Lateral thinking is solving problems through an indirect and creative approach, using reasoning that is not immediately obvious and involving ideas that may not be obtainable by using only traditional step-by-step logic. . Lateral thinking is concerned with the movement of ideas.

A person would use lateral thinking when they want to move from one known idea to creating new ideas. Edward de Bono defines four types of thinking tools:

• Idea generating tools that are designed to break current thinking patterns—routine patterns, the status quo
• Focus tools that are designed to broaden where to search for new ideas
• Harvest tools that are designed to ensure more value is received from idea generating output
• Treatment tools that are designed to consider real-world constraints, resources, and support.

A person would use lateral thinking when they want to move from one known idea to creating new ideas. Dr. Richard Reese

November 6, 2011 – When I received the following email from Roger Heath, a biomedical engineer who is CEO of www. emstelematics.com, I thought immediately of the concept of “lateral thinking,” arriving at innovation through direct and creative thinking.

Edward de Bono, MD, founder of a thinking institute in Malta, says the medical system is comprised of a horizontal landscape full of vertical holes with a specialists at the bottom of each hole. The problem is the vertical holes do not always intersect. The Internet, social media, and IT Techologies are in the process of connecting the holes. This is especially true in business-friendly environments, where entreprenuers and venture capitalists actively talk to each other.

The medical system is comprised of a horizontal landscape full of vertical holes with a specialists at the bottom of each hole. Edward de Bono, MD

The E-Mail:

We are focused on the ‘front door’ of the hospital, the Emergency Department, where roughly 80% of admissions occur. This is also where most medical record systems are initialized. We are working with Chief Dennis Murphy of the International Association of Fire Chiefs in this area. This is the “eye of the storm” of our projects, you might find this perspective fascinating because this may save cities tens of millions right away, even during healthcare reforms.

Simply put, this involves the prioritizing calls as emergent or non-emergent. Then non-emergency calls (30-60% at the 911 level) may be responded to with a lower cost Mobile Primary Care Unit (MPCU) that can elevate care, lower risks, and save substantial monies. To do this, one needs Decision Support Software (DSS) and mobile telemedicine. In the middle of healthcare reforms, major cities can respond by significantly lowering costs while providing higher levels of care at the same time. It’s a win-win situation, for both providers and patients.

I saw you reporting on Skype being used to qualify ED visits. I view this as potentially very risky, when done without Decision Support Software, like our Odyssey systems. Nurse teletriage was started in major U.S. city some years ago and resulted in a patient lawsuit that was successful and resulted in the complete over-haul of the fire department administration. This set back this concept for some years. Many are experimenting in this area without a great deal of understanding of the inherent risks. I did a post on our site that addresses this issue about using video conferencing only. See: Video Tele-Conferencing is NOT Telemedicine!

I brought the Odyssey DSS software from the UK because I could not find this in the US. It has done over 20 million assessments without a lawsuit. It has been developed over 15 years now. East Midlands Ambulance service has already been saving $11 million annually using the software for some years. I recently was at the Cleveland Clinic reviewing all of this at a very special meeting there regarding call center management. Triage and qualifying patients needs is becoming a central focus. See: DSS Tele-Triage

Prioritizing and coordinating care is the name of the game. It involves very carefully, and safely, matching patient needs to exactly the level of care required.

Reposted from Dr. Richard Reese’ “Medinnovation Blog” view full article

LifeBot has just been advised that R. Lee Heath will have his 33rd patent issue from the U.S. Patent Office. The new patent integrates crucial call management, Personal Emergency Response Systems (PERS) and resuscitation technologies that will only be available from LifeBot.

According to CEO, Roger Heath, “This new patent has major ramifications when applied to managing emergencies during telemedicine home remote monitoring. The majority of these patients are chronic and they are going to have an emergency arise. The patented system does away with the old mantra, “Hang up and dial 911.” because the last thing patients wish to do is disconnect a doctor or nurse during an emergency. There is no reason to hang-up on high-level life-saving medical expertise in the midst of an emergency. This could cost human lives.”

“Most very large telemedicine firms have been investing billions in home remote monitoring and this undoubtedly will reduce healthcare costs. But, they seem to have “skipped over” or completely forgotten that most of these patients are going to have an emergency. This is inevitable.”, states Heath, “So emergency management is critical to saving more lives and LifeBot® holds the exclusive patented technologies to make this possible.”

When this patent is combined with Heath’s patented resuscitation technologies, this forms the basis for the most advanced home remote monitoring systems with emergency management “built-in” says, Heath.

view more…

What do you get when you invest $14 million and 6 years of field tests in an emergency medical services telemedicine system? You get DREAMS™ – Disaster Relief and Emergency Medical Services – described as the most advanced EMS telemedicine system in the world. The $14 million came from the U. S. Army Medical Research and Materiel Command and the Telemedicine and Technology Research Center (TATRC) through a Congressionally Funded military research project. The six years of field tests were done in Liberty County Texas. LifeBot® is the company bringing DREAMS™ to the public safety, EMS, and hospital emergency medicine markets. I had the pleasure to interview Dr. James “Red” Duke and Roger Heath recently about DREAMSTM and what this solution can do for emergency medicine.

What do you get when you invest $14 million and 6 years of field tests in an emergency medical services telemedicine system? You get DREAMS™ Bob Pessemier

DREAMS™ is a complete telemedicine system to connect EMS field units to hospitals and doctors who may be hundreds of miles away and spread out across the country or across the globe. You can transmit voice, video, patient data, and even instruct field personnel on medical procedures. The system integrates voice, video, data, wireless networking, and radio-telephone communications systems. 

The solution can be installed in ambulance or EMS units to create a Super Ambulance or Mobile Primary Care Unit and can also be used by field personnel on an HP Slate 500 tablet PC. Hospitals can connect the emergency department with the field units using the HP TouchSmart 9100 in the hospital.

The goal of the system is to provide better triage, diagnosis, and treatment on the scene. DREAMS™ is designed to help public safety agencies and hospitals save lives, lower liability risk, and reduce costs.

Solution Overview:

DREAMS™ is a complete telemedicine system to connect EMS field units to hospitals and doctors who may be hundreds of miles away and spread out across the country or across the globe. You can transmit voice, video, patient data, and even instruct field personnel on medical procedures. The system integrates voice, video, data, wireless networking, and radio-telephone communications systems. 

