The most common “technology” question coursing through the AAHCP ListServe these days is “What type of EKG machine do you use?” The use of EKG in home care for physicians provides a simple, portable documentation of both the rhythm strip and, if necessary, a full 12-lead EKG. Some devices allow for one-touch visualization of the rhythm strip with memory capture for remote print-out but no 12-lead. Since the rhythm strip is often bundled into any E/M service rendered that date (even if at a different time), and the removal of the transportation fee for EKG lowers reimbursement to about $24 for both technical and professional components, it is important to analyze the purchase of such machines carefully.

The use of an EKG machine in the office setting with the occasional housecall may lead to a different choice of machine than one for housecalls alone. An office setting allows much higher potential volume of testing and places less imphasis on size and weight than the mobile doctor setting. In the mobile setting, additional factors such as print options, battery life, storage capacity, and heated stylus printing methodology become important. I started doing EKGs on housecalls in 1985 and found the only version available then used a 9-volt battery you could buy anywhere (good) and a heated stylus printer to paper which oxidized quickly in the sun (bad).To make the right choice, an EKG machine must ultimately provide a hard printed record and not lose money, so an analysis with certain assumptions can help prevent “buyer’s remorse.”

Once you have defined the form and function of the machine you would like, the physician should analyze the total cost of use. For example, a physician plans to make housecalls full time, and estimates that an EKG will be required every 20th housecall. The useful life of the $3,000 machine selected is estimated to be 5 years on an amotization schedule and the per test use of electrodes and printing paper is $2.50. Her bad debt collections is 10% under Medicare assignment, and it costs a further 10% for billings and collections for her practice. If this physician averages 7 housecalls (HC) daily after vacations and CME time off is taken into account and works a five day week (22-day month), she can calculate the profitability of an EKG machine as follows:

If:

1. Medicare allowed charges for your area are $24 per EKG (revenue)
2. 7 x 22 x 10% = #EKGs/mo
3. ($2.50 x #EKGs/mo) = direct cost/mo
4. $3000/60mo + ($24 x .10 x #EKGs/mo) = indirect cost/mo

Net Income of an EKG machine = Revenue – Cost (direct and indirect) or $369.60 – $125.46 or $125.46.

It seems clear that no one is getting rich using an EKG on housecalls, but other factors might affect the decision to upgrade your service and which machine to choose. The Level IV established patient visit requires moderate to high complexity, which requires the interpretation of lab or XRay generally. Having an EKG reading available may allow compliant billing at Level IV not to mention the importance a tracing might have on the quality of care and the ability to avoid a trip to the emergency room.

Given this type of analysis, adjusted for the physician’s practice style, desires and realities, there are a number of machines to choose from. Below are the names and websites of EKG machines with which I am familiar, and some notes about each. For the 12-lead capability you can expect to pay around $3,000 or more. For the rhythm strip-only devices, costs are much less.

• CM 4000 (www.ttiac.com): most convenient; has one-touch with screen capability, 12-lead with harness, light and fits in the “black bag”
• PC-EKG (www.brentwoodmed.com): the most advanced lightweight fax and email enabled EKG used easily with any portable computer
• Shiller AT-1 (www.welchallyn.com): takes EKG and prints in the home on same device; heavy and bulky but print-out looks like a hospital printout
• Burdick Spacelab Elite II (www.burdick.com): similar to Shiller; unfortunately the old Burdick of the 1980s (the best I have ever used) has been discontinued.
• ActiveEKG (www.activecenter.com): under $500 and works with a handheld Palm; rhythm strip only

The tech newsletters I follow all seem to predict an extended delay beyond 2002 for the arrival of 3G, the so-called third generation of wireless systems that will support all sorts of useful tools for the mobile professional. Although kids in Japan are now streaming movies into the small screens of their DoCoMo-enabled cell phones, the United States is far behind as the telephone pole and cable lobbies pour money into Congress to protect their investment in copper wires. The current spate of medical “niche” solutions seems focused on palm pilots and non-private connectivity options that meet only part of the mobile physician’s needs.

The intense limitations of communications technologies affect the convenience and quality of home care at every interaction and should be approached from a functionality perspective. For purposes of discussion, let us assume there are three critical, “must-have” features of a home care program: scheduling, messaging, and charting. Each of these has a different need for telephonic communication, or at least a better solution than leaving voicemail messages.

Scheduling

The office-based physician finds scheduling of visits virtually transparent, since the front office does it all for him. In a housecall program, or a home health service attempting to predict response times to referring physicians, the need for geographic location of field personnel and timely synchronization of the central schedule to those of multiple people in the field becomes critical. At the time of a physician home visit, the physician needs to know their future schedule on site, so as to mitigate the clinical need for follow-up with their normal routing patterns, vacation times, and possible interference from caregiver/family member schedules. The moment they commit to a follow up visit, how does the central office know that slot is committed, so they don’t overbook the physician in another capacity? How does a sick patient know a two hour response time is actually guaranteed?

Messaging

Perhaps the most complicated issue in managing a fleet of Xray vehicles, twenty physicians in the field and associated physician extenders all coordinated through a Call Center is messaging. Having read books and taken executive management courses in communications through the military (where the importance of messages like “engines all STOP” is critical), I believe this area is the most maligned and least respected of all in home care. Whereas a doctor’s order to “hang two units of packed red cells within the next two hours” in a hospital is virtually foolproof, it is considered fungible or impossible in home care.

