Chris Minter, Components Corp, www.componentscorp.com
       
As early as 1949, wireless technology has had an impact on the healthcare industry in the field of testing and diagnosis.  That year, the Holter Monitor was introduced.   A portable device powered by a battery pack, the Holter Monitor recorded electrical signals from the heart through a series of electrodes, continuously monitoring electrical activity of the central nervous system.  Due to the portability of the device, the testing could be done in a remote location such as the home environment. The information was recorded on reel-to-reel tapes or audiocassettes for analysis.
       
As we look at today’s healthcare industry, I feel the greatest impact wireless technology continues to have on improvements in healthcare management and cost reduction lies in the field of testing for, and monitoring of chronic diseases.
       
A recent study by the California Healthcare Foundation outlines developments in wireless technologies and their impact on the healthcare industry.  As wireless technology has advanced over the decades equipment has become smaller, faster and lighter. Miniature sensors can accurately monitor a number of physiological functions including physical activity respiration, body temperature, heart rate, muscle function, blood glucose levels and oxygen saturation; some small enough to be implanted in the body.
       
Although no significant breakthrough has been made in reducing the size of batteries for better compatibility with some portable devices, the decreased power needs of cell phones and health monitoring devices improve performance.

With the introduction of the cell phone in the 1980s, wireless technologies enabled patients to more readily have voice contact with their healthcare professionals.  But the evolution of cell networks from analog 1G, to digital 2G and presently 3G networks, which enable high-speed communication capabilities, data can be transmitted from remote locations to a central hub for analysis.
       
With these advances over the past few decades, cardiac monitoring has come a long way from the original Holter monitor.  For cardiac patients the Mobile Cardiac Outpatient Telemetry (MCOT) System uses a lightweight, three-lead sensor connected to a small electrocardiogram monitor attached to the belt, which can detect an abnormal event, such as arrhythmia and automatically transmit the data to a service center for immediate evaluation.
       
The GlucoPhone combines a glucose meter with a cell phone.  The patient places a small blood sample on a test strip, inserts the strip into a reader in the phones battery pack and results are transmitted to an on-line database, the information can then be forwarded to their physician.  GPs-enable smart phones can track daily activities of diabetic patients to correlate fluctuations in blood glucose levels with travel, exercise, work patterns, and medication and dietary habits.

For patients with chronic conditions such as diabetes or hypertension, or for elderly patients preferring to remain at home, wellness monitoring capabilities that provide around-the-clock vigilance through mobile communications and other technologies have the potential to save lives and millions of dollars in healthcare costs each year by reducing onsite monitoring at a healthcare facility, and alerting the patient’s physician if abnormalities occur, allowing for prompt treatment.

John A. Carbone, Express Logic, www.rtos.com 

They say an ounce of prevention is worth a pound of cure. One way to bring down the high cost of healthcare is to catch disease early and prevent its progression into a more serious condition that requires exotic, expensive treatment.

As engineers, we help achieve this goal by creating ways to make effective diagnostic equipment more available to the general public. Typically, this requires lower cost electronics, smaller, more portable packaging, and faster processing for on-the-spot diagnosis.
 
Medical devices today employ some sophisticated technology, including 32-bit microprocessors and a load of well-tested software. With much of the cost and performance of these devices dependent on software that performs the diagnostic analysis, it's natural to look there for innovation that might reduce overall healthcare cost. We need to develop software generation technologies that produce code quickly without errors for the bulk of electronic devices and more configurable system components selected to suit the needs of individual devices.

Even now, the commercial operating systems that control these devices offer modularity and small size so that software costs can be kept down. This area will get increased attention in the future, and the payoff will be faster time to market for new diagnostic devices and greater availability at the local office level. This will result in lower cost of care as we nip more serious conditions in the bud and avoid costly treatment of advanced stages of these diseases. 

John Greenland, LDRA Technology, www.ldra.com

Software quality in medical applications is undergoing a transformation. In the past, some testing was done, but rigorous testing and changes only occurred if something went seriously wrong. Recent steps by lawmakers are pushing the medical industry to take a more preventative stance by threatening to heavily fine or imprison CEOs of companies not doing due diligence. Software quality is one of the areas coming under greater scrutiny. It won’t be long until a medical certification process of software is in place.

