Imagine being at a hospital a few decades back. There is an emergency at the door-step. Doctors and nurses are stepping in to attend to the situation. Counsellors are trying to calm people down associated with the affected patient. Constant real-time monitoring of the status was something that was manually done by experts. Randomness and confusion prevailed.
Enter today; the term real-time monitoring is very much possible, thanks to technology. It is the evolutionary advantage that gives us the edge to achieve more with the invisible fabric of connectivity that envelops us—the Internet. If you thought the Internet was an information bank, its brainchild—the Internet of Things (IoT) is another form of it, sweeping off information from things and helping us learn what we are and what we could do with data.
India has seven doctors for every 10,000 people, and data from Indian Medical Association shows that the country needs more than 50,000 critical care specialists. This implies that smartconcepts need to be introduced to save the situation and fill the void.
“Problem of non-availability of quality care for critical patients in rural areas prompted us to design ICU Connect and NICU Connect solutions. During our innovation process, we collaborated with a world-leading neonatal equipment manufacturing company to start building solutions for intensive care units (ICUs), neonatal ICUs (NICUs) and neonatal care centres,” says Rajendra Kurady, co-founder and managing director, RTWO Healthcare Solutions.
Analytics in healthcare is at the forefront of providing a way of predicting life-threatening diseases. Millions of India’s poor patients wait for days to gain admission to public hospitals. It is thus imaginable that potential for connected healthcare solutions, where people need not wait for their turns, are immense.
Reinventing the invented
Innovation is a merger of ideas and thoughts to improve existing technology and making it way better than it is. Monitoring health vitals in real time may be at its infancy today, but it is about to go light years ahead as we speak. The innovation we are talking about here revolves around uberistaion of medical device data.
The product connects the vital stats of humans that require intensive care to healthcare providers via servers, enabling monitoring of the patients in real time. Unlike traditional systems that merely focus on data acquisition, monitoring and reporting, this product can use predictive analytics to identify an issue proactively. It uses algorithms built into the device to give preventive alerts before the patient goes into crisis. Moreover, it has a small electronics board with an HL7 conversion kit to ease the documentation process.
“We have one among the highest mortality rates for any country in the world. About 70 per cent of infant deaths and more than half of under-five child deaths occur in the neonatal period. Manual data-capturing errors in ICUs and NICUs are not sufficient to enable accurate diagnosis and treatment due to the rapid changes in the condition of critical patients. This leads to deaths in critical care units (CCUs) or NICUs,” says Kuradi.
At the heart of this innovation are crisis-prediction algorithms. These are built based on variation of some key vital health parameters like heart rate, temperature, respiratory rate and oxygen saturation to predict diseases like sepsis, RDS and asphyxia for neonates or adults. These parameters are captured from multipurpose bedside devices like baby warmers and ventilators. For example, when hypothermia or hyperthermia strikes a patient, there is a greater risk of getting sepsis as the patient panics while the heart rate elevates.
Trending indicators that monitor these heart rate variations indicate the progress while the system takes help of algorithms and smartly switches itself to the next level of monitoring and observes additional parameters like oxygen saturation in the body. Unlike traditional systems, these trends are based on clinical protocols designed by expert neonatologists, which are out for comparison by the prediction engine.
The solution also aims to solve the key pain points by potentially predicting life-threatening infections based on the variation in vital parameters. Remote consultation specialists now have access to a multitude of information and complete profile of the patient, while making it convenient to diagnose and delivering the right care at the right time.
With the IoT, constrains of distance, time, better predictability and manual intervention disappear. This online saviour or connected ICUs leverage Cloud, intelligent algorithms, prediction engines and medical monitoring devices present near the patient to gather vital data, while replacing a designated person providing personalised care.
Connecting these care units
Breaking the barriers of non-connectivity, ICU Connect and NICU Connect systems leverage the power of real-time monitoring of vital health parameters, leveraging Wi-Fi, LAN and mobile networks.
Real-time or historical vital stats could be viewed at the nursing station, physician’s office, central monitoring station or from any distance using a smartphone application.
Additionally, the system can be used to program customised alerts with respective health parameters and conditions that flag up in case of deviations from set benchmark levels. Real-time notifications are sent to the concerned neonatologists and intensivists anywhere in the world. This could prevent neonates or very sick people going into crisis mode.
Cloud connectivity
ICU Connect platform is built on open source technologies to control the cost of solutions. This Cloud based solution needs minimum infrastructure at minimum cost of deployment. ICU Connect and NICU Connect solutions come with three main sub-systems that include both hardware and software components.
Aggregator connectivity hub. This hardware hub has multi ports, which connect to multiple devices. Data streams into the Cloud or an external device with the help of Wi-Fi or LAN. Connectivity hub also has data buffering capabilities to store required minimum data before sending it to the Cloud.
ICU Connect and NICU Connect servers. Data aggregation from different devices is implemented in this stage. Data-listening mechanism, device driver implementation, HL7 conversion and data-publishing mechanism help accumulate and process data. Algorithms for trending critical diseases are the key components of the application.
ICU Connect and NICU Connect client applications. System components at this stage include real-time data broadcaster and message subscriber. Web socket protocols are implemented for effective browser based readings on the computer, tablet or smartphone. At the client end, reporting systems include plotting and charting mechanisms to assist with trends and patterns that again need expert eyes for evaluation.
Similarities and differences
Most competitor applications are integrated applications for electronic medical records or hospital information systems that require expensive IT infrastructure, making it a costly affair for its beneficiaries. “The only solution was to use open source software and indigenous connectivity engines with inbuilt HL7 conversion engines,” says Kurady.
HL7 message helps manage medical records by transmitting new or updated documents, or by transmitting important status information and/or updates for the record. Real-time monitoring through analytics, prediction engines combined with HL7 conversions could be viewed and analysed using any smartdevice. Customised alerts could be set to capture the attention of the expert or doctor and can be set by the expert himself.
Crisis prediction becomes achievable by leveraging data from every component available on the bedside of the patient such as patient monitor, ventilator, warmers and even syringe pumps. This implies that vital information could be extracted from these systems as well.
The future of critical healthcare
As vital health data starts pouring in from the machines through wireless or wired media to the aggregator device, the analytics platform powered by prediction algorithm kicks in to create trends and real-time charts for reporting.
Statics and readings could be logged in anywhere from a stationary or a moving infrastructure, which is an add-on. This approves the fact that NICU Connect and ICU Connect can be installed and connected anywhere in a cost-effective manner, fulfilling a healthy offering for a critically-ill patient.
“In essence, we are offering uberisation of medical device data, connecting the doctor to the critical patient’s data via universal critical care real-time remote monitoring system with customisable alerts and predictive algorithms, enabling healthcare delivery beyond boundaries,” says Dr Prasanna Ganapa, co-founder and head of strategy, RTWO Healthcare Solutions.
In a never-concluding note, Cloud based healthcare is truly catching up and essentially will leverage all computing power that there is using the IoT. ICU Connect platform is on constant upgradation with respect to clinical features, aggregator models and healthcare analytics.
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Shanosh Kumar is technology journalist at EFY. He is BCA from Bangalore University and MBA from Christ University, Bengaluru