Understanding the complexities of messaging involves dissecting the intracacies of knowing when to send a message, how to priortize it, what medium to use, how to receive it, how to store it, how to recover it, and when to time-stamp it, just for starters. Some physicians type fast, some a little, most not at all; the use of handwriting recognition software (allowing the computer to digitally recognize each letter), or allowing the computer to recognize speech are all options in the marketplace now. How does one recover a message for quality assurance purposes? When was it sent? Can you prove it? When was it read? Can you prove it? The biggest risk I see in home care communications is the “he said, she said” conundrum when something is missed.

The Electronic Medical Record

Using telephony to transfer the mobile EMR is now gaining great attention in our field, yet few physicians or nurses appreciate the difficulties involved. They include meeting the new HIPAA privacy standards, deciding on a web-based or web-enabled architecture, modem speeds, compression software, compatibility of local systems with firewalls and other security measures, committing to a server-based system or peer-to-peer architecture, and meeting the seemingly infinitely variable demands of clinicians for keyboards, no keyboard, templates, macros, voice commands, voice transcription etc.

Having become familiar with all of the above problems and seen the incredible efficiency of a few physicians in our medical group using a paperless, mobile office, I must confess I have not found or seen demonstrated the critical next step: providing a complete, scalable system that any number of physicians could use (analogous to the partial low-tech solutions many are familiar with using a handheld computer and a wireless modem).

The costs of such a complete “Final Solution” is not insignificant. It is easy to spend $1 million on just a virtual private network (VPN) at present, although many handheld computer operators are making false claims of “HIPAA compatibility.” However, just having a VPN that meets privacy standards does nothing to help a clinician in the home communicate with mobile home health nurses with adequate documentation, create a robust, compliant EMR, or receive updated critical lab values in a prioritized way which protects staff from needless phone calls and insecure voicemail messages.

Three Lessons I Have Learned in 16 years of using telephony on housecalls

Voice transcription (the computer recognition of free speech) has a role, but it isn’t what you think. The fantasy of talking to a computer and having your chart printed is not here, no matter what the salesman says. Although new versions (such as version 5.0 of Dragon Naturally Speaking Mobile Professional) are infinitely better than the Kurzweil software we paid $25,000 for in 1986, they must be seen for their functionality.

Voice transcription consists of a speech engine which accesses a personal file of your speech pattern and vocabulary created by hours of voice mapping (the more the better), coupled with an EMR setup that allows you access to voice transcription. Having created four separate personal voice files with four different software licenses, it suddenly occurred to me that it was stupid to continue separate voice mapping with the same speech engine on AOL Speaks (keyword “aol speaks”) transcribing email messages, My Ivan (www.onevoice.com) for surfing customized web pages specifically modified to allow me to call out numbers instead of clicking, Dragon Mobile Professional (www.dragonsystems.com) to dictate into a digital recorder for later dowloading of files and messages, and Breveon (www.breveon.com) to dictate within the fields of a customized EMR. None of these programs crossed over to the other key functions without redundant voice mapping or additional, licensed features.

Hope is on the way. A little known company (www.digitaldictate.com) is about to launch the product mobile physicians need: voice transcription middleware which allows you to use any device, including a phone, and any of the three major speech engines (which you probably already own if you are reading this article), and voice for commands or free text (within the limitations of the speech engine and your commitment to voice mapping) wherever your cursor lies on the screen.

This means that one inexpensive product will allow you seamless talk to your computer while driving, and command it to read you your messages (text-to-voice), shift to the internet to check out traffic patterns, go to your GIS (geographic interfacing system) program and get directions, or finish a medical record dictation. Transcription costs will be reduced to a “proofing” function as you stream your audio wave files across your wireless broadband modem to a server somewhere else which can handle the huge memory needs for accurate voice transcription. Stay tuned.

HIPAA is no big deal. If you take the time to read the entire regulation, in effect since April 24, 2001, you will find the word “reasonable” used some forty times to describe the expected security standards. Although we must take the effort and expense to operate within a secure, 128 bit encrypted virtual private network for the transfer of digital information of patient matters, this effort will nearly always provide an adequate infrastructure for meeting HIPAA standards. The need for efficiency and protection against hackers, spoofers, and internal casual surfing will drive systems design more than HIPAA for the mobile, paperless physicians, unlike our paper-based peers in the hospital.

Don’t wait for the next “new thing” before you launch your telephony solutions. It is quite frustrating to invest in software and hardware technologies in an industry that continues to ignore the realities of healthcare computing needs by designs meant only for the office. Telecom companies still think that putting the ‘computer in the phone’ is the answer, while physicians need such high memory and computing power that putting the ‘phone in the computer’ is the only final solution for a single device. However, VOIP (voice-over IP), which will allow you to talk live to your computer with real-time audio streaming to your server or peer client, is still beyond the pricing and computing power of most mobile professionals. Decide your budget, your scalability needs, your level of in house technology support and get started now; it will only get easier in the future.

Summary
We have come a long way since I started making housecalls in 1985 using a twelve pound, briefcase-sized cell phone in a van installed with the ETAK navigator. Now, we make housecalls with a broadband wireless modem always connected to our office and partners, scheduling patient follow-ups in the field with automatic instant synchronization to the office schedule, printing the EMR real-time thirty miles away at will, signing orders on a PEN computer, e-faxing or e-mailing prescriptions from the home, and messaging with time-stamped, archived handwritten or typed e-mails protected at the highest level of privacy within our wide area virtual private network. Paper is the enemy of telephony and it can be slain.

