Health Care Goes High-Tech

The infiltration of digital devices over the last decade radically altered how people communicate with one another and the world around them. But health was one area largely unaffected by the digital revolution. In fact, health care remained relatively unchanged from a regulatory and technology perspective for decades.

But today, many aspects of health care are changing — and changing fast. While health-care policy changes make headline news on a daily basis, a significant technological evolution is taking place as well. A combination of factors, like the release of data by the U.S. Department of Health and Human Services (which has helped drive innovation in health-related apps), as well as the availability of biosensors, genome sequencing and imaging capabilities, are finally allowing technology to transform the delivery of health-care services.

According to the Centers for Disease Control and Prevention, more than 75 percent of U.S. health-care costs are due to chronic, preventable conditions. As a result, significant attention is being paid to how technology can help people with such diseases manage them more efficiently, as well as encourage them to make healthier lifestyle choices.

“It’s not just about applying technology to medicine; it’s about applying technology in the right areas,” said Jonathan Reichental, CIO of Palo Alto, Calif. “A flu shot doesn’t cost much. The big things suck up most of the cost. Fortunately technology can have a practical impact on prevention and disease management.”

5 New Technologies That Could Change the Face of Health Care 1. The San Mateo Medical Center in California is using digital avatars to help patients with post-surgery physical therapy. Molly the avatar interviews patients about pain levels as a video guides them through exercises and 3-D cameras measure their movements. 2. University of Utah electrical engineers developed a system that may keep senior citizens in their own homes longer. Wireless sensors are placed around the perimeter of a room at two levels, corresponding to someone standing or lying on the floor. Anyone standing — or falling — inside the network alters the path of signals sent between each pair of sensors. 3. Smarthaler is a concept system recently developed for asthma patients. The inhaler uses acoustic detection technology, together with a cloud-based server and mobile app, to monitor and interpret whether a patient is administering doses properly. 4. Senseonics is developing a continuous glucose monitoring system made up of an implanted sensor, a wireless transmitter and a mobile app. With this device, glucose levels can be measured remotely every few minutes, and alerts can be sent to both the user and the physician about impending hyperglycemia or hypoglycemia. 5. The Mayo Clinic and Northern Arizona University are testing how well telemedicine robots equipped with a specialized camera system can help assess athletes with suspected concussions during football games. The robot is remotely operated by a neurologist who can look for signs of a concussion and consult with sideline medical personnel.

For example, rather than making regular office visits to manage a chronic disease, patients can use portable devices to monitor their vital signs, take tests at home and perform many tasks. Doctors can remotely and continuously monitor heartbeats, blood pressure, the rate and depth of breathing, body temperature, oxygen concentration in the blood, glucose, brain waves and activity.

“There’s a great need to be more involved in what happens when patients are not seeing us, because a lot of health outcomes are related to patient behavior,” said Shivan Mehta, director of operations at the Penn Medicine Center for Health-Care Innovation. “These technologies are finally allowing us to ask, ‘How do we go beyond the traditional health-care delivery system and make an impact when patients are not in our offices?’ The proliferation of new technologies makes it a lot easier for us to connect with them. We no longer have to rely on a letter or an email.”

At Penn, this concept is called “connected health.” Tools like patient portals, mobile technologies, text messages, apps and remote monitoring let patients communicate with doctors either actively or passively. Penn is even testing technology that measures whether patients open their pill bottles.

“We’re working to improve medication adherence for patients that have had a heart attack,” said Mehta. “Patients that have heart attacks are not taking the meds they are supposed to. The adherence rate has been found to be less than 50 percent. We can spend a lot of money on all these things — but if people don’t take their medication, it doesn’t matter.”

Studies show that patients who don’t take their medication following a heart attack are much likelier to have another cardiac event or require a return visit to the hospital. To improve the adherence rate, Penn is using a remote, Web-based monitoring platform and behavioral economic principles to improve patient outcomes. Patients who are part of the study get remote monitoring pill bottles that connect to the platform. The patients receive daily alerts to encourage them to take their meds, and the technology measures whether they actually do. Patients also are enrolled in a daily lottery, which makes them eligible for cash awards for adhering to their medication regimen.

“The idea is to improve the value of the care we provide and to improve how we connect with patients,” Mehta said. “It’s not just about cutting costs. We want to improve outcomes in an efficient way.”

Meanwhile, the University of California, Los Angeles (UCLA) recently implemented technology to monitor patients’ rehabilitation after a stroke. Doctors there developed a wireless monitor that’s strapped to the ankle of the stroke patient. The monitor can detect the patient’s frequency and pace of movement, and that data is then fed back to the patient via his or her smartphone.

“The system encourages patients to exercise and recover more quickly than if they are simply provided an exercise regime without the feedback,” said Dr. Molly Coye, chief innovation officer of the UCLA Health System. “The interactivity has been found to be a great motivator.”

