WiCis Health WhitePaper

Telemedicine: Real-Time Trauma and Clinical Care with Global Reach


Telemedicine is the use of new technologies, particularly wearables, software and telecommunications, to enable physicians to provide care to patients from anywhere. Telemedicine is focused primarily on patient care and not on other medical services such as provider training, administrative services or ongoing medical education which fall under the umbrella of TeleHealth.

The ability to use technology to monitor patients in real-time, share information about their condition and provide treatment remotely improves the quality of care and saves lives. Advancements in new products and platforms in recent years, including the new found value in ‘big data’, have made it possible to quickly access, analyze and share information. But much of this collected data sits unused, it’s value unrealized, with no action taken. The next step in leveraging the value of this data is to collect, monitor and share it in real-time. There is immense value for both the patient and the care provider in remotely monitoring the patient’s situation in real-time and providing whatever support or care is necessary.

Telemedicine provides value in manydifferent conditions including:

• Monitoring a patient in physically stressful environments such as adventure sports, climbing or sailing
• Preventative care and prescription management
• Monitoring of chronic conditions such as diabetes or heart disease
• Post traumatic injury care and treatment
• Remote post-hospitalization care

The types of vital biometric data requiredto be captured and shared in real-time include:

• Heart rate
• Body temperature
• Oxygen saturation
• 3 lead EKG
• Blood pressure
• Concussion Brain sensors

This vital data combined with additional patient information such as location, direction, speed and altitude (accelerometer) will provide caregivers with a full picture of the current condition of the patient anywhere in the world. The combination of health and location data will ensure the patient is under constant supervision.
A system that can provide the vital sign monitoring power of an operating room to the patient anywhere, including home or in the most remote locations of the world, would be very beneficial to anyone in need of monitoring or treatment.

Medical caregivers have limited capabilities for providing virtual healthcare to patients in remote locations. Today, connecting the patient to the right specialist is largely dependent on the patient’s ability to travel to the physician’s location. The challenges of providing care range from the ability to monitor acute or chronic conditions remotely, to monitoring the health and safety of workers, and providing life-saving care immediately after an injury.

Because of the time-sensitive nature of this data, it needs to be collected, monitored and acted upon in real-time. This type of system would allow for specialized medical resources from anywhere in the world to monitor a patient’s condition and provide the appropriate care. Another challenge is obtaining accurate information regarding the condition of the patient. Audio and video calls are not sufficient or reliable options as it is dependent on the patient’s ability to communicate symptoms. In order to reduce the risk of error, new solutions are needed to obtain data that is dependable
and more objective. Utilizing emerging technologies, including medical wearable devices, to provide real-time data on the condition of the patient can add value in at least three different scenarios:

• Pre-injury monitoring

• Monitoring of chronic conditions and

• Immediate trauma and/or post-injury care

Pre-Injury Monitoring

Worker Safety – It is in the best interest of businesses to ensure the safety of its employees to increase productivity as well as save on workers’ compensation claims.

Monitoring the vital biometrics and location of workers in real-time allows the employer to recognize when there is a change in the well-being, fatigue or other condition of the employee and prevent a potentially harmful event from taking place. Simultaneously tracking location, direction and speed ensures that the appropriate care can be sent directly to the employee wherever they are. Specific use cases to support worker safety by monitoring health and location include:

• Heavy Equipment Operation
• Manufacturing Floor
• Construction
• Public Safety

Sports/Adventure – Athletes and adventurers participating in extreme sporting or adventure events are pushing their bodies to their physical limits while in some of the most rugged and remote geographies in the world. The ability to stream live data via satellite is imperative in order to monitor the well-being and location of a participant during the event in real-time. In some use cases, direction, speed and altitude are critical pieces of data to be used in locating the participant. This allows friends, family or physicians to see if any vital signs show an indication of deterioration and immediately provide assistance anywhere in the world. Use cases where sharing this data in real-time is critical include:

• Mountaineering
• Endurance Racing
• Sailing

Monitoring of Chronic Conditions

Chronic Diseases – For those patients that have been diagnosed with a chronic condition, a solution that allows them to lead a normal life with minimal disruption can mean freedom and independence. A solution that monitors vital biometrics, via small wearable devices, and location in real-time provides patients, family and physicians with a new level of peace of mind. Benefits to the patient include less travel time to visit their physicians and less disruption of their personal lives. For physicians, benefits include more accurate vital data for diagnosis, improved office efficiency, tracking of medication usageand improved health outcomes for patients.

