Health Care Technology Meets Mobile Applications

Mobile Application to Prepare for Future Stroke Scenarios

  Bradley James Shedd

Southern Polytechnic State University

Major: Information Technology

Date: November 6, 2012

Abstract

On July 31, 2012 I witnessed a loved relative have a severe stroke and heart attack.  I want to research and report if there are any types of applications on mobile devices that help stroke victims or perhaps prevent future strokes.  The worst part about being in a hospital is waiting for the doctor to give a final diagnosis and discharge the patient.  The scope of this report is to discuss how the doctors use their mobile technology.  The health field has this technology available to doctors, but I want to find an application to help patients at their home.  The application would allow the stroke victims to announce what they want without speaking, by touching pictures of daily activities on some device like a Personal Digital Assistant (PDA) or a smart phone.  We live in a world that is filled with cutting edge technology at an affordable price for everyone.  Every friend of mine, including myself, has a smart phone and home computer.  The health field has found a way to keep in touch with your doctor through a webcam on your computer or a camera on your cell phone.  The Health Insurance Portability and Accountability Act of 1996 (HIPPA) has guidelines to follow to keep confidential health files sent over wireless networks secure.  I would like to find out what current health field technology there is today, and see if there are some inventions in mobile applications that will improve the stroke patient’s recovery process.

1 Introduction

The fourth most leading cause of death in the United States of America is cerebrovascular diseases, also known as strokes.  The first leading cause was diseases of the heart (Hoyert, 2012).  Since cellular devices are becoming very popular in the United States, it is important for Americans to know how they can use their cell phone to help improve their health.  The PDA is being used by doctors to monitor patients while making their rounds at the hospital.  There is a portable device that can store, view, and record the new progress of each patient for review by the doctor. 

 “Although primary stroke centers (PSCs) are equipped with the resources and personnel to provide patients with acute stroke with a timely, adequate assessment and emergency stroke treatments, they represent only a minority of all hospitals” (Demaerschalk, 2009).  Every second counts when someone suffers an attack from a stroke.  The patient is confused and may or may not know that a stroke has happened.  When an emergency team of doctors and nurses are in the room at once, one could be confused as exactly what has happened.  The solution to this is having a telestroke team that consists of clinical, administrative, and research members (Demaerschalk, 2009).  “Neurologists, emergency physicians, nurses, and radiologists should collaborate on the provision of remote care for patients with acute stroke. In general, telestroke practitioners are board-certified vascular neurologists; however, no formal requirements for the practice of telestroke currently exist” (Demaerschalk, 2009).  If one physical therapist is in the room with the patient, the patient could feel more relaxed. 

The act of surviving a stroke is like fighting from the grasps of hell and the more the patient is oblivious to this the better.  When the patient is undergoing rehabilitation, the doctor can record and view the patient’s recovery with a webcam.  “Fisher proposed a hub-and-spoke model of telemedicine-delivered stroke care designed to enhance the administration of acute stroke therapies” (Demaerschalk, 2009).  Now, a doctor can view several patients at a time and in theory speed up recovery from the stroke.  The doctor may also use their PDA to view the patient practicing physical therapy from their home. 

2 PDA Pros and Cons

         Now, when a patient is out of the emergency department and is starting the recovery process from the stroke, their progress needs to be monitored for at least three to six months during the brains neurological recovery process.  The mobile telemedicine system was introduced in 2009 and streams video of the patient in rehabilitation to the doctors smart phone.  The doctor is using a Windows 2003 phone with a stylist pen to view the patient on the phones screen.  The video feed would transmit to the doctor’s phone but with a low bit rate.  This means that the patient could have a facial droop, a side effect of a stroke, and the doctor would not recognize the facial features on their phone (Kim, 2009).  However, the audio quality was fine and the doctor could listen to the speech abnormalities (Figure 2). 

2.1 HIPPA Protected

The first intention of instantiating the Health Insurance Portability and Accountability Act of 1996 was to improve portability and continuity of health coverage (Gartee, 2011; pg. 47).  The cellular telephone, a portable phone, is a picture perfect solution to improve portability health coverage.  Two of the four areas of the Administrative Simplification Subsection of HIPAA, privacy and security, are questionably at risk when confidential records are being transferred over cellular airspace (Gartee, 2011; pg. 47).  Since the patients confidential health records are being sent from the hospitals database streaming live video through the internet, to an access point or base station and then to the mobile phones VPN there needs to be some security (Figure 2).