UCLA also has an in-home monitoring program for patients with congestive heart failure and complex chronic diseases. “These in-home programs are becoming more common, because they decrease the cost of care and the need for patients to come back for follow-ups or to return to the hospital,” Coye said. “We believe in the next five years as many as 15 to 20 percent of patients will be monitored in the home because of the complexity of their chronic diseases. Within 10 years, as the technology becomes lighter, smaller, less expensive and delivers more power, we may find that most people with chronic diseases are monitored remotely on a routine basis.”

Enabling Change

While remote monitoring and innovative new technologies may change how doctors monitor patients outside the office, changes also need to be made within doctors’ offices and hospitals to improve the efficiency of managing patients.

Lyle Berkowitz, associate chief medical officer of innovation at Northwestern Memorial Hospital, who recently wrote Innovation with Information Technologies in Healthcare, said Northwestern doctors now use electronic medical records (EMR) for mainstream activities like documenting, ordering and reviewing patient charts, and an enterprise data warehouse for analytics. Such tools help them improve efficiency and reduce costs.

“Within our EMR, we created over a dozen care pathways using standard messaging functionality plus a checklist philosophy to delegate work to the appropriate level of staff,” Berkowitz said. “For example, we created a pathway for the finding of hematuria (blood in the urine). When a physician wants to evaluate this finding, instead of trying to remember all the steps themselves, they simply initiate the pathway in our EMR and send it to our care coordination team who ensures the patient gets an imaging study and sees a specialist.”

Berkowitz said this model allowed the hospital to reduce the completion time of this process from more than 70 days to less than 35 days, and helped more patients get the care they needed while saving costs because fewer overall visits were required.

“Using HIT to help delegate routine and non-reimbursable work to the appropriate level of provider can free up time for physicians to do the more complex work upon which they should be focusing,” Berkowitz said. “If all primary care physicians in the nation used a service like this, the amount of time saved would be equivalent to having increased access to almost 20,000 new primary care physicians every day. Health-care IT systems traditionally have been focused on quality, which is a great start, but the future needs to also focus on efficiency.”

But for EHRs to work well, doctors must want to use them. According to a recent study by TCS Healthcare Technologies, Case Management Society of America, and the American Board of Quality Assurance and Utilization Review Physicians, the majority of doctors still like communicating the old-fashioned way. The study found that most providers still use telephone (91 percent), face-to-face conversations (71 percent) or letters (74 percent) to communicate with patients rather than opting for portals, remote monitoring or online personal health records. Of the more than 600 health-care providers surveyed, only 15 percent said they use patient portals for communication, 7 percent use remote monitoring devices, and 8 percent use smartphone applications.

Reality Check

While remote sensor and other patient monitoring technologies are available today, cost remains an issue.

“Today, much of it is not affordable,” Coye said. “But within the next five to seven years, the sensor technologies required to monitor vital signs and exercise, calculate caloric expenditure, watch for early signs of infection and for deterioration of chronic conditions, will be so inexpensive we’ll be able to monitor most patients at an affordable cost.”

Based on the significant investment now flowing into health-care technology, it appears likely that will only be a matter of time. Even as federal incentive dollars from the HITECH Act dwindle, private investment in the health IT sector has stepped up to the plate, topping $737 million in the third quarter of 2013, according to a recent report from Mercom Capital Group.

Many states also are encouraging innovation in health care. The New York Digital Health Accelerator Program, for example, is a nine-month program for early and growth-stage digital health or health IT companies that’s run by the New York eHealth Collaborative and New York City Investment Fund. The program is designed to provide a vehicle for health-care providers and entrepreneurs to work together to develop innovative technologies that leverage patient health records to support collaborative care and coordination.

“Providers were looking for new apps to help them meet their emerging needs as we move from Medicaid to a managed care model, but they didn’t have the technology tools to make that happen,” said Anuj Desai, director of business development at the New York eHealth Collaborative. “The New York Digital Health Accelerator Program was developed to bridge that gap.”

Future State

Looking ahead, it seems unlikely health care will stagnate as it did in the past.

“What’s ahead of us is going to change the game in terms of better outcomes in health care,” Reichental said. “As we evolve from a volume-based to a value-based reimbursement system, I think we’ll see major evolutions in how we use IT in health care.”

But it’s not just about the technology, said Berkowitz. “Technology is often the easy part,” he said. “The key is creating the right processes and business models to enable them. Once the proper incentives are aligned to keep people healthy, rather than treat them when they are sick, we will have a future where the majority of health care is done virtually via computer automation and telehealth. This will help ensure easy access and low-cost care, while preserving more time for physicians to deal with the more complex cases which need their attention.”