Dr Declan Bogan gives an overview of connected health and the current activities by companies, researchers and clinicians across the island of Ireland.
Put very simply, connected health is the utilisation of "connecting" technologies (communication systems - broadband, wireless, mobile phone, fixed phone lines) and medical devices for healthcare applications. An example would be having a patient monitoring their blood glucose level and feeding the values remotely, via wireless connection or over a mobile phone to their GP or hospital. The machine can make the connection for the patient. The GP or hospital or telemonitoring centre can then take action as appropriate to the data.
One of the aims of connected health is to facilitate increased independent living within the ageing well population. It is also to enhance management of patients with chronic conditions through telemonitoring and telecare. Connected health solutions will not replace primary and secondary care but enhance it, giving patients and their families focused involvement in their care. The acceptance of the technology by the end user, the clinicians and GPs, the interoperability issues and the clinical need are the challenges. The stakes are high and the rewards are growing year-on-year. The following are some of the estimates that the market will be worth in the year to come:
-Tele-health: $591m, 2005; to $5.96bn, 2010; and $8bn by 2012 (CAPSIL)
-Tele-Care: $220m, 2005; to $337m, 2010 (Frost & Sullivan, 2006)
-Home Automation: $232m, 2005; to $446m, 2012 (Frost & Sullivan, 2007)
-The global remote healthcare market is worth about £394m and is predicted to grow to £4bn by 2010 (GE Healthcare)
Local academics have not missed out on the opportunities presented by the emergence of converging technologies and all its potentials. A number of European framework projects including MORE (www.ist-more.org ) and Caalyx (www.caalyx.eu) have involved Irish academic institutions delivering on complex pan-European-focused efforts in connected health. The FP6 funded Caalyx project, in which researchers from the University of Limerick's Wireless Access Research Centre (WARC) participated, involved development of an innovative tele-monitoring system for elderly users with wearable sensors and sensors used only in the home. In addition to the monitoring function, the system provides the elderly user with a means of communication with peers, family, health professionals and Caalyx caretakers. Follow-on projects are underway developing this technology.
MORE, another FP6 project, is a research project that was undertaken by the TSSG group at Waterford Institute of Technology. The main goal of the project was to provide a cost-effective, proactive management service for patients with chronic diseases, like diabetes, through remote monitoring. The new technology developed facilitated communication across groups of users using a variety of different wireless standards in addition to addressing the problem of how the interaction between humans and embedded systems can be efficiently supported.
Other CSET projects, SRCs and AREs, have research programmes with connected health applications in mind. The Wireless Sensor Applied Research Centre (Wisar), based in the Letterkenny Institute of Technology, has a focus on wireless body area networks. The WiSAR lab is a centre of excellence in wireless sensor network (WSN) technology, which aims to become the hub of research and applied solutions for technology companies in the region. The research themes of the centre are to develop WSN solutions in the Body Area Networks for industrial collaborators.
The link-up between Netwell and SToRC, both based in Dundalk Institute of Technology (DKIT), has seen the approval of the Centre for Affective Software for Ambient Living Awareness (CASALA). The CASALA project objective is to work with Irish industry to achieve product innovation, business competitiveness, and market leadership in the emerging ambient assisted living (AAL) sector. The AAL refers to the drive to provide ICT solutions to extend the time the elderly can live in their home environment by increasing the autonomy of people and assisting them in carrying out their daily activities.
The Nestling Technology for Wellness Centre (Netwell) (netwellcentre.ie) provides a regional centre of excellence for the applied research, development and exploitation of sensor, digital media and ICT technologies that support sustainable environments, enhancing the quality of life and well-being of older people living independently. Louth is an age-friendly county and is being used as a test bed for AAL research. The centre's primary objectives are to:
- Home-health technologies;
- Post-diagnostic interventions;
- Product innovation for regional enterprise;
- Influence public health policy.
In Northern Ireland, Professors Chris Nugent and Jim McLaughlin of the University of Ulster (UU) are working on remote monitoring systems, sensor development, and mobile communication technology for healthcare applications. September 2010 sees the Computers in Cardiology conference coming to Belfast and an opportunity to focus on Ireland as a centre for connected health R&D. Topics at the conference include home monitoring, computerised ECG, medical informatics, and mobile coronary care. Professor Nugent's group is also completing a test bed facility at UU, which will be available to academics and companies to investigate their concepts within a simulated environment.
The Technology Research for Independent Living (TRIL) programme has seen Intel's Digital Health Group supporting local R&D. This is a collaborative effort, with Intel, IDA, UCD, NUIG and TCD bringing resources and attention to the field of social connection, cognitive function and falls prevention research. It has yielded BioMobius, an open-source hardware, sensors, software, services and a graphical development environment research platform for new product development, and ShimmerTM (Sensing Health with Intelligence, Modularity, Mobility and Experimental Reusability). Shimmer helps researchers reduce the time spent developing core foundation technologies, allowing them time to focus on their own specific research. As it is highly reconfigurable, Shimmer can also be repurposed for various sensing tasks so it saves the researchers money as well as time (www.shimmer-research.com). It was licensed in 2008 to an Irish SME, Real-Time Technologies, who manufacture, and distribute the product. Kieran Daly, business development director at Shimmer says, "We currently have customers in 26 countries, which equates to a couple of thousand shimmers. The bulk of our customers are in the US/EU."
