May 2009

Wearable Medical Devices Electronic solutions for the flatter world : Dr. Sreekanth S. Raghavan, Director, Paediatric Cardiology,Manipal Hospital, Bangalore

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Technology is becoming a critical factor in monitoring patients with speed and accuracy.


In our quest for a superior quality of living, wearable medical devices have enabled us to better care for our diseased and non diseased senior members of our society. Medical technology has advanced exponentially in the last decade, partly due to embedded chip technology with faster processing capabilities. The cost of health care has spiralled to uncontrollable levels that even the developed socialistic countries are finding it difficult to care for their aging and diseased population.

The need for a WeMed product stems out of a longer life expectancy, better management options for chronic disease, the time constraints involved due to frequent monitoring and health care visits apart from the prohibitive hospital visit costs.

In a general scheme, medical devices are either implantable, wearable or non contact. Autonomous devices that are worn by a person and provide medical monitoring or support over a prolonged period of time qualify as wearable medical devices.

The desirable characteristics for a WeMed would be that it is small, light, unobtrusive, and designed for operation by unskilled users. It should also provide real-time feedback, alerting mechanisms, medical decision support, and wireless access to information.

Technological advances have definitely provided the ecosystem for better health support and monitoring systems. However, adapting them to a wearable realm is the key.  High density packaging, micro electronics miniaturization, powerful signal processing and compact communication capabilities have widened the application horizon. Indeed none of these would work without power and hence availability of low power consuming chips and better battery life has provided high reliability to these systems. The current expectations or guidance is at least a 4 year field life for the batteries.

Of course, one of the major concerns is the biocompatibility issues when more than one WeMed is utilized in a patient. The sensor technology has to provide not only reliable sensing of the required parameters but also accommodate, without interfering with other medical devices. So, one challenge when different devices are made and used for patient monitoring is to be able to seamlessly amalgamate the data obtained from the devices, and to collate and present to the physician in the most lucid way possible.

On the services front, it should be robust in delivering point-of-care service. It must facilitate unconfined medical monitoring and support, and assist in remote management of medical conditions. It has high value in rehabilitating patients, the chronically ill, and the disabled by monitoring their health parameters, and can also assist in their daily functioning. It plays an important role in emergency management by alerting and activating the appropriate health care sequences. A smarter version of the future would be able to suggest automatic stabilizing solutions during emergencies.

At least in the current scenario, it has a major role in chronic disease management involving the heart, brain, the kidneys and diseases that produce physical limitations. One interesting study published in the journal Lancet, looked at patients who were on a wearable hemodialysis device for chronic renal failure (1). There were 8 patients who did not have any major adverse reactions, but interestingly all of them confirmed that they would recommend it to other patients on chronic hemodialysis. This study reiterates the value of WeMeds in managing chronic disease conditions that dampen a good quality of life. Some of the recent efforts in cardiac disease management by monitoring heart rates and identifying abnormal heart rhythms have helped in preventing major cardiac events and in cardiac rehabilitation. Some of the R&D has focused into other potential areas such as Diabetes and patients on Insulin therapy, Stroke, Dementia and disorders with physical limitations.

The value of WeMeds in any home health and nursing care patients cannot be over emphasized. It provides the much needed flexibility and accessibility for the elderly. Also, its utility in life style management situations is copious. They can guide and assist in weight management and also maintaining the necessary regimen for better performance in healthy individuals.

Some of the recent efforts in cardiac disease management by monitoring heart rates and identifying abnormal heart rhythms have helped in preventing major cardiac events and in cardiac rehabilitation.

Gone are the days when patients have to spend enormous time travelling apart from wasting their limited resources in accessing good health care. It is well within our era that advanced technology and communications are being leveraged to better the health care in remote and inaccessible areas. The typical scenario would be connecting WeMeds with telemedicine consoles to transfer medical data to the expert physicians in urban centers of excellence. Some of the existing GPS, data processing and digital image compression technologies have brought these capabilities within our reach even in our lifetime.

With the economics of health care being the major driving force behind WeMed products, the bumptious older versions are giving way to more smarter, intuitive and sophisticated versions, forcing physicians to get comfortable with advanced communication systems, apart from the mundane medical diagnostic and therapeutic advancements. Indeed, the medical world is getting flatter. However, the ultimate success of a medical device is not in its technology but in its utility

Ref:1.The Lancet; Dec 15, 2007; 370, pg 2005″

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