Technology and travel health

First published in ITIJ 87, April 2008

Frank Gillingham, medical director of HTH Worldwide, explains some of the technologies that can help travellers in distress

A young executive from London with a history of kidney stones is driving to a business appointment in Moscow when he suddenly develops severe flank pain. Concerned that he may be experiencing the early symptoms of a recurrence, and completely unfamiliar with the local medical community, he flips open his international cell phone and clicks the medical icon that appears on its screen.  His wireless device has global positioning capability, so the addresses and phone numbers of the three hospitals closest to his location automatically appear. He selects a hospital within two kilometers, and then clicks ‘urology’ under the hospital listing. Three English-speaking urology specialists, along with their office addresses, contact information, and biographies are displayed.  The young man, whose side pain is now intensifying, selects a physician who is a member of the Royal College of Physicians, and who trained in the UK. An email is generated to the physician’s office with a request for an urgent appointment. Within five minutes he receives a text message back from the physician’s office that the doctor will meet him at the hospital. Feeling much more confident, but now with sweating and severe nausea, the young man’s global positioning system directs him to the hospital.

Sound futuristic? Not really, as the technology and healthcare resource databases are already in place to make this scenario quite realistic. Digital Cyclone, a subsidiary of Garmin, LTD, a global positioning company that provides services and content for several US wireless carriers, partnered with the Mayo Clinic and the Joint Commission on the Accreditation of Hospitals in February 2007 to launch a software application that delivers an array of health information and tools directly to cellular phones. Included in this portfolio of services is the ability to find, and be directed to, the closest emergency room or urgent care center based on one’s location within the United States.

Worldwide capability

HTH Worldwide, a Philadelphia, Pennsylvania- (US) based provider of international healthcare services, recently launched a mobile application of its online database of contracted healthcare providers in 178 countries. Global wireless devices with Internet access can now be used to find hospitals and physicians in hundreds of international locations. HTH also has a patented electronic appointment scheduling facility, and has begun its work with global positioning service providers to enable cell phone and PDA users to identify and access physicians and hospitals around the globe based on location.  The company maintains that ‘before long, world travellers will have in the palms of their hands the ability to find, make appointments with, and be directed to quality medical care almost anywhere on the planet’.

Many travel insurers have already found that SMS (short message service) or text messaging offers an effective and economic way of communicating with policyholders. For those not familiar with SMS, it is a form of sending a message from one wireless device to another. A user will type a message and then send it to a short number code (which is nothing more than an abbreviated phone number). In the advertising world, a company wishing to sell downloadable material such as ringtones may prompt potential customers to text ‘ABC ringtones’ to ‘12345’.  American Idol, a popular television show in the US, prompts its viewers to vote for their favorite performers via text messaging.  Where permitted by law, travel insurers are able to advertise their services to an audience that has purchased cell phones for international travel.  

young adults under the age of 25 are more likely to text message their friends and family than to speak on a phone

A recent survey in the UK showed that young adults under the age of 25 are more likely to text message their friends and family than to speak on a phone. With 82 per cent of the UK adult population owning a mobile phone, text messaging has proved to be an effective way for companies to communicate with their clients. As an insurer, there are three different ways to text message medical information:

1) Call to action: a text message is initiated by the service provider reminding the subscriber of an appointment or action, such as taking a medication. As an example, the UK-based Tower Hamlets Primary Care Trust partnered with mobile health promotion specialists iPLATO to help increase the number of women attending breast cancer screening clinics. Supported by the Public Health Team, surgeons from the Trust use the iPLATO patient care messaging system to send patients timely reminders of their screening appointment. Due to the success of this initiative, iPLATO was awarded a SMART Feasibility Grant by the Department of Trade & Industry to study the feasibility of a national implementation of a system in the UK to remind outpatients about scheduled appointments using text messaging technology.

2) Automated clinical: a request for information such as treatment for sunburn is initiated by the client and a programmed response is sent. The Center for Psychotherapy Research in Stuttgart, Germany, reports that a German hospital for psychosomatic medicine has developed a text message-based intervention for the aftercare treatment of bulimia nervosa. The program is offered to bulimic patients for six months following discharge from inpatient psychotherapy. The intervention consists of weekly messages from the patients on their bulimic symptoms and a corresponding weekly feedback that is a mixture of pre-programmed parts and individually tailored information. Preliminary results indicate that the program is well-accepted and gives support to bulimic patients after finishing inpatient treatment.

