As we marvel at the gadgets that companies such as Nike, Fitbit, Jawbone and Apple have recently produced and brought to market--gadgets that can record our heart rate, calories expended, and steps taken—one can only think of how this technology could likely be used on a greater scale to help those who truly need it the most: people with chronic medical illnesses such as emphysema, diabetes, or congestive heart failure.
A recent article by J.C Herz in Wired Magazine provides an excellent beginning point to do just that: recognizing how we, as a society, have yet to harness such powerful and innovative technology to help millions with chronic medical illnesses.
As things currently stand, which Herz eloquently outlines in her essay, existing companies’ technology in wearables has for the most part been utilized by tech aficionados and athletes who marvel in tracking personal health data—but not ultimately benefiting society at large.
In her article, Herz makes clear references to multiple regulatory stumbling blocks, adding not only cost but logistical nightmares to pushing forward--including HIPAA and the FDA, to mention two big ones. She points out that so many of these nifty and innovative gadgets are often put away, gather dust, and may not outlast the novelty of a 6-month period.
In fact, a report last month by PricewaterhouseCoopers’ Health Research Initiative (HRI) evaluating the state of wearable digital technology and devices further supports our current dilemma: Less than half of people who own a wearable use it on a daily basis.
The report, which surveyed over 1,000 consumers, is sobering to say the least. Based on the report, 21% of people in the US have purchased such a device, with 52% of those persons neglecting to use it on a daily basis. Tucked into this 52% of persons are 10% who have stopped using their device altogether.
As a follow-up, HRI released a more recent report just days ago evaluating how the future paradigm of healthcare needs to catch up to other sectors of our economy to improve not only efficiency but quality of care. Entitled Healthcare delivery of the future: How digital technology can bridge the gap of time and distance between clinicians and consumers, the report provides a compelling argument for a change in how we monitor patients with chronic medical issues in the home setting, along with how patients communicate with their healthcare providers and the healthcare system as a whole.
The take-home of this report is that there is a growing acceptance among physicians, with a more open attitude toward adopting digital technology for their medical practices, with clear suggestions for insurers, healthcare companies, physicians and other stakeholders to explore and develop such technologies to help patients who suffer from chronic illness.
“Digitally enabled care is no longer nice to have, it’s fundamental for delivering high quality care,” said Daniel Garrett, Health Information Technology Practice Leader, PwC US. “Just as the banking and retail sectors today use data and technology to improve efficiency, raise quality, and expand services, healthcare must either do the same or lose patients to their competitors who do so.”
The HRI survey spoke with over 1,000 industry leaders, physicians, nurse practitioners, and physician’s assistants.
The findings of the report:
1. Put diagnostic testing of basic conditions into the hands of patients: Close to 42% of physicians are comfortable relying on at-home test results to prescribe medication.
2. Increase patient-clinician interaction: Half of physicians said that e-visits could replace more than 10% of in-office patient visits, and nearly as many consumers indicated they would communicate with caregivers online.
3. Promote self-management of chronic disease using health apps: 28% of consumers said they have a healthcare, wellness, or medical app on their mobile device, up from 16% last year. Nearly 66% of physicians would prescribe an app to help patients manage chronic diseases such as diabetes.
4. Help caregivers work more as a team: 79% of physicians and close to 50% of consumers believe using mobile devices can help physicians better coordinate care.
"The adoption and integration of digital technology with existing healthcare processes has not yet fulfilled its potential to transform care and value for patients," said Simon Samaha, MD, Principal, PwC. "The next five years will be critical, with leaders emerging from those who use digital technology to innovate and revamp the interactions between consumers, providers and payers."
It’s clear from HRI’s report that major stakeholders in the healthcare industry including hospitals, insurers and the pharmaceutical industry all believe that major changes will occur in how healthcare is delivered. However, several barriers exist in preventing the implementation of this new paradigm of healthcare. These include issues of security, privacy, consumer consent, data-sharing, fragmented workflows and digital buy-in.
HRI’s recommendations for healthcare stakeholders:
1. Generating actionable insights through analytics to yield better outcomes: Analytics allow healthcare providers to tailor unique care plans for patients while also managing care plans and improving patient health. Additional goals of treatment are to identify high-risk populations for focused care.
2. Using increasing amounts of data to rethink the workforce and workflows: Using technology to adjust the workforce, which can reduce costs and improve quality. The end result is to adjust staffing based on advances in technology. Digital technology can be used to ensure physicians are practicing at the top of their licenses and leverage care extenders, such as nurse practitioners, when appropriate.
3. Targeting digital interventions for where they make the most sense: Health systems need to figure out how and where digital technology may replace or augment traditional office visits based on a patient’s medical condition.
Sean MacLeod, President of Seattle-based Stratos, an incubator of healthcare technology for new product innovation takes a similar position with PwC’s report, urging the healthcare industry to make a greater commitment toward caring for an important segment of our population— aging baby boomers and those with chronic medical illness.
“On the wearable side, our market position here [at Stratos] is that this technology is great--Fitbits, mobile EKGs, pedometers, but 'so what'--the only difference between this and technology 20 years ago is that connectivity and the cloud computing power that’s behind it. You are not getting any other actionable data than you could have acquired as a first user or early adopter from the late 1990s,” said MacLeod.
“We have always taken the approach that these are great enabling technologies and the adoption factor really points that the market is ready for this—but the market space that they are being applied to is somewhat arbitrary,” added MacLeod.