The solution can be installed in ambulance or EMS units to create a Super Ambulance or Mobile Primary Care Unit and can also be used by field personnel on an HP Slate 500 tablet PC. Hospitals can connect the emergency department with the field units using the HP TouchSmart 9100 in the hospital.

The goal of the system is to provide better triage, diagnosis, and treatment on the scene. DREAMS™ is designed to help public safety agencies and hospitals save lives, lower liability risk, and reduce costs.

For Example:

Let’s say you have a Medic unit set up with the DREAMSTM solution and they respond to a car accident that is 100 miles from the nearest hospital. Doctors will be able to view the patient and their injuries with one of the three cameras mounted in the unit and the even view the scene so they can determine method and extent of injuries. They can look up patient records from a hospital database and consult in real time with a hospital trauma department. Patient vital signs and other telemetry data are transmitted to the hospital. A doctor in the trauma center could help the paramedics close a large laceration (something they are not trained to do) that is critical to a patient’s survival. Triage and patient care becomes much more effective and efficient. They can also communicate with anyone they need to even if they are on a cell phone, land line, or a completely different radio system.

What Sets Them Apart:

A major differentiator of DREAMSTM is that it is an all-in-one integrated system designed to work seamlessly from the field to the hospital in any technology environment. This system was used for six years in Liberty County Texas and is the only telemedicine system used in actual disasters (Katrina, Rita, Ike).

The people behind this solution are also unique. Dr. James Duke is a renowned trauma surgeon, introduced the first helicopter life flight program in the U.S., attended to Governor Connally’s wounds during the JFK assassination, and hosted the former PBS series, “Bodywatch”. His credentials and involvement in EMS is on the scale of legendary.

Roger Lee Heath is an entrepreneur and inventor who is credited with bringing the Automated External Defibrillator (AED) to the EMS world. Mr. Heath is another legendary figure in telemedicine technology.

Dr. S. Ward Cassells received the General Maxwell Thurman Award for his participation in the design of the DREAMS Digital Ambulance telemedicine system, is the former Assistant Secretary of Defense (Health Affairs), and is the John E. Tyson Distinguished Professor of Medicine and Public Health, and Vice President for External Affairs and Public Policy at the University of Texas at Houston, and Senior Scholar at the Texas Heart Institute. 

The contribution these three have made to health care and telemedicine over the years is very impressive. They should know what they are doing with LifeBot and DREAMS.

Client Quote:

“Through our close collaboration with innovative technology leaders like LifeBot, HP mobile technology products bring physicians closer to the point of care, regardless of their location. In the back of an ambulance where every second counts, this type of technology is particularly critical, said Chris Mertens, vice president, Healthcare, Personal Systems Group, HP. “Combining our HP Slate 500 and HP TouchSmart PCs with Lifebot’s DREAMS™ ambulance teletriage system is revolutionizing speed of care in emergency health situations and truly saving lives.”

From Roger Heath: “DREAMStm has many applications beyond ambulance telemedicine – the software can be used on hospital mobile telemedicine carts and desktops, or by neurologists on LifeBot’s hub and spoke system to meet American Heart Association recommendations for telestroke. DREAMStm can expand those capabilities to include teletrauma, e-ICU, and disaster management. With the 1.5 pound HP Slate tablet PC, a physician or intensivist can remotely connect hospital-to-hospital or hospital-to-ambulance from almost anywhere, and at any time, to save lives. Call centers, or “telemedicine hubs” may quickly triage and dispatch higher levels of care. Improved communications and care coordination provides for new efficiencies significantly lowering healthcare delivery costs.”

View full Article on Emergency Management

Phoenix, AZ, USA September 8, 2011 : Cardiac defibrillators, used to shock heart arrest victims back to life, are in widespread use throughout the world today. They are in virtually all hospitals, most ambulances, at airports and major public gatherings, aboard airplanes and sea going vessels. They are implanted similar to pacemakers. But, what if defibrillators could use 80% less energy? Could they be much smaller lighter and cost less? Would there be less pain and heart tissue damage?

LifeBot® announced today that founder, R. Lee Heath, has received Notice of Allowance from the U.S.P.T.O. of his 32nd patent focusing on integration cardiac defibrillation and telemedicine robotics.

Most of this is possible according to CEO and founder R. Lee Heath. With his 32nd patent issuing, LifeBot® is even better positioned to deliver these exclusive resuscitation and telemedicine technologies. LifeBot® is focused on the use of remote telemedicine to manage critical emergency life saving procedures.

New Reports: Successful Defibrillation with 80% Less Energy:

Researchers in the U.S. and Germany surprised everyone just a few weeks ago announcing the results of their extraordinary studies showing that defibrillation may be performed using counter-shocks with almost 80% less energy. The studies were done on internal procedures with electrodes connecting directly to the heart. But, according to Heath, it is just a matter of time before this area of research will have an impact on external procedures as well. Each study demonstrated that a series of small shocks could produce similar results to that of a large single counter-shock or the conventional method most commonly utilized by all defibrillators today.

According to Science Daily, “An international team of scientists — from the Max-Planck-Institute for Dynamics and Self-Organization (Göttingen, Germany), Cornell University (Ithaca, New York) the Ecole Normale Supérieure de Lyon (France), the University Medicine Göttingen (Germany), the Rochester Institute of Technology (USA), and the Institut Non-Linéaire de Nice (France) — has developed a new low-energy method for terminating life-threatening cardiac fibrillation of the heart. They have shown that their new technique called LEAP (Low-Energy Anti-fibrillation Pacing) reduces the energy required for defibrillation by more than 80% as compared to the current conventional method. Their discovery opens the path for the painless therapy of life threatening cardiac fibrillation.”

The LifeBot® – A Telemedicine Robot to Keep You Alive™:

According to Heath, the methods used in the above studies are the same methods reflected within his patent already issued by the USPTO. ( US Patent # 7,672,720 , Domestic and International Patents Pending. ) Heath was very gratified to see the research by such esteemed institutions affirming his already patented methods. Heath also stated that, in his opinion, this research only “scratches the surface”. There is more work to do to carry this into widespread use for both implantable ( Internal Cardiac Defibrillators or “ICD” ) and external ( Automatic External Defibrillators or “AED” ) systems. Either way, Heath’s already awarded patent is designed to apply to both instances of use.

