By Poornima Venkatesan, senior consultant, Virtusa.
In today’s value-based care environment, patient engagement is a vital key to success in clinical outcomes. This is especially true for chronic diseases such as arthritis, where continuous care is necessary because of the disease’s physical, emotional and economic impact on patients. Although the advent of specialty drugs in the past decade has made disease control possible, clinicians still face challenges in patient care because patients’ preferences about therapy aren’t often considered.
Understanding patient goals and expectations
While a clinician’s goal is to achieve remission, a patient’s goal could be clinical or nonclinical and varies depending on their individual characteristics and demographics.
Patients from low-income countries such as Morocco expect access to primary care (never mind rheumatologists), support services and education about the disease. The high expenses related to rheumatoid arthritis (RA) in such countries result in poor treatment compliance, school absenteeism in children and deterioration in quality of life. Comparatively, even with excellent health insurance systems in the United States, one in six adults with RA reduce their medication use because of high out-of-pocket costs. Most patients expect cost-effective care. In wealthier countries like the United Kingdom, patients expect increased social connectedness and family support.
Elderly patients expect reduced pain, fatigue and side effects, whereas young adults expect independence and normalcy from their treatments. Women, who are most affected by RA, might expect a lesser impact on family life and childrearing.
If such multidimensional expectations are not met, patients tend to discontinue their treatment. As new biologics and non-biological complex drugs (NBCDs) are developed, patient adherence is essential in determining both therapeutic and potential adverse effects. Studies reveal that frustration towards the method of drug administration (like self-injection) also impacts adherence. In the U.S alone, the total cost of non-adherence is estimated between $100 billion and $289 billion annually.
Therefore, it is important for the patient and the physician to trust each other and have open discussions about treatment strategies and expectations to ensure better alignment and cooperation.
Measuring patient engagement
The first step towards patient engagement is awareness of their current engagement levels. The patient activation measure (PAM) tool is helpful here. PAM measures the attitude and knowledge of patients about the disease and treatments. Studies have proven that highly activated patients have better outcomes via increased medication adherence, resulting in lower healthcare costs through fewer ED visits, hospital admissions and re-admissions. By continuously monitoring activation levels, providers can measure sustained changes in patient behavior and personalize their care programs.
We can also measure engagement levels by taking advantage of data. Data derived from direct [electronic health records (EHR), claims] and indirect sources (wearables) provide a holistic view of an individual patient. Simple analytics applied to population data can predict patient behavior. For example, analytics can help providers know which patients are likely to miss their appointments, which patients will fill their prescriptions on time, and so on. Detailed patient-based data could also lead to better and more accurate diagnoses and treatments.
Digitalization is inevitable: Technology and healthcare are becoming more inextricably linked as new innovations and discoveries are made. Many health-related devices and services have been created in recent years with the express purpose of improving everyone’s quality of life. As a result, many international healthcare companies, like Now Health International, are now implementing innovative digital solutions to deliver better healthcare services.
Recently, broad steps are being made in the field of preventive medicine – below are some of the top digital solutions for preventive healthcare.
By now, just about everybody wears a fitness tracker or a smartwatch, or owns a smartphone. The ability to count steps to measure one’s activity level is a great start, and is only the beginning. Vital signs data can now be collected by devices we have on us, which can then be automatically analyzed and sent to your healthcare provider in order to provide crucial information as to your state of wellness.
You can also be alerted to the amount of calories you’ve consumed, reminded to go for a walk or do some stretching exercises, or even take a short break. Sleep monitoring apps collect data while you doze and provide you with helpful information on how much rest you were able to get on any specific night.
With remote monitoring, the need to go to a clinic appointment can be greatly reduced as well. Even big companies like Apple are working on a way to determine blood sugar levels in a non-invasive way, which can change the lives of millions of people suffering from diabetes.
Traditionally, health agencies rely on doctors, patient surveys, labs and research studies to collect information on pathogens and outbreaks of diseases. In the event of a serious outbreak, early reporting and progression tracking is critical to getting treatments out quickly and effectively, as well as preventing its spread. Digitalization is changing the way we respond to infectious disease outbreaks with portable genome sequencing as well as epidemiological surveillance and remote monitoring.