MacLeod asks the question: “Is there actionable data that really affects the healthcare system and the costs that are associated with it?”
“What about the diabetics, what about people with epilepsy, what about those with chronic mental illness? And those without resources that get trapped within the health care reimbursement cycle and don’t get predictive and preventable care on a regular basis that helps them through avoiding a worsening of a chronic disease, but also to allow them to manage the disease with their healthcare professional.”
“The big promise here,” explains MacLeod, “is that by implementing these devices in a meaningful way to truly address chronic or preventative medicine—that will be the way you will likely have a large impact on the cost structures of the system.”
“The way that the system is set up right know, it’s very hard to do an ROI calculation that is meaningful across the board, and as a country and you probably won't get there unless you end up in a single-payer type of environment,” adds MacLeod.
In his view, “The system still hasn’t broken out of an acute-care type of engagement. As a typical healthcare consumer you see your doc for 15 minutes a year. There isn’t a viable or sustainable paradigm for monitoring and tracking the chronicity of care.”
So, the issue is whether we can implement wearable technology to make a meaningful change in how we approach caring for patients.
“There has been a paradigm shift in the marketplace currently from this acute-care setting to more of a chronic-care setting—but it hasn’t shifted yet to address the continuum of wellness. The ISB (Institute for Systems Biology) program in Seattle takes it further to do predictive medicine in such a way that evaluates leading indicators of decreasing wellness. It enables a physician, stakeholder or individual to take proactive measures to not only address a decrease it wellness, but to course-correct it back to a state of wellness,” said MacLeod.
Most medical technology companies today are also attempting to engage in chronic health management, so as part of that, they are pulling wellness apps and wearable technologies into their portfolios, as their “companion products” to their core business. (This could include a pharmaceutical, pacemaker, or healthcare customer relationship management system.)
“These companies are coming up to speed as how to apply the technologies—but they are not educated in the consumer market so they are bit uncomfortable with the “consumerization of their core competency,” believes MacLeod.
“It’s a slow-moving market, so until the consumers of these actionable data devices actually demand it, there is little likelihood that the system will change because of the lack of momentum due to inertia of payers, reimbursement systems and the cost structure that currently exist.”
There is a movement for comparative data that has been growing and this may be addressed by placing technology that is accessible to patients and medical providers in the home setting.
Readmissions of patients through the emergency department cost the healthcare system billions of dollars per year, so developing technology to monitor variations in parameters of chronic disease states may help reduce US healthcare expenditures. Monitoring blood glucose and changes in oxygen saturation, as well as changes in blood pressure, are simple things which can not only improve outcomes but help to reduce costs.
According to Rich Able, CMO and Founder of X2bio, a company dedicated to sensors for monitoring head injuries, “effectively utilizing wearable technology is the key to helping advance our healthcare system to reach the next level---detection and correction of course-based data, predicated on real-time evaluation.”
Apple and Google, according to Able and MacLeod, serve as channels to the consumer side, but the innovation he feels needs to come from the medical technology space for long term chronic care or wellness paradigms to be successful, with reimbursement paradigms following close behind.
Novel Platform Developed by Stratos: Digital Health Feedback by Proteus Digital Health, a.k.a. HELIUS
Helius is an example of a unique technology incubated and refined by Stratos for Proteus Digital Health, based in Redwood City, California. The technology connects patients with their medical providers using novel ingestible sensors powered by the body’s natural compounds. A specialized wearable sensor attached to the body and then connected by Bluetooth technology to a smartphone or tablet can then provide real-time feedback relative to the effects of specific medications (heart rate, activity level). Helius received European regulatory approval (CE Mark) in August of 2010, and FDA market clearance as a medical device for co-ingested applications in July of 2012.
"Proteus has revolutionized a platform that completely digitizes the pharmacological response and compliance schedules in a living being, said MacLeod. “It foresees the future of healthcare where clinicians, caregivers, and family members are connected to a patients' well being.”
The end result is that “Proteus brings a positive paradigm shift to the notion of personalized medicine and the ‘Connected Human,’” added MacLeod.
Baby boomers driving a changing healthcare approach
Many believe that encouraging the use of connected devices, such as Proteus, may help decrease re-admissions rates, especially with an aging demographic. The new paradigms for health care of our aging population will have to involve the home-care setting.
Able stresses that “75 million baby boomers taxing on the healthcare system” will make treatment in the home using wireless and wearable technologies imperative.
So what will be the driver that will finally push technology into the home, making other approaches suboptimal?
“It’s a realization that the cost structures of today will ultimately bankrupt us as families, or us as a community, or us as a country,” according to MacLeod. “How many years in a row can you put up with double digit increases in your healthcare costs?”
If cities could embrace such technology, potentially in pilot programs to actually demonstrate economic advantages to an integrated system using wearables in a “connected home”, which then translate into improvements in prosperity, reduced cost of living, improved lifestyle and wellness, it is feasible that insurers and other stakeholders would take notice.
A National Initiative to Change How We Manage Chronic Disease?
An initiative from the White House might be the best way to approach integrating wearable technology and digital health to make the connected home the new paradigm to manage people in the outpatient setting.
Just as the electronic health record (EHR) became a national priority, so too should mobile and wearable technology invested in chronic medical care in the home setting become a top priority on the nation’s agenda.
“This is a point of national pride that we should do this,” urges MacLeod. “Lets create a brand new industry and own it.”
MacLeod sums it up another way: “This is the new moonshot for 2016. We will not only will put a man on the moon, but we will bring him back.”