Smaller size and weight with reduced cost? “Yes”, says Heath, “The external defibrillator prototypes we have constructed and tested some time ago are only about one and one-half inches square.” This has given rise to speculation that these systems could be integrated or added to a PC, tablet, or even a cell phone. This has already been the subject of additional patent documentation on file at LifeBot® for some time.

The patent covers the unique concept of a “Telemedicine Robot” or “LifeBot®” or life support communications system that any one may use under very adverse circumstances. Integrated is the ability to trigger remote telemedicine so a doctor or nurse is virtually “on-the-scene” to aid the patient and/or rescuers. Contact with 911 or 999 dispatch may also be independently initiated as well. Electronic or Personal Medical Record ( EHR or PCR ) may be immediately shared as well as GPS and common location records.

The “robot” may even initiate emergency calls for help if the owner is alone and collapses or becomes completely disabled. Some have termed the LifeBot® as, “OnStar® for your home or business”, but the system goes much further. The product will be made available to consumers for personal use “over-the-counter” the same as existing AEDs.

It goes without question the LifeBot® will be an invaluable life-saving tool for use by paramedics and lay rescuers. It should also be noted that the patented system is the first and only design to fully integrate and automate the American Heart Association’s recommended “Chain of Survival” which says dial 911 first before deploying an AED. There is no easy breakdown in this chain when using the LifeBot®. No doubt, paramedics and rescuers will love carrying substantially smaller more cost effective defibrillators.

Sending patients that may be at risk home is a difficult and potentially very risky prospect for both hospitals and physicians. The concerned physician can send the patient home with a LifeBot® knowing that an emergency system has been put in place should the most dire of consequences arise.

Many patients are in denial and very hesitant to dial 911, but with the LifeBot® most agree that patients will likely call much earlier for a telemedicine consult to assess whether symptoms are potentially serious. The prospect of patients calling with the earliest symptoms is an idea readily embraced by members of the Sudden Cardiac Arrest Association and the Chest Pain Society.

32nd Patent Notice of Allowance – A Legacy Continued:

R. Lee Heath is best known as the inventor making possible the modern Automatic External Defibrillator (AED) through his patented electrode defib-pads ( R2-Pads or Combo-Pads ) that are placed on the chest to shock cardiac arrest victims. He was recommended for the Lemelson MIT Prize by American Heart Association officials and other peers. The first use of his earliest inventions has placed him in cardiac electrophysiology labs around the world, where he has conversed with the most prominent cardiologists about procedural and theoretical treatment methods for more than thirty years. “This is how it happened”, says Heath.

Now that legacy is continued with the Notice of Allowance for his 32nd patent now issuing. This patent specifically addresses his latest defib-pad electrode designs. The designs are not only corrective of many serious problems that exist, but it is also complimentary to the LifeBot® Telemedicine Robot™ already patented. The two patents form the basis of a complete comprehensive end-to-end personal life support system and advanced paramedic or lay rescuer system design. Integration of the two preserves features for delivering quality and continuity of patient care.

Priorities and Long Term Goals:

On August 17th, LifeBot® acquired the exclusive world-wide rights to the most advanced emergency telemedicine technologies called DREAMS™ ( Disaster Relief and Emergency Medical Services) developed by Texas A&M University, Texas Engineering Experiment Station, UTHealth Houston, and the U.S. Department of the Army. The Digital EMS Project was funded by more than $14 million from the Telemedicine and Technology Research Center (TATRC) an office of the U.S. Army Medical Research and Materiel Command, Defense Department agencies.

LifeBot® is currently pursuing accounts that represent the potential for immediate military use of DREAMS™, whole state’s and whole nation’s standardization on DREAMS™ for use primarily for hospital to ambulance telemedicine. So the number one priority of the Company is the marketing and deployment of the DREAMS™ telemedicine systems. Those who use existing LifeBot® products, including DREAMS™, will save money by easily launching the more advanced patented solutions in the future.

Long-term the plan is to pursue deployments of the LifeBot® Telemedicine Robot™. Market research indicates the annual defibrillation markets exceed $10 billion annually. LifeBot® estimates that the total consumer markets for the robot exceed $70 billion. The Company may consider an additional equity financing to accelerate this to the fore-front. This is especially true in light of the results demonstrated by the very recent research in Germany and the U.S. supporting the Company’s patented methodologies.

“Most very large telemedicine firms have been investing billions in home remote monitoring and this undoubtedly will reduce healthcare costs. But, they seem to have “skipped over” or completely forgotten that most of these patients are going to have an emergency. This is inevitable.”, states Heath, “So emergency management is critical to saving more lives and LifeBot® holds the exclusive patented technologies to make this possible.”

References and Links:

1. Science Digest, “A LEAP in Controlling Cardiac Fibrillation: Researchers Develop a New Low-Energy Defibrillation Method”, http://www.sciencedaily.com/releases/2011/07/110714072907.htm
2. Nature.com, “Cardiovascular disease: Several small shocks beat one big one” http://www.nature.com/nature/journal/v475/n7355/full/475181a.html?WT.ec_id=NATURE-20110714
3. Nature.Com, “Low-energy control of electrical turbulence in the heart” http://www.nature.com/nature/journal/v475/n7355/full/nature10216.html?WT.ec_id=NATURE-20110714
4. About R. Lee Heath and LifeBot – Numbers List of Awarded Patents view more..
5. LifeBot: “LifeBot Acquires World-Wide Rights to DREAMStm “Super Ambulance” and Emergency Telemedicine Technologies”
   view more..
6. mobihealthnews.com, “Interview: Roger Lee Heath’s LifeBot and Super Ambulances”
   view more..
7. LifeBot Commentary by R. Lee Heath , “Video Teleconferencing is NOT Telemedicine!”
   view more..
8. Hewlett Packard, “Ambulance 2.0: Bringing Doctor-Quality Care to Ambulances” view more..

Related Media Download Links:
a. High Resolution Image LifeBot Telemedicine Robot: LifeBotTelemedicineRobot.jpg

LifeBot® announced today it has exercised its Option Agreement securing the exclusive worldwide licensing rights to DREAMS™ Digital EMS, the $14 million advanced EMS ambulance and hospital telemedicine system developed by Texas A&M University, Texas Engineering Experiment Station, UTHealth, and the U.S. Department of the Army.

