Connected Health - good news for patients and healthcare workers?

December 23, 2013

Over the past few months, there have been several media articles highlighting the intention of Medicare to fine over 2,000 US hospitals a total of $227M for failing to meet benchmarks designed to reduce readmission rates.  Qmed’s article on the topic predicted that many hospitals will look to invest in telehealth and remote patient monitoring technologies – sometimes referred to as eHealth, mHealth or, as we prefer to call it, Connected Health.  These technologies have been hyped for many years as the future of medicine, but perhaps here, at last, is a key driver – one that is punitive

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Whilst this is undoubtedly good news for developers of Connected Health technologies and products, the question remains, is it good news for patients and healthcare workers?  The answer to that will depend on the extent to which technology can replace some of the care provided in a hospital environment.  What we are talking about here is the ability of technology to monitor patients’ health in a remote setting, to treat the patient in some way, and most importantly, to alert clinicians when they need to revert to ‘Plan B’ – readmit.

Designers and manufacturers have woken up to the fact that the ‘patient journey’ or ‘user experience’ is just as fundamental as how the electronics will operate or how the data processing will occur

Sensors

Sensors to detect a deteriorating condition or an adverse event.  These could be chemical, optical, electronic or even mechanical.  The challenges here are sensitivity and specificity, accuracy, lack of invasiveness, real-time detection (rather than discrete sampling), etc.

Data transfer

Data transfer protocols; originally via USB stick and ethernet, but increasingly via wireless transmission, such as 4G, Low Energy Bluetooth, and NFC.  Here the challenges extend to range, reliability, security, etc.

User interfaces

Engaging user interfaces.  The smile of the bedside nurse may be replaced by a SmartPhone app which, at the touch of the screen, gives information about your condition or instructions as to what to do next. The surge in awareness of the power of the SmartPhone needs to be tempered by the realization that this is a serious device on which a person’s life could depend.  The challenge for developers is, therefore, to correctly evaluate such user interfaces and put them through the same degree of rigor as any medical software would require.  In any case, the FDA will soon be having their say on the matter, when a new directive is released later this year.

Advanced algorithms

Advanced algorithms to make sense of the constant stream of often noisy data, looking for trends or triggering events, and converting it all into actionable information for the patient or the clinician looking from a distance.

In the ideal world, when packaged together into a single product, the above technology components work invisibly and unobtrusively to monitor the patient and provide information to busy clinicians at just the right frequency and content such that there is no increased risk to the patient for not being at hospital and no inconvenience to the clinician as a result of the patient not being physically present.  Easier said than done, right?  

Usability

Usability, or what is sometimes referred to as Human Factors.  Technology alone will not do it. Designers and manufacturers have woken up to the fact that the ‘patient journey’ or ‘user experience’ is just as fundamental as how the electronics will operate or how the data processing will occur. Especially in a home environment, where highly trained nurses are not on hand, the Connected Health device has to be robust, intuitive and above all, safe.  The same is true at the back end of the Connected Health system (for, after all, it is a system rather than just a device): the information relayed to the physician must be compatible with their work-flows and adjustable to their preferences, otherwise, they are unlikely to adopt.

Verihaler

Finally, the article expresses the hope that the ‘carrot’ of reimbursement will gain ground as well as the ‘stick’ of punitive action.  It is good to hear of the movements in that direction on the part of Medicare, but what of the added strings attached of ‘Accountable Care’: reimbursing on the basis of outcomes rather than patient volume?  Many healthcare providers are starting to think in these terms, but it’s a risky business to guarantee clinical outcomes when your traditional product is only one of many contributing effects.  A solution that some are exploring is to own more of the total patient service, through bundling of disparate products into one commercial offering, or ensuring interoperability such that a device can ‘speak to’ other devices and ensure optimized treatment.  Such tactics may be possible for big players that can vertically integrate, but these new Accountable Care requirements are likely to create a formidable barrier for newcomers to the industry for whom the randomized, double-blinded clinical trial was a trial indeed.

As a product development company, Sagentia has been closely involved in many of these issues, whether it be advising clients on new healthcare technology strategies, running usability studies or building complex Connected Health products.

 

Andrew Jackson

Sagentia

 

 

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