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Exclusive interview: Dr. R.A. Brest van Kempen, CEO of RS TechMedic

RutgerHere is a treat for all you medical gadget lovers. An exclusive interview with Dr. R.A. Brest van Kempen who just happens to be the CEO of RS TechMedic. His company has produced some amazing high tech medical devices over the years. One of their most revolutionary product on the market today is a telemedicine device called Dyna-Vision. Only for you, Dr. R.A. Brest van Kempen talks about his company’s products and shares news about the development of software which will enable you to monitor your patient in real time using your iPhone.

Could you tell me more about yourself, about your background?

I studied at the Catholic University of Leuven in Belgium and have been a “clinical perfusionist” in cardiovascular surgery for 10 years in 3 leading hospitals in Belgium and the Netherlands. I started my MBA study in 2006. In 1999 we founded RS TechMedic, a company developing medical technologies. I am responsible for marketing and sales, the operation of the company and the machine-to-man interfacing design of the products. With our dedicated hardware and software engineers we’ve developed 9 medical devices and clinical software so far and our latest development is focused on the fast growing telemedicine market.

Please shortly describe the history and milestones of your company, RS TechMedic?

We developed products for Terumo CardioVascular Systems, Maquet, Martil Instruments, and a number of other companies. These products were all high-tech developments and are on the market as we speak. The most advanced product was our automatic micro-air removal device for heart-lung machines. With this technology we are able to significantly reduce the postoperative cognitive dysfunction in heart surgery patients. Out of 160 companies, we were granted the Innovation Award 2002 for this product.

dyna-visionCurrently one of your major products is Dyna-Vision. Tell me a little bit more about it and the ways it differs from similar products on the market?

Dyna-Vision is developed with the latest available technologies. What we often see is that other companies are “upgrading’ existing products to be used for telemedicine. We are convinced that this is not the best solution. We created a wish list of physicians and their patients and developed a new technology based on these requirements. This is a different strategy and makes that we can offer the most recent technology.

We are a bit careful with making comparisons as Dyna-Vision as we really see Dyna-Vision as a new “type” of products and not as one of the existing ones. Our device gives you 3, 5 or 12 lead ECG, Heart Rate, Heart Rate Variability, RR-time, Plethysmogram and Oxygen Saturation.

Basically, the device creates a data file to be used in different software for analyses. Currently we certified 4 packages: Cardio, Monitoring, Health and Fitness and Research. This makes Dyna-Vision a multi-purpose device. Physicians can use Dyna-Vision for different indications optimizing there return-on-investment.

Dyna-Vision is the first and only device in the world with an integrated mobile phone. With this connection the recordings are transmitted to a remote server for analysis by a physician. This process is fully automated so there is no action required by the patient to transfer the data. A physician can download the recordings for analysis from anywhere at any time. Also, we offer the unique feature of real-time remote monitoring. For example, a patient has symptoms and contacts the physician who can simply login to the server to monitor the actual streaming parameters on a computer !



Dyna-Vision is supported by several software packages (Cardio, Health & Fitness, Research , Monitoring) aimed at different types of users. Which one is the most popular so far?

  • Cardio is far ahead of the others as cardiologists are very used to recording and analyzing ECG. That makes that we can offer our Dyna-Vision as the “next generation” holter recorder. The patients are connected to the device in their practice. When the patient leaves the practice, the ECG is continuously transmitted to the cardiologist. The patient can be monitored for longer periods of time and does not have to come back to the practice to “download” data from the device. With Dyna-Vision, the patient has more freedom and can be sure that the cardiologist can always analyze the ECG, also when the patient is at home.
  • Monitoring is closely related to Cardio and it is commonly used to monitor remote patients.
  • Health and Fitness is rapidly growing since the wellness sector is focusing more on preventive medicine lately to expand their offering to their clients. When our test shows underlying health problems they refer their client to a physician for further analysis.
  • Research is used by universities but it is a very specific market. This is a niche which does not grow fast.

If I choose to use Dyna-Vision in my medical practice how much security can I expect regarding my patients’ data?

Dyna-Vision “creates” a data file with the recorded parameters. This data file is encrypted before transmission and it does not contain the name of the patient. The files are transferred from the server to your PC Software after entering a security code. After download, the files are decrypted and attached to the correct patient record. Although it will probably never be possible to design an unbreakable security, we took great care of making our product as safe as possible.

You have announced that your company will be launching the first real-time streaming patient monitor on the iPhone platform. How did you come up with this idea? Did you receive any requests from your customers for such a monitor on iPhone?