Phoenix, AZ, USA August 17, 2011 : LifeBot, LLC acted today to secure its leading technology position in emergency telemedicine systems. Considered by many to be the most highly developed ambulance to hospital EMS telemedicine system ever deployed, DREAMS™ Digital EMS is the first and only system to provide interactive simultaneous “live” transmissions of critical patient data, audio, and video. The system, in essence, brings hospital specialists to the scene giving to doctors and nurses a virtual tele-presence to collaborate in saving lives and managing disasters in real time, on the “battlefield”, at home or abroad.

Not Just a Concept : Proven in Use for Over Six Years:

The DREAMS™ Digital EMS system is the most highly developed field tested and proven emergency telemedicine system in the world. Developed with over $14 million in funding from the Telemedicine and Technology Research Center (TATRC) an office of the U.S. Army Medical Research and Materiel Command, the Digital Ambulance System has been deployed in actual use for over six years in five prototype ambulances in Liberty County, Texas.

The project was headed by renowned surgeon, James “Red” Duke, Jr. who utilized the system to triage and treat victims in New Orleans “live” during Hurricanes Katrina from the Memorial Hermann emergency room in the Texas Medical Center in Houston. DREAMS family products were also used to support remote clinics during the Katrina and Rita disasters.

Both Dr. Duke, and former Assistant Secretary of Defense (Health Affairs) Dr. S. Ward Cassells, received the distinguished General Maxwell R. Thurman Award, presented at the American Telemedicine Association, for participation in the design of these advanced telemedicine systems.

“Most attempts at ambulance based telemedicine systems have had extremely limited success, but DREAMS™ has actually delivered on its promise to get the job done and over a number of years.” says LifeBot CEO, R. Lee Heath, who is also best known as the inventor making possible the Automatic External Defibrillator (AED), recommended for the Lemelson MIT Prize by American Heart Association officials and others.

The “Super Ambulance™” System utilizes multiple remote controlled cameras to provide hospital based emergency specialists invaluable live intelligence, emergency preparedness or “situational awareness” so prompt, objective, and safe life-saving assessments and treatments may be made. The hospital knows more precisely “what”s coming in the door” and can accurately prepare the appropriate assets accordingly to both reduce costs and loss of life.

The patient’s physiologic vital signs, data, and medical record reporting (EHR or e-PCR) are updated dynamically between the hospital and the scene. The system is especially valuable for treatment of cardiac, trauma, stroke victims and is important in remote areas where transport times may be prolonged. And, the system may actually act to protect ambulance personal and providers during sensitive difficult situations. It may enhance critical decisions during disasters and mass casualty events. DREAMS™ Digital EMS can make the difference in saving thousands of lives, reducing medical errors and their associated risks further lowering costs.

Not Just for the Ambulance, but Hospitals too:

The DREAMS™ system is not solely for use in ambulances, but also for tele-cardiology, tele-stroke, intensive care (e-ICU tele-ICU) and many additional hospital-to-hospital and physician-to-hospital applications as well. LifeBot mobile telemedicine cart and desktop systems will also utilize the DREAMS™ Digital EMS system as well.

The Most Advanced Telemedicine Tablet Solution:

LifeBot has signed a Joint Marketing Agreement with Hewlett Packard. The DREAMS™ Digital EMS solution has been tested on the 1.5 pound portable Slate Tablet PC as well. This means intensivists, cardiologists, neurologists, trauma and emergency disaster specialists can login and achieve tele-presence from almost any location and at any time to save lives.

Additional Solutions for Telemedicine:

Other major technology projects for LifeBot are included in the licensing signed today. “The DREAMS™ Digital EMS system is really a family of solutions”, according to CEO Heath, “and this makes this technology licensing even more exciting.” This includes a stand-alone system called a Deployable Telemedicine System (DTS). This may be used by hospitals to expand their facilities during disasters or dropped into the battlefield to deliver telemedicine as well.

Included is the Back-Pack Telemedicine System, in which battlefield, mobile or tactical medics can actually wear telemedicine systems to save lives in remote or difficult to access locations. It is ideal for medics using motorcycles, ATVs, bicycles, mountain rescue, and helicopter transport, for example. Ultimately, it may even be used by private and municipal providers to deliver telemedicine into homes and businesses to save lives. “When you combine these with our LifeBot patented technologies”, Heath said, “it sets the stage for a roll-out of multiple critical solutions that will only be available from LifeBot.”

Care Coordination and Telemedicine Hubs:

If the ultimate objective is to lower healthcare costs, provide for efficiencies of care, and elevate the quality of care, then LifeBot can accomplish all of these things too. Important is prioritization of patient”s needs and connecting the right medical expertise or using care coordination. This becomes the central “the name of the game”. To accomplish this LifeBot now has the experience and solutions to build full call centers or telemedicine hubs, at the dispatch, hospital, or battlefield levels.

These centers can use LifeBot triage solutions and telemedicine to intelligently coordinate and safely determine if patient needs are emergent, non-emergent; send ambulances to “real” emergencies and match the needed medical expertise into each particular situation. This is absolutely key to both lowering healthcare provider costs and responding with comprehensive disaster management. This may also fulfill the objectives of the Mobile Healthcare Project of the International Association of Fire Chiefs by providing for “treat and release” and reimbursement for non-emergent calls which may rescue financially distressed Fire and EMS services.

“We will be making more announcements soon as this roll-out of these solutions unfolds.”, said Heath.

[hr]

About DREAMS™: The DREAMS™ (Disaster Relief and Emergency Medical Services) digital emergency medical services (Digital EMS) program is led by famed trauma surgeon and educator, Dr. James H. “Red” Duke, Jr. Dr. Duke is professor of surgery, holder of the John B. Holmes Professorship and chief of surgery at the University of Texas Health Science Center at Houston (UTHealth), as well as medical director of Memorial Hermann Life Flight.