Examples of conditions that can be monitored using data collected from wearable devices, and where outcomes can be improved include:

• Opioid addiction – Sensors to track respiratory rate and heart rate,
both which slow down with overdosing

• Hypertension – Sensors to track blood pressure as well as medication adherence

• Obesity – Sensors to track weight as well as diet diaries

• Anxiety and Depression – Sensors to track sleep and stress levels

• Alcohol Abuse – Sensors to track breath ETOH

• Drug Abuse – Sensors to track heart rate and respiratory rate

• Eating Disorders – Sensors to track weight

• Post-Injury Care – Hospital Transport –

Another advantage to a solution that collects vital data in real- time is being able to monitor that data while a patient is being transported. After an injury has occurred, small wearable devices can be applied to the patient by the onsite caregiver (EMT, medic, doctor etc.) to immediately begin sharing vitals in real-time. The receiving hospital can then monitor the condition of the incoming patient which allows the physicians at the hospital to prepare to receive the patient appropriately as well as provide medical advice and direction to the onsite caregiver during transport. Vitals, location, speed, ETA, etc. can be shared during transport whether by ground or air. If the mode of transport changes, e.g. picked up by an ambulance and later transferred to a helicopter, the monitoring could continue and follow him all the way
to the hospital. Finally, the patient can be monitored at home during his recovery.

Onsite Treatment – First responders to an injury scene provide critical care to a patient to provide an initial assessment and stabilize the patient’s condition. However, in many cases they are not necessarily prepared or trained to recognize the patient condition or an internal injury.

The ability to apply a ‘kit’ of wearables to the patient quickly and easily will allow the first responder to begin sharing vital data in real-time and receive assistance from other physicians. A solution that simultaneously shares vitals, location, audio/video communications as well as photos, will allow a remote physician to provide assistance to the first responder. This assistance may include a specialist that can also see the real-time data from anywhere in the world. Other types of information could also be captured at the scene including a portable ultrasound system that shares the image real-time as well for remote diagnostics from the point of injury.

Technology Advancements

Major advancements have taken place in commercial technologies in the past few years that are now enabling the type of monitoring and sharing data in real-time required by the use cases above. The four key areas of improvement that are driving this breakthrough capability are wearable medical devices, smartphones and applications, network connection ubiquity and the cloud.

Wearable medical devices – These devices continue to get smaller, less obtrusive, smarter and cheaper. Bluetooth and other low power wireless technologies are improving the battery life so they can be worn for longer periods of time before recharging. Consumers are now more familiar with using these monitoring devices and comfortable using an app to store and share the data using their smartphone.

• The global wearable medical device market was $3.2 billion in 2016 and
is expected to cross $7.9 billion in 2021, growing at a healthy CAGR of
over 19.5%1
• 60% of people between 18 and 34 years old wore a connected wearable device at least once a month during 20162

Pulse Oximeter Heart Rate Body Temp Smartphones and apps – Smartphones have revolutionized the way we move data to and from the internet, from anywhere, with ease. The penetration of smartphones continues to climb, even in developed countries. It’s safe to say that the smartphone and the use of applications is a part of the daily lives for most people.

• 87% of Americans have their smartphone by their side day and night 3
• Globally, an average of 9 apps are used on a smartphone daily 4
• 72% of people in the US own a smartphone vs. 92% of people between 18-34 years old 5

Network connection ubiquity – High speed wireless networks cover virtually every part of the earth. WiFi is available in many large city centers, 3G and/or 4G covers the vast majority of the populated areas of the world and satellite connectivity is available in the most remote corners of the world. All of these networks provide speeds that are far faster than what is needed to share vital sign data. Satellite networks have improved to the point that moving medical data, even video streaming, at a low cost is now also

The Cloud – The cloud has made it much easier and cheaper for organizations to store, analyze and share vast amounts of data. Utilizing this immense network of servers allows enterprises and government agencies to invest less in hardware on their own premise and use the storage i the cloud as their needs grow and shrink. The cloud allows for easy ‘scaling’ of computing resources as storage requirements grow. It also makes it easier to share data with third party systems leveraging standard industry APIs and protocols.

