By Neil Versel
While many in mobile health look at ways to get personal monitoring devices into the home to help manage diseases, several figures with deep backgrounds in trauma care are trying to commercialize a system to prevent death from heart attacks and stroke.
Central to this effort is Roger Lee Heath, an inventor and entrepreneur who holds dozens of patents including for the technology that enabled the automatic external defibrillator. Widely known in emergency medicine but a relative newcomer to health IT, Heath now heads a Tempe, Ariz.-based company called LifeBot that could be on the verge of bringing advanced telemedicine mainstream.
In November, LifeBot signed an option to commercialize the Disaster Relief and Emergency Medical Services (DREAMS), a $35 million ambulance-based telemedicine and disaster-management system. DREAMS, developed by the University of Texas Health Science Center at Houston and Texas A&M University in conjunction with the U.S. Army's Telemedicine and Advanced Technology Research Center (TATRC) and the U.S. Army Materiel Command, powers what's being touted as a "Super Ambulance." The system, now in use in a handful of rural Texas counties, provides live transmissions of multiple remote-controlled cameras, telemetry data and patient records between ambulances and hospital emergency departments and trauma centers.
Principal Investigator Dr. S. Ward Casscells, a former assistant secretary of defense for health affairs, led the DREAMS project and won several awards for his work. Trauma surgeon Dr. James H. “Red” Duke Jr., who treated Texas Gov. John Connally after the shooting that killed John F. Kennedy, created the Super Ambulance and tested DREAMS on Memorial Hermann Life Flight air ambulances. He used the system to remotely triage patients affected by Hurricanes Katrina and Rita in 2005.
“People have known about it for years, but it’s never been commercialized,” Heath says.
LifeBot plans on combining DREAMS system with other technology, including Odyssey clinical decision support software for teletriage, developed by Plain Healthcare and in wide use in the UK. LifeBot has secured a U.S. distribution licenses for Odyssey. “It actually distills down differential diagnoses,” Heath says.
Triage software helps cut down on 911 abuse and may prevent emergency systems from overloading during mass-casualty events, according to Heath. He says teletriage reduces ambulance transport volume by 20 percent to 60 percent, saving as much as $2,000 per unnecessary transport.
According to Heath, Odyssey, which is common in telehealth services but not emergency care, has saved the East Midlands region in England $11 million in the last seven years, and Philadelphia officials expect to cut operating costs by $2.5 million a year by deploying the teletriage software.
Heath says the system, which costs $50,000 per ambulance, is the first to use the full audiovisual capabilities of a new version of an emergency communications protocol. Digital VoIP technology in the DREAMS workstation integrates radio, video and telephone communications in a single device, transmitting vital signs from the ambulance while maintaining a live link to medical expertise at a trauma center.
Emergency medical technicians generally chart observations in a patient care report, often using an electronic form called an ePCR. “That’s not the way teletriage is oriented,” Heath says. “It’s much more clinically intense.” According to Heath, “Teletriage is the only safe way to do it because it references all the data,” including information from portable ECG and ultrasound equipment.
“My plan is to have this flow from the ambulance to the triage to the hospital,” Heath says.
In a Super Ambulance, paramedics wear cameras on their head and carry the LifeBot system on 1.5-pound HP slate computers. The touch screen allows remote physicians to draw “play-by-play” on the screen to help the EMT provide better care. Other cameras mounted in the ambulance can be controlled by physicians in the trauma center. “Backpack telemedicine is being tested,” Heath adds.
A barcode scanner in the ambulance can read a patient’s driver’s license to bring up demographic information so the ED can see if any records are on file. “DREAMS is the first and only system than sends all the data,” Heath says. “It’s a complete patient charting system, and it’s all live.”
One of the Army’s interests in DREAMS was in developing bioterrorism identification and response. Heath has a proposal to an undisclosed major city to provide nurse teletriage services in case of a pandemic. “You’re developing a database to see where there are symptoms,” he says. “It’s another reason why you need to do nurse teletriage.”
LifeBot also has been asked to commercialize teletriage for prisons in at least one state, which can save money for cash-strapped correctional systems while eliminating the need to transfer incarcerated criminals.
Another component of LifeBot, which Heath recently received a U.S. patent for, is a home unit called a “personalized survival system.” Armed with monitors, videoconferencing software and even defibrillation paddles, the device helps treat patients at high risk of heart attack or stroke—often heart patients recently discharged from the hospital—until help arrives. “You can send a patient home with a unit that will keep them alive,” says Heath, who may have the system ready to demonstrate at the HIMSS conference next month.
It’s a step beyond remote monitoring, which, according to Heath, has no plan for emergencies. “People were so focused on the AED that they forgot to make the call,” Heath says.
Heath has had help on the robotic home product from longtime robot designer Tony Dyson, who is best known for building a little droid named R2D2 in the 1970s. Dyson’s interest is in the consumer product, which can initiate 911 automatically using VoIP technology if it detects fibrillation.
“There’s no comparison to anything on the planet like DREAMS,” Heath says.