The software, hardware, and telecommunications aspects of this program are led by Texas A&M University Researcher Larry Flournoy, and Texas Engineering Experiment Station researcher James Wall, Ph.D. The digital EMS program has developed and deployed wireless video communications and combining AVL/GPS (Automatic Vehicle Location/Global Positioning System) technology and advanced software to enable ambulances and helicopters to reach the victim sooner, begin triage, diagnosis and treatment on the scene, and coordinate helicopters and ambulances to minimize transport time to the nearest appropriate facility, using continuous “live” communication with these facilities.

DREAMS™ Digital EMS has already been successfully deployed and tested aboard “Super Ambulances™” in multiple counties of Texas. In addition, these “Super Ambulances™” also have aided with rescue efforts during the aftermath of the Hurricanes Katrina and Rita. DREAMS™ is a tested and proven “battlefield” application.

The development of this system was in conjunction with U.S. Army Medical Research and Materiel Command (USAMRMC) through its Telemedicine & Advanced Technology Research Center (TATRC). TATRC performs medical reconnaissance and special operations to address critical gaps that are underrepresented in DoD medical research programs. Versions of DREAMS™ also include field and disaster deployable versions that may be dropped into combat theaters and a HMMWV 9978A2 (Humvee) prototype for in-the-field use by the U.S. Military.

About LifeBot®: LifeBot provides exclusive patented and military developed telemedicine solutions for emergency management of hospital-to-ambulance and hospital-to-home communications. These systems are used to send and receive live video, voice and patient vital-sign data transmissions primarily in support of heart, trauma and stroke victims in ambulances. The company’s patents focus on extension of these life-saving systems into consumer use in the home and business.

The company was founded by R. Lee Heath, who is best known as the inventor businessman making possible the life-saving Automatic External Heart Defibrillator (AED) now in common use throughout the world. Mr. Heath was recommended for the Lemelson MIT Prize by American Heart Association officials and other peers. His experience spans almost four decades in the design and deployment of emergency life-support and their communications systems.

OK, I’ll say it. Health is not skin deep. It’s what’s inside that counts too, sometimes much much more.

Recently a paramedic friend in Texas told me about a day where they took their DREAMS Ambulance to a shopping center to provide open public testing or free health screening as a public service to his community. Most of the people that showed up appeared happy healthy and smiling. But, once he began to hook up subjects to his equipment and look at their vital signs, electrocardiogram, blood pressure, etc., he found many of them had very serious health risks. Most appeared just fine on-the-surface, until then.

“Health is not skin deep. It’s what’s inside that counts too, sometimes much much more.”  Roger Lee Heath

Recently my brother went in for surgery on his knee, an old basketball injury. Pretty simple, right? He appeared quite healthy for years. Well, they hooked him up only to find he was a primary candidate for a heart attack and needed a stint from an interventional cardiologist right away to save his life. Previously, this had gone completely undetected.

Just take a look at the photo above. This appears to be a happy healthy couple, unless you find out one has a myocardial infarction (MI) in progress (STEMI) or another has risky tachyarrhythmias or is simply not well perfused and may have an impending risk of stroke. Potentially, it is not as pretty a picture in a strict healthcare context.

Yet, if you look at the prominent telemedicine equipment suppliers today, you may be shocked to find out most have little or no experience in the healthcare field at all; little knowledge of medical devices and acquiring this critical life-saving inside information. Chances are they were ushered into the healthcare industry because someone wanted video conferencing only. A recent television ad shows a patient in an ambulance talking to a doctor in the Emergency Room on a tablet. But, how will this fair as a comprehensive EMS telemedicine system? Most would say generally not very well and perhaps more risky for the healthcare or emergency professional who could make more informed decisions with more complete information. But, who needs urgent care, and who doesn’t? How can these patients be effectively detected and prioritized?

The Main Issue – Care Coordination:

Very recently, I attended a conference at the Cleveland Clinic on healthcare call center development. After almost 40 years working primarily in the Emergency Medical environment I heard terms such as “Care Coordination” and “Patient Care Coordinator”, terms not so common in this industry. Yet, the Emergency Department is really the true front door to most hospitals with up to 80% of patient admissions often occurring there. If one is to reduce medical errors or risks and more clearly determine what level of care a patient needs, how can one go about accomplishing this in a thorough and safe way?

First – Use Really Good Triage and TeleTriage:

Asking the right questions is important. It can save a life. If you don’t, obviously your risks and chances for medical errors are significantly increased. So how do you ask the right questions? How are they properly clinically referenced, and what are the differential diagnoses? How do you quickly drill down a query to make sure a patient in need doesn’t fall through the cracks. The answer is to use proven Decision Support Software (DSS) to help you do this. It can speed your assessments and assure you are deploying a safety net for those patients in urgent need who otherwise might have gone undetected. It can also save time and eliminate “Over Triaging” by making sure exactly the right questions are asked, not a hand-full of questions that may not directly relate to the exact symptoms before you. When attached to a patient’s medical record, it demonstrates adherence to standards of care and significantly lowers provider risks

Put quite simply, the human brain simply cannot reference millions of words of clinically referenced research, but Decision Support Software can, and it can help you do it within just a few minutes to save a life. It can provide for both accurate and early detection of the risks at hand.

Second – Acquire Physiological Data:

Go beyond video teleconferencing by acquiring vital signs data, ECG, 12-lead, pulse ox, blood pressure, video exam cameras, etc. This gives one the ability to look inside and see what is really happening. This is the only objective way to fully assess the risks. Of course, the modern ambulance may do some part of this already, but almost none fully integrate decision supported triage, video, physiological data, and patient medical record charting into one system.

A proper telemedicine system design should also store this important data together. Most systems don’t. In fact many do not record video, much less important patient physiological data. Of utmost importance is for the telemedicine system to “Tag” patient data for each call, encounter or instance so that one patient’s medical record does not get mixed with another’s. Without this feature, risks for the provider are significantly increased.

If you are in a location where there are no fixed or wireless network connections then this is more important, if an intensivist, EMS professional, neurologist, or cardiologist has to assess a patient’s vitals or early symptoms later. If you operate air or ground ambulances or patient transport operations the system, once in route and connecting to networks, should prioritize this critical data and send the most important life-saving information first to the hospital. Then faster more accurate responses to the problems at hand are assured.

