The Internet of Healthcare Things

 

By Mitch Work, MPA, FHIMSS

The patient should be made to understand that he or she must take charge of his own life. Don’t take your body to the doctor as if he were a repair shop.

   –Quentin R. Regestein, MD, associate professor of psychiatry, Harvard Medical School

Many healthcare organizations are currently seeking to leverage the potential benefits of the Internet of Healthcare Things (IoHT), where objects have network connectivity and data can be shared and analyzed, resulting in better, more efficient healthcare and giving patients the power to proactively care for themselves.

A report from Accenture (2015) spells out how these connected devices and machines are poised to transform healthcare. According ot the study, healthcare organizations soon will be able to leverage devices to support high-tech operating rooms that can track patients, staff, and tools so everything isa at the right place at the right time; tap into wearables that can provide customized feedback on health; and use remote monitoring tools to help keep patients safe in their own homes.

The value of these connected devices will become even greater when predictive analytics is used to gain more knowledge from the data they generate. For examples, if a device can predict that someone is likely to have a heart attack in the next few hours, the healthcare provider may be able to take action and prevent the event from occurring.

Professionals and patients alike are acknowledging the IoHT’s potential. Eight-five percent of doctors recognize that using wearable health devices helps patients become more engaged with their own health, and 76% of patients say the use of connected technology has the potential to improve their health (Accenture, 2015).

Experts at the McKinsey Global Institute (Manyika et al., 2015) point out that the IoHT can:

…improve patient adherence to prescribed therapies, avoid hospitalizations (and post-hospitalization complications), and improve the quality of life for hundreds of millions of patients. The devices could be used to monitor and treat illness, extending life spans for people with chronic illnesses, and reducing cost of treatment. In addition, value could be derived by achieving improved wellness, using data generated by fitness bands or other wearables to track and modify diet and exercise routines (p.18.

The study estimates that such improvements could have a global economic impact of $170 billion to $1.6 trillion per year by 2025.

This potential is being met with interest from all corners. For example, installation of sports and fitness apps will grow to 248 million by 2017, according to a report from HIS, a research company based in El Segundo, California, 2013). With the rise of smart watches and other wearable devices, the number of connected fitness monitors is expected to exceed 1.3 billion in 2025 (Manyika et al., 21015). In addition, there is also rapid growth in devices and systesm for in-home monitoring of patients, particularly those with chronic conditions such as diabetes.

Challenges abound

Yet while the IoHT’s promise has been acknowledged, there are signs that actually realizing the potential associated with these connected devices comes with plenty of challenges.

According to the research firm Endeavor Partners, about a third of all fitness trackers are abandoned after the first six months of use (Ledger, 2014). Another healthcare investment fund, Rock Health, reports that only about half of Fitbit’s 20 million registered users actively used their tracker in 2015 (Associated Press, 2015).⁶

The problem is that devices’ data typically only engages people for a short time before the novelty wanes. Healthcare organizations need to find a way to get patients to move beyond the initial infatuation with connected devices and toward the realization of demonstrable results. To do so, organizations will have to overcome a variety of obstacles.

Physician engagement

Often, when patients start to use connected devices, physicians and other professional caregivers are not looped into the process.

“There is an abundance of wearable fitness and wellness devices on the market, and many of them have the ability to continuously capture data, but few of them are actually tied back to physicians or other professional caregivers,” says John Bojanowski, president of Honeywell Life Care Solutions. As a result, many of these early technology adopters, who are generally interested in improving their health, simply review the data in isolation, without guidance about how to act upon it.

Likewise, individuals who could benefit from the use of such devices to improve their health may lack motivation to use them at all.  For this group, physician involvement can help change behaviors and leverage wearables to their full potential.

 “If a physician identifies that a patient is prediabetic, he or she could use connected devices to receive biometric readings from the patient more frequently and provide interventions that could keep the diabetes at bay,” Bojanowski says. “Such care is much more effective than a quarterly (or annual) doctor’s visit. Instead of getting a snapshot of how the patient is doing at a single point in time, the doctor gets a more holistic view of the patient’s progress, making it possible to offer the clinical care that can truly make a difference in the disease progression.”

In addition, it’s important to ensure that the physician is receiving incoming data in a usable manner.

“You have to make sure that the data are aggregated and delivered to the physician in a format they want and need to appropriately care for the patient. The data has to make it possible for the physician to monitor the patient’s success and alter care plans if needed,” Bojanowski says. “For example, seeing how many steps a patient takes each day might not be helpful to some physicians; a trend outlining physical activity over time may be of greater value. Presenting the information in a meaningful way is the goal.”

Support from top-level leadership

To be successful, connected health programs need high-level buy-in as well as on-the-ground support from organizational leaders.

