Conceptual Design of a Telemedicine System for Diseases such as Diabetes Type 1, 2 for Higher Efficiency in Disease Management & Treatment Patterns

The components of telemedicine are either electronic, mechanical or a combination of both. These have to be manufactured taking into consideration their specific requirements and the functions which they have to perform. The telemedicine system offers improved disease management and enhanced quality of care. The system should be kept debugged and virus-free. The patient’s logbook is used to register details about the patient. These details include the test results, treatments being currently undertaken, and exercises. It would also contain a record of the treatment method carried out previously and the corresponding results. This information will then facilitate the patient to mark his progress and the caregiver to suggest better medication. Ultimately, timely & effective communication within the period is achievable.

Introduction

Purpose

The telemedicine system would facilitate communication between say for instance a diabetes patient and his GP [1]. The system will enable the physician to suggest a probable cure or at least provide immediate relief to the patient even when they are physically apart. It aims to serve the rural people who don’t have access to the facilities instantly. The following are the requisite features of the telemedicine system:-

1. To define the requirements for the new telemedicine system (both monitoring and communication).
2. To explore possible system configurations using various design methods (TRIZ, systems models, and risk analysis).
3. To outline the embodiment of the preferred system concept. 

Scope

The system attempts to open channels for proper communication to be established between the patient and the General Physician. The system is useful for patients suffering from diabetes, nurses, physicians, and health centers.

User characteristics

Diabetes is caused when the body loses its ability to use carbohydrates for energy generation. This in turn gives rise to increased blood sugar levels. Insulin is a kind of hormone made by the beta cells found inside the pancreas. Insulin transports glucose from the bloodstream into the various organs of the body. Glucose is a form of sugar which supplies energy to the body. Insulin is responsible for controlling the blood sugar level. In the case of Insulin resistance, the muscles, liver, and fat cells stop using Insulin effectively even though an adequate amount of Insulin is produced in the body. As a result, the pancreas reduces Insulin production in due course of time [2-4].

Amount of Insulin that needs to be supplied to a diabetic person: 1ml-5ml. Insulin is dissolved in liquids at varying strengths and is then used. Commonly used insulin saturations include U-100 and U-40. There are certain ingredients added to Insulin to maintain freshness and improve workability. Intermediate and long-acting Insulin is made to act longer with the help of such additives (Tables 1,2).

Ways to monitor blood glucose levels:-

• HbA1c (Blood Glucose Testing)
• Blood glucose meter

The various ways to supply the body with Insulin include:-

• Insulin pills
• Insulin shots
• Insulin pumps
• Insulin injections (Syringe)
• Injection pen
• Inhaled Insulin

Telemedicine system

To check for and diagnose diabetes, it is necessary to carry out a urine test which would test glucose and ketone levels from the breakdown of fat.

There are two kinds of blood tests used to diagnose diabetes, these are:-

• Fasting blood glucose levels: If the blood glucose level is found to bear a value higher than 126mg/dL twice, then the person is diagnosed with diabetes. However, if it lies between 100-125mg/dL (milliliters per decilitre), it is said to be Prediabetes or impaired fasting glucose level.

Both these conditions suggest the probability of type-2 diabetes.

• Haemoglobin A1c Test: Besides helping patients to monitor and control their blood glucose levels, this test also enables diagnosis of Diabetes and identifying Prediabetes. The test indicates the condition according to the blood glucose level detected, levels indicate:- 
• Normal - 5.7%
• Pre-Diabetes - 5.7% to 6.4%
• Diabetes - 6.5% or higher

Higher blood glucose levels increase the susceptibility of the body to other problems such as:-

• Blurred vision
• cardiovascular diseases
• kidney disease
• stroke
• Nerve damage

• Oral glucose tolerance test (OGTT): The test takes around 3 hours in which first a sample of flood is taken and tested. The person then is given a sample of glucose of around 75mg to drink followed by another round of blood glucose level testing after 30-60min. 

The results and their interpretation are as follows:-

The test requires the insertion of a needle to draw blood which could be troublesome for some patients. Other risks associated with it include:-

• Excessive bleeding and hematoma
• Infection
• Nausea, blackouts
• Non-fasting (Random) blood glucose level

It is another testing system to monitor the blood glucose level using a portable device called a Glucometer. It comprises test strips and small needles, known as lancets. The strip determines the blood glucose level with the help of a chemical substance and uses the digital medium to display results.

Normal blood glucose level lies within the range:-

• 70-130 mg/dL before taking meals
• Less than 180mg/dL post-meals

Blood glucose levels lower than the above-mentioned values indicate hypoglycemia, hyperglycemia, however, is caused when the values lie at higher ranges than those mentioned.

Risk includes pain sensation due to the needle-prick (Figure 1).

Figure 1: Insulin Administration (Glucotest, Eckman 2010).

Some other factors that increase the risk of developing type-2 diabetes include race or ethnicity, genetics, and age.