Disease Outbreak Prediction
Computers are helping health care professionals in the field calculate how fast a disease can spread, how many people will be affected, and determine which patients should receive priority care. The epidemiological web platform BioCaster mines text from social media platforms, blogs, and news sites to gather information on a specified area that may be a hot spot for an outbreak. There is also the option of receiving warning alerts via text or email to help users keep themselves safe.
We put a lot of faith in health technology: to make us better, to save our systems, to revolutionize healthcare. We may be looking at it from the wrong side entirely.
The social determinants of health matter more than our ability to deploy doctors or provide insurance; physical and mental, health is always more social than clinical.
But most of our health tech that is supposed to be revolutionary is aimed at clinical factors, rather than the social determinants of health. Yes, telehealth can increase reach, but it is still just a matter of touchpoints, not a fundamental change to the lifestyles and cultures that determine health.
Same with all our EHR systems creating more ways to record information, more ways to quantify patients, to put more emphasis on engagement and quality-based reimbursement. Even genomics and personalized medicine are taking a backseat to soliciting reviews and trying to turn the patient experience into a number. It all puts greater focus on the clinical encounters, on how patients “feel” broadly about each minute aspect of their time in the medical facility.
A Digital Disease
As politicians trade blows on minimum wages and the ACA, the likelihood grows that insurance benefits and livable incomes (and lifestyles) will get pushed further out of reach for more people.
Modern work is tech-centric, which means lots of sitting, and manages to facilitate increased snacking without being particularly physical, a double-whammy that prevents employment or higher incomes from leading to healthier choices. For the less-skilled, normally accessible jobs are in the sights of automation and disruption. While tech is taking over medicine and opening up new possibilities, it is also transforming the labor market and closing countless doors to workers.
By extension, technology is changing the social framework that determines public health. Income inequality is growing, wage growth is stagnant, and no amount of awareness can change these front-of-mind concerns for people who may well want to eat better and exercise more, or even commit to seeing the doctor more often and following his or her advice to the letter.
Poor people can’t necessarily eat better as a simple matter of choice or doctor’s orders. Planning meals and purchasing healthful foods is a tax on limited resources–time as well as money. Working three jobs to pay the bills, many lower income individuals also don’t necessarily have time to exercise. And more likely than not, those working even high-paying jobs are sitting all day, sapping their bodies of energy and resilience, undoing the good of their intentions and smart devices alike through attrition.
Mobile technology is impacting every element of American healthcare–from insurance and billing to documentation and caregiving, the impacts are being felt. The truly transformative element of the mobile revolution is not the technology itself, or the way it changes the look and feel of the tasks it affects. Despite complaints of the depersonalizing effect of technology, the ultimate value of mobile in the sector will be how it enhances and encourages communication.
Providers are Going Mobile
Already, flexibility and functionality have already drawn providers to mobile devices and solutions. Voice-to-text technology and similar automated solutions are in the offing to relieve the documentation burden that has dampered some amount of enthusiasm toward digitization. Bolstered by these advancements, caregivers will go from subjects of their EHRs to masters of patient encounters.
One of the huge benefits of mobility — as opposed to simply being networked on desktop computers or having a digital health records solution — is the capacity for greater native customization and app development. Native apps are like the currency of the mobile, smart device world providers are entering. Developers can deliver personal, branded interfaces that allow doctors to choose precisely how they want their dashboards to look, giving their EHRs a custom touch that has been sorely lacking throughout their implementation.
App-centric development will further reduce the friction of adoption and utilization, giving doctors a sense of empowerment and investment, rather than the bland inertia that has carried digitization thus far.
The personalization of the technology through app development will help boost adoption, and return the focus to what the technology enables, rather than how it looks or what it has replaced. Mobile technology’s strength will be in reconnecting doctors and patients, and creating bridges of data and communication across the continuum of care.
Patients are Going Mobile
Patient-facing health apps and mobile point of access to care combine convenience and cost-saving with a learning curve. Increasing the visibility of EHRs through mobile portals gives patients greater reason to develop some basic health literacy, and levels the playing field during doctor encounters. The more providers use mobile solutions, the more incentive patients will have to do the same.
