Policy gets personal

How technology and policy intersect to provide better healthcare

As technology marches forward, it continues to influences government policy, and those policies encourage greater adoption of information technology in healthcare. Nearly every month, federal and state lawmakers introduce bills meant to improve healthcare access for patients.

Telehealth has been a top healthcare topic for states, while federal policy initiatives in the areas of interoperability and electronic health records continue to push health agencies around the nation to greater sharing of data and technology use.

A more cohesive policy approach to health information technology on the federal, state and local levels promises to streamline care while enhancing people's lives. Or it could involve far greater stakes—a life-or-death episode—when a Wisconsin man suffers a stroke while driving on a freeway 40 miles from a major medical center.

Mike Harrigan, 65, was driving to a morning meeting near Madison. "All of a sudden, my left hand began to shake. I could not control it," he said. "The left side of my face was not responding, was slumping."

Harrigan pulled over, called 911 and was taken by paramedics to nearby Watertown hospital, a small regional facility that partners with neurology specialists from University of Wisconsin Health in Madison, about 40 miles away. UW Health's telestroke program uses high-speed broadband to provide care for stroke victims.

All of a sudden, my left hand began to shake. I could not control it...the left side of my face was not responding, was slumping.

With this program, a specialist in Madison can communicate with medical professionals in Watertown or elsewhere on a laptop, review the CT scan sent electronically and prescribe stroke treatment. "You can see anything you would see at the bedside," said Dr. Marcus Chacon, a UW Health neurologist.

"You can hear a patient, you can hear their speech, you can tell if it's slurred, you tell if they are using the wrong words, you can determine if there's weakness present on one side of the body," Chacon said.

Policy initiatives are inspiring hospitals and health care systems to improve service and delivery of care with the kind of high-tech interoperability and data sharing that saved Harrigan's life. Federal support for electronic medical records via the Health Information Technology for Economic and Clinical Health Act of 2009 has been instrumental in encouraging their adoption, and participation in the Hospital Consumer Assessment of Healthcare Providers and Systems national survey is inspiring providers to improve their interactions with patients.

But greater standardization is needed. From a policy standpoint, connected technology can only continue to realize this potential to improve healthcare with a common set of data exchange standards. "I think we are poised over the next five to 10 years to see a real resolution on the mechanics of health data and information exchange, even as challenges will remain in such realms as assuring information security and privacy," said Susan Dentzer, senior policy adviser to the Robert Wood Johnson Foundation.

Electronic health records were just the beginning. Healthcare systems are now using an array of technological products, including smartphones and tablets, to diagnose and care for patients. They also use wearables, remote image capturing, connected devices that measure blood pressure, heart rate and glucose levels, and other digital diagnostic medical devices. Wearable technologies such as smartwatches are proving a useful conduit for collecting and transmitting health data from patients to their providers. Samsung and other companies are providing high-tech products like these that bridge the provider-patient distance.

Continued adoption of healthcare information technology and more widespread use of electronic health records are key to achieving more connected care. "Samsung and other technology companies…care deeply about where and how health data and information are collected and how they are used," Dentzer said. For this data to turn into actionable health information, "it has to be in the hands of both patients and health care providers."

"There must be more emphasis on individuals—patients and consumers—and on giving them the capacity to pull out of the health care system the information they need, and push the system to give them information they need to help manage their own health," Dentzer said.

There must be more emphasis on individuals-patients and consumers-and on giving them the capacity to pull out of the health care system the information they need, and push the system to give them information they need to help manage their own health.

Congress is doing its part to advance telemedicine initiatives. The Medicare Access and CHIP Reauthorization Act, passed by Congress in April 2015 and signed into law by President Obama, is helping deliver more widespread telemedicine access. The Act has set in motion changes to reimbursement and financing of health care, because not all telehealth costs are currently reimbursable. Medicare, for example, does not cover all telehealth applications, and states have different standards for Medicaid reimbursement of telehealth expenses. And there is no single widely-accepted standard for private payers.

