Mobiles that support healthcare, Financial Times 5 October

James Barlow, professor at Imperial College says that the UK government is providing grants to support technical trials among NHS clinicians from 2006.

Mobiles that put your life in your own hands
By Malini Guha
October 5 2005

Hannah Boschen has suffered with diabetes since she was a child. The 25-year-old administrator at Oxford university says that, until recently, her life revolved around the disease, which affects about 18m people in the US and 3m in the UK, and can cause complications such as heart disease, kidney failure and blindness if not properly controlled.

Now, however, she is better able to manage the condition, with the help of a new system that makes convenient use of her mobile telephone.

The technology, called "think positive diabetes" or "t+ diabetes", is the brainchild of Lionel Tarassenko, chair of electrical engineering at Oxford university. Prof Tarassenko has been working on applications of healthcare and technology for 25 years and has co-founded e-San, an Oxford-based company, to commercialise and market his ideas.

His innovation is one of many in the field of tele­medicine, which uses telecommunications technology to connect patients with healthcare providers at a distance. For example, a nurse can transmit digital images of a patient's condition to a doctor; house alarms can alert medical services to an elderly patient's fall; and home-care systems monitor the vital signs of the housebound.

Many, however, have been disappointed at the limited take-up of previous initiatives. "Telemedicine has had a difficult history so far," says Prof Tarassenko.

One of the reasons for past failures, he says, has been a lack of convenient technology. Systems that relied on fixed-line connections, for example, required patients to be at home, resulting in poor compliance.

In 2002, when the GPRS mobile network (2.5G) for mobile phones was launched, Prof Tarassenko saw its potential for managing chronic disease. His idea was to design an easy-to-use, portable and inexpensive system for the 70-80 per cent of those sufferers who can "self-manage" their condition with minimal intervention from a doctor - rather than focusing on the housebound elderly and infirm, the population usually targeted by e-health companies and the government.

Prof Tarassenko brought in Clive Peggram, former managing director of AIG Financial Products, an AIG subsidiary, and now a partner in Comvest, a venture capital firm, to form e-San, having worked with him on bringing other innovations to market.

Mr Peggram, who became e-San's chief executive, co-founded Comvest in 1999 with ex-AIG colleagues to invest primarily in medical technology, looking to universities for promising opportunities. "Compared with finance, I liked seeing tangible results - and I'm an asthma sufferer as are my children," he says.

After forming a partnership with Oxford university, e-San won grants totalling £1.3m from the corporate social responsibility funds of two telecoms companies: Vodafone, which supported its trials for diabetes and after-care cancer management, and O2, which funded trials for asthma and cystic fibrosis. The remainder of the £3.5m e-San has raised to date has come from a combination of Comvest, small government grants and contributions from friends and family. The company is planning another funding round to market the t+ system across the UK, and eventually plans to list on the alternative investment market.

E-San addressed diabetes first because it offers the largest potential market. Launched in April, its t+ system, which uses a standard glucose meter linked via a Bluetooth connection to a GPRS-enabled mobile phone, has attracted several hundred users.

When patients test their glucose level, the reading is automatically sent to the phone via the Bluetooth connection. They then spend about 10 seconds confirming information about diet, exercise and general health via the phone's keypad. The phone then sends the data to e-San's central computer.

Within seconds, the computer sends back a graph showing patients how well they have succeeded in controlling sugar levels in the past week, month or year - and the influence their lifestyle has had on these results. Patients can also use the system to order repeat prescriptions of insulin and other medication from a pharmacy.

Most telemedicine applications involve one-way communication from patient to doctor. The doctor may phone if something is amiss, but may otherwise not get in touch for weeks or months. With the t+ system, however, patient feedback is immediate.

E-San has moved to protect its ideas, filing patents covering immediate feedback, its graphical display and the facility for ordering repeat prescriptions. Getting these patents granted worldwide will be "quite a long process", says Mr Peggram. Yet even without these, he adds, e-San has a strong "first-mover" advantage.

The system is not free from competition. One alternative is a home healthsystem that monitors vitalsigns including blood glucose levels. Another, still some years from launch, is a wearable sensor that constantly measure a patient's glucose levels.

E-San has also sought to make its system affordable, at a cost of £49 plus a monthly service charge of £7. Users must also have a GPRS-enabled mobile phone (2.5G or 3G) that is compatible with e-San's Bluetooth cradle as well as a glucose meter manufactured by LifeScan, a subsidiary of Johnson & Johnson.

Because of the advantage of differentiation e-San's product can bring to Life­Scan's products, Mr Peggram is hoping to work closely with the larger company to help market the system to healthcare professionals around Europe. E-San is also planning a commercial pilot of the t+ system with Lloyds Pharmacy, the retail pharmacy group, to be launched in some regions from November. Lloyds hopes to benefit from the extra footfall, customer loyalty and repeat prescriptions generated through e-San's system, says Mr Peggram.

The company hopes to find another close partner in government. With diabetes and its complications costing the health services several billion pounds a year, Mr Peggram argues that the e-San system would be highly cost-effective.

One of the best ways of introducing it would be to support trials of the system among NHS clinicians. James Barlow, professor at Imperial College and co-author of the Audit Commission's 2004 Report, "Implementing Telecare", says that for the home-bound elderly, the UK government has moved to act through its £80m "Preventative Technology Grant", which will come into place in April.

The success of the grant, he says, will depend on whether local social services and primary care trusts institute the complex organisational changes to make tele­care work. What are not needed, he emphasises, are more small-scale pilots. "Only by designing schemes that can be made mainstream if they prove successful will we gain better knowledge of the cost-benefits of telecare, as well as its benefits in terms of improving people's quality of life."

The US Department for Veterans Affairs (VA) provides a model of what mainstream services might look like. The VA, which began with a pilot of 1,000 patients with chronic disease five years ago, will have 20,000 patients receiving care via home telehealth by October 2006. Adam Darkins, chief consultant for care co-ordination, says its current 10,000 patients are highly satisfied and it has reduced hospital visits among these by one-third.

With government support, says Mr Peggram, self-management on a mobile phone could quickly become a success that cuts across social classes: "Mobiles can indeed help to save lives."