Well, when I demonstrate Dyna-Vision to cardiologists they always ask me if it is possible to receive ECG data on their mobile phone for a quick analysis. Until now we were a bit hesitating to develop such a tool as it seems more easy than it actually is. Besides that, there are a number of security issues you have to take care of and finally, the processor speed and screen resolution of the phones are still not really suitable for high-resolution multi-parameter monitoring. But, then the iPhone came with the high resolution screen and some very useful programming tools to graphically optimize the streaming data to make it technically possible.
Now we can offer a true telemedicine system for ambulant patients where patients can call their physician when they experience symptoms. The physician can immediately look at the streaming ECG.

In your opinion how did the iPhone influence the whole telemedicine field? Does it offer anything new regarding the mobile phones already on the market?

I must say that I found only a few interesting applications on the iPhone for medical use. The actual use has to grow I believe and this will take time. The main problem is that Apple made it difficult to distribute applications through the central appstore and this brings uncertainty to commercial developers. We had the same discussion within the company: do we develop an iPhone application with the risk of difficult distribution after development or even removal from the Appstore… or do we develop a “common” web application that we can freely distribute. This is a difficult decision but we choose the iPhone for the technical specifications. On the side, the added value of an iPhone to our own Dyna-Vision must not be forgotten. The graphical interface is fun to use and is relatively fast. The iPhone does offer new features that are not found in other phones yet, but other brands are coming up with new products that have somewhat similar specifications.

Explain some of the key features of the iPhone software for Dyna-Vision?

With the software the physician can login to the server and start a live data streaming session. After authentication, the data stream starts and the software automatically starts in monitoring mode. The user can change the layout of the screen and the colors of the graphs. The application is touch screen controller (obviously) and makes use of “flips” to graphically enhance the interface.

Will iPhone be able to communicate with Dyna-Vision unit only by GPRS or also via bluetooth?

Initially we will launch it with the GPRS connection. However, the next release by the end of this year will also support the Bluetooth connection.

When do you expect that iPhone version of your software will be available?

We are introducing the iPhone Telemedicine Application during the Medica in Dusseldorf, Germany to be held from 19-22 November 2008. Immediately after that it will be commercially available. However, it is only sold to licensed physicians who need to register with our company. We will authorize them in the system so that they are able to use the iPhone application.

Was it difficult for your software engineers to start developing for the iPhone platform using the tools from Apple?

The Software Development Kit from Apple needs some work so to say before you are able to use it to its full extend. On the other hand, if you have an experienced software engineer this is not a problem. Also, you do not have to take care of compatibility with other platforms as is the case when developing JAVA applications. So in the end, it is less difficult than developing for other platforms.

How do you comment on the likely ban of iPhone sales in the Netherlands? Will it in any way interfere with your plans?

Assuming that you are referring to the internal battery I do not worry about it. First of all, Apple is already discussing the new law with the government and it seems that there are three escapes that Apple can use to bypass the law.. The most important one is the use for medical purposes where the battery is an essential part for the correct functioning of the product. When it is easily removed, this creates issues with data storage and patient safety.
By law, medical devices have a waiver for this requirement and as we are selling it as a part of our medical device… probably we are okay. Nevertheless we are facing this challenge not only for the Netherlands as it is a European Law..

We will not only sell the iPhone Telemedicine Application in the Netherlands but all over Europe. As an example we just made an agreement with a telecom provider that has 35 million subscribers. Early next year we will expand to the USA and Asia. We have contracts with different telecom providers for monthly iPhone plans. We just have to wait and see how things will end up but my hopes are that Apple will work hard on solving the battery problem urgently…

Now that you have stepped into Mac arena, can we expect the Macintosh version of your Dyna-Vision software for desktop computers?

Of course it is already possible to use Dyna-Vision Software on Macintosh with a windows emulator but we are working on a OSX version. We have no release date scheduled but I estimate this will be ready Q1 in 2009.

There you have it! Something to look forward to, a new and revolutionary way to monitor your patients on the iPhone is coming soon. We will keep you updated.

A big thanks goes out to Dr. R.A. Brest van Kempen for this interview.

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Vaccine Record on iPhone

Vaccine record
Do you keep a vaccine record for your child? Do you know when and which shots has your child received? You would be surprised how many people don’t have a clue about this, from my experience almost 99%. But this can turn up to be a very important piece of information, especially if your child has to for any reason visit the emergency room. Child Vaccine Record app for iPhone lets you store this information and carry it with you all the time. Not only this, it can also keep a record of your child’s allergies and periodic measurements like height, weight, BMI, head circumference, body temperature and blood glucose values.