Third – Send the Data “Real-Time”

Ideally critical patient data should be provided Real-Time or “Live”. If you have to send the data to a server somewhere, and critical care professionals have to take the extra time to separately locate that patient’s data, this only prohibits or delays prompt assessments and patient care. The data should be made immediately “Usable”. The difference may be life-saving. In addition, there can be additional costs associated with server services. Patient confidential medical record information may also be more protected when shared with only the select parties or the professionals involved.

Fourth – ePCR EHR (Electronic Health Record) and Data Portability:

In an age where EHR and patient charting has become such an important central focus, a proper telemedicine system design should not only store this critical data, but also allow you to forward the data immediately. An example of this is the sending of a 12-lead ECG to activate a STEMI Alert at a hospital cath lab. The system should allow for full data portability, or the ability to save all this information as one complete report. Then complete information, video and physiologic data, may be attached to the patient’s medical record very efficiently.

It is far better to minimize long-term costs and adopt one system that does it all at the outset.”  Roger Lee Heath

In proper telemedicine design, One System should do it all. The alternative is to try and adapt or cobble together many different video, data and charting components, a real mess. ePCR, EHR, video and data from separate systems can only manufacture a nightmare for Data Portability and delay critical patent care. This also sets the stage for major inefficiencies and running up major costs of deploying telemedicine systems. It is far better to minimize long-term costs and adopt one system that does it all at the outset.

Fifth – Video Conferencing is Important

Video Teleconferencing in healthcare is invaluable, but is just one component in a true comprehensive telemedicine system. That is the opinion, at least, of many who have invested a lifetime in delivery of quality patient care. As put forth by one Medical Director, “A picture is worth a thousand words, but perhaps a video is worth a million words.” A video is the central component in many patient assessments. It is essential in trauma and disaster management to assess method of injury, the patient’s exact state, situational awareness, what disaster and rescue assets are on the scene, and much more. It may even provide for legal protection of medical and rescue personnel, similar to the experience of law enforcement. Video recording may pay for itself over-night in such a situation.

But, Health is not skin deep. It’s what’s going on inside that counts, sometimes much much more.

About:

The above commentary was put together by R. Lee Heath, best known as the inventor making possible the modern Automatic External Defibrillator (AED). His company, LifeBot® is involved in the design and deployment of advanced communications telemedicine hubs and call centers for healthcare coordination.

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LifeBot® pro­vides exclu­sive patented and mil­i­tary devel­oped telemed­i­cine solu­tions for emer­gency man­age­ment of hospital-to-ambulance and hospital-to-home com­mu­ni­ca­tions. These sys­tems are used to send and receive live video, voice and patient vital-sign data trans­mis­sions pri­mar­ily in sup­port of heart, trauma and stroke vic­tims in ambu­lances. The company’s patents focus on exten­sion of these life-saving sys­tems into con­sumer use in the home and business.

The sys­tems are also designed for man­age­ment of major crises, dis­as­ters and emer­gen­cies by hos­pi­tal based and field pub­lic safety emer­gency pro­fes­sion­als and for the U.S. Mil­i­tary in bat­tle­field oper­a­tions. We inte­grate next gen­er­a­tion broad­band capa­bil­i­ties not inher­ent in today’s inter­op­er­a­tive dig­i­tal radio com­mu­ni­ca­tions so the ben­e­fits of achiev­ing telemed­i­cine, tele­health, and emer­gency pre­pared­ness objec­tives may all be fully realized. To learn more about these systems, please contact us.

By Jim Christensen of Hewlett Packard

In the back of an ambulance, every second counts. So imagine that as paramedics race down the street, they can whip out a tablet to help analyze symptoms while a physician at the hospital can help give virtual triage. Touch and tablet technologies are paving the way for some amazing new solutions in healthcare and I recently saw how HP and LifeBot are working to remotely speed up emergency treatment.

LifeBot, an Arizona-based company specializing in telemedicine, is revolutionizing speed of care by enabling EMTs to send video, voice and streamed medical data from the ambulance to doctors back at the hospital. They use the HP Slate 500 to help make this all possible.

Here’s how it works: Inside an ambulance, paramedics wear head-mounted cameras and carry the lightweight 1.5-pound HP Slate. The Slate’s touchscreen allows paramedics to easily input critical medical information while other cameras mounted in the ambulance can be remotely controlled by physicians back at the hospital. There, physicians can use HP TouchSmarts or HP digital signage to draw “play-by-play” on the screen to help EMTs provide better care.

The LifeBot and HP-based solution, on display at HIMSS 2011 last month, simulates how doctors can interact with EMTs from their hospital office. You’ve already seen some pictures here, but you can view more photos from our FLCKR album, or just check out the LifeBot Slate in action:

Ambulances will soon be getting some major technological upgrades effectively turning them into “super ambulances.” These technologically enhanced ambulances will allow paramedics to share patient data, video feeds and other information in real time with the remote hospital – a revolution in emergency care. This is thanks to Roger Lee Heath, an inventor and entrepreneur with over a dozen patents to his name; his most recent being the LifeBot. It’s a system installed in ambulances to help paramedics and EMTs better communicate with the hospitals on the go – when treatment can be at its most critical stages. Paramedics can get expert instructions from doctors remotely to help keep patients stable and also the hospital is better prepared for the patient’s arrival when using the LifeBot system. Below you can see a video of the system in action. When combined with other Teletriage systems, this system helps create the “Super Ambulances” that EMTs and other first responders have been dreaming of. The platform is the Hewlett-Packard Slate tablet that weighs in at just 1.5 pounds. It features a 3 MP outward facing camera and a VGA inward facing webcam working together to capture both the patient and operator in field use, recording video and capturing still images.

Beyond the immediate capabilities of the device itself though, it is connected to the DREAMS(tm) telemedicine system. DREAMS was developed by the U.S Army Materiel Command for emergency and disaster systems deployments. The system allows for the sending and receiving of live patient physiological data, play-by-play screen color drawing with annotation, isolated video zoom to hi-res imaging, complete patient medical record ePCR charting systems, and multiple camera remote controls.

Aside from the tablet, the ambulance will come equipped with three additional cameras, all remote-controlled from the hospital. This allows the paramedic to focus on the patient while the doctor can take a look at any area they feel is important. The paramedic will also wear a head-mounted camera to transmit not only their work on the patient in the ambulance, but anything going on outside the ambulance before transport, like during a multiple car accident.