Dr. Bayne is the Founder and Chairman of The Call Doctor Company, dedicated to providing technology solutions for mobile physicians.

While you might rather put your trust in the haphazard jabs of a medical student than a bloodsucking machine, the researchers at Imperial insist that their robot is far more reliable than a human. Besides hitting the vein first time, every time — a track record few human blood takers can match — the robot won’t overshoot the vein. This is a common problem for some patients that can cause painful bruising. To find the vein, the robot uses a primitive sense of touch. Gently prodding the different parts of the arm, it records the force of the probe bouncing off the tissue to determine what lies underneath the skin with an accuracy of one millimeter.

“The force depends upon the elasticity of the skin underneath,” says Alex Zivanovic, a mechanical engineer working on the project. Muscle is hard and fat is soft, he explains, while veins have a unique feel to them, “like an underinflated balloon.”

Once the location of the veins has been displayed on a screen, the operator can choose the best one and instruct the robot to proceed. As the needle penetrates the skin, the robot uses strain gauges to monitor the force exerted on it by the tissue. The moment the wall of the vein is breached, the robot stops, ensuring that the needle doesn’t overshoot.

This approach is particularly flexible, says Tony Firth, an anatomist at Imperial, because it doesn’t assume that everybody’s veins are all the same size or at the same depth. This makes it useful for finding veins in small children or obese people.

David Keeling, a consultant hematologist at the Oxford Hemophilia Centre, says it can also be extremely difficult to find veins in patients after a lifetime of treatment. “If you are sticking a needle into the same veins you can get inflammation, thrombosis and the vein can become occluded,” he says. Essentially, patients run out of veins to use and in some cases permanent catheters must be inserted.

But Keeling wonders how easy it would be to get a small child to keep still — even when strapped into the device. And Zivanovic admits that many people he has talked to were none too enthusiastic about a robot wielding a needle. Nevertheless, he hopes that drawing people’s attention to the robot’s safety features, such as its limited field of motion, will persuade the faint-hearted.

The system is semi-autonomous. It suggests the most appropriate area to pierce but leaves it up to the operator to make the final decision. Eventually Zivanovic would like to build a fully autonomous robot that would choose the most suitable vein.

So far, Zivanovic has only tested his device on artificial limbs designed as practice tools for medical students. These contain various layers of gels, tubes and latex membranes, and even artificial blood, which Zivanovic says gushes out into the needle when the vein is penetrated.

The BioZdTEL uses CardioDynamics’ proprietary BioZ noninvasive impedance cardiography (ICG) technology to ollect hemodynamic measurements, including cardiac output, stroke volume, systemic vascular resistance and fluid status. That information then is transmitted to physicians via the Internet.

If cleared by the FDA, CardioDynamics plans to utilize the BioZdTEL exclusively in its DiTEC (Diagnostic, treatment and Education of Cardiac Disease) program that links kidney disease specialists with cardiologists.

“The DiTEC clinical program is designed to directly assist nephrologists by enhancing cardiac evaluation and disease management activity of the patient in the dialysis setting, thereby augmenting the overall cardiac care provided by the treating nephrologists, slowing cardiovascular disease progression and preventing urgent trips to the hospital for preventable cardiac events, such as congestive heart failure and intra-dialytic hypotension,” Dr. John Strobeck, president of HEART-LUNG ASSOCIATES OF AMERICA (HLAA; Hawthorne, NJ), said in a statement issued by CardioDynamics.

In March CardioDynamics entered into an alliance with HLAA, in which CardioDynamics would provide its BioZ cardiography technology to dialysis centers that utilize the cardiology, diagnostic and disease management services of HLAA.

The alliance stemmed from concern among heart and kidney specialists that hypertension and heart failure are inadequately treated in dialysis patients. The American Heart Association and the National Kidney Foundation estimate that cardiovascular events account for half of dialysis patients’ deaths, according to CardioDynamics. Traditionally, nephrologists have focused on the complexity of their patients’ kidney disease and dialysis treatment and have not been able to adequately address the opportunities to prevent and intervene in cardiovascular complications, the company said.

Under the CardioDynamics-HLAA agreement, end-stage kidney disease patients who are at high risk for cardiac events are monitored with the BioZ impedance cardiography technology during each dialysis treatment, the companies said in the earlier report.

The BioZdTEL device would facilitate transmission of the patient data obtained through that monitoring, CardioDynamics said.

“The BioZdTEL development is an important step in the company’s information technology strategy of linking physicians to physicians and patients to physicians, via the Internet, Michael K. Perry, CardioDynamics CEO, said in a statement.

“We believe the Internet and wireless technologies will be important drivers to facilitate change within healthcare, and we plan on being on the forefront of this emerging $25 billion Internet healthcare market. We are committed to the development of Internet-based ICG devices and discussion are in progress with leading medical monitoring companies for inclusion of our proprietary technology into their product offerings,” he said.

According to CardioDynamics, more than one million patients worldwide suffer chronic kidney failure, which, if treated properly, requires dialysis treatments up to three times a week.

Shares of CardioDynamics trade on Nasdaq under the symbol CDIC.

CardioDynamics International Corp. is a medical technology and information solutions company. Its BioZ system noninvasively provides medical professionals with hemodynamic data.