When apps are connected to prescription management and can monitor adherence to treatment plans, mobile devices provide a two-way mirror enabling doctor and patient to remain connected long after the encounter is over. This can allow providers to better anticipate and intervene where drug abuse is at risk, as well as to prevent ED admissions and re-admissions beyond what telehealth has been able to achieve.
Even without connecting providers, mobile health apps will also support personal health management, with an eye to prevention as well as education. From diet-planning to workout tracking and even disease management, patients have more ways than ever to study their bodies and better understand their unique wellness needs. As providers and their EHRs evolve to integrate mobile patient-generated data, the potential for customization will make each encounter more conversation-driven, using data as a platform to educate, engage, and advance communication.
All these personal, data-rich conversations will help push prevention and population health into front of mind for a generation.
The impact of the digital revolution is widespread, but arguably few industries have felt the impact more than the health informatics field. From medical mobile applications to vital-monitoring wearables, smart technology is taking the health care world by storm and remodeling patient care delivery.
Over the years, health informatics has strengthened provider-patient relationships and empowered patients to take control of their health care. But that’s just the beginning. Here’s a look at how health informatics will take shape in 2017 and continue to be one of the most promising fields for STEM careers.
Improving Patient and Hospital Information Security
Cybersecurity is top of mind for health care specialists as the world grows increasingly reliant on technology. From large retail chains to voting polls, cybersecurity breaches are on the rise. And hospitals are no exception. Earlier this year, a hospital in Kansas reported a cyber attack in which the hackers forced the hospital to pay a ransom in exchange for unfreezing their data.
Understandably, hospitals are desperately seeking new ways to improve the security of their data. Hospitals are addressing vulnerabilities by making security a part of their existing governance, risk management and business development initiatives. By building more secure network infrastructures and educating all staff, hospitals are able to better protect their information in the short term. In the longer term, it will come down to hiring more security specialists to identify and correct security threats. This is why the cybersecurity field is taking off and more individuals are earning cyber security degrees to gain entry into the field.
Decreasing Healthcare Costs in the Long Run
Before things get better, they tend to get worse—and that seems to be the case with healthcare costs. At first, the cost of health care will rise as hospitals and physicians’ offices purchase and implement new systems. But once the upfront cost has been covered, these new systems and machines will decrease operational costs for hospitals by simplifying daily processes.
On the other hand, individuals seeking health care will see the long term benefit thanks to the increased efficiency of electronic health records (EHRs). Since EHRs provide a comprehensive overview of health history, it will become easier to identify potential health risks and administer treatments early on with fewer doctor visits. Early detection and diagnosis is key to lowering health care costs and, ideally, making us a healthier population.
Most people are familiar with wearable technology today and how they track information related to health and fitness of the wearer or the person engaging with it. One in five American’s now owns a wearable tech device. The focus on wearable tech is on for both the consumer as well as the health care providers and the health insurance industry.
Susan Hahn-Reizner, who is on the advisory board of Northwestern School of Professional Studies, has put together a comprehensive infographic that looks at how wearable technology is changing the healthcare services industry.
The Current State of Wearables
The use of wearable tech is still in its infancy; however, users are starting to weigh in on both the benefits of wearable technology as well as the unmet expectations that come with it.
The most popular wearable devices in the market are fitness bands and smart watches. On the consumer side of wearable tech, 56 percent of consumers believe the average life expectancy increases at least 10 years because of wearables monitoring vital signs. Forty-six percent of consumers also believe wearable technology can help them to lose weight and maintain a more active lifestyle.
On the flip side there are many unmet expectations that come with wearable technology. Abandonment is a big issue with wearable technology with more than 33 percent of wearable device consumers using the device less or not at all after a year of purchase the device. Another big issue for consumers is privacy and security breaches that come with this technology. Eight-two percent of consumers have concerns because of invasion of privacy and another 86 percent worry that wearables make them more vulnerable to security breaches.
How Health Insurance Companies Are Pushing Wearable Technology to Consumers
The health insurance company Humana began using wearables to reward fitness activities with reduced premiums, gift cards and health devices. A three-year study of employees who participated in this program showed a 44 percent decrease in the number of sick days taken.
BP distributed 16,000 FitBits to its employees as part of a larger healthcare plan for its workforce. This helped to drop corporate healthcare costs well below the national growth rate. Over the course of 25 years, it’s estimated that wearable technology and remote patient monitoring technologies could help to cut hospital costs and save more than $200 billion. As you can see wearables can help to put a huge dent in cutting healthcare costs.
