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[電子工程專輯] 醫療電子業渴望走進你家大門

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關鍵字: 醫療照護 醫療電子 市場門檻

醫療照護系統的高成本(部分來自昂貴的診斷系統)一直受到爭議,在這樣的壓力之下,幼教DVD醫療電子領域也必須證明自我價值所在。很多人認為,醫療電子技術的貢獻,將是催生能實現家用低價醫療照護方案的各種元件與網路,但市場門檻為該領域的起步階段帶來阻礙。

「醫療照護技術的改革是我們共同的責任。」美國醫療植入裝置大廠Medtronic負責新治療方法業務的副總裁Rebecca Bergman,在IEEE醫療與生物工程學會大會(EMBC '09)上表示:「科技並非是這個課題的核心,但我們應該讓科技成為解決方案的一部份,而不是製造問題…這是我們需要具備的態度。繪圖、圖像、靜態影像軟體

Bergman認為,在相關系統複雜性日益升高,以及法規與大眾關注加深的趨勢下,醫療電子業者需要更對新科技的帶來的風險與益處有更清楚的認知。Medtronic新上任的科技長Richard Kuntz則指出,成本問題已經快速成為醫療照護系統最主要的爭議所在。

Kuntz表示,「相對療效研究(comparative effectiveness research)」是醫療照護改革領域的流行口號,因此廠商不得不在低成本療法當道的市場上,證明成本提升所帶來的附加優勢為何;而他估計,要延長一年壽命的代價大概是4萬5,000美元。

醫療照護產品供應商Johnson & Johnson Services的新興技術部門副總裁Joseph Smith也指出:「那些我們所打造的儀器設備是解決方案的一部份,但往往卻被認為是問題所在。」

美國民眾需要醫療照護 卻吝於支出

EMBC '09的多位演講者指出了美國醫療照護領域所面臨的危機。在美國,民眾老化與過胖的問題是衍生慢性疾病的兩大殺手,但願意付錢給醫療照護服務的人卻越來越少。Smith表示,三分之二的美國人體重過重,有6,500萬人有慢性心血管疾病,有2,000萬人罹患糖尿病。而華盛頓大學電子工程系教授Yong-Min Kim則表示,美國民眾一年的醫療照護花費總計為2.5兆美元,佔全球總金額的45%,而這些費用有大多數是來自壽命僅剩數月的65歲以上人口。

Kim並指出,美國醫療支出的前三大項目依次是藥品、醫療造影,以及包括基因療法、心血管支架等其他先進治療技術。而醫療體系溝通的貧乏,往往導致許多重複性測試,醫療照護程序也需要許多繁瑣的文件往來。

此外,目前至少有5,000萬美國民眾沒有醫療保險。「這些人會把醫院急診室當做一般診所,並帶來許多問題。」Kim並強調,醫院是醫療照護費用最高的地方。為此Kim與許多人投入了居家醫療照護方案的開發,例如透過連網消費性電子設備、可穿戴電子設備來監測民眾的健康情況,特別是那些慢性疾病患者。

「到目前為止還沒有出現針對慢性疾病的不間斷照護治療方法典範,但我認為我們會達到該目標;」Johnson & Johnson的Smith表示:「解決方案將會是與醫護人員連線的嵌入式或是可穿戴式裝置。」

全球的研發人員已經投入這個領域超過十年;「自1997年以來,我們的願景是開發出讓民眾只要花499美元就可在大賣場買到的超音波設備。」Kim表示。但眼前仍有許多挑戰,首先是缺乏針對這種消費性醫療設備的標準;而如何能讓這些設備具備易用性、又能確保個人醫療資訊透過網路傳送的安全性也是問題。基本上,這樣的工作就是要將醫療電子技術與市面上各種消費性電子與電腦連網裝置融合;對此Smith表示:「我想不出還會有哪種介面比這更複雜。」

