My favorite part of public speaking is that point in the monologue I call the “ah-ha!” moment. This is when I’ve captured the attention of the audience with a single quote, image or data point, and it’s the moment that can make or break a presentation. During my engagements over the past two years, I’d say the “ah-ha!” comes while I’m discussing the importance of remote patient monitoring (RPM) for disabled populations.
I usually start by going into some detail about patients with long-term illness or injury, who are unable to leave the house and thus rely on the attention of traveling nurses. I then mention the daily challenges of motivation and interest. I describe the tendency among homebound patients to prematurely cease their therapy exercises, because they erroneously believe that personal improvement has been made.
Or I simply reveal my favorite quote from an old college friend: “We live in a high-tech, low-touch society.”
A Problem of Access
I should provide a little context. Remote care can be a serious barrier for patients with brain injuries, vision/optic nerve reactions, multiple sclerosis, cerebral palsy, stroke and muscular dystrophy. In some cases, just getting to a facility involves a great deal of effort and coordination. Home care nurses are employed to look after such cases with the assigned task of getting their patients “unhomebound” as quickly as possible.
Patients live all over the country and nurses can’t be everywhere all the time. That’s why remote patient monitoring (RPM) technologies are of such interest to the medical community. The idea is that iPhone apps and telephony products allow for the same quality of care with fewer in-house visits. For a nursing population that drives twice as many miles annually as UPS, that’s quite an impressive benefit.
There’s a problem, though. For all the wonderful technology that’s out there, much of it is inaccessible from the standpoint of cost, availability or awareness. Mobile apps and devices continue to proliferate, yet 28% of home health patients return to the hospital due to a lack of follow-up care. Even worse, medical non-adherence is the fourth-leading cause of death in the United States.
Let’s go back to that old college friend. She is a healthcare professional who works with homebound patients. We were discussing this when she mentioned that wonderful quote by Nedra Gillette, Director of Research Resources for the American Occupational Therapy Association: “We live in a high-tech, low-touch society,” which perfectly crystallizes the RPM dilemma.
Hearing this quote, for me, defined a personal “ah-ha!” moment when everything suddenly clicked. It became very clear that the problem with RPM mobile apps and devices isn’t merely a question of capability. It’s how the devices are implemented and whether the benefits can be easily distributed among health providers, reimbursement agents and patient communities — from both clinical and financial perspectives.
The early thinking on RPM was that automating as much as possible would benefit both patients and health care providers. Investors have certainly noticed — AT&T last month announced a partnership with Valued Relationships Inc. to deliver an RPM service targeted for physician practices, hospitals and payers. In fact, the RPM industry is expected to hit $295 million by 2015, with such emerging markets as China and India expected to participate in the market’s expansion:
Increases in chronic disease cases and the elderly population, in addition to technology innovations, are seen as reasons why the patient monitoring market will continue to experience strong growth on a global scale. GBI predicts that market to grow at a compound annual growth rate (CAGR) of 4 percent per year. China and India are expected to be “potentially lucrative markets” for growth due to their “huge patient bases and … under-served” populations.
One of the lessons learned is that iPhone apps alone won’t predict outcomes, improve care practices, or make people well. Behavior can only be modified through consistent and productive feedback. Technology is simply a means to better track and understand that behavior, so perhaps the solution is in better alignment of technological devices with everyday life.
iPads From the VA, Computers in Your Clothes
A number of recent developments point to a rosier outlook. One is the decision by the Department of Veterans Affairs (VA) to give pre-loaded iPads to veterans to help them communicate better with their physicians. The “Clinic-in-Hand” pilot program is designed to improve contact points between doctors and patients, using special apps that monitor heart rates, blood pressure and other vital signs. The caregivers can securely track their patients’ progress and intervene when necessary, with full access to administrative tools.
Another development is the creation of wearable computing devices that operate as health monitoring tools. Sonny Vu is an entrepreneur who runs a company called Misfit Wearables, which places wearable sensors in clothing and everyday objects to unobtrusively track health data. Vu sees his company as the next evolution of RPM, and he might be right:
Mobile health devices and software could change medicine profoundly, allowing people to continuously monitor vital signs and better track and modify behavior. That’s important because chronic diseases like obesity and diabetes are on the rise. “We’re seeing an infusion of mobile technologies into people’s lives,” says Susannah Fox, who studies technology and health care for the Pew Internet & American Life Project. “And we’re seeing a very rainy forecast in terms of people’s health.”
The idea of smart textiles is not new (look at what fiber students at the Maryland Institute College of Art are doing). However, the placement of tiny sensors in some haptic interface, such as a glove or brace, allows for possibilities that homecare nurses have desired for some time: improved care and quality touch points despite financial and logistical constraints.
Moving forward, it’s clear that some amalgam of personal technology and behavior modification will cultivate an exciting digital landscape. It is also clear that the quality of care will continue to be determined by the patient/provider relationship. To quote Vince Kuraitis, author of the eCareManagement blog on healthcare technology, “Maximizing automation isn’t necessarily the right way to go. A better way to look at this is as optimizing the right mix of automation and patient involvement.”