Guest post by Mark Ott, vice president of product, RoundingWell.
As 2016 unfolds, the move from fee-for-service to value-based care is entering a more advanced stage. As the process evolves, priorities for healthcare providers of resources, teams and tools becomes more convoluted. To keep on track, both for healthcare organizations and CMS changes, providers should keep in mind the following:
The care management/coordination record rises in importance, especially as team-based care models expand
Some call it a care management medical record and others call it a care coordination record. Regardless of the term, the concept is essentially the same. EHRs are basically encounter management systems, but as care expands beyond the in-person encounter, capturing and tracking what happens between patient visits will be of utmost importance. In addition, enabling care teams to stay on the same page about a patient’s care plan, track action steps, and reduce the friction of working together will be crucial to succeeding in a value-based world. Expect to see the Care Management Record concept start catching fire in 2016.
Demand will increase for consumer-grade user experiences in healthcare enterprise software
For so long, clinicians on the frontlines of care delivery have had to struggle with software that’s hard to use, difficult and downright frustrating. The biggest culprit for poor user experiences in healthcare software has to do with the enterprise purchasing process. Vendors build for buyers, like the C-suite, who aren’t also the end users. If the end user and the buyer were the same, you’d see healthcare software vendors value user experience like what we see in other B2B industries, not to mention B2C industries. Regardless, in 2016 we will see more buyers value products with consumer-grade user experiences. Much of this has to do with end users’ reluctance and sometimes outright resistance to adopting technology in their worklife. Clinicians often get a bad wrap for being technology averse. But in reality, it’s not that they’re averse to technology; it’s that they’re averse to bad technology.
Integrating wearables and their data into care delivery processes will remain a niche activity
The enthusiasm around wearables, trackers and remote monitoring is exciting and there is enormous potential for device data to impact the delivery of care in ways that benefit both patient and provider. But the technology hasn’t caught up with the promise of what they can be, and that won’t change in 2016. Not only is the technology not yet able to deliver, but the incentives and processes to support wide-scale deployment are not in place yet. Though all signs point to wearables becoming an integral part of delivery of care, this won’t happen next year.
Guest post by Cathy Reisenwitz, content specialist, Capterra.
Every year at Capterra we predict the top trends in business technology. Last year we predicted gamification, wearables, telemedicine, mobile medicine, and 3D printing would be the top 5 medical technology trends for 2015.
This year, we expect wearables, telemedicine, and mobile medicine to continue to advance. They’ll be joined by cloud computing, patient portals, and big data.
Telemedicine has come a long way, from remote villagers using bicycle pedal-powered, two-way radios to communicate with the Royal Flying Doctor Service of Australia to helping recovering stroke patients in rural Minnesota avoid hours-long (and often snowy) drives for follow-up care.
As the technology has improved, the investment has increased. Transparency Market Research valued the global video telemedicine market at $559 million in 2013. Today, they predict it will grow to $1.6 billion by the end of 2020. Walgreens, the largest U.S. drugstore chain, and telehealth provider MDLive recently expanded their virtual care collaboration to 20 more states in November, bringing the total to 25.
Telemedicine offers tons of value to a large, growing segment of the population: seniors. Telemedicine improves care by getting it to remote patients who live far from hospitals. It also enables homebound patients to get high-quality care. It makes care cheaper, and allows seniors to stay at home longer. It benefits providers by making their jobs more flexible. And it also eliminates picking up new illnesses in a clinical care setting.
In rural Minnesota, nurses check motor skills by asking patients to push, pull and squeeze with their hands and feet. A doctor, located further away from patients, can advise on care onscreen.
Going back to wearables, their mass adoption has made store-and-forward telemedicine much easier. Devices like Fitbits automatically collect valuable health data. Store-and-forward telemedicine just means that data goes to a doctor or medical specialist so they can assess it when they have time. Watch for more EHRs learning to connect with wearables in 2016.
More EHRs will provide patient portals
Patient portals grew in popularity in 2014 and 2015. Twenty-six percent more patients received lab tests via an EHR patient portal between 2013 and 2014. Patients also received 50% more health and disease education through their portals in that time. “Patient engagement through health technology such as patient portals is rapidly increasing,” Craig Kemp, leader of innovative partnerships for Merck Vaccines, told mmm-online.com.
