Guest post by Susmit Pal, healthcare strategist, Healthcare & Life Sciences, Dell EMC
Susmit Pal
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]
Guest post by Charlotte Hovet, MD, MMM, and Joseph Kim, MD, MPH.
Charlotte Hovet, MD, MMM
Remember a few years ago, when online shopping was first getting started, and everyone used words like “e-tailer” to refer to companies that sold stuff on line? When was the last time you heard that used? It has become an anachronism, because almost every company is now an e-tailer. And “online shopping” has become merely shopping, because no one thinks twice about buying via the Internet.
The phrase mobile health will soon be headed for extinction in the same way as “e-tailer” because it is becoming a routine way to consult your medical practitioner. Over the next couple of years, it will become a major force in healthcare, and in five years no one will think twice about using remote communications to get medical help. We predict there will soon come a time when young people will wrinkle their noses and ask “Really? You had to drive to the doctor’s office, and sit in a waiting room and infect a bunch of other people just to get some Tamiflu? That’s insane!”
Both public and private health plans are rapidly adding coverage for e-visits. Not only are they cheaper, they are also more effective for some types of care and consumers greatly appreciate this trend. While the baby boom generation may still have some holdouts who don’t like mobile communications, the majority of people across all age groups have not only adopted mobile technology, they’ve melded with it.
Joseph Kim, MD, MPH
So the question for physicians and hospitals is not whether to adopt e-visits and mobile technology, but how to use them most effectively.
We co-hosted a webinar on the topic recently, in which we looked at mobile technology from the perspective of patients and caregivers. Both sets of stakeholders have a shared need: simplicity and ease of use. Merely making an application or function mobile isn’t enough. How mobility is integrated and used makes a big difference in the value derived.
During the webinar, we polled attendees on which mobility trends will have the biggest impact in the coming year:
47 percent think a greater use of digital communication between patients and healthcare providers will have the biggest impact.
5 percent voted for Telehealth replacing more in-person visits with healthcare providers
While 14.7 percent see increased use of medical-grade disease management mobile apps and growing adoption of health/fitness wearable devices and apps by consumers.
Improved quality and continuity of care (42 percent)
Time efficiency (41 percent)
Improved communications with patients (37 percent)
Cost efficiency (23 percent)
Patient demand (22 percent)
We think those answers underplay the importance of patient demand and leave off a very important driver of mobile technology: widespread payer adoption of reimbursement for telehealth visits.
If you’ve ever watched a person go through the first stages of coping with type 2 diabetes – and with the disease at epidemic levels, many of us have a close friend or relative with the disease – you’ve seen them struggle to put into practice all the information, advice and strategies they are given.
This is true of most people with newly diagnosed chronic diseases, not just diabetes. To avoid complications, and the huge costs in both suffering and money that come with them, they have to learn a new way of living. Medication and other treatments can’t take the place of lifestyle changes. And despite their best efforts, many people are defeated by the challenge.
We now spend 70 percent of our healthcare dollars on chronic disease care, much of it to treat complications that lifestyle changes could avert. All that money isn’t really helping. People continue to suffer and to lose years of productive life. If we could find a way to help these people improve their health, we could dramatically reduce both suffering and costs.
Chronic disease patients need tech support
One thing we’ve learned here at Dell is that in helping hospitals implement an electronic health record (EMR), at-the-elbow tech support makes a big difference. And learning to use a new EMR has many of the same challenges as learning to live with diabetes.
To go live with a new EMR, doctors and nurses have to learn a new way of working. It’s more than just a software change. It’s changing everyday habits that have kept the operation running for years. That’s why it is crucial to have someone to guide the caregivers through the first days and weeks. The right support lowers users’ frustration, increases their confidence and makes the difference between a quick, smooth transition and a drawn-out, rocky transition.
That kind of tech support could also help patients with diabetes and other chronic diseases learn a new set of habits. For diabetics, even a simple thing like breakfast can be a challenge. If you can’t pick up your usual donut, what’s the alternative? Friendships can be harder. “No, sorry, I can’t go to happy hour for chips and a margarita,” isn’t what your friends want to hear. Add in blood sugar checks, medication and a new exercise routine, and it can be overwhelming. None of it is fun, and all of it distances you from friends and daily comforts.
Diabetes education classes can help, just as training classes for doctors and nurses can help them learn a new EMR. But patients also need the same at-the-elbow tech support for their new life that caregivers need for their new EMR. They need a knowledgeable, friendly healthcare tech support agent who can suggest a happy hour walk with your friends or what to drink instead of a sugar-loaded margarita. Or tell you about a healthy breakfast sandwich that is right on your way to work. Or how to tell your mom that you won’t be eating her famous pancakes at Sunday brunch. Someone to boost your confidence and make you feel like you can succeed at this new life.
