Whatever you want to call it – a movement, a project, or an inevitability – few healthcare undertakings have inspired as much enthusiasm, skepticism, excitement, and dread as the Internet of Things.
The prospect of billions of web-enabled devices pouring untold petabytes of patient-generated health data (PGHD) into the EHR ecosystem has some clinicians a little nervous, but this big data jackpot may also bring stunning new breakthroughs for patients on an unprecedented scale.
The past twelve months sparked significant interest in the novel IoT environment, as consumers gravitated towards innovative wearables and developers prepared to retool their products to meet anticipated demands for slick, intuitive data visualizations and analytics capabilities.
But 2016 is likely to bring even more action on the IoT battlefront as providers and their partners gear up to put PGHD to work.
What are some of the most important areas of focus for the healthcare Internet of Things? How will the IoT really work, and what will patients expect from their providers as more wearables, monitoring devices, and smart home care tools become integrated into daily life?
Improving population health management and chronic disease care
Chronic disease management has become a popular example of how the IoT can immediately and drastically impact the lives of patients. While the number of new diabetes cases may be leveling off, the millions of Americans living with the condition – and the millions more suffering from chronic heart diseases, kidney disease, hypertension, asthma, and COPD – still need constant and coordinated care.
Many of the earliest healthcare IoT devices include home monitoring equipment, such as wireless blood pressure monitors, internet-enabled blood glucose monitors, smart scales, intelligent prescription management devices, and telehealth command centers. These tools allow patients to keep constant watch on their biometrics, and even allow data to flow seamlessly into their providers’ EHRs, giving clinicians 24/7 access to fluctuations in vital signs or other important metrics.
“Think about all that vital information – the blood pressure, the heart rate – coming in from the patient's home, being run through algorithms,” said Dr. Hargobind Khurana, Senior Medical Director of Health Management at Banner Health.
Using home telehealth tools and remote monitoring technologies, elderly patients at Banner Health are getting better, more cost-effective care for their chronic conditions without the difficult prospect of traveling to and from their providers on a regular basis. Dedicated health coaches and care coordinators are responsible for monitoring these data streams, integrating the IoT into their workflow proactively for chronic disease management.
“You might not have to look at every single data point, but if there is an absolute number that is not okay, or if there is a trend that is not acceptable, that gets highlighted and our nurses will evaluate it,” Khurana said. “They will call the patients, get an assessment of what's going on, and connect with a pharmacist, physician, or social worker depending on what the issue is.”
Developing the precision medicine point of view
This detailed perspective on a patient’s daily behaviors and health changes may also have applications for precision medicine and personalized treatments. Researchers in the life science and pharmaceutical fields have been quick to jump on IoT-based initiatives like Apple ResearchKit, which promise an enormous wealth of passively-collected health data to mine for actionable insights and new discoveries.
A recent survey by law firm White & Case found that 93 percent of life science and healthcare technology companies are aligning their future development strategies around digital health innovations, while fifty-three percent believe that remote monitoring will be the industry’s biggest area of growth in the near future.
For precision medicine, which requires huge patient cohorts to detect large-scale patterns in disease development and treatment, the Internet of Things is a gift of epic proportions. IoT devices can collect the big data required for advanced research and sophisticated analytics, and may help scientists marry next-generation gene sequencing techniques with real-life patient experiences to highlight previously unavailable insights into how genomics impact outcomes and responses to therapies.
Integrating patient engagement into all facets of life
Creating sustained and meaningful patient engagement is at the root of many of the healthcare industry’s reform efforts, but keeping patients interested in actively making smart decisions about their own care has been a difficult task for providers.
Subpar tools, such as lackluster mHealth apps, confusing patient portals, and non-existent health information exchange and EHR interoperability capabilities leave patients feeling frustrated and unlikely to come back to technologies that leave a bad taste in their mouths.
But when it comes to patient engagement, the promise of the Internet of Things is passivity. Wearables and other devices automatically collect data, leaving patients free to pursue their daily activities without having to stop and remember to hit “send” on their sleep logs. Reminders and communications are often automated, and patients don’t have to do anything specific in order to trigger provider-sided alerts when their blood sugar has been out of whack for a couple of days.
Patients are already familiar with the cloud-based technologies that make these events possible, and many are eagerly embracing devices that will integrate their healthcare needs more deeply into their thought-free technology suites.
In late 2014, nearly twenty percent of adults were planning to add a wearable device to their personal technology arsenal, one survey found, and the vast majority of patients already have powerful IoT hubs in their hands as smartphone owners.
The challenge for healthcare providers will be to integrate PGHD into the care process in a similarly seamless way. Few EHR systems are capable of accepting and displaying passively-collected IoT data in a meaningful way, and some clinicians are not yet fully on board with the idea that this information will have any real value to the care process at all.
But patients are demanding more access to their data and better integration of their opinions and needs into their relationships with their providers. Clinicians may simply have to bite the bullet and catch up with the expectations of their consumers if they want to succeed in the increasingly important world of patient engagement.
Cutting costs as out-of-pocket expenses rise
After all, patient engagement is becoming a major factor in the financial health of both patients and their providers. While healthcare organizations diving into risk-based contracting need to produce better outcomes to keep their reimbursements high, patients are finding that online tools and communication strategies may help keep dollars in their pockets, too.
High deductible plans and hefty co-pays are leading patients to turn to web as a first line of defense against common health concerns and chronic disease check-ups. A study published this month in the American Journal of Managed Care found that patients are much more likely to email their providers instead of scheduling an office visit when they are required to pay more than $60 for an in-person chat.
A free email from a smartphone can save them cash – and may have benefits for their providers, too. Backed by Internet of Things devices, proactive home monitoring for chronic disease patients and more effective physical asset monitoring by providers could save the healthcare system up to a quarter of its business costs, according to one report.
At Banner Health, that promising prediction is already coming true. Two years into the Intensive Ambulatory Care Program that uses home monitoring to keep an eye on elderly chronic disease patients, Banner has already seen savings of around 27 percent, Dr. Khurana said, by slashing preventable hospital admissions and long-term care facility visits.
Surrounding patients with appropriate Internet of Things devices provides clinicians with the constant contact required to act immediately when a patient is exhibiting warning signs, he said, even before the patient is sick enough to think about picking up the phone.
“Taking [a] holistic approach and having a significant amount of touch points with these patients, provides enough data on a timely basis that we can take proactive steps to manage the problems,” Khurana said. “We can change some medications, help them through some symptoms, or catch something that is exacerbating a problem and hopefully change the course of that condition.”
“It makes a difference when you can build trust with a patient and have a central team which is solely responsible for managing or helping these patients on a timely basis. That makes a difference in how they use healthcare and whether or not they end up in the hospital.”