Mobile TeleHealth

1. Healthcare in Local and Global Networks Prof. Dr. Timo R. Nyberg [email_address]

3. KNOWLEDGE Guidelines Graded evidence Databases: drugs, laboratory, genome Images and videos for training skills Ethical summaries Patient information Patient data Genome map Database of ”all” previous patients Probably beneficial therapy Simulation Individualized prediction of the effects of treatment Patient’s values and choices Selection of treatment Selection of medical treatment in the future Decision support Doctor’s interpre- tation and experience Source: Kunnamo Paid by Insurance? Available nearby? Etc????

4. Insulin H Protaphan 32 U. Metformin 500 mg 2 x 2 Aspirin 100 mg 1 x 1 Simvastatin 20 mg 1 x 1 Enalapril 20 mg 1 x 1 Amlodipine 5 mg 1 x 1 Medication 15.6.2005 New R       R R R R R Continuous medication 05.07.2003 Long-acting insulin Insulin H Protaphan 32 U. M. Valli/KSKS Type 2 diabetes 23.6.2001 Metformin 500 mg Diformin retard 2 x 2 I. Kunnamo Type 2 diabetes 12.11.2004 Aspirin 100 mg Disperin 1 x 1 S. Miettinen Antiplatelet drug 20.06.2004 Simvastatin 20 mg Simvastatin Ratiopharm 1 x 1 I. Kunnamo Hyperlipidaemia 04.12.1999 Enalapril 20 mg Enalapril Generics 1 x 1 I Kunnamo Hypertension 26.05.2005 Amlodipine 5 mg Norvasc 1 x 1 K.Virta/KSKS Hypertension Medication used during previous month 23.6.2001 Amoksisilliini 750 mg Amoxin 1 x 2 I. Kunnamo Acute maxillary sinusitis Medications withdrawn 21.02.1998 Hydroklorothiazide 25 mg Diurex mite 1 x 1 K.Virta/KSKS Hypertension + amiloridechloride 5 mg Withdrawn 15.3.1998. Cause: Rash I Kunnamo       Detailed view R R R R R R R Always visible view Medication data

5. Data must be available at the point and time they are needed - if not, it is useless - if not, it is useless

12. Source: Valle T & Tuomilehto J, 2004 1) Numbers Finland on 31.12.2004 Target value NOT in target (%) NOT in target (n) 1) T1: HbA1c < 7,5 % T2: HbA1c < 7,0 % T2: RR < 135/85 T2: LDL-kol < 2,6 Poor care quality results 72 % 167 300 82 % 190 500 69 % 139 400 79 % 26 400

13. 19 x 8 x  TK 2005 Cost of poor therapy City of Helsinki 2004

14. Mobile Phone Test result RFID reader BlueTooth etc.

16. WEB (professional)

17. WEB (individual)

19. City of 200000 population, target group about 30000 over 40-year-old men in occupational health care system Screening with Internet or PDA 30000 men Path 6 Other Intervention Therapy concepts Path 5 Combi Path 3 Insulin Path 2 Oral Path 4 Excercise Path 1 Diet 1 ½ hour 3 1 month 2 1 week Segmentation based on a) risk screening, b) life style, and c) Motivation 10000 men 4 continuous Self care Self measuremets Mobile phone Intelligent support system FEED BACK ACT MEASURE

21. Technology Choises x Mobile Phone x PDA x Internet Technical functionality Cost effectiveness Easyness of use Notes Screening xx xxxx xxxxx xx xxx xxxx x xxx xxxxx Cell Phone, PDA and Internet ok Segmentation & Monitoring xxxx xxxx x xxxx xx xx xxxxx xxx xx Cell Phone and PDA work well Intervention xxx xxxxx xx xx xxxxx xxx xxx xxxxx x Cell Phone & Internet OK PDA best Self Care xxxxx xxxxx xxxxx xxxxx xx xxxx xxxxx xxx x Cell Phone is the best choise

28. . Thank You for Your Attention [email_address]