“It’s not easy to deliver a successful remote patient monitoring program. You need clear support and drive from top-level leadership,” Bojanowski points out. “And you need a program owner who really takes accountability and responsibility for driving results. Simply placing monitors in homes is not enough without a plan for success.”

Documented financial viability

While the IoHT carries much potential in theory, organizations are likely to wait on the sidelines until there is more proof that these initiatives can hold their own financially.

“There are still issues around reimbursement and who is paying for these programs, as well as the cost to scale them more broadly,” Bojanowski says. “Organizations are trying to find a way to make it financially viable to use the devices for not just hundreds of patients, but for hundreds of thousands.

“Many organizations are slow-moving when it comes to the adoption of connected devices,” he adds. “Because it is an investment that also requires dedicated personnel resources to deliver value, they need to be certain it’s going to drive outcomes. In some cases, that is why it is simpler to default to the more familiar system of having a telebank of nurses calling patients on a regular basis and referring to it as telehealth instead of taking it to the next level.”

Success beckons

Some trailblazing healthcare organizations are finding their way around these challenges and tapping into the potential of the IoHT, proving that the model is viable.

Physicians Preferred Monitoring (PPM), a health and wellness management company based in Florence, South Carolina, has developed a telehealth program that serves recently hospitalized and moderate- to high-risk chronic disease patients. Through this initiative, the organization is deploying remote telemonitoring as a tool to establish a continual physician relationship with many patients who are Medicaid eligible and who often live long distances from medical facilities.

“Early on, we made a corporate commitment to use remote telemonitoring to reach patient populations who reside in underserved and remote locations,” says Mark Fuleihan, vice president of business operations at PPM. “Using remote telemonitoring, which was in its early adoption stages when we began, seemed like a natural solution for us.”

 

Indeed, the technology is living up to its promise. One of PPM’s clients, Select Health of South Carolina (SHSC), a health plan and wholly owned subsidiary of AmeriHealth Caritas, has established a remote telemonitoring program for high-risk Medicaid patients with multiple chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure, and diabetes. An early clinical study at SHSC compared a cohort of 123 high-risk patients enrolled in the telemonitoring program with another high-risk population of 619 SHSC members based on data reported over a 12-month period (Figure 1).

 

Even though the patients in the telemonitoring cohort were 30% more at risk (sicker) on average than the patients in SHSC’s high-risk population group, they reported 25% fewer paid hospital days. In addition, ER costs for these telemonitoring patients were 18% less than the costs for patients in the high-risk group, and prescription drug costs came in at 9% less.

 

Such numbers are promising. If all of the 619 high-risk patients had been enrolled in the remote telemonitoring program and had reported results similar to the RPM cohort over the same period, the group would have realized a reduction of 1,114 paid hospital days, a savings of $14,237 in ER costs, and a reduction of $93,469 in prescription drug costs. Further, satisfaction surveys of patients enrolled in a PPM remote monitoring program indicated that 92% are satisfied with it. A more recent survey with similar patients reported a 100% patient satisfaction level.

 

With results like these, healthcare leaders are apt to develop greater confidence in the potential of connected health—and as a result, they can unleash the potential of the IoHT and move toward constructing a better healthcare world.

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Mitch Work is president and CEO of The Work Group, Inc., a Chicago-based marketing communications company. He can be reached at mitchwork1@workgroupinc.net.

 

References

Accenture. (2015, June 4). 2015 healthcare IT vision: Top 5 eHealth trends. Retrieved from http://www.slideshare.net/accenture/2015-healthcare-it-vision-top-5-e-health-trends

Manyika, J., Chui, M., Bisson, P., Woetzel, J., Dobbs, R., Bughin, J., & Aharon, D. (2015, June). The Internet of things: Mapping the value beyond the hype. San Francisco, CA: McKinsey Global Institute. McKinsey & Company. Retrieved from http://www.mckinsey.com/insights/business_technology/the_internet_of_things_the_ value_of_digitizing_the_physical_world

IHS. (2013, July 11). Sports and fitness app market to expand by more than 60 percent in five years [Press release]. Retrieved from http://press.ihs.com/press-release/design-supply-chain/sports-and-fitness-app-market-expand-more-60-percent-five-years

Ledger, D. (2014, January). Inside wearables: How the science of human behavior change offers the secret to long-term engagement. Retrieved from http://endeavourpartners.net/assets/Endeavour-Partners-Wearables-and-the-Science-of-Human-Behavior-Change-Part-1-January-20141.pdf

Associated Press. (2015, July 9). Fitbit thrives despite abandonment issues. Retrieved from http://www.pressherald.com/2015/07/09/fitbit-thrives-despite-abandonment-issues/