Regulations and standards

There are several regulatory standards framed to ensure that patients are not deprived of their essential rights. Antitrust, state licensing, and other such state laws covering liability and malpractices do not create a congenial atmosphere for telehealth in the present scenario. The existing laws are still in the development phase and need to be established in a manner that encourages the telemedicine system [5-7]. Medical practitioners are supposed to deliver their services within their states and as of now providing services across borders is yet to be legalized. John Oxedine, the State Commissioner of Fire Safety and Insurance of Georgia developed the Georgia Partnership for TeleHealth in collaboration with the state medical board and the state insurance industry. This incident laid the foundation for the legalization of the telemedical system.

Functional properties

• The telemedicine system offers improved disease management and enhanced quality of care.
• Eliminates the need for manual data recording and transfer of measured values.
• Physicians can access the data anytime via the Internet and can give appropriate suggestions. They can also correct any deficiency or lacunae in the current treatment pattern.

Physical properties

1. Bluetooth enabled meter
2. Wireless transmission services in mobile phones, laptops, etc.
3. Real time transmissions
4. Automatic transference of patient’s test results in their online log book. The details can then be accessed by their caregivers.
5. Internet connection
6. Disk storage space

Interface requirements

• Administrator section: This section will be managed by the patients who will have administrative rights and can grant accessibility rights to their caregivers. Its key function is to provide security to the system.  
• Data section: The patient’s data should be accessible to the caregivers and should be secure as well (Table 3 & Figure 2).
• Alerts: The GP can set alerts about the schedule of exercises and prescribed medicines with the help of various user-friendly features such as IMs (instant messaging), emails, text messages, etc. Any change required in the schedule can also be notified to the patient instantly.  
• Add-on (s): Availability of add-on (s) like e-books on diabetes, health guides, exercises, and training programs, blogs. Besides this, it can also be used by caregivers for advertising and hosting diabetes-related information to attract potential customers.  
• Online store: A kind of medical store where every medicine can be made available in the required amounts is another desirable feature. In case, a certain medicine is not available the physician can provide guidance to the patient on an appropriate alternative.

Figure 2: Flowchart about database management system.

Environmental conditions

Any telemedicine revolves around the use of electronic devices for testing, storage, and transmission of patient data (Figures 3,4). It thus poses the threat of e-waste, exposure to excess radioactive radiation, etc. However, at the same, it can also be considered as an environmentally friendly and cost-effective method since it helps save a lot of paper which would have otherwise gone wasted recording and maintaining data and other details.

Figure 3: Telemonitoring, access to GP, teletreatment & information transmission.

Figure 4: Data Transmission (Data Transmission, incentre.medical.phillips.com).

Maintenance

It is one of the most important factors to be considered. The physical conditions and cleanliness of gadgets and devices used here must be properly taken care of. At the same time, the software used for telehealth services needs to be updated periodically such that no loss of data takes place (Tables 4,5).

Disposal

Older data forms that are no longer useful shall be erased from the system to avert confusion. The hardware components must be reused after use.

Schedule

(Table 4)

Validation

The installation can be verified using the following URL,

http:///ems/MRxtest.mrx?SourceName=test. (Data

Implementation, incentre.medical.phillips.com)

For testing within the firewall, the following URL can be used,

http:///ems/MRxtest.mrx?SourceName=test or http:///ems/MRxtest.mrx?SourceName=test. (Data

Implementation, incentre.medical.phillips.com).

Manufacturability, distribution and storage requirements

(Table 5)

Installation

The steps to be followed for installing the Bluetooth mobile are as follows:-

Training of personnel

Given the complicated nature of the system, it is imperative that adequate training be provided to the task force, including the designers, engineers as well as workers (Table 6).

Safety

It is very important to keep up the safety of the system. The system should be kept debugged and virus-free. Also, it has to be necessarily ensured that the hardware poses no physical threat to its users.

Cost

The cost of the system must be kept to a minimum such that it doesn’t put any strain on the patients as well as the caregivers or any other user.

Documentation

The patient’s logbook is used to register details about the patient. These details include the test results, treatments being currently undertaken, and exercises. It would also contain a record of the treatment method carried out previously and the corresponding results. This information will then facilitate the patient to mark his progress and the caregiver to suggest better medication. The table below shows an example of a documentation file (Table 7).

Conclusion

Adequate & timely reporting of diseases is a precursor to effective treatment mechanisms. The GP plays a timely & leadership act in handling and monitoring every act of patient – care such as appropriate nursing requirements. The point of action while staying remote can serve as a holistic treatment venue if certain monitoring devices & care are provided to the patient without laborious movements & time spent.

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6. Krupinski E. Practice guidelines for teledermatology [Internet]. American Telemedicine Associations. 2007.
7. Schwarz MHP. Telemedicine and diabetes management [Internet]. Diabetes Prevention. 2010.