“The process would be greatly facilitated by a portable instrument that could be used in any suspect location and was capable of rapidly detecting and characterizing microbial pathogens.”

NEW YORK & PARIS & SANTA BARBARA, Calif.–(BW HealthWire)– Sept. 20, 2001–

– IRCAD/European Institute of Telesurgery, France Telecom and Computer Motion Announce that Surgeons in New York Successfully Operated on a Patient in France Using Surgical Robots and a High-Speed Fiberoptic Solution

IRCAD/European Institute of Telesurgery (EITS), France Telecom (NYSE:FTE), and Computer Motion Inc. (Nasdaq:RBOT) today announced that on Sept. 7, a 68 year-old woman in Strasbourg, France, became the first patient in history to receive a complete telesurgery procedure performed by surgeons nearly 4,000 miles away.

Operating from a France Telecom/Equant center in New York, Professor Jacques Marescaux, M.D. of the European Institute of Telesurgery (EITS) and Dr. Michel Gagner of New York performed a complete laparoscopic cholecystectomy (gall bladder removal) on the patient in Strasbourg at the Hospital Civil/I.R.C.A.D. The telecoms solution between the surgeons and the robotic system enabling such a procedure was provided by an end-to-end high-speed fiberoptic service deployed by several France Telecom group entities. From New York, surgeons used the Computer Motion Zeus(R)(TM) Robotic Surgical System to control the surgical instruments on the patient in France.

While some parts of this system are approved by the FDA for use on patients in the U.S. in a non-remote scenario, the system used in this proof-of-concept has not been approved for commercial release by the FDA. This system has been CE-marked for commercial distribution in Europe.

The patient was released from the hospital approximately 48 hours after surgery and reported a return to normal activity the following week.

Professor Marescaux attributes the patient’s remarkable recovery to the less traumatic, minimally invasive approach used in the demonstration, and marks the beginning of a new age of telesurgery.

“We can now extend the reach of the surgeon so that an expert can intervene any place in the world,” said Prof. Marescaux, who is founder and president of the Institut de Recherche contre les Cancers de l’Appareil Digestif (IRCAD) and the European Institute of Telesurgery (EITS) in Strasbourg. “I felt as comfortable operating on my patient as if I had been in the room. But the knowledge of the level of medical science and technology that enabled the surgery are a landmark for all medical treatment and training to come.”

“France Telecom has always been enthusiastic about supporting the development of exciting new technologies such as this,” said Jean-Pierre Temime, director of Marketing for France Telecom Enterprise Services. “This was a tremendously challenging project, since we had to apply our expertise in high-speed services within an extremely exacting environment in terms of the reliability and security needed. These are in fact the same services we deliver every day to equally demanding corporate customers. This world first prefigures a host of other tremendously promising applications that will be possible using high-speed telecommunications services that are already in place. And we’re not talking about utopian dreams but real, concrete solutions that can be deployed right now.”

“Today’s announcement is the first step towards the convergence of technology and medical science that will treat patients with less pain and faster recovery, anywhere in the world,” stated Robert W. Duggan, chairman and CEO of Computer Motion. “The participants believe that this demonstration has the potential to interest medical professionals throughout the world in the newest applications of interventional telemedicine.” Duggan added: “Future explorations into the potential of telesurgery and tele-collaborative surgeon training will be measured by the benchmarks established by this event. We are very pleased to have EITS and France Telecom as our partners on this project and are proud that our products are making significant inroads in the emerging field of tele-collaborative surgery.”

“I strongly believe that advances in telemedicine will bring many positive changes to patient care,” said Yulun Wang, PhD, founder and chief technical officer of Computer Motion. “The obvious benefits are just now being discovered as we reduce the barriers of distance between practitioner and patient. In the near term, I see this partnership of technology, communication, and medicine creating significant new means for training doctors.” Dr. Wang continued, “The adoption of advanced minimally invasive procedures continues to be the engine that drives Computer Motion’s research and development efforts. The goal of these efforts is to provide improved patient outcomes and quality of life across a broad range of surgical disciplines. It is an exciting opportunity to apply these advances to a larger patient population, freed from the limits of time and distance. Computer Motion is uniquely positioned to assist with the necessary surgeon training and education, as well as application of these new techniques in the operating room. No other company offers this broad range of solutions to today’s health-care professional.”

The participants believe that this demonstration has the potential to interest medical professionals throughout the world in the newest applications of interventional telemedicine. The teams hope that future applications will have the potential for bringing dramatic changes to the delivery of patient care.

The success of the demonstration on a human patient marks this moment in history as the first-ever successful collaboration of its kind between medicine, advanced technology, and telecommunications. Future explorations into the potential of telesurgery and tele-collaborative surgeon training will be measured by the benchmarks established by this event.

Commenting on the operation, Professor Marescaux said: “I believe that this demonstration of the feasibility of a completely safe remotely performed surgical procedure — and notably the first trans-Atlantic operation — ushers in the third revolution we’ve seen in the field of surgery in the past 10 years.

“The first was the arrival of minimally invasive surgery, enabling procedures to be performed with guidance by a camera, meaning that the abdomen and thorax do not have to be opened. The second was the introduction of computer-assisted surgery, where sophisticated software algorithms enhance the safety of the surgeon’s movements during a procedure, rendering them more accurate, while introducing the concept of distance between the surgeon and the patient. It was thus a natural extrapolation to imagine that this distance — currently several meters in the operating room — could potentially be up to several thousand kilometers.