To ensure software quality, a sound software development process needs to be established. By using modern verification and testing tool technology, developers can trace all aspects of their application from requirements through static and dynamic analysis of source code into automated test. By doing this, developers can verify software components earlier than is traditionally possible with system level test.  Finding defects earlier contributes to lower cost of quality, lower certification costs, less product recalls, fewer lawsuits, etc.  According to the Caper Jones-ASM study done in 1996, defects found at the unit test stage cost 15 times more than those identified during coding, 30 times more than those found at system test, 100 times more than at integration and 1000 times more than those found in deployed, fielded systems!

Automated traceability and verification helps the overall development process by also reducing development time. Vinter and Poulsen looked at the Prevention of Errors through Test and found that there is a 3 times reduction in defect detection time between automated verification methods (static and dynamic analysis) and non-automated verification methods. Given that debug time typically takes 80% of the development time, a three-times savings results from an enormous time savings. 

Veronica Marques, Texas Instruments, www.ti.com

There are several technology breakthroughs that have the potential to reduce health care costs. One of them is medical imaging where semiconductor innovation is enabling lower power and smaller size to make equipment more accessible and affordable. Ultrasound equipment, for instance, is becoming more and more portable or even handheld allowing for every ambulance and doctor’s office to be equipped with ultrasound devices, thus enabling earlier diagnostics and treatment as well as use at the actual point of care in emergency situations. It also means that ultrasound now becomes accessible in remote and emerging regions where it has not been easily available to everyone before. Semiconductor technology can further drive this trend in ultrasound as well as other medical imaging technologies by providing integrated solutions reducing board space, cost and development time of innovative medical imaging designs to further improve the quality of health care in all areas of the world. 

Paul Errico, Analog Devices, www.analog.com  

The advancement of information technology (IT) into the healthcare sector will help reduce costs by leveraging standardized health records to enable cost-effective care and proactive health and wellness initiatives.  Recently, the Mayo Clinic was highlighted in an ABC News report as an example of how to improve care while containing costs.  According to the report, “A lot of experts are convinced that the Mayo model -- in which patient tests are minimized, doctor salaries are fixed, records are electronic and groups of doctors work together -- proves that healthcare reform isn't about who pays for care, but about how it is given.”  The foundation of patient data to fill those records comes from a broad range of medical devices used in laboratories, clinics, hospitals, and the home.   

Traditional platforms like ECG (electrocardiogram), ultrasound, and CT (computed tomography) continue to offer high levels of diagnostic value by using new measurement techniques that leverage advanced analog, mixed signal, and digital signal processing semiconductor technology.  Laboratory systems like blood and DNA analyzers are faster, and provide a wealth of patient information.  The growth of accurate, reliable, and safe products for the home will also help to drive down costs by giving people the tools needed to manage disease, promote health and wellness, and deliver drugs in a safe and effective way.   The Continua Alliance was created to ensure interoperability of future home healthcare devices with IT infrastructure expansion. 

Martyn Howgill, InHealth, www.inhealth.org

With advances in genomics and proteomics, nanotechnologies, microfluidics, communications and information technologies, microelectronics, robotics, and many others, almost every field of technology is relevant to medical products. Among those with potential for reducing costs, here are a few:

Neuromodulation. Efforts to explore the application of devices, drugs, and combination products on Parkinson’s disease, Alzheimer’s disease, and conditions such as dementia and depression are still in their infancy. But they are showing great promise as therapies that can restore a patient’s functions or forestall disease progression—in both cases reducing costs by minimizing the need for intense long-term care.

Surgical procedures. Advanced technologies and related procedures are making surgical interventions less invasive and traumatic, thereby increasing the patient volume, reducing surgical costs, cutting recovery times, and enabling more people to quickly return to productive lives. Research into devices such as percutaneously implanted heart valves, carotid artery stents, peripheral artery stents, and orthopedic implants, is creating new generations of products that will provide better care at lower cost.

Molecular diagnostics. Advances in the field of in vitro diagnostics—including genomic and proteomic testing—may be suited to widespread population screening at reasonable costs.