NI and connected health
Northern Ireland, and especially InvestNI, has taken an active role in connected health investment. As a representative of the life science sector BioBusinessNI (www.biobusinessni.org) has been working on a number of projects in this area. A number of innovative Northern Ireland companies including Axellis, Marturion, Intelesens, Randox, Almac and Heartsine have been developing connected health products. One project sees the engagement of clinicians and HSC Innovations with companies as they seek to network together to create collaborative projects to meet clinical needs in respiratory, cardiac and vital signs-based monitoring systems. The major success of the BiobusinessNI ABC (Academic, Business and Clinicians) collaborations project was the development of McElwaine SMART's telemonitoring centre in Lisnaskea, Fermanagh and their joint venture with Bosch. BioBusiness is planning to do another project aiming to replicate some of the successes, but on an all-island basis.
In parallel, the European Centre for Connected Health, Northern Ireland's investment in a large scale roll-out of a telemonitoring system, has been ongoing. Telemonitoring is a clinical practice that involves remotely monitoring patients who are not at the same location as the healthcare provider. In general, a patient will have a number of monitoring devices at home, and these devices will transmit information on people's vital signs via telephone or wirelessly to the remote monitoring service provider and, if necessary, to their healthcare provider. The focus has been on supporting patients/clients with complex long-term conditions such as Cardiovascular Disease (CVD), Chronic Obstructive Pulmonary Disorder (COPD) and Diabetes. The successful applicant will be announced later this year. The service provider will collect, process, analyse, and then transmit or otherwise make available relevant data to designated points of contact. This could include triggering alerts, provision of a triage and education/health promotion. The volume of patients/clients is set to increase incrementally to at least 5,000 in 2011.
As a spin-out from the centre, the European Connected Health Campus was set up. The aim was to capitalise on the back of the international interest shown during the procurement programme ongoing at the centre. The aim was to attract those parties to Belfast as a centre for connected health research and to provide thought leadership in the area of governance, engagement, procurement and implementation of connected health projects, which yielded a manifesto for connected health. (www.echcampus.com/summit09/Manifesto%20for%20Connected%20Health.pdf)
Each connected health project has varying degrees of complexity but always with the aim of making a process more robust, reliable, more cost-effective, and ultimately beneficial to the patient and the care-giver. This can be in the simple connectivity provided for social inclusion by the likes of "friendly call services" through to the development of connecting ambulances to hospitals, and electronic health records by Slainte Technologies, Bodytab, HRI and Valentia Technologies or telemonitoring/telecare (McElwaine SMART, Fold telecare, Emergency Call Services etc). Due to many constraints, the acceptance by the HSE of an overall connected health solution is not forthcoming. In the republic, individual care centres and hospitals are developing their own solutions, e.g. GPIT (National General Practice Information Technology Group) which is supporting the roll-out of ICT infrastructure for GPs who work with solution providers. This includes using mobile phone and text for patient appointments, transmission of laboratory results etc. G-Pace/HRI is providing a web-based database for patients with cardiac implants.
There are a number of SMEs and MNCs who have their focus on the ageing well population and the management of chronic disorders. Intel has shown leadership within the MNCs with engagement of its digital health group out of the Leixlip site. Intel's digital health group has been involved across the island in connected health initiatives. IBM's innovation group at Mulhuddart has also been active in this space and is actively looking for healthcare applications to use its cloud computing capability. SMEs and high potential start-ups are providing products directly into this space as well as support services to the industry. Recently established local companies such as Shimmer, Valentia, S3 Silicon & Software Systems Group, Slainte Technologies, Heartsine, Intelesens, Randox, Almac and Vitalograph have growing local and international sales while high potential start-ups such as Axellis, G-Pace, Garivo, Bodytab, Clearway Medical, Automation Intellect, and Biancamed are developing niche products. In the supporting wings are organisations such as WISEN, Accendo, Benetel, Centre for Design Innovation, BDI, NCSR, NIBEC Bluebridge Technologies and Marturion offering capability in some of the following areas:
- Medical sensors
- Wireless networks
- Signal pattern recognition
- System integration
Where to next?
Working with key players, Enterprise Ireland and other agencies are also aiming to support this emerging sector. An advisory group was engaged in September 2009. This support may include a Competence Centre Programme, which will provide more than €30m over the coming five years to deliver industry-defined research programmes in emerging areas of strategic importance. (www.enterprise-ireland.com)
With the creation of the infrastructure north and south of the border, the potential for competence centres, the focus on ambient assisted living, multinational and SME activities, research programmes, the potential for cross border collaborative efforts through InterTradeIreland, BioBusiness networking projects, InvestNI, Enterprise Ireland and IDA's interest in the whole area, there has never been a better time for Ireland to join together and create an expertise across the country . The only thing remaining is to show local roll-out of the solutions created and demonstrate clinical relevance and success.
Dr Declan Bogan is project manager for Medical Devices and Connected Health, a collaborative network project funded by InvestNI. He has over 12 years experience within the life science sector covering a diverse set of roles within many organisations in manufacturing, R&D, commercialisation and quality. For more information or informal discussions contact Dr Declan Bogan, Declan@biobusinessni.org