“This is what we have just demonstrated thanks to the combined technical prowess of Computer Motion, which created the digital robot required, and France Telecom, which was able to deploy a broadband transmission service with optimized compression, thus limiting the time delay between the command of the action and its return on the monitor to a level that is virtually imperceptible to the human eye.

“The demonstration of the feasibility of a trans-Atlantic procedure — dubbed `Operation Lindbergh’ — is a richly symbolic milestone. It lays the foundations for the globalization of surgical procedures, making it possible to imagine that a surgeon could perform an operation on a patient anywhere in the world.”

The France Telecom group provided an end-to-end high-speed fiberoptic service that enabled the surgeon to work with virtually no time delay between the instant he manipulated the robot controls in New York, and saw the result on the patient in France.

Despite a distance of about 4,000 miles (7,000 kilometers), it was imperative that a constant time delay of less than 200 milliseconds be maintained between the surgeon’s movements and the return video image displayed on his screen. This is especially challenging since the time delay includes video coding/decoding and signal transmission time.

France Telecom’s high-speed service linked with the solutions developed by France Telecom R&D engineers made it possible to achieve an average time delay of 150 milliseconds. This represents a decisive breakthrough for telesurgery, which previously was strongly limited due to the time delay problem.

For France Telecom, meeting this daunting challenge meant indeed guaranteeing the quality, reliability and security of the transmission speeds. Drawing on the expertise of Equant in end-to-end high-speed services, the France Telecom group linked all of the equipment (video camera, robotic system, video conference, telephone) over a trans-Atlantic high-bandwidth fiberoptic service (10 megabits per second).

“To support the success of this proof-of-concept, we had to go beyond the technical challenges of providing flawless service quality, reliability and security,” commented Tom Wyrick, vice president, Equant North America. “By deploying an end-to-end fully managed solution, we were able to deliver critical applications, such as broadcast-quality video, secure ATM data transmission, IP telephony, videoconferencing and LAN interconnection, thus eliminating the distance barrier between patient and surgeon. We are proud to be a partner in the world’s first trans-Atlantic telesurgery procedure and applaud the teamwork present both within the France Telecom group and with our distinguished partners.”

While unique in itself, the operation underscores two of the areas that are driving the use of high-speed services — video and new work methods. Video is an increasingly pivotal communications resource thanks to the improved quality that is possible with high-speed services.

At the same time, the performance of these services is encouraging the development of collaborative working, teleworking, tele-information and mobility, eliminating constraints of time and space.

Project partners

IRCAD

IRCAD (Institut de Recherche contre les Cancers de l’Appareil Digestif Institute for Research into Cancer of the Digestive System) has since 1994 worked on applying basic cancer research and developing new medical technologies. In 1993, recognizing that surgery was making a fast and ineluctable transition from the industrial era to the computer era, Professor Jacques Marescaux created an innovative private sector organization dedicated to leveraging the value of basic cancer research, with IRCAD, and developing new computer-based technologies for surgery, with EITS.

The idea was to create a center where surgeons, physicians, researchers, engineers and computer specialists could combine their talents at a single site.

This initiative aimed to meet a two-fold challenge: innovate to demonstrate European capability for creativity and innovation in a sector where the United States already enjoyed a reputation for excellence, and develop high-level training. Indeed, expanding the use of new technologies in this area is intimately linked to providing high-level training.

IRCAD-EITS has grown into a world-class surgical training institution, considered one of the top in the world. This success is reflected in the number and diverse origins of the surgeons who enroll for its courses. The center welcomes more than 3,000 surgeons annually from three continents, who receive training thanks to the collaboration of an international team of 800 experts.

IRCAD-EITS received financial support from Axians.

France Telecom

France Telecom is one of the world’s leading telecommunications carriers, with over 86 million customers on the five continents (220 countries and territories) and consolidated operating revenues of 33.7 billion Euro for 2000 (20.4 billion Euro at June 30, 2001).

Through its major international brands, including Orange, Wanadoo, Equant and GlobeCast, and through France Telecom R&D for innovation, France Telecom provides businesses, consumers and other carriers with a complete portfolio of solutions that spans local, long-distance and international telephony, wireless, Internet, multimedia, data, broadcast and cable TV services.

France Telecom is the second-largest wireless operator and the number three Internet service provider in Europe, and a world leader in telecommunications solutions for multinational corporations. France Telecom (NYSE:FTE) is listed on the Paris and New York stock exchanges.

Computer Motion Inc.

Computer Motion is a high-tech medical device company evolving surgical practices to enhance patient lives. The company develops, manufactures and markets proprietary computer-enhanced and robotic surgical systems, which enhance surgeons’ capabilities, improve outcomes and reduce costs.

Computer Motion’s products include the voice-controlled AESOP(R) Endoscope Positioner, the first FDA-cleared surgical robot; the HERMES(TM) Control Center, a centralized system which enables the surgeon to voice control a network of “smart” medical devices; the Socrates(TM) Telecollaborative System for surgeon mentoring, training, and practice collaborations; and the ZEUS(R)(TM) Robotic Surgical System for new minimally invasive microsurgery procedures, such as endoscopic, beating heart bypass surgery.

The ZEUS System is CE-Marked. Computer Motion has completed an FDA-approved Phase 1 Investigational Device Exemption (IDE) for: coronary bypass, general laparoscopic and thoracoscopic surgery, as well as mitral valve surgery and fallopian tube reanastomosis for clearance of the ZEUS System.