Yet these connective technologies are helping people live healthier lives. Harrigan said he is fully functional today, thanks to telemedicine. "It ended up being, frankly, unbelievably fortunate, almost, I would have to say, miraculous," he said.

With wise policies, the best technology and seamless data sharing, more stories like Harrigan's are possible. "As that whole world unfolds over the coming decades, there will be countless ways we will collect that data, assess it and get it to entities that can use it. It will be a very different world, and Samsung and others will play a role in that," Dentzer said.

Healthcare goes mobile

Better care, better lives

Health providers across the nation are increasingly turning to state-of-the-art mobile technologies that help patients live healthier lives. Tablets, wearables, home monitoring solutions and virtual reality products are connecting consumers with their doctors like never before, and help professionals provide better care for their patients.

Indeed, remote health monitoring via mobile and other applications has correlated with a sharp drop in hospitalizations among heart patients and other sufferers of chronic disease, according to many studies, including research from the National Institutes of Health. With mobile health solutions, patients are encouraged to be more compliant with their care, including taking their medications appropriately, and to have interactive relationships with their doctors.

Heart Rate Sensor

Following your every beat

In 2014, the Galaxy S5 was the first smart phone with a built-in Heart Rate Sensor which enables you to measure your heart rate directly on your phone.

Mobile healthcare can potentially benefit employers, as well. Healthcare is a huge expense that hits them in two ways: by direct expenses that they pay in insurance premiums, and from people missing work from illness. Consequently, some corporate wellness programs are integrating wearable fitness tracker devices into their activities, which helps employees stay healthier and helps companies negotiate lower insurance rates, said J.P. Gownder, a vice president and principal analyst at Cambridge, Mass.-based Forrester Research Inc.

With this in mind, health systems are starting to coordinate care via mobile apps so doctors can interact directly with patients about their diabetes, for example, and have them measure their morning glucose levels as well as ensure dietary compliance.

For instance, Partners HealthCare in Boston has partnered with Samsung Electronics and Massachusetts General Hospital to develop the next generation of personalized digital and mobile health and wellness applications.

The project is focused on developing mobile health tools that help clinicians remotely monitor patients' vital signs, while encouraging patients to better manage their health and wellness. The first phase of this collaboration includes software development and clinical research that uses Samsung Gear Fit fitness watches and Galaxy phones to improve management of chronic diseases like diabetes, hypertension and obesity.

"We collaborated to create an app that is the front phase of intervention with patients," said Dr. Kamal Jethwani, senior director of Connected Health Innovation at Partners HealthCare. Patients are given these technologies and use them to collect and transmit their health data, such as physical activity and heart rate, to their doctors.

All of this data tells us more about the patient. We make it available to providers through the medical record, and provide more personalized messaging back to the patient.

"All of this data tells us more about the patient. We make it available to providers through the medical record, and provide more personalized messaging back to the patient," Jethwani said. "The goal is to improve lifestyle modifications, control blood glucose levels, reduce blood pressure and so on."

Partners HealthCare's implementation of connected health solutions, combined with Samsung's mobile technology, demonstrates how purposeful deployment of mobile health technology can help doctors better monitor their patients' health, and encourage healthier behaviors.

"We believe that this project can re-imagine the future of health and wellness and deliver innovative, convenient and powerful personal connected health tools," said Joseph C. Kvedar, MD, vice president at Partners HealthCare, Connected Health.

"Our goal is to leverage personalized digital and mobile health solutions to address the real needs of healthcare providers and patients, create better compliance, help individuals lead healthier lives and improve clinical outcomes."

  • Biosensors Smartwatches Electronic Monitors Smart Hearing Aids Drug Delivery Devices Virtual Reality Headsets

    Healthcare You Wear

    Empowering Connected Care

    Wearable medical devices are transforming how we care for our health. Replacing heavy-duty medical monitoring systems, wearables can free patients from the hospital, improve treatment accuracy and even reduce fear and pain. And the data that wearables provide can be used in unprecedented ways to advance diagnosis and treatment methods in the future.

