November 3, 2014

Conference highlights progress on different fronts in connected health technology

Technology is not the focus of the Connected Health Symposium, but technical advances play a major role there because of the potential for digital technology to help health care meet its broad goals of listening to patients and of coordinating care among these patients, their family members, and the professional team.

In fact, enticing high-tech toys (some of them not so expensive) lie out there for us to grasp if we are ready. In some ways, the technology is far more advanced than the health care providers who could benefit from it, and it is up to those institutions need to evolve organizationally and culturally. But on the other hand, much technology looks good only on the surface, and quickly comes to shame when connected to real-life workflows and patient needs.

In this article, I'll classify some of the technical solutions I saw at the symposium and describe what I see them offering, as well as where more work is needed on either the technology or the provider side.

Devices: bold without being big

For people used to traditional blood pressure cuffs, infusion pumps, and other conveyers of individual health, the modern landscape for devices will surprise you.

For instance, the Muse and BioBeats Pulse headbands provide biofeedback about brain activity. These have been used by many people to reduce stress and learn how to focus better on what they want to achieve.

Going down a notch more in size are two wearable thermometers, the Fever Smart patch and the Raiing iThermonitor. Fever Smart is so tiny and light that you can attach it to a sleeping child without waking her, and then go to sleep yourself secure in the expectation that a wireless connection on the patch will alert you if the temperature goes up. The iThermonitor is connected to online services that can record data over time and produce a graph to help you or a clinician track temperature over hours or even days.

Basis exemplifies the current generation of commercial fitness devices for consumers. It sits on the wrist and displays several statistics on a real-time basis, such as heartbeats per minute and distance traveled. The video demonstrating the device was so glitzy that it didn't get around to mentioning the feature that might make it useful, which was a web site that collected its data through a wireless connection and showed trends over time. I believe that people can choose healthier activities by seeing their performance in comparison with their own earlier behavior as well as the behavior of others.

Most provocative of all the devices on display was a stunning presentation by Sensoree, which makes clothing whose colors change in response to the wearers' brain activity or stress level. A lovely stage show with music and circus performers demonstrated that the technology is beautiful and arresting. Whether it's health-enabling or exhibitionism is open to discussion, but apparently it can be useful for people who have trouble conveying feelings, such as those with autism or Alzheimer's.

These products illustrate the progress taking place in health and fitness-related devices: smaller size, lower cost, easier use, more intelligent output (usually by transmitting data to a web service). The challenge facing the manufacturers is to adopt standards that allow data from these disparate sources to be mashed up and produce new insights. Interoperability is something consumers must learn to demand.

Communication tools

Clinicians know well that personal relationships are key to effective care, and the relationship is what patients ask for most often. As I wrote after attending a doctors' forum where a former National Coordinator spoke, "Their focus is not on meaningful use but on meaningful contact." Technology can easily get in the way--but can it also help make the connection?

The CaféWell Health Optimization Platform, from Welltok, guides consumers to live more healthily, whether they have a chronic condition or just a busy lifestyle. The platform uses information from from patients and their insurers to create personalized health itineraries. For instance, CaféWell knows from the insurer when your last regular check-up was, and can prompt you to schedule another check-up. After you go, it can ask you how you felt about it and whether you want any guidance. It can then direct you to help from partner services, such as asthma management by Propeller Health or prenatal care for at-risk mothers by Wildflower Health.

The iCancerHealth service from Medocity helps cancer patients follow treatment plans, contact their physician and hold a video consultation, or form a social network with other cancer patients.

Some services have offer more targeted applications with potentially large impacts. Thus, Connected Living provides social networking tools and educational content for seniors, allowing then to connect with their communities, family members, and caregivers. RubiconMD helps doctors do remote consultations. A consultation over RubiconMD is similar to phoning up a respected colleague, but streamlines the process. You press a button and make a request, to which the expert on the other end can spend ten minutes replying for a small fee.

There's even an app that teaches clinicians how to communicate better. Kognito presents simulated discussions with patients around sensitive topics. At various points it presents visual bubbles to the clinician to let her understand what's really bothering the patient, and asks her to choose an intervention. It then shows a typical patient reaction, a form of interactive training.

Evidence based medicine

Another goal of software developers in healthcare is to take clinical decision support to higher and more sophisticated levels. QPID Health searches through data in the patient's record and produces charts for the clinician to help them make the right care decisions in a timely manner. Apervita is a somewhat general-purpose platform that takes analytics from credentialed research institutions such as Cleveland Clinic, Partners, Mayo and Johns Hopkins. The analysis permits providers, payers, and pharma, for instance, to create and subscribe to analytics that predict readmissions, track trials, collect adverse effects, and crunch data to detect fraud.

Monitoring, compliance, and alerting

A number of services go beyond communication to bring treatment into the patient's daily life. Klio Health and Twine Health are examples of such services. The Center for Connected Health, which runs the symposium, recently announced a partnership with Daiichi Sankyo to develop a mobile app in this area.

These services typically access personal data and use evidence-based medicine to determine whether something in data calls for a physician's intervention. In this way they can avert crises and hospitalizations. For example, with Klio Health, providers are alerted if a patient's symptom pattern signals an exacerbation of the condition, while the patient is alerted to call the provider.

Glooko lets diabetes patients transmit glucose levels automatically to mobile device and cloud. From this data it can generate alerts in dangerous situations.

At one extreme of the monitoring tools is AiCure, which pops up when a patient is supposed to take his medication, takes a video of him swallowing it, and transmits it to the health care provider. I can see how this may be necessary for psychiatric patients, substance abusers, those with dementia, and others who resist their treatment plans. But it has to be backed up by punitive consequences, and the premise of connected health is to make the patient an equal partner in behavior change.

The ethical dilemma presented by AiCure reminds us that technology presents a balance between doing things for us and giving us more leeway to doing things for ourselves. As devices and services grow, gathering more data about us and providing more sophisticated interventions, the premise of putting the individual first in connected health must be kept in the foreground.

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