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Access life-saving information in the field using iPhone

I came across a press release which further strengthened my belief that iPhone is perfect for doctors. The whole project is so exciting that I just didn’t want to leave anything out. That’s why I decided to include the complete press release here.

iPhone and new technology enables health providers to access key life-saving information

BLACK DIAMOND, AB, Oct. 3 /CNW/ – When Foothills Regional Emergency Medical Technician (EMT) Mike Anderson recently arrived at the scene of a car accident and found a person unconscious, he assessed the patient’s condition and realizing he had little patient information, activated an iPhone to obtain necessary health data on the person’s allergies and current medications.

Since April, the Calgary Rural Primary Care Network (PCN) has conducted a pilot project using iPhones and unique software to provide secure access to patient data to physicians and other health providers outside of health facilities.

At the Foothills Family Medical Centre, Dr. Tim Dowdall and the nine other family physicians volunteered to pilot and manage the iPhone initiative funded by the Primary Care Network. The iPhones have been modified to increase security of patient data with protocols that exceed those of banking machines and other secure networks. Also, even if an iPhone is lost or misplaced
somewhere, no patient information resides in the phone. As well, a Patient Impact Assessment, a standard security review done by the Primary Care Network when new health technology was introduced, validates the company’s security safeguards.

The iPhones are linked with a state of the art software program that allows physicians and other designated health providers to pull information from the local electronic medical records in the Foothills Clinic to the point of care.

“The iPhone and support software,” says Dowdall, “improves the quality of care and access to necessary patient information for those of us who are working outside of our clinics and need data to make a clinical decision.” This is the kind of information sharing required to serve patients living in a
community with increasingly complex health issues.

Theresia Berry, a Paramedic with Foothills Regional Emergency Services in Black Diamond, south of Calgary, believes the iPhone has become an invaluable tool for accessing necessary patient data. “Often before we even arrive at the scene, we can use the iPhone, find out the patient’s past medical history, and just have a better idea of what we’re dealing with so we’re prepared,” she says.

They might receive a call because a person is in distress, but it could be one health condition or several medical issues. Sometimes even when they arrive at the scene, the person or family members may not be aware or under too much stress to explain clearly the medications and health conditions of the person affected.

“The iPhone gives us immediate and accurate clarification of the person’s health status,” she explains. Dr. Dowdall gives a unique example of taking the health iPhone and going
on vacation in Banff, Alberta. He received a call from his clinic about a patient and unlike in the past, when a non-urgent decision would be deferred until his return, he activated the iPhone, looked at the patient data, and made a decision.

This information sharing project and the use of technology supports the type of collaborative practice required among health professionals to coordinate and improve medical care. Homecare nurses in their offices can currently use the solution in linking patient electronic data from the Foothills Clinic. There are huge benefits in accessing information when visiting clients’ homes. Frequently people with complex health needs are confused regarding their conditions and various drugs and treatments that are being employed. Having one shared “source of truth” in the electronic record is extremely beneficial to get the care team on the same page.

Berry does admit there is one challenge in sometimes using the iPhone, especially in a more rural location. Cell phone reception is occasionally not good. However, Berry says she and her partner, EMT Mike Anderson, are aware of those locations and are usually able to obtain the necessary patient data before entering those areas.

Response to date from all physicians involved in the iPhone pilot project has been positive, says Dowdall. What makes the technology unique is that physicians can input into the software program the level of patient information other health providers require to do their jobs while restricting
access to any other information. This collaboration, and providing iPhone access to patient medical records, is likely a first in Canada and represents a significant step forward in having all health professionals working as a team to provide better health care to patients in Alberta.

Primary Care Networks (PCNs) are a made-in-Alberta approach to improve the delivery of primary care. A Primary Care Network is formed when a group of physicians and Alberta Health Services agree to work together to provide enhanced primary care services. In addition to physicians, other health professionals are key partners in delivering PCN services. Alberta Health and Wellness, Alberta Medical Association and Alberta Health Services are partners in the development of Primary Care Networks.

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EyePhone for iPhone

EyePhone is the new application for iPhone which might prove useful to an ophthalmologist in the field to quickly assess a persons vision. It includes several ophthalmic tests such as Ishihara, near vision acuity, amsler grid and fixation target. Flashlight and pupil gauge are also there.