This news release contains forward-looking statements concerning the company’s business and products. Actual results may differ materially depending on a number of risk factors, including the risks of competition and competing technologies, duration or suspension of clinical studies, regulatory clearances and approvals, and physician, hospital and payor acceptance of the company’s products. These factors and other risks inherent in the company’s business are described from time to time in the company’s Securities and Exchange Commission filings, including its Annual Report on Form 10-K. The company undertakes no obligation to revise the forward-looking statements contained herein to reflect events or circumstances after the date hereof to reflect the occurrence of unanticipated events.

IRCAD European Institute for Telesurgery (EITS) Web site: http://www.eits.org/

France Telecom Web site: http://www.francetelecom.com/

Computer Motion Inc. Web site: http://www.computermotion.com/

Magnetic resonance imaging is a “highly accurate” technique for diagnosing deep vein thrombosis (DVT) and may be particularly helpful to pregnant women and travellers at risk of developing dangerous blood clots, British researchers said on Monday.

Professor Alan Moody and his team in the department of academic radiology at Nottingham University tested magnetic resonance direct thrombus imaging (MRDTI) in 101 patients with suspected DVT above and below the knee. The results were compared with those already obtained using venography by two experts who found that the MRDTI diagnosis was accurate throughout the lower leg venous system.

“The great advantages that MRDTI has over other methods to detect thrombosis are that it is non-invasive, quick and reliable,” said Dr. Moody whose findings are published in the Annals of Internal Medicine. “MRI has this wonderful ability to pick out different characteristics of tissues and because of the way blood behaves, it gives out this very good signal of where the clot is,” Dr. Moody told Reuters Health. The method “does not require contrast agent and is highly accurate and reproducible,” the investigators point out in their journal report.

Although venography has largely been replaced by ultrasound, the researchers said that both techniques rely on changes secondary to a blood clot such as impaired blood flow. These results might be inconclusive below the knee, whereas MRDTI directly reveals the thrombus. They added in a news statement that MRDTI enables radiologists to diagnosis the disorder at an early stage even before symptoms are apparent. “Action can then be taken to prevent the clot [from] becoming larger and blocking the blood vessel, or the clot breaking off and travelling to the lungs and causing pulmonary embolism.”

Although the study did not include pregnant women, Dr. Moody is confident that MRDTI could play an important role in monitoring blood clot formation. “DVT can be a major problem during pregnancy and in a few cases may be fatal,” he said. The clots often originate in the pelvis, which are difficult to detect using ultrasound. “MRDTI produces good images of the pelvis and the pregnant mum would not need X-rays for us to see the blood vessels.” DVT in travellers during long-haul flights causes great concern and the speed and reliability of MRDTI could, in the future, identify those most at risk, the researchers added. Dr. Moody said that the limited number and capital cost of MRI machines might limit widespread use of MRDTI at present. However, running costs were competitive at around US $1000 per hour, enough time to scan three or four patients.

Ann Intern Med 2002;136:89-97

Mobile service providers are closely watching the clock as the next implementation deadline approaches for the FCC’s wireless E-911 requirements. At the same time, emergency system dispatchers are looking for answers on how to get the radio and computer equipment they need to process wireless E-911calls.Boulder, Colo.-based wireless data management technology vendor Intrado [TRDO] is expanding its location technology offerings to include what public safety answering points (PSAPs) need. Intrado, which this month changed its name from SCC Communications, will roll out its “PS-MAP” offering in August, Dan Hoskins, vice president and general manager of Intrado’s wireless business unit, told Wireless Today.”In order to be able to provide that 911 service in terms of supporting the wireless carriers, one of the big issues is the technology at the PSAP,” Hoskins said. “We think that [PS-MAP] will help take that problem off their back.”

Under the FCC’s wireless E-911 order, carriers as of April 1998 had to be able to transmit call-back numbers on wireless 911 calls and provide the location of the cell sites transmitting those calls. By October of this year, carriers must be able to pinpoint where the caller is calling from. However, carriers only have to provide that information to PSAPs that can handle it and only after they request it. Of the 4,300 PSAPs in the United States, 48 have asked to receive wireless E-911 location information, said Bill Dyer, Alcatel’s [ALA] director of new ventures for network applications. So, wireless carriers have had little reason to actually deploy their E-911 capabilities.”

It’s kind of a strange position that everyone is in,” Dyer said. “It’s just early in the whole process. It’s something that I think will still take some time for the market to work out.”

Like other players, Paris-based Alcatel was attracted to the location technology space largely because of the technology’s commercial possibilities. Wireless carriers can use the same equipment they deploy to provide E-911 coverage to offer their customers location-based mobile e-commerce services, as well as other wireless applications that need location information.

So far, however, Alcatel has been frustrated in the wireless location space, Dyer said. “We see the carriers rolling things out slightly slower than we anticipated,” he said. “The carriers deferred any type of location service until their 911 infrastructure was in place. Now that the infrastructure is going into place, you see some delays happening there because of technical issues.

“Wireless providers could be the frustrated parties after they finally launch location services, Dyer added. “We had expected the carriers to see the opportunity for locations services on the commercial side. We just saw that the carriers were just trying to meet the demands of subscriber growth and so most of the resources they had were going toward that. We think that if the carriers had deployed some of these services early on, they would have learned quite a bit and they would be in a much better position.”