New technology makes at-the-elbow support possible for patients
Sadly, most of patients are pretty much on their own. The result is confusion, loss of confidence and a sense that it is all just too hard. And that means expensive complications and more suffering.
The good news is that new telehealth technology can bring at-the-elbow support to patients at home, at a price that is affordable. While support can’t be literally at a patient’s elbow, secure video conferencing can give patients access to doctors, nurses and health coaches who can answer questions, give advice on medications, food, exercise and how to lose the unhealthy foods without losing the relationships that are tied to them. And most patients already have the technology needed – a smartphone, tablet or computer.
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
Elevator pitch
Serving the healthcare and life sciences industry gives us a strong appreciation for the resource dedication and demanding processes that result in life-saving innovations. We understand that IT is critical in its function to accelerate research and development. That’s why we’re committed to simplifying IT and optimizing the entire enterprise. We provide customers with comprehensive technology and support solutions that help increase productivity while streamlining compliance readiness and improving communication throughout the care continuum. Our ultimate goal is to ensure that IT is improving patient care.
Founder’s story
As a pre-med student at age 19, Michael Dell founded PC’s Limited with $1,000 and a game changing vision for how technology should be designed, manufactured and sold. After just four years, Dell completed its initial public offering in 1988, raising $30 million and increasing market capitalization from $1,000 to $85 million. Dell’s commitment to the healthcare industry is exemplified by his ongoing efforts to improve the efficiency and quality of care today. Speaking at the Health Evolution Partners Leadership Summit in 2011, he encouraged healthcare organizations to expedite adoption of electronic medical records (EMRs) and cloud computing to create new information-driven efficiency and care advantages. “Digitizing patient information and making it available in a secure and convenient way across our healthcare system are among the best opportunities we have to improve U.S. healthcare and create a better system for future generations of Americans,” Dell said. Dr. Cliff Bleustein, chief medical officer, supports the company’s strategic initiative to revolutionize the way healthcare is managed with patient-specific data that spans the entire continuum of care and leads to better outcomes. Dell Healthcare & Life Sciences’ focuses on improvement of quality, patient safety and efficiency starts at the intersection of information and technology.
Market opportunity
When healthcare is information-driven, data is interconnected and available when and where it is needed to save lives. Data becomes knowledge and moves healthcare beyond episodic care to preventative, precision medicine. And data ultimately allows patients to take control of their own health. Dell’s four-part information-driven healthcare approach is a reflection of our commitment and expertise:
Guest post by Mitchell Goldburgh, cloud clinical archive product manager, Dell.
Stage 2 meaningful use criteria require providers to make diagnostic reports and associated images accessible through a certified electronic health record. That presents a difficult hurdle for many hospitals, especially community hospitals that are not connected to a large health system. And with the plethora of EHRs in use across healthcare, the task may be difficult for some multi-hospital systems.
This is a watershed moment for many imaging practices, and Stage 2 requirements may be the factor that sends most imaging files to a vendor-neutral archive (VNA).
Knowing that Stage 2 will require facilities to integrate their medical images with EHRs, the best VNA providers have in place automated tools that can integrate these files with all of the major EHRs and with many of the smaller EHR vendors. The value of a VNA comes from local and remote content brought to EHRs with a consistent presentation of results and images at the point of clinical care. VNA solutions offer a global viewer with a common toolset to navigate documents and imaging content, thus simplifying the access and freeing users from the need to learn multiple application navigations.
As technology in imaging increases the complexity of data, the presentation of information consistently for non-imaging specialists within the accountable care group becomes crucial to “customer” satisfaction with the imaging services. But VNA software is only a part of the solution – an integrated model that simplifies delivery of content can best be achieved with a service delivery model enabled with cloud content management.
Archiving-as-a-serviceis the model for the future
So what does this model entail? A good vendor-neutral archiving solution enters the scenario once a clinical exam is reported. At that point, the job of the PACS is done. The exam file is transmitted to an on-site server (supported by your archiving service provider) that transforms it into a vendor-neutral format. Current files are stored on site for fast access and also uploaded to a secure cloud platform. At this point content notification occurs, informing external systems that the report and clinical imaging data are available. In this model clinicians can view content anywhere, from any device, either as a stand-alone application from the VNA or through the web-enabled EHR accessing the VNA.
Dell unveils findings from its first Global Technology Adoption Index (GTAI), uncovering how organizations truly using security, cloud, mobility and big data to drive success. The market research surveyed more than 2,000 global organizations and found that security is the biggest concern in adopting cloud, mobility and big data. Furthermore, while 97 percent of organizations surveyed use or plan to use cloud and nearly half have implemented a mobility strategy, big data adoption is trailing as approximately 60 percent of organizations surveyed do not know how to gain its insights.
