The article reviewed here is a South Korean paper on ‘Ubiquitous Healthcare Service Using Zigbee and Mobile Phone for Elderly Patients’ by Hak Jong Lee and colleagues. In the introduction the authors discuss the ever more pervasive nature of technology. While noting the focus on hospital information systems, they note the possibility of using technologies to allow communication between the hospital and patients outside of the hospital. They note that a new wireless internet protocol Zigbee has been developed which offers a number of advantages including low power consumption. Such technology is being increasingly used in consumer electronics and the researchers were interested to see how this might be applied in healthcare. They therefore looked at a specific population – older adults – and wanted to see if they could monitor glucose levels and ECG’s in the community.
The study was a small prospective study (n=29) carried out in 2005. I found it slightly amusing that the 6-page article had been initially received in June 2006 and that the revised version was received in July 2008 when it was accepted. However delays between submission and publication in journals can be due to the logistics involved. I wasn’t clear on how sample selection was achieved and this will have a bearing on the results as successful use of the technology requires that the subject is able to use several technologies effectively. 9 subjects in the study received an ECG vest which they wore and which took readings every hour. If they were symptomatic (e.g. with palpitations) they would press a button to initiate a data capture. 20 of the subjects used a glucometer – to measure blood glucose levels. The subjects were trained in the necessary skills to ensure that the data was transmitted from the equipment to the web using a web-based program. A nurse contacted patients once weekly to administer a questionnaire regarding ‘convenience and satisfaction’. The details of the questionnaire were not included in the paper, nor were details regarding the validity and reliability of this instrument. Technical data regarding the equipment such as error rates were also identified.
With regards to the glucometer readings, the researchers found that information loss between the glucometer and the web-based service occurred in 22% of recordings and that this occurred at several points along the pathway including the mobile phone and a defect of the glucometer. A problem noticed by the participants was a large difference between the new wireless enabled glucometer and readings on the previous glucometer causing several subjects to withdrawal. However overall satisfaction was rated as 8.5/10 by the subjects (which most probably represents the intuitive meaning of scoring out of 10 which is commonly used outside of the research field). In terms of the ECG monitoring, some of the subjects withdrew from this part of the study due to a
‘fear of transmission of electromagnetic waves, skin eruption at the place where the ECG line and electrode were attached to the body and troublesome problems of attaching ECG‘
Interestingly only 57.9% of the transmitted data from the ECG was considered useful. The mean satisfaction score for the ECG sensor was 5.79. Discomfort occurred as a result of the ECG being attached to the body for 24-hour periods. As there was frequent transmission of data, the battery life of the mobile phones was also an issue.
In conclusion, this was a proof of principle. The technology itself proved effective here but it must be remembered that the technology does not occur in isolation but instead must operate within the wider healthcare environment. This in turn is dependent upon cultural factors, budgets, infrastructure and an appropriate evidence-base for the relevant healthcare service. Many technologies that achieve the chosen objectives and fulfill a useful function do not pass on into the mainstream as these barriers must be overcome. The researchers note that the emphasis in this study was on the technical aspects of the technology rather than the clinical utility. The rate at which data loss occurred as well as the need for participants to use several pieces of technology and the relatively small sample size means that further studies should examine the clinical utility in more detail. Glucose and ECG monitoring are potentially useful in various services and if a successful technology is achievable then it offers an opportunity for leveraging healthcare resources. Other types of monitoring device have the potential to be utilised using the same wireless protocols although this is already occurring using a variety of other technologies also. This study illustrates some of the difficulties that a technological solution to a healthcare problem needs to overcome in order to be of clinical utility. If such barriers are consistently overcome then this would enable new services to be developed and may impact on outcome measures in services.
Lee H J, Lee S H, Ha K-S, Jang H C, Chung W-Y, Kim J Y, Change Y-S and Yoo D H. Ubiquitous healthcare service using Zigbee and mobile phone for elderly patients. International Journal of Medical Informatics. 78. 2009. 193-198.
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