That better position would be generating additional revenues after spending less for simple location services than they will spend to implement E-911 capabilities, Dyer said. While a nationwide wireless E-911 footprint could cost as much as $1 billion, a nationwide location system for commercial applications would cost about $10 million. Although their operation is linked to the same systems that will provide E-911 information, commercial location applications cost less because they don’t use all the elements of E-911 systems.

However, doubts about actually generating location service revenues have kept carriers out of the commercial space, Dyer said. “Without a solid business case for mobile location-based commerce, it’s very difficult to figure out how [infrastructure costs] can be recouped,” he said. “The thing that I think they would have learned is what services the user is interested in, what is the user willing to pay and what services are most profitable.”

What carriers already know is that PSAPs’ stumbling block is paying for the equipment and technology to handle wireless E-911 information. That’s not surprising, Hoskins said, because pubic safety agencies’ budgets are focused more on providing emergency response services than on information technology upgrades. “We’ve been in contact with several states and we’ve gotten strong expressions of interest,” he said. “We said we have to build this thing in a way that it can fit in the operational budget of a PSAP.”I think a big reason why it’s receiving strong interest is it clearly hits public agencies on two fronts,” Hoskins added. “First, it’s affordable and, second, it takes a major headache off their hands.”

According to Intrado’s research, PSAPs would pay an average of more than $500,000 over five years to acquire and operate the equipment they need to handle wireless E-911 information. Intrado will provide PS-MAP as a service to PSAPs, with per-month fees determined by the number of dispatch positions an agency has. The company would not disclose its fee levels.

In addition to the service it will offer to PSAPs, Intrado already is offering wireless operators the three elements of E-911 service: mobile positioning centers, position determining entities and coordinate routing database. Routing databases determine to what PSAPs wireless 911 calls are routed, position entities interact with network-based or GPS location technologies to determine callers’ locations and positioning centers combine that information to connect 911 calls.

Intrado uses SignalSoft’sposition-determining software and servers from Compaq Computers [CPQ] for its mobile positioning centers. It is building a nationwide coordinate routing database and is contracted to provide that information for 22 U.S. wireless carriers, including seven of the 10 largest, Hoskins said.”One of the things that we do is we can provide the entire bundle of services, or we can provide just the coordinate routing service,” he said.

Alcatel provides mobile positioning centers for wireless location systems. “It’s the piece that takes all your different elements and ties them together,” Dyer said.

The Bottom Line

Despite the commercial potential of location technologies and the opportunity PSAPs would have with Intrado’s PS-MAP to handle wireless E-911 information, mobile service providers’ interest in location technologies still isn’t overwhelming. VoiceStream Wireless [DT] last September received a one-year waiver from meeting the FCC’s October deadline for being able to transmit location information to PSAPs, and AT&T Wireless [AWE] and Nextel Communications [NXTL] are asking for similar extensions.

Cardio Dynamics International Inc. said Monday a study by the Mayo Clinic found that hypertension patients using the company’s technology were better off than those that did not.

The independent study found that 65 percent of patients using the Sorrento Mesa-based company’s heart monitor with prescribed medication were more likely to reach a targeted blood pressure level than those with regular treatment.

The monitor, called the BioZ, is a computer-based device that measures the change in blood volume and velocity in the aorta with each heartbeat. It is noninvasive and uses four sensor pads to monitor electrical currents in the body.

In a press release announcing the study’s results, the Mayo Clinic said “noninvasive hemodynamic management achieved superior blood pressure levels and control rates, when compared to management by experienced hypertension clinicians.”

The Mayo Clinic released the finding last week at a meeting of the American Society of Hypertension in San Francisco. The local company released it yesterday before the market opened.

Cardio Dynamics’ stock opened Monday at $4.40 — 10 cents above Friday’s close. The company closed regular trading at $4.50 a share, an increase of more than 4.5 percent over Friday’s close.

Michael Perry, chief executive of Cardio Dynamics, likened the importance of the study’s results to finding the Holy Grail.

“This is a significant study for us because it is really the first outcome study where you can see clinical evidence of patients being treated better by utilizing the data our systems provide,” Perry said.

The study looked at 104 patients with uncontrolled hypertension, commonly know as high blood pressure.

The Minnesota-based Mayo Clinic divided the group into two equal units and tested one group with regular drug treatment based on the advice of doctors and the other group with prescribed drugs based on the BioZ device.

Analyst Matt Desmond with Oregon-based RedChip.com, a research firm covering small-cap companies, said Cardio Dynamics had been working to expand the use of the BioZ.

“This study bears out that there’s possibly a big opportunity for them in using it for the treatment of high blood pressure,” he said.

Perry said the results should help sales to physicians. Cardio Dynamics has 35 salespeople primarily marketing the BioZ to cardiologists — physicians that treat heart failure.

“There are 50 million (people) — 10 times the size (of the population with congestive heart failure) — with hypertension, and most of that is either undetected or uncontrolled,” he said.

“This study has huge implications,” Perry added.

Cardio Dynamics’ stock has been on an upswing since it dipped below $3 in late March — when the company announced first-quarter earnings. At the time, Cardio Dynamics reported the 13th consecutive month of increased sales on record numbers.

The company said the record $4 million in sales Cardio Dynamics tallied for the quarter was 51 percent more than the previous quarter. Last year, the company’s sales totaled $13.1 million.

