Hermens Hermie J, Vollenbroek-Hutten Miriam M R
Roessingh Research and Development, Enschede, Roessinghsbleekweg 33, 7522AH Enschede, The Netherlands.
J Electromyogr Kinesiol. 2008 Dec;18(6):908-19. doi: 10.1016/j.jelekin.2008.10.004. Epub 2008 Nov 11.
The growing number of elderly and people with chronic disorders in our western society puts such a pressure on our healthcare system that innovative approaches are required to make our health care more effective and more efficient. One way of innovating healthcare can be obtained by introducing new services that support and enable these elderly and people with chronic disorders in a more independent living and in self management with respect to their disorders. Examples of such services are remote monitoring and remotely supervised training (together RMT). Remote monitoring focuses on continuous monitoring of the health status with the assurance of assistance whenever required. Remotely supervised training focuses on efficient and effective individually tailored training anywhere and anytime with intensity not feasible in an intramural setting. It is expected that services of remote monitoring and remotely supervised treatment will become important for at least patients (safety, more in control, convenience), health care insurances (efficiency, cost reduction) and healthcare service providers (more effective care). RMT systems are in general quite complex distributed Information and Communication Technology (ICT) systems. RMT systems integrate ambulant sensing to measure relevant biosignals and (possibly) subject's context information, secure data transport and storage, appropriate decisions support systems to assist in both technical and clinical decision making but also feedback on information to both patients and care providers. Feedback is essential for patients to make them aware of their health status, to give them a feeling of safety and to motivate and enable them to change/improve their health status. Feedback of information to healthcare professionals enables them in making appropriate decisions and to monitor changes/improvements in a patient's health status. Despite this apparent complexity, these systems must be very dependable to be accepted and used in a healthcare setting. During the past years knowledge and experience has been gained with the development of the building blocks of RMT systems. In parallel, experience has been gained with respect to the challenges involved when using RMT systems in a clinical environment. Examples are: activity monitoring in low back pain, monitoring of spasticity, myofeedback in subjects with neck shoulder and lower back pain and post rehabilitation home training. Until now, the main focus has been on the technical realization of the sensing and transportation part of it. The development of intelligent decision support systems is still in its infancy and clinical validation studies and models how to implement these services and how to make them profitable are largely lacking. In conclusion, the combination of Biomedical Engineering with Information and Communication Technology has opened a new extensive area of research and development with a high potential to have substantial impact on our future healthcare.
在我们西方社会，老年人和慢性病患者的数量不断增加，给我们的医疗保健系统带来了巨大压力，因此需要创新方法来提高医疗保健的有效性和效率。创新医疗保健的一种方法是引入新服务，以支持和帮助这些老年人和慢性病患者更独立地生活，并对自身疾病进行自我管理。此类服务的例子包括远程监测和远程监督训练（统称为远程监测与训练，RMT）。远程监测侧重于持续监测健康状况，并确保在需要时提供援助。远程监督训练则侧重于随时随地提供高效、有效的个性化训练，其训练强度在机构环境中是不可行的。预计远程监测和远程监督治疗服务至少对患者（安全性、更多掌控感、便利性）、医疗保险（效率、成本降低）和医疗服务提供者（更有效的护理）都将变得重要。RMT系统通常是相当复杂的分布式信息通信技术（ICT）系统。RMT系统集成了移动传感技术，用于测量相关生物信号和（可能的）受试者的情境信息、安全的数据传输和存储、适当的决策支持系统，以协助进行技术和临床决策，同时还能向患者和护理人员反馈信息。反馈对于患者至关重要，能让他们了解自己的健康状况，给予他们安全感，并激励和促使他们改变/改善自己的健康状况。向医疗专业人员反馈信息能使他们做出适当决策，并监测患者健康状况的变化/改善情况。尽管这些系统看似复杂，但要在医疗环境中被接受和使用，它们必须非常可靠。在过去几年里，在RMT系统的构建模块开发方面已经积累了知识和经验。与此同时，在临床环境中使用RMT系统时所面临的挑战也积累了经验。例如：腰痛的活动监测、痉挛监测、颈肩和腰痛患者的肌反馈以及康复后家庭训练。到目前为止，主要重点一直放在其传感和传输部分的技术实现上。智能决策支持系统的开发仍处于起步阶段，而且在很大程度上缺乏临床验证研究以及关于如何实施这些服务并使其盈利的模式。总之，生物医学工程与信息通信技术的结合开辟了一个新的广泛研发领域，极有可能对我们未来的医疗保健产生重大影响。
