New Medical Monitoring - various sources Dec 2000

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New Medical Monitoring added 12/20/00

'This Is the Future of Medicine' Business Week Dec 11, 2000
Blazing trails on a vast frontier called electronic care management

Vivometrics, a Southern California startup, wants to put a shirt on your back. But the company's lightweight, stretchy garment is not your average muscle-T. Embedded in the fabric are four black bands equipped with electrodes and physiological sensors designed to record more than 40 vital signs, including fluid in the heart, breathing rate, and oxygen consumption.

The gigabytes of data stream from the sensors to a handheld computer discreetly located in a hip pocket of the shirt. Standard issue, one supposes, for Captain Kirk and the rest of the Enterprise crew. But Vivometrics says you will be able to order its Life Shirt within a year or two.

Vivometrics is blazing trails on a potentially vast frontier of e-health known as electronic care management. The first examples were fairly crude devices such as smart bathroom scales that could help heart failure patients keep accurate records of their weight. But like everything in the world of silicon, fiber optics, and radio communications, patient-care devices have shrunk in size, soared in IQ, diversified in application, and become so cheap that the most parsimonious HMO will soon consider them a bargain. As a result, gadget makers are zeroing in on a wide range of diseases, monitoring the blood sugar of diabetics, the EKGs of heart-attack survivors, and the breathing rates of asthmatics. ''This is the future of medicine,'' says William W. George, chief executive of Medtronic Inc.

Ultimately, electronic care will save money and lives. The Institute for the Future reckons that some 120 million Americans, about 40% of the total population, will be living with a chronic disease by 2010. These patients will incur $600 billion in medical costs that year--a 16% increase from today. But Net-capable devices could help curb that escalation. Cost-effective ''virtual office'' exams could ease the burden on beleaguered hospitals, while improving the quality of care.

More than 50 companies are competing in the business of keeping patients out of the hospital. They are startups with names like Alere Medical, LifeMasters, and Health Hero Network. Old Economy players such as CorSolutions and Accordant Health Services Inc. also have jumped in with Web versions of their traditional telephone-based medical services. Meanwhile, both Medtronic, the Minneapolis device maker, and Agilent Technologies Inc. , the semiconductor spin-off of Hewlett-Packard Co. are developing their own Internet-ready monitors.

Patients like Bryan Bellanger can attest to the benefits of remote care. Suffering from heart failure, the 49-year-old from Louisiana must keep a close eye on his weight. Even a couple of extra pounds can add so much strain that he becomes short of breath and dizzy. So when his weight skyrocketed last March, his doctor asked him to step on Alere's high-tech scale. Now, when Bellanger checks his weight every morning and evening, the readings are instantly transmitted via a modem to a computer server at Alere's headquarters in San Francisco, where a team of company nurses keeps an eye on him. The remote monitoring makes him try harder--and indeed, since he began using the scale, Bellanger has dropped 60 pounds and hasn't experienced any more problems with his heart.

For greater interactivity, Alere and Health Hero Network of Mountain View, Calif., have designed simple Internet appliances that monitor the symptoms of heart failure patients. Health Hero's gadget, called the Health Buddy, is a toaster-size appliance with a video screen and several half-dollar-size teal buttons. Every day, when a patient turns on her ''buddy,'' questions about her condition zip over the Net to the video screen. A few clicks of the teal buttons, and the patient sends her answers back to the nurse who is monitoring her remotely.

Implantable devices such as Medtronic's Chronicle may also play a role in electronic care. In collaboration with Microsoft Corp. and IBM, Medtronic plans to spend more than $200 million to develop an implantable heart monitor that will automatically beam its recordings to a patient's doctor wirelessly. The first prototype appeared in 1999, and a commercial device could be on the market in several years.

More good news for e-care businesses: Patients seem to recuperate more quickly when they know that a nurse or doctor is aware of their conditions around the clock. Based on this insight, a Baltimore startup called VisICU is targeting intensive-care units at community hospitals. Typically, such units are staffed at night by nurses, not physicians. But recent studies have shown that ICUs can cut mortality rates by 55% simply by having a doctor on the site 24 hours a day. So VisICU developed a system for wiring hospital ICUs so that an off-site doctor can monitor patients in real time--and in an emergency, run a videoconference with the attending nurse. The company already is monitoring 36 ICU beds in two Virginia hospitals and hopes to expand to 175 beds in five hospitals in the next year.