• 70% of global businesses have at least an app in the cloud
• 50% of global businesses will use cloud for data storage in 20176
• 43% of global businesses will use cloud for data analytics in 2018

The Solution: I-Streme from WiCis:
I-Streme is a secure, end to end solution that collects, monitors and shares vital data anywhere in the world in around one second. I-Streme consists of three main components:

Smartphone app (Android & iOS) – The I-Streme application is available to be downloaded from the Google Play store. The functionality of the application includes the following key capabilities:

• Connects to multiple wearables/sensors with a single application.
Typically, each wearable device comes with its own application. I-Streme allows the user to wear multiple devices andmanage them with a single application. WiCis does not manufacture wearable devices or sensors, rather I-Streme allows the user to choose which device(s) to use and the I-Streme application will manage connectivity for that
wearable device(s). Remote charging is accomplished with solar panel charging systems.

• Collects data from the wearable device/sensor – Via the Bluetooth
connection between the wearableand the smartphone, the application
manages the collection of the different data streams and transmits that data over any wireless network (satellite, WiFi, mobile…).

• Manages other types of data
I-Streme supports many types of data including GPS location, direction, speed, altitude, photos, video clips, social media posts and video streaming, SOS. As with the wearable data, this data is then transmitted over the chosen wireless network.

• Selects best available network – Because many use cases take place
in remote locations, the I-Streme application includes the intelligence
to choose the network that will provide the best connection and highest throughput available including WiFi, 3g/4g, satellite, etc.). I-Streme is compatible with these satellite networks; Thuraya, Iridium, Globalstar, Inmarsat and MSAT.

• Manages bandwidth – In remotelocations, a low bandwidth network
may be the only connectivity choice for I-Streme. In this case, the
application will optimize the transmission of the data with prioritization and compression techniques to ensure the lowest latency possible.

• Controls cost – I-Streme is set to transmit data every second by default to ensure that every data point is being monitored. However, if network cost is a consideration, the application can send data in
regular intervals; every 1, 5, 10 15 minutes, for example.

Platform – The I-Streme platform is a HIPAA compliant, cloud-based, secure aggregator of the data collected and transmitted from the smartphone application. It can easily be scaled and can reside either in the public cloud or behind an enterprise/government firewall.

Key functions include:
• Manages data – The platform collects, stores, analyzes and shares the data being transmitted in the system. A built-in analytics engine can develop trends and key insights gathered from the data as well as analyze multiple data points for condition diagnosis.

• Serves data to I-Streme dashboard –
All data points collected are fed to the I-Streme web portal dashboard to be viewed in real-time.

• Shares data with third-parties – Select data can be shared with third party systems via standard APIs and protocols, e.g. HL7. Examples include electronic health record (EHR) systems, advanced analytics
platforms, etc.

Web Portal Dashboard – The I-Streme web portal dashboard is a secure tool that allows all the data shared by the platform to be viewed in real-time from any browser, from anywhere in the world,including desktops and mobile devices.

I-Streme Web Portal Dashboard
• Customizes view of data – The view of the data to monitor the patient is customizable. Each data point is visible in a small window ‘widget’ including vital data from wearable devices, geo-location, direction, altitude, weather, messages, pictures, video, ultrasound image, etc.
• Manages groups – The dashboard can monitor a single patient and can
also create groups with many members in each to monitor groups in different geographies, missions, a different set of wearables, etc.
• Warns of worsening conditions – A min/max threshold value can be defined for each data point being monitored on the dashboard and an audible alarm/alert will sound if that pre-set threshold has been met. For example, falling blood pressure, rising heart rate, low blood oxygen saturation, etc.

The implications are enormous: As described above, I-Streme is bringing a very strong virtual health solution to the market offering a myriad of inexpensive wearables that can be tailored for use in many telemedicine use cases. From pre- injury tracking, to monitoring chronic conditions and post-injury care, physicians and families around the world now have the capability of monitoring loved ones in real-time. For physicians, this system will decrease their risks and costs while providing better patient outcomes.

The key benefits of I-Streme:

• Protect loved ones
• Save lives
• Save costs
• Share data with other third-party systems

With I-Streme, it is now possible to remotely monitor a patient anywhere in the world, in real-time, with the gold standard capabilities established by a hospital operating room.