醫療電子商機潛力無窮 只是還看不到

無論如何,市場商機是確實存在的;有人估計,大概有64%的醫生使用智慧手機,而光是Apple的iPhone就可提供600種醫療相關應用程式。最大的挑戰或許是建立一個讓民眾願意掏錢買居家醫療系統與照護服務的方式。

另一家業者Boston Scientific的心律調整器部門研發副總裁John LaLonde表示,截至2008年底,估計250萬個包括心律調整器在內的植入式醫療裝置中,已有60萬個透過家用電子設備連線到醫療院所,樂透六合彩.股票.賭博學習但卻沒有一家提供這種遠端服務的廠商賺到錢;目前有1.5萬個植入式裝置用戶正接受該公司的遠端監控服務。

LaLonde指出,有些公司是將遠端服務費用加在植入式裝置價格中,有的公司則是出租家用設備、DVD9電影直接賣服務,還有少數公司是與保險業者合作;雖然已經有許多試驗案例,但目前的業務模式就是無法成功。

醫療電子市場面臨的關鍵問題之一,就是仍缺乏醫療院所對遠端監測優點的實證;大多數人都認為遠端系統有助於確認病患症狀,並能減少民眾跑急診室的花費,卻沒有相關研究可指出這類系統的使用者因此大幅節省了醫療照護支出。所以LaLonde認為,要為醫療照護系統找到一個持久可行的業務模式,廠商恐怕還得經歷一番辛苦試煉。「我覺得我們在一種“向下沉淪(race to the bottom)”的狀態──投資升高了市場期待,但卻有更多投資是沒有掌握到價值的。」他表示:「但儘管問題重重,領先的科技業者們還是紛紛想進入這個市場;」像是Dell、Google、IBM、Intel、Microsoft等。

這些廠商看到醫療電子領域正在以類似音樂、影像產業之數位化的模式不斷細分;LaLonde指出:「他們很渴望能做些什麼,而他們得弄清楚那些“什麼”是什麼。」

民眾願意買單才是重點

醫療電子領域的另一個挑戰,是讓民眾接受新科技。一位正參與歐洲最大的可穿戴式醫療系統試用計畫HeartCycle的研究人員就表示,目前可穿戴式醫療監視設備的最大障礙,就是說服一般民眾把它們穿在身上。

澳洲也有一個類似的大型研究計畫,期望未來當地光是一個省份就能因此每年節省2,400萬的慢性心血管疾病患者醫療照護費用。澳洲目前正在與Nokia Research合作開發手機應用程式,目標是募集200個使用者加入試驗。xyz

參考原文: Medical electronics seeks role in health care debate,by Rick Merritt

Medical electronics seeks role in health care debate
Goal of enabling low cost home care faces hurdles

MINNEAPOLIS — The medical electronics sector is under pressure to prove its value in the debate over the high costs of health care—some of the costs driven by expensive diagnostic systems. Many believe the sector's biggest contribution could be developing devices and networks that drive a shift to lower cost care at home, but market hurdles have stymied early efforts.

"We all have a responsibility to be involved in health care reform," said Rebecca Bergman, a vice president of new therapies at Medtronic (Minneapolis), a leading maker of implantable devices. "Tech is not at the core of this issue, but we should make tech part of the solution and not part of the problem--that's the attitude we need to have," she said in a talk at the recent conference of the IEEE Engineering in Medicine and Biology Society (EMBC '09) here.

Medical electronics companies need to set realistic expectations of risks and benefits of new technologies in an environment of rising complexity of systems and increased scrutiny by regulators and the public, she said. "How we deal with that will take very big thinkers," she added.

Cost is quickly becoming the key issue in the health care debate, said Richard Kuntz, recently named as chief science officer of Medtronic.

"Comparative effectiveness research is the buzzword in health care reform," said Kuntz. "So we have to show added costs add benefits," in a market where the lowest-cost therapy wins and where the value of an added year of life is pegged at about $45,000, he added.