EyePhone was developed in Brazil by Valemobi for a company called Eyecare and it is available for free in the iTunes app store.
EyePhone

Take a look at various tests it offers.
EyePhone

Near Visual Acuity Test
EyePhone

Distance E Test
EyePhone

Fixating Test
EyePhone

Color Test – Ishihara
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Amsler Grid
EyePhone

Pupil Gauge
Pupil Gauge Test

I am not sure how much useful this app will turn to be. If nothing, those Ishihara test plates look pretty amazing. Nevertheless, it is very exciting to see that creative medical apps for the iPhone seam to be appearing on regular basis.

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Apple Medicine

Apple has recently opened a section on their website devoted to medicine. Here you can find white papers, videos and interviews about how Apple technology and innovative partner solutions are transforming the work of medical professionals. It is definitely worth visiting from time to time regardless if you are a Mac or PC user.

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Zollinger’s Atlas of Surgical Operations on iPhone

Modality has just released their two new educational apps for the iPhone. They started with fantastic Netter’s anatomy flash cards and now they moved on to one of the most respected step-by-step guides to general surgery procedures, Zollinger’s Atlas of Surgical Operations. Zollinger’s Atlas of Surgical Operations consists of several parts devoted to gastrointestinal, miscellaneous abdominal, vascular, gynecologic and additional procedures. So far Modality has released upper and lower gastrointestinal procedures.

Here is what they say….

The classic guide to general surgery procedures is now available for the iPhone and iPod touch. Based on the renowned Eighth Edition as available on AccessSurgery, Zollinger’s iPhone applications allow you to access step-by-step instructions and superb line drawings for numerous general surgical procedures. Some procedures also include fully-narrated, slideshow presentations outlining each step in the procedure, from Intro and Indications through Post-Operative Care.

Using the intuitive iPhone interface, you can navigate through detailed images with the flick of a finger, pinch to zoom, and tap to read easy-to-follow instructions for each procedure.

Procedures included in these two apps….

Gastrointestinal: Upper:

• Closure of Perforation—Subphrenic Abscess
• Enteroenterostomy, Stapled
• Enterostomy
• Fundoplication
• Fundoplication, Laparoscopic*
• Gastrectomy, Hofmeister Method
• Gastrectomy, Polya Method
• Gastrectomy, Subtotal
• Gastrectomy, Subtotal—Omentectomy
• Gastrojejunostomy*
• Gastrostomy*
• Hemigastrectomy, Billroth I Method
• Hemigastrectomy, Billroth I Stapled
• Hemigastrectomy, Billroth II, Stapled
• Laparotomy, the Closure
• Laparotomy, the Opening
• Loop Ileostomy*
• Meckel’s Diverticulectomy
• Percutaneous Endoscopic Gastrostomy—PEG*
• Pyloromyotomy—Intussusception
• Pyloroplasty, Stapled
• Pyloroplasty—Gastroduodenostomy
• Resection of Small Intestine
• Resection of Small Intestine, Stapled
• Resection of Small Intestine, Stapled (Alternative Methods)
• Roux-en-Y Gastrojejunostomy
• Total Gastrectomy
• Total Gastrectomy, Stapled
• Vagotomy
• Vagotomy, Subdiaphragmatic Approach
• Zenker’s Diverticulectomy
• Anatomy of the Large Intestine

Gastrointestinal: Lower:

• Abdominoperineal Resection
• Abdominoperineal Resection, Total Mesorectal Excision
• Abdominoperineal Resection—Perineal Resection
• Anterior Resection of Rectosigmoid: End-to-End Anastomosis*
• Anterior Resection of Rectosigmoid: Side-to-End Anastomosis (Baker)*
• Anterior Resection, Stapled
• Appendectomy*
• Appendectomy, Laparoscopic*
• Closure of Colostomy
• Colectomy, Left, End-to-End Anastomosis*
• Colectomy, Right*
• Colon Anastomosis, Stapled
• Drainage of Ischiorectal Abscess—Excision of Fistula in Ano
• Ileoanal Anastomosis
• Surgical Anatomy of Large Intestine
• Total Colectomy*
• Transverse Colostomy*
• Excision of Pilonidal Sinus
• Injection and Excision of Hemorrhoids
• Rectal Prolapse, Perineal Repair*

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First thing I noticed is that these apps are very large. They have 264 and 140 MB. Also, they are a bit pricey. Each costs 34.99 dollars. The whole book would cost you 180 dollars at Amazon.com. It is up to you to decide, but there is no denying that Zollinger’s Atlas looks great on the iPhone and is, of course, so much cooler, among other things. Imagine how your next date will be impressed when you show her how to perform Anterior Resection of Rectosigmoid just before the movie. OK maybe not, but your geek surgery residence friends sure will.

Here are some photos.

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Scalpel in one hand, sterilized iPhone in the other, and start cutting.

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