The company’s second quarter ends May 31, and the results will be reported on June 21, Perry said.

Analyst Desmond expects the study will positively impact Cardio Dynamics’ sales at the end of the year.

“I highly doubt it’s going to bring an overnight increase in sales,” Desmond said, “but I would expect it to help the company in their overall effort to build a sales base.”

Samsung Spin-Off’s New Biometrically Enabled Remote Control Device Features TruePrint Technology and Bluetooth Portability to Revolutionize Wireless Security

In what is seen as a revolutionary development in keyless entry access and the elimination of passwords, AuthenTec Inc., the industry leader in fingerprint authentication integrated circuits, announced today that it was selected by IFKey Co., Ltd., to provide its TruePrint(TM) based products for use in the world’s first biometric intelligent fingerprint key remote control device. This new development in wireless security will enable its users to benefit from single-key access in their home and work environments.

IFKey, a spin-off of Samsung SDS, developed the IFKey fingerprint key to provide convenient, safe and secure protection for users to access their doors, cars and computers; to provide easy and safe e-commerce shopping transactions using finger authentication for your cell phone, PDA and PC; and to provide wireless remote convenience to control security systems, alarms and remote controlled environments.

Integrated into the device is the EntrePad AES4000 sensor, a TruePrint Technology based product. TruePrint is the patented technology that reads beyond the surface layer of the skin to the live layer, where the true fingerprint resides. Unlike surface based optical, thermal and DC capacitive technologies, TruePrint is not affected by common skin surface conditions such as dry, worn, callused, oily, or dirty skin which can affect the sensor’s ability to acquire accurate fingerprint images. TruePrint is the first fingerprint identification technology capable of being used by everyone, under virtually any condition. TruePrint’s ability to acquire everyone makes it the most accurate and convenient fingerprint authentication technology on the market today.

“Our relationship with IFKey creates an exciting new opportunity for us to implement our AES4000 in a wireless remote security application. We’re making history, since no one has ever developed a remote control device that can, with the touch of a finger, control access to your car, your front door, your PC and your office – all in one simple, yet highly secure single unit,” says Steve Mansfield, Vice President of Marketing for AuthenTec.

IFKey’s Hong-Sik Koo, the company’s CEO, says that AuthenTec’s TruePrint based technology was the driving force behind their decision to partner with AuthenTec. “Our partnership with AuthenTec allows us to include TruePrint based products, the best fingerprint technology available today. Our fingerprint authentication remote devices must work for everyone, under all conditions. We want to be assured that we will have the most superior level of authentication available to our users by using the AES4000.”

The IFKey unit features a detachable remote transmitter that uses Bluetooth for secure portability and bi-directional communication. The remote transmitter, which contains the AES4000 sensor, is kept by the user and the receiver can be installed indoors or outdoors. One transmitter can control many receivers. Seventeen patents are pending for the IFKey system.

About IFKey

IFKey Co., Ltd., headquartered in Seoul, Korea, is a biometrics security provider specializing in wireless fingerprint authentication technology. In November 2000, IFKey originated as an in-house start-up (Mega Venture) of Samsung Data System (SDS), Korea’s largest systems integration company. In June 2001, after eight months as an in-house incubator with an investment of over one-half million dollars by Samsung, IFKey completed the development of its prototype product and held a successful product launch. IFKey became an independent entity on June 21, 2001 and obtained certification as a venture company from Korea’s Small & Medium Business Administration.

IFKey develops, manufactures and sells advanced biometric security and network utility solutions through its Portable Wireless Fingerprint Authentication Key System. The wireless system transmits and matches the user’s fingerprint for safe and secure single- key access. IFKey’s device is designed to provide a feeling of satisfaction and optimal security to customers by employing the latest technologies such as separate/merge fingerprint data authentication to protect customers’ privacy; real time encrypted communication through bluetooth; access control and emergency access and authorization. In addition, one can activate and control various devices with the remote control system such as access to doors, starting up automobiles, accessing offices, controlling access to documents and making financial transfers–all with a single key. Most importantly, IFKey provides customer satisfaction by delivering its unique patented technology that moves biometrics from the Hollywood movies into one’s own hand.

About AuthenTec

AuthenTec, Inc. is a fabless semiconductor company providing leading edge fingerprint sensor products to the biometric and security industries with products integrated into personal computers, wireless communications, access control, personal electronic devices and home security. AuthenTec’s product families include FingerLoc(TM) for security applications such as access control or time/attendance, and EntrePad(TM), a convenient and secure way to access PCs and portable products such as PDA’s and cell phones. All of AuthenTec’s products are based on the company’s patented TruePrint(TM) technology. Uniquely, TruePrint reads below the surface layer of the skin to the live layer where the true fingerprint begins. It is the first fingerprint identification technology that is capable of being used by everyone under virtually any condition. AuthenTec’s products provide a natural and convenient way for people to enjoy secure e-commerce and Web access; for businesses to manage networks and control access; and for individuals to secure access to their personal data, homes, and even automobiles. In addition, AuthenTec’s Solution Provider Network (SPN) aligns participating members together to provide complete biometric fingerprint identification solutions by integrating the FingerLoc and EntrePad sensors into mice, keyboards, wireless and access control devices.

For more information, visit http://www.authentec.com or call 321/308-1300.

EntrePad, TruePrint, and FingerLoc are trademarks of AuthenTec, Inc. All other trademarks or registered trademarks referenced herein are properties of their respective owners.