To Err Is Human: Building a Safer Healthcare System
To Err Is Human: Building a Safer Healthcare System
  • bruce
  • 승인 2009.12.07 10:39
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Dr. Kim Yang-sig, director of Mobicomm Inc. %26 KW U-Globe Corp.

The world is becoming more and more health-conscious. Society, health policy and patient needs are all changing dramatically. The challenges society is currently facing are related to the increase in the aging population, changes in lifestyle, the need for healthcare cost containment and the need for improvement and monitoring of health-care quality.

Today's progress in science and technology offers miniaturization, speed, intelligence, sophistication and new materials at lower cost. In this new landscape, micro-technologies, information technologies and telecommunications are key factors. Telemedicine has also evolved into u-Healthcare. It has been used initially to exchange patient files, radiographic data and other information between healthcare providers.  This usage has contributed to new trends in hospital extensions through all-day monitoring of vital signs, professional activities, entertainment and home-based activities.

The paradigm shift in the healthcare sector resulted from several driving forces for change.  These driving forces are a mandatory search for cost containment, changing demographics, decentralization of healthcare delivery, changing disease patterns, impact of information and communication technology including IT support for clinical decisions, more informed and demanding patients, the well-being factor, the responsibility shift for healthcare into the patient's hand, and knowledge management.

The new possibilities for home-care and ambulatory monitoring are provided at 4 levels.  Micro-technologies offer the possibility of small size, but also of intelligent, active devices, working with low energy, wireless and non-invasive or minimally-invasive techniques.  Wearable devices are particularly user friendly and combine sensors, circuits, supply, display and wireless transmission in a single box, which is very convenient for common physical activities. Healthcare smart clothes make contact with 90% of the skin and offer many possibilities for the location of sensors. These sensors have to be thin, flexible and compatible with textiles, or made using textile technologies, such as new fibers with specific mechanical, electrical and optical properties.  Healthcare smart homes are designed to improve the patient's living conditions and to avoid the cost of long hospitalization.  Exo-sensors are used for measurement of the activity and behavior of the patient. The field of applications is very large.  For example, it could be used for continuous monitoring of elderly populations, professional and military activities, athlete performance and conditions, and people with disabilities.

The emphasis is put on prevention rather than on treatment. In other words, the focus of the future healthcare services will be more on prevention rather than cure.  This may happen with the widespread use of vital sign monitoring of several user groups. For instance, monitoring patients with chronic disease and elderly people.  This new healthcare approach has to take into account a lifestyle for improving prevention. In this context, patients and healthcare consumers are waiting for noninvasive or minimally-invasive diagnosis and treatment methods for home-care, short stays in a hospital, enhancement of rehabilitation, information and involvement in their own treatment.

For the patient to be more and more involved in his or her own therapy, new responsibilities and ethics have to be defined. A societal healthcare education has to be provided to physicians and to patients to get all the benefits of this new context. Therefore, the integration of monitoring capability into ubiquitous healthcare devices and systems seems to be one of the most promising user-friendly and affordable solutions. In fact, u-Healthcare describes the application of information and communications technologies across a whole range of functions that affect health. It is the means to deliver responsive healthcare tailored to the needs of the public.

Today, we have now reached the point where the devices, systems and services like the Hygeian Ultimate Service for u-Healthcare have a real maturity and a real place in the healthcare market. As the penetration of mobile smart phones and the use of wireless networks increase, a critical mass of users, general practitioners, and patients are being created for the provision of u-healthcare services. Advances in telecommunication and miniaturization technologies support both professional-to-professional high-bandwidth telemedicine operations and low bandwidth personal applications, enabling the individual to take greater responsibility in self health-management. In addition, progress in science and technology offers many new possibilities and solutions that bring intelligence, speed, miniaturization, sophistication and new materials at lower cost. And the new possibilities for home-care and ambulatory monitoring are provided through several technological platforms such as micro-sensors, wearable devices, smart devices and smart homes.

U-healthcare service markets have opened in many different sectors.  These include personal sensor technology for integration into fixed and mobile consumer electronic products, communications infrastructure for disease prevention and health maintenance, centralized diagnostic services, evidence-based medicine and drug databases. The current trends in healthcare and well-being lead to the development of a new market of personal healthcare that can be defined as products and services to improve the health status and the personal performance outside institutional points-of-care.

Products for critical life situations are offered, from dedicated technical solutions for disease management through medical call centers, to home rehabilitation programs and fitness optimization. The future outlook for Ubiquitous Computing, Smart Fabrics and Interactive Textiles for biophysical monitoring and position location applications is extremely strong.

Entire areas of traditional healthcare depend on informatics. Hospital laboratories are heavily computerized with many analyses, especially in biochemistry and hematology, being fully automated. Modern imaging techniques depend on informatics. The prescription of medications without computer assistance is a source of significant error and excess cost. Computer-aided diagnosis, which began more than 40 years ago, is now recognized as indispensable in rare diseases and in the day-to-day quality of care. And Electronic Health Records (EHR) are fundamental building blocks of all of these applications. The EHR allows the sharing of medical records between healthcare providers across disciplines, institutions and geographic boundaries.

On the basis of above-mentioned e-Healthcare System, u-Healthcare will be a large scale multi-disciplined area which corresponds to a broad field of applications spanning from clinical applications, (e.g. u-Consultation, clinical decision support, vital signs monitoring, u-Homecare, ambulatory u-Healthcare, and u-Prescribing) to personalized healthcare professional continuing education and u-Prevention through longitudinal healthcare event recording and lifetime health care records. U-Healthcare must be human-centered and requirement-driven.

"To Err Is Human: Building a Safer Healthcare System" concludes that a Ubiquitous Computing Healthcare System could pay for itself in the near future while preventing injury to hundreds of patients.

However, validations on the devices and systems, compliance with regulations, property rights, the still high cost of technology and market opportunity assessment, slow down the commercialization process and reduce the chances for sustainable business cases. Several business models and reimbursement schemes are under consideration from manufactures and service providers, but also from national authorities and health insurances. Not to mention, of course, the education, the user acceptance, the ethical and social issues (e.g. resistance to new technologies) implied by the use of such systems.

The success of personal healthcare and lifestyle management systems and services, or u-Healthcare Services, possibly the next mass market after communication, will depend strongly on the positive positioning of the consumers.

By Kim's Internal Medicine, M.D. Kim Yang-sig, director of Mobicomm Inc. & KW U-Globe Corp.

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