the next big thing: In a modern version of beating swords into ploughshares, Eurofighter technology is being installed in ambulances.Sally Whittle reports

Published: 21/03/2002, Volume II2, No. 5797 Page 18 19

Medicine and the military are not obvious bedfellows - but research firm QinetiQ is starting to change all that. Best known as the company behind the Public Record Office's ailing 1901 census website, the offshoot of the former Defence Evaluation and Research Agency's real strength lies in developing cutting-edge technologies for military use. Armed with a£10.8m government grant, QinetiQ has also been developing technologies to improve the delivery of patient care in NHS hospitals since 1999. The results are being rolled out in pilot projects at some of the UK's largest hospitals, including Guy's and St Thomas'Hospital trust and Frimley Park, and the Surrey Ambulance Service trust.

The semi-state-owned company has used its expertise in military technology to develop many of the systems. The e-Medics electronic treatment manual and patient monitoring system, for example, uses voice-recognition software first used in Eurofighter jets.

Surrey Ambulance Service trust is now testing the system, which uses specialist medical software running on a laptop.When an ambulance arrives at the scene of an incident, the paramedic's first task is to record the patient's vital signs, such as breathing and heart rate. E-Medics software guides the paramedic through this process and records the information on a secure computer file that can later be passed on to hospital accident and emergency staff. Using voice-recognition software means the paramedic doesn't have to stop treatment to type information into the computer, and means instructions can be relayed by a computerised voice directly into an earpiece.

The system's main advantage is that it offers a way for doctors to capture and share vital patient information, says Dr Iain McNeill, medical director of Surrey Ambulance Service trust. 'The system doesn't just record what the paramedic does - it also explains how to conduct certain procedures, and warns if they are going to do something dangerous - like administer a fatal overdose.'

The cost of the technology is still unknown, but should be extremely cost-effective over time, says Andrew May, a team leader with QinetiQ. 'This kind of software will reduce mistakes, and also improve the efficiency of paramedics'work.

'All the patient data is automatically sent back to the hospital, so paramedics can spend less time at the hospital delivering patient information.'

The wireless link uses advanced communications techniques, which QinetiQ researchers have incorporated into the system using a combination of GSM (global system for mobile communications) and mobile data networks, already widely used in radio communications within the emergency services. These transmit data from the portable PCs while GSM, commonly employed in mobile phone communications, relays information from PCs at the scene. The wireless link also provides real-time multimedia communication between the ambulance and the hospital.

Though paramedics and hospital staff are in constant radio contact, the e-Medics system allows the hospital to transmit diagrams or instructions to the paramedic based on real-time patient monitoring.

Wireless technology is also at the heart of the AeroMedical Information System, or AMIS.

Traditionally, when patients are airlifted from remote locations, their medical records are paperbased, resulting in delays passing on vital medical information.With AMIS, a patient's medical history is stored on a removable Flash storage card, known as a portable information carrier. These are a similar size to the cards used in digital cameras and remain connected to AMIS during the flight so that when the patient arrives in the UK, they hold a complete set of medical notes and patient history.

These electronic records are based on computerised dog-tags trialled by the military for use in the battlefield. Paper documents identifying dead or injured soldiers were often burned or ripped off. The portable information carrier record can be plugged into a monitoring system installed in helicopters and planes. This is combined with a system that monitors vital signs, and AMIS transmits the information ahead to a UK medical facility, while the plane is still in the air. The card is constantly updated to maintain the currency of the medical record.

'If a patient's condition becomes worse, flight medics can establish a two-way directional link with a specialist on the ground for a second opinion, ' says Keith Smith, channel manager for health at QinetiQ.

The idea of using wireless technology and removable storage media to carry and transmit medical information is central to the vision of a virtual hospital, says Dr John Navein, clinical adviser to the government's Defence Technologies for Health programme. 'Evolving technologies allow healthcare providers to be in constant communication with colleagues, and to have constant, real-time monitoring of patients, ' he says.

'Not only will this improve the standard of care, but it can also free beds by allowing non-critical patients to be monitored as they go about their business.'

The virtual hospital combines a series of monitoring tools to alert doctors to deterioration in a patient's condition, while the patient is still in their own home. 'Our aim is always to allow cancer or chronic pulmonary disease patients to stay in their homes wherever possible, ' explains Dr Navein.

'These patients are extremely vulnerable to infection, and are more likely to be exposed to lifethreatening infection in a hospital. Also, the sideeffects of treatments like chemotherapy are markedly easier to manage if the patient is in a comforting and familiar environment.'

Patients taking part in the trial are given prototype 'virtual pills' to take while they are at home. These pills are actually miniature radio transmitters in a harmless biodegradable coating, which are active within the human body for up to 48 hours. 'The pill's transmitter monitors the body's core temperature, and can then wirelessly transmit that information, ' explains Mr May. 'The patient then carries a hand-held computer that can receive the information.'

The computer - a Compaq iPaq running Microsoft's PocketPC operating system - regularly checks the virtual pill for changes in core body temperature, a critical indicator of health in cancer patients. It also asks the patient at pre-set intervals whether they are feeling well.

If the patient's temperature changes and they report feeling unwell at two consecutive intervals, the PDA will use the inbuilt general packet radio service or high-speed circuit switched data card to wirelessly send an alert to the hospital, which may then decide inpatient treatment is needed. The system has parameters of what is an acceptable range for the patient, and automatically sends an e-mail to the patient's doctor if the parameters are breached.

'Though it looks like this is an expensive system, it represents a fraction of the cost of inpatient care, ' says Mark Court, a senior systems analyst with QinetiQ.

'The information is sent as an encrypted e-mail, and is extremely secure, which was our number one priority, ' adds Mr May. 'We also do not identify the patient in any of the communications.We use ID numbers which the authorised doctors can interpret, but no-one else can.'

Guy's and St Thomas'Hospital trust is using remote patient monitoring to monitor children with heart conditions.The technology, developed by QinetiQ, reduces the time taken for screening, and can cut waiting lists to see paediatric cardiologists.

The system links echo-cardiology and data transfer systems in secondary care units with tertiary sites, creating an extended echo-cardiology network.

The system works by allowing the patient to visit a local GP or hospital, where an ultrasound image is taken of the heart.The consultant can access the image remotely, with full clinical data and consultant's notes to help decide how to treat the patient.

The key advantage of the system is that it extends best-quality cardiatric care to areas where there may be no consultant, says Bill Tucker, head of business marketing at Guy's and St Thomas's trust.Children with heart conditions are routinely referred to a London-based specialist, causing delays in diagnosis and treatment - often making an already traumatic experience even more so, he says.

The immediate aim of the virtual hospital is ultimately to reduce the pressure on hospital beds, says Dr Navein.According to the Department of Health, the daily number of available beds fell by 2 per cent from 190,000 to 186,000 over the last year. Estimates suggest that remote care of cancer patients alone could reduce hospital stays sufficiently to reverse this decline.

Longer-term, doctors would like to see a seamless stream of medical services, integrated with webbased services from other agencies, such as social services and the police, says Dr Loua Al Shaikh, consultant intensivist at Frimley Park Hospital.

Providing the health service sticks to industrystandard technologies and protocols, he believes, it should be possible for everyone to carry their own electronic smart device that contains medical and other vital records, which can be slotted into readers at the relevant public service point.