Until recently, the convergence of IT and healthcare has been focused on software applications for bioinformatics and data mining, medical data analysis, healthcare information management and companies utilizing the Internet to deliver their services. However, the need and opportunity for “embedded IT” in healthcare tools and devices is much larger than this, and by 2010 several of these technologies may have become “household items.” This would lead to a new, more efficient healthcare environment with greater safety, accuracy and personalized care.

More Efficiency in Care
Due to improved access to information, patients are increasingly empowered to demand the appropriate and personalized therapy they expect to receive. They, as well as medical providers, expect faster, more convenient and safer interactions with healthcare professionals and hospitals. While personal interactions with physicians will never be obsolete, there is plenty of opportunity for making theses interactions more useful and timely.

Wireless sensor technology may enable the monitoring and care of patients with chronic diseases such as asthma, diabetes or hypertension. This would provide for an opportunity to intervene on a 24-hour basis, rather than solely during a weekly scheduled 15-minute office visit, during which the patient’s state may be vastly different from his “normal” baseline.

High-risk pregnancies are already now being continuously monitored with devices developed by Healthdyne. Closed-loop systems that will not only monitor and diagnose, but also administer the appropriate therapy, will potentially be a reality soon. Already, Minimed has developed an implantable glucose sensor that works in conjunction with an insulin pump implanted in the abdomen. Patients program the insulin dosage via a handheld computer using radiofrequency telemetry. The ultimate goal is to integrate sensor and pump to automatically and continuously dispense the appropriate amount of insulin.

A further step towards more general physiological monitoring is so-called “smart shirt” technology. Sensatex, for example is developing a wearable motherboard woven into a shirt that tracks vital signs. Originally, this technology was developed for the army to track vital signs of soldiers in the battlefield so triage units could identify those in most urgent need for care.

Another company, Vivometrics, has developed a shirt, utilizing insulated copper wires and sensors, which monitor up to 40 different physiological parameters such as heart activity, breathing patterns and temperature. Data is recorded 50 times per second and sent to a handheld computer then to a processing center. From there, physicians will receive reports within an hour.

Despite the logic behind this, remote patient monitoring and therapy is not — yet — a straightforward business model, as policies for reimbursement and potential liabilities have yet to be figured out. On a smaller scale, however, consultation of physicians via e-mail is already being funded in some Blue Shield sponsored programs. Healinx, a privately held company, is providing Web-based communication services that allow doctors and patients to efficiently communicate with security and privacy.

Improving Accuracy and Safety
According to a study released by the Institute of Medicine in 2000, 98,000 patients die from medical errors in American hospitals every year, making medical errors the eighth leading cause of death. Several safeguards have already been implemented to fulfill the Institute’s goal to reduce medical errors by at least 50 percent by 2005.

Information technologies find broad applicability here. Computerized/typed prescriptions, rather than handwritten ones, are already mandated in several states. Also in use are electronic prescribing systems, which alert the physicians to possible drug interactions, allergies and dosing errors while the prescription is being filled out on a handheld PDA, such as an iScribe, Epocrates or ePhysician device.

Less obvious, yet indispensable to new product development, are IT applications in imaging technologies as well as surgery. Calypso Medical is developing a “GPS System for the Body” that will focus a radiotherapeutic beam on a tumor target in real time, while minimizing radiation to healthy surrounding tissue. The same technology is expected be used to guide surgeons towards non-palpable tumors, and hence, lead to greater surgical accuracy.

Robotic surgery will almost certainly be more widely adopted, once reliable systems have been in use and generations of physicians been trained to work with them. Further, several multidisciplinary programs (e.g., Intuitive Surgical, Computer Integrated Surgical Systems at Johns Hopkins University, Jojumarie or Surgical Assist Technology Group) are incorporating insights from computational modeling, mechanical engineering, robotics, imaging and optical tracking to improve surgical outcomes.

IT has already revolutionized the area of radiology and imaging, with more innovation yet to come. Computer-assisted detection technology (CAD) uses computer algorithms to analyze digital images, acting as a safeguard or second set of eyes for the radiologist to point out suspect areas. R2 Technology already has clearance for its screening mammography system, which is also licensed to iMammogram.com, offering a consumer service to take a “closer look.”

Ultrasound is another area where major innovation is expected over the next few years. Novasonics will be launching a novel, truly handheld and portable ultrasound device, which incorporates the computing power of two Cray II computers in a handheld configuration weighing less than three pounds. New algorithms for image generation and power consumption made this invention possible. The “Sonic Flashlight,” which is currently being developed at the University of Pittsburgh, is using ultrasound technology to obtain tomographic images, which were otherwise only possible with CT or NMR scans.

Personalizing Medicine
Disease states can now be modeled by capitalizing on the insights from the genomic revolution and combining it with empirical and phenotypic information. Entelos’ Physiolab biosimulation technology was adapted from simulation technologies originally developed for the engineering industry, and hence, optimized for the modeling of biological systems. Far beyond what traditional bioinformatics companies can do, the Entelos system synthesizes data obtained from peer-reviewed papers, databases and experimental results and hypothesizes and simulates biological effects to ultimately predict human clinical efficacy.

While the technology is being developed today to aid drug development in all stages, from target identification and validation to candidate selection and clinical testing, this technology may also have long-term potential to improve patient care. The company’s Web site shares some of its vision — how its virtual patient technology may ultimately lead to individualized patient care, and selection of the most appropriate and effective therapy and lifestyle modifications to lead to the best possible clinical outcome for a given patient.

Other companies in this newly emerging field of in-silico biology include Camitra, Physiome Sciences and Strand Genomics in Bangalore, India, which also focuses primarily on the drug development aspects of this technology.

Related to personalized care are high throughput screening and diagnostic technologies that allow for point-of-care screening and pharmacogenetic testing. Infineon, the tenth largest semiconductor company spun out from Siemens, has just announced the development of an electronic biochip that can detect up to 128 biomolecules, such as DNA and proteins, at the same time. The technology is based on pairs of neighboring gold electrodes for each target molecule to be detected.

Interestingly — and supporting the notion that healthcare may be the “next big application for information technologies” — other traditional technology giants such as Motorola, IBM and Sun Microsystems are emerging players in the healthcare industry.

Dr. Vera Kallmeyer is the founder of Veritas Venture Partners, a healthcare fund, which pooled interests with Earlybird in 1999. Formerly, she was CTO and Vice President of Corporate Development at Aviron, a vaccine start-up company, which she took public.

Dr. Kris Venkat is currently chairman of Morphochem, Inc., Transvivo Inc., and Automated Cell, Inc. He is chairman of the supervisory boards of Accentua Pharma AG and Juelich Enzyme Products GmbH, both based in Germany. He also serves as visiting professor of biochemical engineering at Rutgers University.
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