“We know that security, cloud, mobility and big data are the top IT priorities in all industries, but we need a deeper understanding of the practical realities of how companies are using these technologies today and what, if anything, is preventing them from unleashing their full potential,” said Karen Quintos, chief marketing officer, Dell. “This research cuts through the hype and provides a clearer roadmap for how Dell can enable our customers to thrive.”
“Despite mounting security risks and increased reliance on the Internet and technology to run their businesses, many small and midsize organizations are underprepared to deal with today’s security threats, let alone those of the future,” said Laurie McCabe, partner, SMB Group. “These companies know that disruptive technologies like cloud, mobility and big data can drive innovation and create competitive advantage. But it’s often difficult for them to take a strategic approach and overcome security concerns in order to fully harness the potential.”
Security Concerns Are Creating Big Barriers The Dell GTAI found that IT decision-makers still consider security the biggest barrier for expanding mobility technologies (44 percent), using cloud computing (52 percent) and leveraging big data (35 percent). While security concerns are holding organizations back from further investing in major technologies, a lack of readily available security information is similarly preventing organizations from being prepared during a security breach. Only 30 percent of respondents said they have the right information available to make risk-based decisions, and only one in four organizations surveyed actually has a plan in place for all types of security breaches.
The security barrier becomes even more serious as the C-suite becomes less engaged. Only 28 percent of organizations polled have a C-suite mindset that is fully engaged with security initiatives. However, in organizations where executive leadership is involved in security, confidence is markedly increased. Among organizations that are very confident in their security, 84 percent of senior leaders are fully or somewhat engaged, compared to only 43 percent of senior leaders at organizations who are not confident in their security.
Other significant Dell GTAI security findings include:
Guest post by Cliff Bleustein, M.D., M.B.A., chief medical officer, Dell Services.
For decades, reimbursement for the time spent coordinating care and keeping people healthy has been mostly non-existent. But the tide is turning, as government and private payers see that coordinated care and the time spent keeping people healthy can lower the amount of money they spend treating illness.
Primary care physicians are even seeing higher reimbursements in some areas. For example, beginning in 2011, CareFirst BlueCross BlueShield, the largest insurer in the Washington, D.C., area, substantially raised reimbursement rates for general internists and family practitioners who adopted the medical home model, which emphasizes care coordination. They also rewarded them with significant bonuses if they met quality standards and reduced costs. They also provided the physicians with round-the-clock nursing assistance to help with their sickest and riskiest patients.
CareFirst CEO Chet Burrell said in news reports that the program is saving “hundreds of millions of dollars in accumulated, avoided costs.”
Government payers are also reaping benefits from coordinated care, including Medicaid, Medicare and the Veteran’s Administration.
That’s good news for everyone. Coordinated care requires an upfront-investment in people and technology that is often beyond the resources of a primary care practice, but it is far less expensive than the business-as-usual, uncoordinated care that has seen costs rise at double the rate of inflation for most of the past two decades. If public and private health plans make that upfront investment, paying for the time and the needed resources, they can reap the financial benefits while patients reap the benefit of better health.
Consumer health technology is attracting a lot of supporters on the business and medical ends of the spectrum because some of the more recent advances in this area are making it possible for people to be more proactive about their own health and initiate preventive measures. Awareness is a major component of effective prevention, and when consumers have the ability to discover any potential problems before they get out of hand, it can potentially save them a lot of money and improve their overall health status.
The question, then, is how companies can empower consumers to take responsibility for their own health through accurate and convenient information.
The resources that are scattered around the Internet would seem like the most obvious choice, but the problem there is that a consumer can just as easily base his or her decision on the large amount of misinformation that is circulating in and around the data that could really help them understand their condition.
A patient won’t prevent a thing if they misdiagnose their own problems. Even then, simply determining the potential problem doesn’t automatically suggest the appropriate answer or treatment. There have, however, been some technological advances that can address these concerns.
Making Reliable Technology Available
If the Internet isn’t the most reliable source, then, what other options are available? How can consumers find the best information and make sure they get an accurate diagnosis without actually going to the doctor?
Serving the healthcare and life sciences industry gives us a strong appreciation for the resource dedication and demanding processes that result in life-saving innovations. We understand that IT is critical in its function to accelerate research and development. That’s why we’re committed to simplifying IT and optimizing the entire enterprise. We provide customers with comprehensive technology and support solutions that help increase productivity while streamlining compliance readiness and improving communication throughout the care continuum. Our ultimate goal is to ensure that IT is improving patient care.