    Here is a look at wearables that are freeing, improving AND elevating healthcare, and what is coming on the horizon.

1 2 3 4 5 6 7
Sources: U.S. Pain Foundation, Circulation Journal, U.S. Food and Drug Administration

Powering connected care

Health systems modernize IT infrastructure

Imagine you're walking down the street and you start to have chest pains. Rather than panic, you use your smartphone to call your healthcare provider, who immediately dispatches a driverless car outfitted with medical equipment to your location.

You get in, and you are instructed via your smartphone how to use the blood pressure monitor to check your blood pressure. You are also instructed how to put on the portable digital EKG machine, which can be remotely monitored by your physician, who can decide if the driverless car needs to transport you to the nearest hospital.

Indeed, hospitals, clinics and other healthcare providers are moving to modernize their health IT infrastructures to improve services. They aim to connect patients and providers over the Internet to save time and money as well as resources. The ultimate goal: to save lives.

Although the above scenario may sound far-fetched, healthcare pioneers like Innovation Labs at Kaiser Permanente IT are actually working to bring that idea as well as others to fruition – sooner rather than later, said Susan Dentzer, a senior health policy adviser to the Robert Wood Johnson Foundation, a Princeton, New Jersey nonprofit.

To enable healthcare for its members wherever they are, Kaiser Permanente, an Oakland, Calif.-based healthcare services provider, is looking at very different ways of doing things given the technology that already exists or will exist soon, Dentzer said.

Advancements in mobile and display technology are now making it possible for doctors and medical practitioners to spend more time doing what they do best – taking care of patients – and less time on the administrative side of care delivery.

"The electronic health record has transformed healthcare delivery, but at the same time it has had unintended consequences on the patient-doctor relationship,"" said David Rhew, MD, chief medical officer and head of healthcare, Samsung Electronics America, based in Ridgefield Park, New Jersey.

Physicians have three options during patient encounters, he said. They can enter the encounter information after the patient visits, which extends the workday and leads to physician burnout; type data during the encounters, which often means physicians focus on their computer screens and not on their patients; or hire scribes to enter the data, which adds expense to the overall process.

"Advancements in mobile and display technology are now making it possible for doctors and medical practitioners to spend more time doing what they do best – taking care of patients – and less time on the administrative side of care delivery," Rhew said.

For example, tablets enable patients to participate in the process at the time of registration and potentially before and after their visits. Physicians can rapidly access selected parts of patients' records on tablets, while continuing to communicate directly with their patients, Rhew said.

"Screen mirroring from tablets to large displays enable patients and their family members to see images, results and other relevant aspects of their medical care," he said. "Mobile and display technology can foster greater understanding and engagement during the patient encounter, which can lead to better outcomes and more efficient care."

Research from Framingham, Mass.-based IDC indicates that virtual care will become routine by 2018. "Over the next five years, 80 percent of consumer service interactions will make use of IoT (Internet of Things) and big data to improve quality, value and timeliness."

This year, millions of people in the United States will probably have their first video consultations, be prescribed their first health apps and start using their smartphones as their own diagnostic tools, according to the "Top Health Industry Issues of 2016" report from New York City-based PwC.

Over the last several years, there has been significant progress implementing electronic health records in various healthcare organizations throughout the United States, Dentzer said.

Seizing all the potential from the ability to record and access and exchange data is now the name of the game.

"And now the collective healthcare system can step back and ask what the real objective is – higher value health care," she said. "Seizing all the potential from the ability to record and access and exchange data is now the name of the game."

Big healthcare systems have the capacity to pull together existing and future technology, and figure out how to deliver care. Some health systems have said that within five years, half of their patient encounters will take place over the smartphone, Dentzer noted.

