s heart rate variability, EHG of uterine muscles, and arrhythmia identification. This part was more an overview of the possibilities of such a system – it would be used to telemonitor at risk pregnancies. Pretty neat!
The second half was on a project that implants sensors and records EMG signals from the bulb and isthmus of the oviduct and uterus corn during estrus and early pregnancy in pigs. Televeterinary? Absolutely! But it also provides basic scientists with data to help us better understand the physiology and pathophysiology of the reproductive system – yes pigs and humans are that similar!
There were two talks on teldermatology. My talk discussed the utility of using eye-position recordings of expert dermatologists to train dermatologists and residents on how to use and interpret accurately photographic and dermatoscopic images. These tools are widely available, relatively inexpensive and fairly easy to use – but interpreting the images correctly to determine if a lesion is benign or malignant is not as easy. Thus most patients with single pigmented lesions (suspicious for melanoma) need to travel and wait to see a dermatologist – enter teledermatology! Thus the need to develop better training methods and maybe understanding how experts look at these images can help.
Oddly enough my talk was followed by one on an “e-Melanoma Diagnosing and Learning System: Current Status” (Hippe). The project is compiling a set of synthetic images of melanocytic skin lesions that can be used for training tool development as well as perhaps development of automated image analysis tools.
A lot of the other talks – whether the authors realized it or not – were also about telemedicine. After all, telemedicine increasingly involves all sorts of images and automated analyses of these images (not just radiographs and pathology slides) are clearly going to be part of the future of telemedicine. Likewise, telemedicine means big data and big data means bioinformatics – what are we going to do with all the data these remote monitoring systems are collecting?!
It’s one thing to say everything will be uploaded to a data analysis service and the healthcare system notified of events out of the ordinary, but it’s quite another thing to actually do this. As Dr. Zerth noted at one point in a discussion – this is where the expenses comes in! Once the event occurs we still need to deploy resources to deal with it and help the patient in need – and that is what we still need to figure out in many, many applications.
But that’s what makes research and listening to these dedicated scientists (and their students) at conferences like ITIB so exciting! Kudos to the organizing committee, especially Ewa Pietka, PhD of the Silesian University of Technology, Poland!