3) Personal clinical: similar to a telephone hot line, it is client initiated, with healthcare professionals responding to specific questions about personal health. Sometimes the advice is definitive, while at other times the patients are referred to specialists, hospitals or clinics. In May 2006, the San Francisco, California Department of Public Health began sending cell phone text messages to young people seeking advice about HIV/AIDS, pregnancy and other sex- and health-related issues. If a cell phone user sends the text message ‘sexinfo’ to one of two phone numbers set up by the health department, the system will send back a reply asking the user to choose one of several categories that matches his or her question. The programme aims for the text messaging process to take about one to two minutes, and most messages end with the distribution of a phone number that users can call for more information. There were more than 4,500 inquiries in the first 25 weeks, and more than half of those led to follow-up questions and referrals to health clinics.

Transfer of information

To facilitate transmission of glucose information between patients and physicians, France Telecom uses the Orange GSM cellular network to send data to a secure server that contains patient files. Physicians are thus able to easily check the files and send appropriate medical advice to individual patients via SMS text messages. In Scotland, young diabetics send a text message to their doctor to check how to modify their insulin treatment after eating certain foods, or drinking alcohol at a party.

A division of the US Army is currently trying to get funding for a program that could support soldiers with brain injuries. Ron Poropatich, deputy director of the Telemedicine & Advanced Technology Research Center at Fort Detrick in Frederick, Maryland, says the service would send daily questions to patients' cell phones to determine whether they are adhering to their therapy programs at home. Health workers would assess patient responses and figure out whether additional neurological or psychological help is needed.

Because text messages must be limited to 160 characters, anyone wishing to provide more information must do so by sending instructions via a text message for downloading an application or accessing a website visually compatible on a handheld. Of course, there is no limit to the amount of information and data that can be provided from a download or a web site. As an example, a travel insurer wishing to send a copy of its benefit schedule, instructions for filing a claim, its list of preferred providers, and immunisation requirements for travel may send a text message with instructions for downloading such information to a cell phone or PDA.

Web power

Over the past 10 years, health and travel insurers have spent countless millions developing and refining corporate websites that appeal to existing and potential policyholders. Unfortunately, these exotic websites do not all show as well when viewed on the tiny screens of a PDA or cell phone with internet access. This has spurred an entire new wave of technology called wireless application protocol, or WAP, designed to modify websites to fit onto much smaller screens. An insurer should expect several hours of dedicated IT time to complete this transition. Alternatively, a company may wish to develop a downloadable application of its essential information for its wireless users.  There are a variety of hurdles to overcome in this process, such as selecting an operating system (e.g. Palm, Symbian, Microsoft), device manufacturer (Blackberry, Nokia, iPhone, etc.), carrier (T Mobile, China Mobile, Verizon, etc.) for whom to develop an application. There are many ‘aggregators’ willing to help (Brew, Motricity, etc.), but for a steep price.

the integration of global positioning systems and access to healthcare is lagging far behind other services

The efforts of Digital Cyclone and HTH Worldwide notwithstanding, the integration of global positioning systems and access to healthcare is lagging far behind other services such as locating a good Chinese restaurant, the closest McDonalds hamburger outlet, or a cheap gas station. As can be appreciated, information on the closest hospital emergency room may be crucial to receiving healthcare when one is in a critical situation and in unfamiliar surroundings. The same holds true for physicians and dentists whose timely services are needed in urgent, but not emergent situations.  The leading global positioning service information providers such as TeleAtlas and NavTeq have not yet earmarked hospitals and physicians as ‘core’ points of interest for their widely used applications.  Google provides very rudimentary information on healthcare services on their maps, as a recent examination of the Google maps of Paris, Rome and Madrid identified only a handful (8-10) of hospitals in each city.

Travel health insurers should take note of these emerging wireless technologies, as being able to communicate with their clients and to direct them to providers with whom they are contracted may significantly improve patient care, reduce fraud, and improve the bottom line. In addition, very costly medical evacuations and transfers can be minimised if patients are given a convenient and reliable means of getting to the right providers at the first sign of trouble. Providing a 24-hour call center will always have its place in the travel insurance/assistance world. Having the same information literally in hand, with the ability to select and make appointments with healthcare providers, profile hospitals, locate pharmacies, translate medications, and understand medical terms in a foreign language is raising the bar.