Those could be anything from accessing health records to making appointments to breathing over their smartphones to see whether their breath shows any markers of cancers that could be remotely monitored.

To deliver better care to its members, Danville, Penn.-based Geisinger Health System, for instance, is looking into giving tablets to patients who will undergo elective procedures at various hospitals.

The tablets will have built-in software, including videos of patient rooms, how their procedures will play out, and other preoperative information. Patients will also be able to keep the tablets after their surgeries for remote follow-up appointments via video chat apps.

"The opportunities are there for vendors such as Samsung to work with the big healthcare systems to develop these models and test them," Dentzer said. "All of the innovative technology firms and telecommunications companies have a lot of opportunity right now to work with the healthcare systems and develop these things."

The new house call

Mobile technology engages youth, improves care

Although passage of the Affordable Care Act has reduced the number of uninsured Americans, health care remains expensive and out of reach for many. And for at-risk youth who lack family or community support, good health care can seem out of reach.

Community partnerships are enabling mobile clinics like the San Francisco-area Teen Health Van to meet this urgent need with connective technology and personalized care on the go. When technology helps doctors work more efficiently, they can spend more time interacting with patients. That face time is especially important when treating at-risk youth.

The mobile clinic, in operation since 1996, travels to schools, shelters and community centers in San Francisco, San Mateo and Santa Clara counties. "We are a safety net for unmet needs in mental health, nutrition and other care," said Seth Ammerman, pediatrician and medical director of the mobile clinic, which treats pre-teens, teens and young adults. Lack of immunization is "the tip of the iceberg for these underserved kids," Ammerman said.

The Teen Health Van gives comprehensive treatment and physical exams, in addition to health education, social services referrals and counseling in nutrition, mental health, substance abuse and other services. Funded by gifts and grants, the clinic employs a physician, nurse practitioner, two social workers and a registered dietician to serve more than 400 youth yearly—40 percent of them homeless.

It's exciting because kids these days are totally into this interactive stuff... It helps them be more engaged with their health.

To attract more patients, the clinic partners with local community agencies that also serve this demographic in San Francisco and San Jose. "It's a very collaborative model," Ammerman said. Establishing trust with these young patients has been key to effective care, and keeps them coming back. "We have a return rate of 70 percent. It shows kids are engaging with it and coming back on their own," Ammerman said.

Connected technology in a mobile setting also brings home the doctor/patient relationship. Samsung and the Children's Health Fund recently partnered to power the clinic with an upgraded state of the art vehicle with two exam rooms, and outfitted it with interactive technology from Samsung.

Dr. Irwin Redlener, president and co-founder of the Children's Health Fund, is confident the partnership "will help chart a new path forward in demonstrating how technology can make quality health care available to many underserved children throughout the United States."

The mobile clinic delivers care to more young patients, while interactive technology increases their engagement. With Samsung tablets and 32-inch monitors, the clinic loops in specialists through video chat for additional care, and shares visual information with young people to get them to take ownership of their personal health.

"It's exciting because kids these days are totally into this interactive stuff," Ammerman said. "It helps them be more engaged with their health."

Samsung and the Children's Health Fund have committed to closing the access gap for poor children by using technology solutions in mobile-unit settings. "These solutions are designed to improve the quality and efficiency of care, expand access to care and transform the patient experience for underserved children," said Dr. David Rhew, chief medical officer and head of health care at Samsung Electronics America in Los Angeles.

Samsung tablets, for example, make health concepts "big and easier to see and understand," Ammerman said. "We can draw on it together. I can draw something about the location of the headache, explain medications or other information."

On average, the patients stay in the program two to three years. "We'll see them as long as need be. If they age out, we have a transition plan to continue to get the care they need. With the clinic's new technology, this is easier," Ammerman said.'

"Technology usually trickles down to underserved populations. This is cool that kids are the first to experience this state-of-the-art technology."

The social lifeline

Technology connects homebound seniors to the world