Overcoming distance and delays is a big hurdle for many people seeking health care, as is the scarcity of qualified specialists in many cases. The emergence of mobile devices with wireless communications is helping to bring more patients the monitoring and care they need.
BY JOHN KOON
For a vast number of people, such as those living in rural areas or in small towns that are far from advanced medical centers, seeing a doctor can be an ordeal. Most likely, they have to drive or take public transpiration to get there. Once they arrived, they often spend much time in a waiting room until they are called? Well, this is all about to change. Instead of traveling to the physician’s office, many more patients will be seen through an Electronic Visit (eVisit).
According to the research firm Deloitte, the cost of worldwide in-person doctor visits totals $175 billion. In North America, approximately 75 million people actually made appointments with their physicians using eVisit out of 600 million total appointments. If this trend continues worldwide, the projection of eVisits is estimated at 100 million and would translate to a savings of $5 Billion.
eVisit in Action
The eVisit model was recently enhanced at the University of Pittsburgh Medical Center (UPMC). UPMC is an $11 Billion healthcare provider as well as an insurer. Its statewide services include 21 hospitals with more than 400 outpatient sites. With the overhaul of its online patient portal called MyUPMC and the launch of UPMC AnywhereCare virtual visit, UPMC offers patients within the state of Pennsylvania the ability to “eVisit” physicians and advanced practice providers 24 hours a day, 7 days a week. This eVisit service for non-urgent conditions is branded as “UPMC AnywhereCare” with 95% of patients rating the convenience of the visit as “very good” or “good”.
Most of the time, a patient may be anxious and eager to receive a quick diagnosis, find out what is wrong with them and have peace of mind. AnywhereCare is able to do just that.”Our goal is to provide a 30 minute turnaround for patients to access a healthcare provider,” said Natasa Sokolovich, executive director of telemedicine at UPMC
How does UPMC AnywhereCare work? A patient fills out a detailed questionnaire online reporting his or her symptoms, much like what you would do during a traditional doctor appointment (Figure 1). The questionnaire is sent directly to a pool of dedicated medical professionals who review the patient’s symptoms and provide a diagnosis and treatment plan. Depending on the diagnosis, a prescription may also be sent electronically to the patient’s pharmacy of choice. Initially, this service was provided only to those with assigned doctors and the wait time was up to 24 hours. However, as the name UPMC AnywhereCare website suggests, the new online service is open to all Pennsylvania residents and is a major improvement over the earlier model. UPMC reported more than 2,700 eVisits since the launch of AnywhereCare in Nov 2013. The average is 210 eVisits a month with an estimated savings of $86.80 per online visit compared with visits to an emergency room, urgent care clinic or in-person office visit.
eVisit allows patients to see a doctor without going to the hospital.
Usually a patient goes through a few stages in the healing process. The first stage is diagnosis. The second stage is prescription, surgery or physical therapy. The third is the recovery stage. This is a very important stage because at this point, the patients have already checked out of the hospital and it is often difficult for the caregivers to track their progress. Sometimes, the patients will also stop following instructions without the caregiver’s knowledge. Whenever there is a re-admission to the hospital, the patient’s condition can worsen and there are additional associated costs. With mHealth, caregivers will be able to access, monitor and track patient information. mHealth refers to mobile healthcare which makes use of wireless technologies to connect patients and healthcare professionals together.
Monitoring and Tracking
Monitoring and tracking a patient’s vital signs and activity level is a crucial part of the healing or recovery process. If done properly, mHealth enables a quicker recovery while allowing patients to enjoy more personal freedom.
MC10, a company based in Cambridge, MA, has a vision to develop a stretchable BioStamp, which adheres to a person’s skin to monitor temperature or motion. The stamp then sends the signals wirelessly to a Wi-Fi hub or controller allowing the caregiver to monitor the condition of a patient. This can also help parents of a newborn to get their much-needed rest knowing that the newborn will be monitored continually and if, for example, a fever shoots up, an alarm will sound.