LifeBot also includes a barcode scanner to read a patient’s driver’s license. This will more quickly bring up medical information that normally has to be retrieved by radio or wait until the ambulance arrives at the hospital. The ability to be aware of potential hazards that an unconscious patient cannot alert them of is crucial here. If a patient has a pre-existing condition or an allergy to medication that might be used to stabilize them during their trip to the hospital, this will be brought to the attention of the ambulance crew, allowing for the best and most accurate care.

A price cannot be placed on a person’s life, but it certainly can be placed on a LifeBot. It will cost $50,000 to add the entire system to one ambulance. This system is a great investment since it not only saves lives, but also saves money. With the cost of placing a fully-trained doctor in every ambulance being prohibitive, having the watchful eye and advice of the doctor from the hospital will ensure that this system pays for itself relatively quickly. According to Heath, Teletriage can reduce ambulance transport volume by 20 – 60 percent, which saves as much as $2,000 per unnecessary transport.

One of the early target markets for the LifeBot is actually in places with lower technology in general: rural areas. These areas are most in need of this service since ambulance rides there can often be as long as an hour to the closest medical facility. If a paramedic is unfamiliar with a critical procedure that is required to save a patient’s life, a remote doctor can walk them through the entire process. The full coverage inside of the ambulance helps the doctor keep eyes and ears on every aspect of the process almost as if they were there themselves.

I don’t think it will be very long until this system becomes standard for hospitals all around the country.

LifeBot offers many advantages, but what are the concerns? Medical records will always remain confidential, but should patients need to give consent to have their image and likeness recorded in this manner? Most people won’t have a problem with a system designed to save their lives, but will conscious patients have to give their permission before the system is turned on? If so, what would be the procedure for unconscious patients? As systems like these become standard in every ambulance, there could be a selection that we choose on our driver’s license, similar to the choice of being an organ donor. In the meantime though, how do we handle it all?

All in all, what we are looking at here is a substantial advancement in remote medical treatment. If implemented more widely, it should reduce the amount of patients that don’t survive the ambulance ride to hospital where they can get full medical treatment. The system is already in place in select areas within Arizona, Texas, and Florida. Plus with the relatively low cost compared to all of the benefits that the system can provide I don’t think it will be very long until this system becomes standard for hospitals all around the country.

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LifeBot® announced today it has released a preview of its 1.5 pound LifeBot® Slate tablet based EMS emergency telemedicine system that integrates DREAMStm, the $14 million advanced EMS ambulance telemedicine and disaster management system developed by Texas A&M, UTHealth, and the U.S. Department of the Army.

Phoenix, AZ, USA January 29, 2011: LifeBot, LLC announced today a preview of the most powerful portable light-weight tablet for real-time management of critical patients located in remote emergency rooms, ambulances, satellite facilities or intensive care units. At only 1.5 pounds weight the LifeBot® Slate enables unprecedented portability and functionality in a mobile healthcare solution that brings high definition interactive voice and video communications that facilitate access to patients and physicians in real-time no matter where they are located. This system also allows for live transmission of critical patient physiological data using LifeBot®DREAMStm software developed with U.S. Army Materiel Command, Texas A&M, and UTHealth Science Center at Houston.

The LifeBot® Slate PC tablet (similar to, but smaller and more powerful than an Apple iPad) may be used to remotely connect to other LifeBot® DREAMStm systems including telemedicine carts and ambulances. This tablet is also based on Microsoft Windows 7, so it is accepted by DoD and meets most administrative compliance for use in large institutions The LifeBot® Slate absolutely revolutionizes speed of care by enabling any paramedic, neurologist, trauma surgeon, emergency medical specialist to obtain immediate telepresence or remote video, voice and data connections using a simple 1.5 pound portable battery operated PC computer tablet solution.

In an article titled, “New device integrates digital data for EMS” by Dan White, he comments, “The LifeBot® physical package is surprising ergonomic, and somehow intuitive. It feels natural, like grabbing the steering wheel of a car. The LifeBot® only weighs 1.5 pounds, and it is a little smaller form factor than an Apple I-Pad.” and, “LifeBot has the potential to redistribute hundreds if not thousands of man-hours. Instead of taking two minutes to talk through a patient report, which is typically incomplete, you could see everything almost instantly. On patients with less than critical injuries, this feature will save a lot of wasted time.”

In another article entitled, “Interview: Roger Lee Heath´s LifeBot and Super Ambulances” by Neil Versel, he commented, “In a Super Ambulance, paramedics wear cameras on their head and carry the LifeBot system on 1.5-pound HP slate computers. The touch screen allows remote physicians to draw “play-by-play” on the screen to help the EMT provide better care. Other cameras mounted in the ambulance can be controlled by physicians in the trauma center.”

Scientists at Texas A&M University, developers of the DREAMStm system, have tested the LifeBot® Slate and stated, “The Slate is a great platform! It seems to be a very good interface. It is a great platform for the DREAMStm application!”.

For those deploying interoperative emergency communications, the LifeBot® Slate platform may also be used with the LifeBot®Communications Controller. This enables the Slate to be carried as a portable wireless device to perform both radio and telephone communications, including UHF, VHF, 800 MHz, 700 MHz, P25 and broadband voice, video, and data. Mr. Heath, CEO of LifeBot®, indicated, “This is yet another revolutionary aspect of this system. It means EMS and emergency coordinators can carry all their communications throughout an Emergency Department in just one hand.”

LifeBot ® Slate Features and Benefits:Utilizes a Hewlett-Packard Slate at just 1.5 pounds weight and 9.21 x 0.58 x 5.91 inches size integrating a 1.6GHz Pentium PC 2MB RAM and 64GB flash drive with video resolution of 8.9″ diagonal WSVGA wide-viewing angle touchscreen (1024 x 600 or 1024 x 768 for some applications). Integrated 3 MP camera (outward facing); Integrated VGA webcam (inward facing) provides display of both patient and operator in field use. Also enables sending of individual high resolution still images.Utilizes exclusive DREAMStm telemedicine system developed with U.S. Army Materiel Command and others, the most advanced in the world specifically designed for emergency and disaster systems deployments.DREAMStm features include sending and receiving of live patient physiological data, live play-by-play screen color drawing and annotation, isolated video zoom to hi-res imaging, complete patient triage and medical record ePCR charting system, multiple cameras remote controls with management of resolution, panning, zooming, etc. It also may store all trended patient charting and physiological data in its on-board SQL database server.Instant Messaging and Paging: Send instant messaging e-mail alerts and mass file or data distribution to hospitals or providers directly from private secure portal display.