Managed-care executives are responding to these remote monitoring systems because they can reduce medical costs. Accordant, based in Greensboro, N.C., has signed up Humana, Oxford Health Plans, and Blue Cross/Blue Shield of Colorado as clients by showing that its program can reduce yearly claims costs by about 20%. As medical expenses rise and doctor's visits continue to shrink, services like those provided by LifeMasters, Accordant, and Vivometrics will only become more valuable. Someday, a life shirt a day may keep the doctor away.

By ELLEN LICKING http://www.businessweek.com/2000/00_50/b3711081.htm

Vital signs monitor	Agilent	Wireless device to take daily measurements of blood pressure and heart rhythm, and zap the information over the Net to the doctor
Alere scale	Alere Medical	When this scale spots an irregularity, such as weight increase indicating fluid retention, it sends a message to a computer manned by nurses
Health Buddy	Health Hero Network	This toaster-sized device uploads daily information about a patient's illness, such as spikes in blood sugar, to the physician's PC
Life Shirt	Vivometrics	This shirt comes with enough sensors to track 40 bodily measurements 24 hours a day. A handheld device can download the data over the Web
Chronicle pacemaker	Medtronic	This device will automatically communicate with doctors via the Net if the heart develops an abnormal rhythm

- - - - - A short article on Vivometrics from Red Herring 12/15/00 - - - - - - - - - -

Wearing your heart on your sleeve

Vivometrics makes an incredibly cool product, the Lifeshirt. But as Dr. Mark Mitchnick, a company director, was telling me, Vivometrics is not really a device company.

The Lifeshirt is the hardware end of Vivometrics's business model, which is to collect medical data (telemetry) from ambulatory people, and then work with other companies, like Enmed and Phase 4, to get the data collated and sold.

A non-bulky vest worn under clothes, the Lifeshirt collects continuous cardiac and respiratory data; it also has sensors to determine if the wearer is upright or reclined. Data are collected by a belt-worn Handspring Visor and then sent to an online service in batches.

Contrary to my expectation, the primary and most lucrative market for this service is not medicine. Instead, Vivometrics's first target customers are the pharmaceutical companies running drug trials. The Vivometrics service will improve the accuracy and, more important, the speed with which data are collected. Time-to-market directly affects profitability for big pharma.

Medicine is, however, a secondary market for Vivometrics. Consumer health (exercise equipment, for example) is a distant third. Vivometrics is funded to the tune of $10.5 million, primarily by Credit Suisse First Boston, and is currently raising a B round.

Additional information

Vivometrics http://vivometrics.com spiffy shockwave/flash animation

http://www.nexan.com/ - - - - - - - - - - - -

Features and benefits of the Nexan System:

•	Wireless sensor technology, allowing freedom of movement
•	Sensors are designed to be simple enough for patients to apply unaided
•	Sensors can be worn over several consecutive days
•	Comfortable to wear, especially important for monitoring during sleep
•	Captures continuous, time-synchronized data on multiple physiological parameters
•	Monitoring from home may minimize the need for clinic or hospital visits

Continuous

•	2 or 3-lead ECG
•	respiration rate & pattern
•	oxygen saturation

Point-in-time

•	blood pressure
•	lung function (PEF, FEV1 and FVC)
•	weight

Patients also have the ability to record events as they occur e.g., if they experience palpitations, or to indicate when medication is taken. The time of these events is marked and the heart and respiration activity occurring at that time can be viewed selectively. This enables the doctor to understand more fully what is happening with the patient at the time of maximum interest.

http://www.sensatex.com/ - - - - - - - - - - - - - - - -

The Sensatex Solution utilizes a groundbreaking electro-optical textile, the Wearable Motherboard™ Smart Shirt , to seamlessly incorporate sensory capabilities with radio and computing devices, representing a highly effective and unobtrusive means of integrating broad-based sensors with the
human body.

By supporting voice and data communications from multiple sensory locations through one wireless backbone, the Sensatex Solution provides an extremely versatile framework for a host of biomedical monitoring applications. The Smart Shirt eliminates the need for loose wires and discomfort experienced by many current patient monitoring devices, while also reducing the false alarm rates associated with their use. Its dependable and unobtrusive monitoring environment remains virtually transparent to the patient, while improving communications with remote monitoring locations, maintaining quality of patient care, and reducing healthcare costs.