Another application of mHealth involves the advancement of mobile and wireless technologies. Due to the pressure of reducing healthcare costs, hospitals try to minimize the time a patient is permitted to stay in the facility. Traditionally, when a patient leaves the hospital, tracking the patient’s progress can be difficult. But this is about to change. Vital Connect, a startup company founded in 2011 and based in Campbell, CA, introduced a wireless device called the HealthPatch MD (Figure 2). This Food & Drug Administration (FDA) approved patch only weighs 10 grams and can adhere to the human body. It is a compact, multifunctional device with a built-in heart rate monitor, pedometer, thermometer and fall detector. Additionally, using Bluetooth 4.0, it can transmit HIPAA-compliant information to a Wi-Fi hub located in the home so that caregivers can monitor the information remotely via a tablet or smartphone. With these types of devices, patients can recover at home while being monitored and cared for remotely.
The HealthPatch MD patch monitor patients wirelessly.
In the recovery process, it is highly advisable for the patients to be active and perform exercise under supervision. But this can be difficult if they are at home or not being supervised directly. More than 10 years ago, companies began researching this problem to come up with useful solutions. Today, there are many wearable fitness devices available on the market, but most of them are not designed for clinical use. In a clinical setting, the exercising bodies may need to move in a particular angle and the measuring devices have to be able to act like a sensor.
For the past 15 years, Modus Health, a medical device maker, has been involved in research in the area of prosthesis development. With their experience and research data, the company introduced the StepWatch, which can be worn around the ankle (Figure 3). This device is designed to track the activities of the patient in a clinical setting.
The wearable StepWatch monitors the activities of the patient.
Most of the commercial tracking devices, including Fitbit and Jawbone, use the tri-axis accelerometer while the StepWatch uses a more accurate proprietary sensing system. This device has undergone many different types of tests in situations involving people with prostheses, slow motion from Parkinson disease, the recovery of stroke and multiple sclerosis. The results were so positive that it is one of the very few devices that actually receives reimbursement status from the Veterans Administration. However, what the device lacks is a wireless connection capability. Users are required to physically remove the unit and connect it to a docking station in order to transmit the data to the care givers.
More mobility with Tablets for Physicians
Ultimately, all these technological advancements should add up to productivity. At this point, multiple benefits are enjoyed by patients using eVisit including access to doctors 24/7 and remote monitor devices to gain personal freedom and peace of mind. For physicians, the use of tablets (Figure 4) has dramatically increased their productivity. Remember the time before the invention of a sheet calculator (today, most people refer to this sort of calculation as Excel) when you needed to perform the computations on a calculator one by one? Today, you are able to change one number and the sheet will automatically update everything else accordingly. Similarly, when seeing a patient, a doctor may need to be constantly mobile to perform necessary tasks. For example, as reported by one doctor, he often needs to leave the exam room to obtain drug information or information from insurers. One report indicated that, by using such a device, the productivity gain is significant at 1.1 hour. As mentioned above, more and more data can now be accessed via a mobile device. If a doctor is in charge of multiple patients, especially those who are in serious condition and in need of intensive care, the doctor may be walking back and forth to the office to access data regarding the condition of the patients. With a tablet, the information can be readily available and allow the doctor to carry on with his/her routine with minimal interruptions.
Tablets enable doctors to be more productive.
What does the future hold?
mHealth does not fix all the healthcare problems but it does have a bright future. The venture capital segment is very keen in investing in mHealth. “We see that the future of mHealth will only get brighter. With the healthcare reform, chronically ill patients and aging population will need to be cared on an ongoing basis, to avoid ER visits and/or hospitalization, as providers are fighting to contain costs. There will be both start-ups and well established companies winning in this segment,” continued Jack Young of Qualcomm Life Fund at Qualcomm Ventures, “Our fund invested in a number of companies developing remote patient monitoring technologies and services and expects great social and financial returns.”
While new medical technologies are being developed independently by many companies, one cannot help but ask, “How will all this equipment work together?” The good news is an international, non-profit industry organization Continua has already established the Continua Design Guideline (2014 edition) to address the secure, end-to-end, interoperability concerns. These global standards have been ratified by the International Telecommunication Union (ITU), a part of the United Nations, and adopted by multiple countries and national health ministries including the United Kingdom and Denmark. Additionally, in 2013 the Food and Drug Administration (FDA) recognized a set of IEEE 11073-104xx standards co-developed with Continua. With new standards and investments in place, expect to see more mHealth offerings coming your way.
San Diego, CA