Compatible with other DREAMStm powered LifeBot®systems including mobile telemedicine mobile carts, PC desktops and ambulance systems.Also may be used for TeleStroke, TelePsychiatry, Teletrauma, Dermatology, Translation Services, Primary Care and Correctional Health Systems, Teletriage, and any General Telemedicine application.Gobitm chipset assures reliable connectivity in more locations with the ability to utilize multiple cellular providers, e.g. local Wi-Fi, 3G, 4G, LTE, Verizon, Sprint, etc.PC based compatible with any Microsoft Windows 7 based telemedicine softwares for Radiology and Ultrasound.Accepts all popular Windows 7 compatible examination cameras.Options available for digital biometric readers, exam cameras, digital stethoscopes, otoscopes, and more. Multiple devices may be connected through the Slate docking station.When utilized with the LifeBot® Communications Controller the LifeBot® Slate may also be used to wirelessly perform UHF, VHF, 800MHz, 700MHz, P25 radio and telephone communications.Tested and approved for use with Odyssey Patient Teletriage software that may enhance triage efficiencies and substantially reduce errors and risks.Upgrade path into future patented LifeBot® and DREAMStm applications.AES encryption for HIPAA compliancy.

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LifeBot® CEO, Heath, indicated that the company is already quoting DREAMStm based systems, including the Slate, as a part of its product line. The company is now considering an invitation to exhibit these systems at the HIMSS Meeting in Orlando next month.

About DREAMStm: 

The DREAMStm (Disaster Relief and Emergency Medical Services) digital emergency medical services (Digital EMS) program is led by famed trauma surgeon and educator, Dr. James H. “Red” Duke, Jr. Dr. Duke is professor of surgery, holder of the John B. Holmes Professorship and chief of surgery at the University of Texas Health Science Center at Houston (UTHealth), as well as medical director of Memorial Hermann Life Flight. The software, hardware, and telecommunications aspects of this program are led by Texas A&M Researcher Larry Flournoy, and Texas Engineering Experiment Station researcher James Wall, Ph.D. The digital EMS program has developed and deployed wireless video communications and combining AVL/GPS (Automatic Vehicle Location/Global Positioning System) technology and advanced software to enable ambulances and helicopters to reach the victim sooner, begin triage, diagnosis and treatment on the scene, and coordinate helicopters and ambulances to minimize transport time to the nearest appropriate facility, using continuous “live” communication with these facilities.

DREAMStm has already been successfully deployed and tested aboard “Super Ambulancestm” in multiple counties of Texas. In addition, these “Super Ambulancestm” also have aided with rescue efforts during the aftermath of the Hurricanes Katrina and Rita. DREAMStmis a tested and proven “battlefield” application.5,6,7

The development of this system was in conjunction with U.S. Army Medical Research and Materiel Command (USAMRMC) through its Telemedicine & Advanced Technology Research Center (TATRC). TATRC performs medical reconnaissance and special operations to address critical gaps that are underrepresented in DoD medical research programs. Versions of DREAMStm also include field and disaster deployable “MASH” style versions that may be dropped into combat theaters and a HMMWV 9978A2 (Humvee) prototype for in-the-field use by the U.S. Military.

About LifeBot®:

LifeBot® provides exclusive patented and military developed telemedicine solutions for emergency management of hospital-to-ambulance and hospital-to-home communications. These systems are used to send and receive live video, voice and patient vital-sign data transmissions primarily in support of heart, trauma and stroke victims in ambulances. The company´s patents focus on extension of these life-saving systems into consumer use in the home and business.

The systems are also designed for management of major crises, disasters and emergencies by hospital based and field public safety emergency professionals and for the U.S. Military in battlefield operations. We integrate next generation broadband capabilities not inherent in today´s interoperative digital radio communications so the benefits of achieving telemedicine, telehealth, and emergency preparedness objectives may all be fully realized.

The company was founded by R. Lee Heath, who is best known as the inventor businessman making possible the life-saving Automatic External Heart Defibrillator (AED) now in common use throughout the world. Mr. Heath was recommended for the Lemelson MIT Prize by American Heart Association officials and other peers. His experience spans almost four decades in the design and deployment of emergency life-support and their communications systems.

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References and Links:

1. “New device integrates digital data for EMS” by Dan White
2. “Interview: Roger Lee Heath´s LifeBot and Super Ambulances” by Neil Versel

By Neil Versel – While many in mobile health look at ways to get personal monitoring devices into the home to help manage diseases, several figures with deep backgrounds in trauma care are trying to commercialize a system to prevent death from heart attacks and stroke.

Central to this effort is Roger Lee Heath, an inventor and entrepreneur who holds dozens of patents including for the technology that enabled the automatic external defibrillator. Widely known in emergency medicine but a relative newcomer to health IT, Heath now heads a Tempe, Ariz.-based company called LifeBot that could be on the verge of bringing advanced telemedicine mainstream.

In November, LifeBot signed an option to commercialize the Disaster Relief and Emergency Medical Services (DREAMS), a $35 million ambulance-based telemedicine and disaster-management system. DREAMS, developed by the University of Texas Health Science Center at Houston and Texas A&M University in conjunction with the U.S. Army’s Telemedicine and Advanced Technology Research Center (TATRC) and the U.S. Army Materiel Command, powers what’s being touted as a “Super Ambulance.” The system, now in use in a handful of rural Texas counties, provides live transmissions of multiple remote-controlled cameras, telemetry data and patient records between ambulances and hospital emergency departments and trauma centers.

Principal Investigator Dr. S. Ward Casscells, a former assistant secretary of defense for health affairs, led the DREAMS project and won several awards for his work. Trauma surgeon Dr. James H. “Red” Duke Jr., who treated Texas Gov. John Connally after the shooting that killed John F. Kennedy, created the Super Ambulance and tested DREAMS on Memorial Hermann Life Flight air ambulances. He used the system to remotely triage patients affected by Hurricanes Katrina and Rita in 2005.

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