When patient’s records are the issue the loss of data is a high risk.  Unauthorized access to patient data through a wireless local area network by an adversary could happen.  The intrusion detection system could fail to detect penetration of an adversary.  The hardware equipment may be improperly set up or installed. 

Therefore, HIPPA has constructed a set of rules for all wireless networks that are located a hospitals and/or involve the transfer of medical records.  Section 9 of ISO IEC 27002 was recommended in 2005 for all hospitals to follow with user authentication for external connections (ISO IEC 27002, 2005).  The HIPPA security implications of Section 9 and 12 include but not limited to: Use security areas to protect your facilities; control use of assets off-site; validate data input into your applications; use validation checks to control processing; prevent information leakage opportunities (ISO IEC 27002, 2005).                         

The telestroke video conference and mobile telemedicine system followed the ISO IEC 27002 protocol.  The mobile telemedicine system uses secure communication over a wireless network by using a mobile virtual private network (Kim, 2009).  The patient’s information is secured from being leaked to adversaries by the “mobile VPN protecting IP packets through an IP security protocol and tunneling over a private network” (Kim, 2009).

3 Health Mobile Technology is Successful

My research has unveiled exactly what I was looking for that can help stroke victims.  Now a doctor can view live streaming video on their phone of their patient.  This reduces the trouble of having to travel to the doctor’s office which could be a problem for a stroke victim if they are home alone.  It would be comfortable to know that a physical therapist can record the patient’s progress while training in the convenience of the patient’s home.  However, the way this technology is introduced is that the patient is in the hospital undergoing physical therapy and the doctor is receiving live video to his/her cell phone.  This makes dealing with more than one patient more convenient for the doctor.  Either way, the quicker the stroke survivor receives medical attention the better.  Now, the doctor can review the diagnosis of the patient faster than driving to the hospital.

 “The system was tested using a PDA-type phone and smart phone, as shown in Figure 2. Both receiving units were able to present satisfactory video for the observation of facial droop and arm movement, and provide satisfactory audio for the detection of abnormal speech” (Mobile App for Acute Stroke).    This device is not available on the market, but is used in a few hospitals.  There were five patients all of whom are stroke victims and the table below shows the results of their progress in the video therapy shown in Table 1. 

4 The Future of Implantations

I believe that the new mobile application can help save lives.  The future is looking forward to microchips that can be implanted into the human brain to send electric signals that will link the neurons together to command body movement and improve speech patterns and other side effects of strokes.  The ZigBee is a microchip that is already in the testing phase using laboratory rats.  “The ZigBee link enables bi-directional communication between the neural stimulator and controlling equipment on outside. ZigBee is a standard small, low power radio-frequency communication protocol based on the IEEE 802.15.4 standard, designed for use in wireless personal area networking (WPAN) applications” (Kim & Yang, 2010).  The microchip is sending data over a network for the doctors to view how the low electric signal is helping the brain recover from the stroke.  The ZigBee is looking to be used in human brains to help improve the three to six month recovery time of a stroke (Kim & Yang, 2010).

5 Conclusion

In conclusion, I recommend on relying on mobile technology to keep good health by avoiding strokes and heart attacks.  I believe the reason why mobile applications are needed for stroke victims is because the quicker the victim gets help and rehabilitation, the faster the recovery process.  “Each second that passes after a stroke the human brain loses 30,000 neurons.  If a stroke is left unattended to for up to 5 hours then the damage to the body are irreversible” said Mr. Hall our class guest speaker.  We need to take better care of ourselves and monitor our health more than just relying on doctor visits.

6 Acknowledgements

This research was conducted for the Foundations of Health Information Technology class at Southern Polytechnic State University.  The author thanks Dr. Chi Zhang for her knowledge of health information systems and leadership as a lecturer for Southern Polytechnic State University.  This project was also conducted for the author’s father. 

Appendix

Figure 1 - Example of video chat with stroke patient.

Demaerschalk, B. M. (2009, January). Stroke telemedicine [Photograph]. Mayo Clinic Proceedings. Figure 2 - The system architecture of the mobile telemedicine system for acute strokes.

Kim, D. (2009). A mobile telemedicine system for remote consultation in cases of acute stroke. [Photograph]. Journal of Telemedicine and Telecare, London.

Table 1 – Score of the visual feed of the doctors PDA

Kim, D. (2009). A mobile telemedicine system for remote consultation in cases of acute stroke. [Photograph]. Journal of Telemedicine and Telecare, London.

References

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