"The instruments we construct are part of the solution, but they are often seen as part of the problem," said Joseph Smith, vice president of emerging technologies at Johnson & Johnson Services Inc. (New Brunswick, NJ), which oversees dozens of medical businesses.

Many speakers at EMBC '09 outlined the crisis ahead. An aging, overweight population in the U.S. is seeing a rise in chronic illnesses as the percent of the population paying for health care services decreases.

Two out of three Americans are overweight, 65 million have chronic cardiac problems and 20 million have diabetes, said Smith. The $2.5 trillion spent in the U.S. each year represents 45 percent of all global spending on health care, and the vast majority of it is spent on people 65 and over in the last months of their lives, said Yong-Min Kim, a professor of electrical engineering at the University of Washington.

The top three health care expenses in the U.S. are medications, imaging and other advanced treatments ranging from gene therapy to stents, Kim said. Poor communications often lead to duplicating tests, and each hour of care leads to an hour of paperwork, he added.

In addition, as many as 50 million Americans are uninsured. "They use the emergency room as their normal health care provider which causes a lot of problems," Kim said noting hospitals are the most expensive place to receive care. The situation has led Kim and others to advocate monitoring health at home via networked consumer and wearable devices, especially for those with chronic illnesses.

"We don't yet have the treatment paradigms for continuous care for chronic diseases, but I think we will get there," said Smith of Johnson & Johnson. "The solution is in embedded or wearable devices linked to therapy," he added.

A race to the bottom in monitoring

Researchers around the globe have been working in this area for more than a decade. "Our vision since 1997 has been to develop an ultrasound device people could buy for $499 at Costco," said Kim. The challenges are many. There's a lack of standards for such consumer medical devices, and a lack of experience in how to make them easy to use yet secure enough to protect personal medical data travelling over the Web.

Essentially, the work requires merging medical electronics with the wealth of consumer and computer networked devices available today. "I don't think there's a more complex interface than that," said Smith.

The opportunity is real. One source estimated as many as 64 percent of physicians use smart phones and as many as 600 medical applications are available for the Apple iPhone alone. The biggest challenge may be finding a way to get someone to pay for home care systems and services.

By the end of 2008 as many as 600,000 of the estimated 2.5 million implanted devices such as pacemakers in use were linked to home devices that transmit data automatically to clinics. However, none of the companies providing those remote services are being adequately compensated for them, said John LaLonde, vice president of R&D in Boston Scientific's pacemaker group which has 150,000 implant users on its remote monitoring service.

Some companies sell the remote services bundled into the cost of the implants, others lease the home devices and sell the services outright and a few have secured reimbursement from insurance providers, he said. Despite the many experiments, "the business models in place today just do not get it done," he said.

One key problem is the industry still lacks clinic evidence of the benefits of remote monitoring. Many believe the remote systems help identify problems that reduce costly emergency room visits; however, one recent study failed to show users had health care costs lowered significantly.

"There's a struggle trying to find a business model that's robust and durable given the way the health care system operates today," said LaLonde. "I contend we are in a race to the bottom in which investment drives up expectations and more investment without capturing value," he said.

"Despite the problems, premier tech companies want in" to this market, LaLonde said, noting new offerings from Dell, Google, IBM, Intel and Microsoft. They "see disruption going on" similar to the digital transitions in music and video businesses, he said. "They have the desire to do something, and they have to figure out what that something is," he added.

Another challenge is getting users to adopt the technology. The biggest hurdle with wearable medical monitors is to get consumers to wear them, said one researcher who is working on the HeartCycle project, the biggest trial of wearable medical systems in Europe.

A similar pilot program in Australia believes it can save $24 million a year in health care costs for chronic heart disease in one province alone. It is working with Nokia Research to develop mobile apps and aims to sign up 200 users for a trial.

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作者: cyenpztfx
  (2010-01-10 05:19)
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