Patient monitoring

Health problems don't always end when the patient goes home from hospital, but new technology is promising to provide the health-care sector with ways to improve the prognosis.

One in five hospital patients experiences some sort of adverse event following treatment, says Gary Hannah, founder, chairman and chief executive of Vocantas Inc., an Ottawa-based maker of software for the health-care industry. He said the events are most often due to drug interactions or not keeping a surgical wound clean.

In severe cases, adverse responses to treatment can lead to patients becoming ill or even dying, according to Radu Leca, president and chief executive of Biosign Technologies Inc., a Toronto-based maker of electronic devices for monitoring patients. But there are also times when treatments simply don't work as intended and the effects aren't immediately visible.

To further complicate matters, Leca says, "most drugs today are taken for chronic diseases, and chronic diseases mean the patient is at home, away from professional supervision."

A 2003 study published in the American College of Physicians' Annals of Internal Medicine, for example, looked at 400 patients discharged consecutively from U.S. hospitals. It found that 19 per cent of them encountered "adverse events after discharge," and determined that about two-thirds of those issues could have been prevented or treated if caught earlier. The report concluded that, "Adverse events occurred frequently in the peridischarge period, and many could potentially have been prevented or ameliorated with simple strategies."

A study of 328 people published in the Canadian Medical Association Journal in February 2004 reported similar numbers. It concluded that, "Approximately one-quarter of patients in our study had an AE [adverse effect] after hospital discharge, and half of the AEs were preventable or ameliorable." It added that 72 per cent of the adverse responses involved drug issues, 16 per cent involved therapeutic errors and 11 per cent were linked to infections.

Doctors and nurses can't keep patients confined to hospital beds indefinitely to make sure nothing goes wrong — but new technology is offering ways to get more immediate feedback on how well a treatment is working and keep an eye on recovering patients from afar. Hospitals can also send people home with tools that let the patient play an effective role in monitoring their own state of health.

New ways of monitoring

Researchers gathered at the Workshop on Adverse Response Monitoring in Ottawa in February to discuss ways of using technology to monitor patients and prevent problems. The Ottawa chapter of the Institute of Electrical and Electronics Engineers (IEEE) organized the workshop, supported by the city's two universities, the Ottawa Centre for Research and Innovation (OCRI), BioSign, IBM Corp., Telus Corp. and its subsidiary Emergis Inc.

Detecting milder adverse responses was one of the key discussions, since it's important both to ensure patients' long-term health and to determine whether new drugs are effective. With that in mind, scientists and engineers are looking for better ways to track what happens in patients' bodies, and to spot problems more quickly when they occur.

At the workshop, David Silver, a researcher in the Applied Physics Laboratory at Johns Hopkins University in Laurel, Md., discussed the example of glaucoma treatments. The usual way to treat glaucoma is to lower pressure inside the eyeball. But drugs designed to do this risk reducing blood flow through the eye, which can be harmful. The problem is compounded by the fact that a given drug may work well in most patients, but have serious adverse effects in a few.

Today, Silver says, ophthalmologists can only prescribe a drug, then re-test the patient's vision after six months to see if it is helping. If it's not, they try a different drug and must wait another six months for the effects to become clear.

The solution may be emerging technologies that can measure pressure and blood flow in the eyeball directly. They could make it possible to test the effects of a drug on an individual quickly, and allow doctors to prescribe another drug if the first isn't working.

Diabetes

New types of monitoring technology could also help diabetics, who must prick their fingers one or more times daily to test blood-sugar levels. This increases the risk of infection, and because it's troublesome and uncomfortable, some do the tests as infrequently as they dare.

"We want to go to a non-invasive form of monitoring," says David Rivkin, professor of physical and life sciences at the European-American University, a private online institution.

Scientists have explored many ways to measure blood glucose without drawing blood. Some rely on light, which can penetrate a short distance into the skin and measure glucose levels by using a spectrometer to measure how the blood scatters the light.

Another approach is to insert very thin optical fibres through the skin so that light can shine light through capillaries. Researchers have even tried inserting microscopic "windows" in patients' skin, with mixed success. The fibre in particular tends to be uncomfortable, says Rivkin — who has had the inserts himself — and both methods are prone to infection.

BioSign is working on another solution. The company's User Fully Integrated Terminal (UFIT) — which consists of a blood-pressure cuff that plugs into an ordinary computer through the Universal Serial Bus (USB) port — was originally designed to measure blood pressure and heart rate. BioSign has added software that Richard Potts, the company's chairman, says can determine blood glucose level based on patterns in the pulse wave.

UFIT transmits readings via secure internet connection to a server than analyzes them. If a reading is outside the normal range, the system can alert the patient's physician and establish a conference call to discuss the problem.

Technology that handles the house calls

One obvious way to reduce adverse reactions to treatments is to have a health-care professional visit or call patients, but it doesn't happen as often as it should. Hospitals often try to do follow-up calls, but nurses are overworked and often the calls aren't made, Vocantas' Hannah says.

Researchers and health companies are working on unobtrusive ways to track patients' condition at home. For instance, Adrian Chan, who runs the Biomedical Sensors and Signals Laboratory at Carleton University in Ottawa, described a "smart rollator" — a wheeled walker with built-in monitoring technology — that can incorporate a heart monitor and be used to monitor a patient's activity levels once they leave hospital.

Vocantas' solution is an automated system that calls patients and uses voice synthesis and speech recognition to ask them simple questions about their condition. It sounds impersonal, but Hannah claims two-thirds of patients in trials said they preferred the automated call to one from a doctor, nurse or pharmacist.

To ensure patients take the right medication at the right time, researchers have come up with pill bottles equipped with sensors and even recorded reminders. MedivoxRx Technologies Inc. in Pittsburgh sells Rex The Talking Prescription Bottle, which can record a spoken message of up to 36 seconds.

PointClickCare, of Mississauga, Ont., has developed an Electronic Medical Administration Record (E-MAR) that replaces the paper charts that staff at chronic-care facilities have traditionally used when giving out medication. The electronic records can be updated faster, and in year-long trials at a Barrie, Ont., nursing home, he says, E-MAR reduced medication errors from 3 per cent to zero.

These are just a handful of the new monitoring technologies that could be added to the medical arsenal in the coming years. Participants in the Ottawa workshop noted that patient-monitoring technology faces various obstacles, from making the technology work to overcoming resistance to change among those in the health-care community. But as Leca says, there's growing momentum behind the development of this type of technology because, "this is one issue that is of interest to everybody."