Electronic Health Reporter

Guest post by Susmit Pal, healthcare strategist, Healthcare & Life Sciences, Dell EMC

Aging populations and the rising incidence of chronic disease consume a disproportionate amount of healthcare resources. In the United States, about 75 percent of healthcare dollars go to chronic disease care and two out of every three Medicare recipients suffer from at least two chronic diseases.^[1] The pressure for relief will grow as the population ages with approximately 10,000 new patients estimated to enroll in Medicare every day for the next 15 years.^[2] The current demand for resources for chronic disease care combined with the imminent spike in Medicare enrollment beg for achievable solutions and strategies that address costs, care quality and outcomes in the short term.

Enter the Internet of Things (IoT), also referred to as the Internet of Medical Things (IoMT) within the healthcare industry. IoT is something that most are well-familiar with, but for the sake of clarity, we define it here as the purposeful connection of intelligent sensors, devices, and software to computer networking systems using Bluetooth, Wi-Fi, RFID or M2M wireless technology in order to promote an inter-functionality that serves a greater purpose. In healthcare, that greater purpose is the achievement of less costly and more information-driven and efficient patient care. Think wearable devices and wireless pill bottles, nanotechnology and ingestibles, and network-enabled medical devices like stethoscopes that can transmit cardiac data directly into a patient’s electronic health record (EHR).

The Impact on Chronic Disease Management
IoT shows great promise in helping to improve the health of patients with chronic conditions. Combinations of remote monitoring, analytics and mobile platforms have repeatedly cut re-admissions of high risk patients with congestive heart failure (CHF) by more than half.^[3] Evermore affordable and easier-to-use devices, such as wireless scales and heart rate and blood pressure monitors are improving overall wellness for the chronically ill. In fact, some researchers estimate that the value of improved health in patients with chronic disease using remote monitoring could amount to $1.1 trillion per year by 2025.^[4]

At the consumer level, the rapid increase in the type and variety of personal mobile fitness trackers like Fitbit^®, and online fitness applications for consumers demonstrates comfort with IoT to monitor physical health. Their very existence has created an avenue for patients to become more accustomed to tracking and managing their health online. In response, healthcare organizations are beginning to incorporate them into their consumer engagement strategies, while payers are starting to offer discounts and incentives tied to wellness management.

IoT is also helping to spur on some rather exciting new technological advancements in chronic disease management. Connected wheelchairs, for instance, are enabling people with disabilities to engage with care providers on a whole new level, communicating health alerts to care teams and repair notices to manufacturers. A group from the University of Missouri is spearheading a development project to utilize home monitoring sensors in an effort to prevent falls among the elderly by providing alerts to the patient when there is a fall risk, while Dell Healthcare is working with hospitals to leverage the use of tablets with integrated card readers to enable remote healthcare for home-based treatments.

There exists an even greater potential for IoT to impact chronic disease management at a population-level when combined with data analytics. For instance, Health Net Connect (HNC) has initiated a population diabetic management program with the intent to improve clinical outcomes and healthcare savings for diabetes, one of the deadliest and most costly of chronic diseases—and the results are impressive. They captured vitals and blood work from study participants over a 6-month period to measure the impact that routine teleconferencing and patient monitoring had on outcome. Patients in the program showed a significant decrease in key biomarkers, including 9.5 percent lower HB A1C and 35 percent decrease in LDL. To put that into perspective, for every 1 percent drop in HB A1C they estimate an $8,600 annual savings, and for every 1 percent decrease in LDL there is a 1 percent decrease in coronary heart disease, which costs on average a million dollars over a lifetime. HNC is continuing this program, noting that “this project has, and currently is demonstrating return on investment with cost savings, improved access for program members to their physician, improved clinical outcomes, and improved knowledge by program members on their disease condition.”[5]

The Road Ahead
Although such insights and applications are encouraging, many issues need to be addressed before fully leveraging IoT for chronic disease management. Such challenges include:

• Regulatory and compliance hurdles: For example, practitioners cannot deliver telemedicine services across state lines, and states have different reimbursement standards for telehealth expenses.[6] Add to that the issue of being able to introduce new medical grade devices as the FDA faces a deluge of new 510(k) submissions.
• Security and liability issues: With IoT comes an increased vulnerability to disclosure or theft of private health information and risk for manipulation of medical devices.
• Data overload: Making timely sense of increased amounts of data can be cumbersome when practitioners are already overwhelmed by information and demands on their time.
• Interoperability issues: Providers are having to deal with an increase in devices, gateways, databases, and so on—all with their own protocols.

However, despite these challenges, IoT in healthcare is expanding dramatically. Some researchers estimate that the global healthcare IoT market will reach $117B by 2020.[7] The incentive to achieve interoperability through federal mandates, societal shifts that focus on prevention and maintenance, the migration to value-based payments, and the rich mine of public health insights to be gleaned from EHR data will push healthcare systems to find solutions to these issues. IoT promises to optimize practitioners’ knowledge and skills and employ cutting-edge technology to achieve the goal of efficient, effective, patient-centered care in the 21st century—and overall better health for the chronically ill.

Footnotes:

[1]  http://www.beckershospitalreview.com/healthcare-informationtechnology/the-key-to-population-health-know-your-chronicdisease-patients-and-coach-them.html

[2]  http://www.forbes.com/sites/dandiamond/2015/07/13/ aging-in-america-10000-people-enroll-in-medicare-everyday/#52e37e135e07

[3] http://mhealthintelligence.com/news/connected-care-platforms-help-high-risk-patients-avoid-the-er

[4] http://www.mckinsey.com/business-functions/business-technology/our-insights/the-internet-of-things-the-value-of-digitizing-the-physical-world

[5] http://healthnetconnect.com/wp-content/uploads/2015/02/WhitePaper2014.pdf

[6]http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/whatarethereimbursement.html

[7] $117 Billion Market for Internet of Things in Healthcare by 2020 http://www.forbes.com/sites/tjmccue/2015/04/22/117-billion-market-for-internet-of-things-in-healthcare-by-2020/#606b224d2471