I was recently invited to give the keynote speech at a conference organized by the Telehealth unit of Alberta Health and Wellness. It was déjà vu  -- all over again. Another stealth application of NBICS. Like nanoforestry (which I wrote about before), tele/e-health, medicine and care (I’ll use the short term telehealth) uses a lot of NBICS products -- but it’s hardly visible in the policy discourse around NBICS.  

If people think at all about telehealth they tend to think about it mostly in terms of video-conferencing. However the field is so much more. It uses many NBICS advances that have already come to pass, and is poised to take advantage of many that are envisioned and still to come. According to the Alberta Government Telehealth Unit,  telehealth is “the use of technology to support the delivery of health services, education, and administrative activities at a distance,” (see also Alberta Government Telehealth Business Plan 2006-2009). It provides new models of care, addresses population needs, helps to remove geographical barriers, increases the capacity of the health care system including clinicians, and provides support for clinicians and the health care system in rural areas or isolated environments.

Some so-called niche markets for telehealth are:

• Aviation healthcare: telemedicine services for passengers and personnel in airplanes.
• Maritime healthcare: telemedicine services on board of ships or offshore.
• Space healthcare: telemedicine services in space, e.g. telemonitoring.
• Defence healthcare: telemedicine services to support health professionals working in military missions in remote or third world countries (Balkan states, Afghanistan, Iraq,…), e.g. telesurgery, teleradiology.
• Disaster Relief: telemedicine in areas of natural disasters (earthquakes, floods).

Many NBICS advances have the potential to be used in telehealth. To give some examples…

The CAVE Automatic Virtual Environment -- an immersive virtual reality environment comprised of four projection walls, a tracking system and hand wand -- enables scientists to interact and view three-dimensional models of biological systems, including cells, tissues and entire organisms (see some pictures here). Eventually this kind of holodeck should be available to individuals, leading to numerous applications.

As one news item states: “Stereoscopic imaging – coupled with recent advances in catheter-based surgical tools – may eventually allow surgeons to do much more complex operations on beating hearts...”

Virtual reality has already found applications: Virtual Reality Training Designs for Children with Autism and Fetal Alcohol Spectrum Disorders; Creating Enriched Learning Experiences for Individuals with Cognitive Disabilities; Virtual reality in the Assessment of Selected Cognitive Function after Brain Injury; Virtual Reality and Computer Technology Improve Stroke Rehabilitation; Using Virtual Reality to Relearn Activities of Daily Living. With the implementation of holodecks one can only envision an increase in use.

Advances in sensor technologies will also drive telehealth applications.
Personal Health Systems like those described below will increase.

• Acquisition of data and information related to the health status of a patient or healthy individual, e.g., through the use of sensors and monitoring devices.
• Processing and analysis of the acquired data  at both ends: locally at the site of acquisition (e.g., with on-body electronics) and remotely at medical centres.
• Communication between various actors, in a loop: from patient/individual to medical centre; from medical centre that analyses the acquired data to doctor/hospital; and back to the patient/individual from either the wearable/portable/implantable system itself or the doctor or the medical centre (e.g., in the form of personalised feedback and guidance to the patient, adjusted treatment via closed loop therapy, control of therapy devices).

A biometric bodysuit developed by Arizona State University shows how electronics and fluidics can be incorporated into clothing to perform a wide range of tasks: from highly functional tasks (like dispensing medicine, detecting pathogens or providing environmental awareness for personal safety and protection) to the aesthetic (clothes that change colors or display patterns as downloaded from a website to change the fashionable motifs and designs of a garment).

The European project -- the BIOTEX project -- weaves new functions into smart textiles. A recent article “Smart Clothes: Textiles that Track Your Health” from the European eHealth News portal talks more about this area. Sensor systems will very likely become so pervasive so that first research studies are under way to develop a Sensor Acceptance Index (SAI).

A Bluetooth Special Interest Group has developed a standard Health Device Profile (HDP) for medical devices.

A recent nanomedical and telemedical technology conference in Quebec Canada offered presentations from from start-ups and established companies like Motorala on telehealth:

• Potential Uses for Implantable Hemodynamic Monitors
• Our Vice President is a Cyborg
• Telemedicine Applications for Non-Invasive DNA Sampling
  and Extraction Device
• Mobile Health Ecosystems and the impact on Nanotechnology
• Novel Wireless, Battery less, Implantable Sensors for
  Chronic Disease Management
• Wireless Implantable Devices for Drug Delivery and Biosensing
• Neurochips and Telemedical Applications
• Designing and Controlling Medical Nanorobots
• Human++: Emerging Technologies for Wireless Autonomous Health Monitoring Devices
• UWB Radios: A New Technology Enabling Autonomous Body Area Networks and Patient or Asset Tracking in Hospital Environments

Many of my columns cover science and technologies that could be used in telehealth -- like the brain-machine interface or the artificial hippocampus. Even my drug columns relate to telehealth. The remotely triggered dispensing of drugs into a patient through an implanted drug pump already exists. The remotely triggered printing of drugs might soon become reality. To quote from an MIT Briefing Book: “Using a three-dimensional printing device similar to a computer ink-jet printer, MIT scientists are 'printing' drugs into pills, creating highly precise doses they say will be more effective and have fewer adverse side effects.”

The Choice is Yours

Telehealth will be at the forefront in using many NBICS advances. It will also drive NBICS developments, as it will be seen as an increasingly big market for NBICS advances.

With all of this of course comes change -- in the job profiles of hospital employees, nursing, and the medical profession; in the concept of privacy and what privacy we as a society can maintain and want to maintain (this is not telehealth specific but is a consequence of the general area of sensor system development (see for example my smart dust column); in patient expectations related to service delivery and the concept of health (I’ve covered the concept of health change in many of my columns; for example here).

It is important that health policy and care is included in horizon scanning exercises, so participants in the health system can see where it is going and can accept or reject certain developments. (I have covered the problem with existing health technology assessment here). Telehealth professionals should be even more involved in foresight with respect to NBICS developments, and how they can be best used in telehealth, in health service delivery, and by patients.

Gregor Wolbring is a biochemist, bioethicist, disability/vari-ability/ability studies scholar, and health policy and science and technology governance researcher at the University of Calgary. He is a member of the Center for Nanotechnology and Society at Arizona State University; Part Time Professor at Faculty of Law, University of Ottawa, Canada; Member CAC/ISO - Canadian Advisory Committees for the International Organization for Standardization section TC229 Nanotechnologies; Member of the editorial team for the Nanotechnology for Development portal of the Development Gateway Foundation; Chair of the Bioethics Taskforce of Disabled People's International; and former Member of the Executive of the Canadian Commission for UNESCO (2003-2007 maximum terms served). He publishes the Bioethics, Culture and Disability website, moderates a weblog for the International Network for Social Research on Disability, and authors a weblog on NBICS and its social implications.

© Gregor Wolbring, All Rights Reserved, 2008. Please contact the author for permission to reprint.