While about half of physicians offer patient portals right now, almost another fifth of them plan to offer one in the next 12 months. In a 2015 survey of more than 11,000 patients, 237 physicians, and nine payer organizations representing 47 million lives, almost a third of patients said they were interested in using a patient portal to engage with their physician, track their medical history, and receive educational materials and patient support. However, almost 40 percent said they’d never heard of a patient portal.
Educating patients on how and why to use portals will be key to getting them to use them in 2016.
This article is part of the “Think Further” series sponsored by Fred Alger Management. For more “Think Further” content, please visit www.thinkfurtheralger.com.
There is almost nothing I’m certain of except that life is an uncertain thing and that it seems to change a lot. Even in the most predictable of settings, even the minutest changes in detail can have a lasting and overwhelming effect on nearly everything in its atmosphere. In healthcare, a space seemingly immune to the status quo, things seem to get a whole lot more complicated. The same can be said of life and death, health and well-being. On their own, they are not so difficult to understand and often, in most cases, predictable and redundant; until the final days, of course, then things begin to get a little more complicated. When we’re fine, we’re fine. Life is good and most of our concerns seem trivial.
Then health gets involved and the minutest change in detail can send our lives in a spiral so much so that we barely recognize our place in it let alone who we are and where we belong. When such an occurrence arises, we begin to rely on beeps and buttons, software and technology in ways never before imagined for the intersection of our lives.
Clearly, the health IT landscape will be completely different five years from now. From where we stand today to where we’re headed, we’ll likely look back on this moment and wonder how we survived such archaic times. Just a couple years removed from the age of the electronic health records, technology that already seems dated and antiquated, is no longer monolithic and domineering to the space as it likely seemed in 2010.
Our future selves might stand on the threshold of 2020 and say that we were being single minded. The technology — EHRs were supposed to save healthcare and are now nothing but foundational. The technology was supposed to simply aggregate information collection, provide for the ability to quickly share information system wide and around the world; and give us the capability accessing all of a patient’s information at the tips of the proverbial finger.
When the promise of those solutions faded (yes, their stars have faded) and as our attention forced us into new technologies (primarily because of consumers’ desire) we are now seeing developments in technology creating touch points that impact patients “where they live” and has become the new force behind healthcare technology.
Consumers will drive healthcare’s future. Probably not a secret at this point, but a point that is hard for the old guard. They’ve had enough of being left out of the ownership process regarding their own health. They’re tired of being locked out of their own records, and kept access to their own information. Such data would not exist without those helping produce it. New consumer technologies have and will further level the field. Consumer tech will continue to spur innovation, at light speeds. Data will flow between healthcare parties and its consumers; HIPAA protections will be waived and open access for the social good will become the norm. Standard and traditional approaches when dealing with patients, in a generation or so, will be completely different and far less segmented, as they are now.
Guest post by Will Hayles, technical writer and blogger, Outscale.
Last year, 2014, was the year the wearables market really took off. No end of wearable technologies were released, each promising to hook users into the personal analytics and quantified self trends. Of course, many of those releases went nowhere, and even some of the big companies saw their wearable devices fizzle rather than pop — the obvious example being Google Glass, which received an unprecedented amount of attention, much of which was negative. But there were many successes, and later this year Apple will be entering the fray with the Apple Watch and its bundle of sensors.
Last year the wearables industry was worth around $2.8 billion. Over the next five years it’s expected be to worth more than $8.3 billion. But there is a market with the potential to dwarf the consumer fitness monitoring market, and that’s chronic illness management, which has, unfortunately, if understandably, seen far less attention from startups. As J.C. Herz notes in a Wired article on the subject, the entire market for fitness trackers is vastly outstripped by the size of the market for blood glucose test strips, which are an essential tool in the monitoring of diabetes.
Herz takes a harsh tone with an industry that has failed to focus research and development on solutions for people who stand to benefit the most, but I’m more optimistic. Healthcare outside of the fitness sphere is a difficult market, with a heavy — and necessary — regulatory burden and entrenched ideas about treatment and patient monitoring. Unity Stoakes, co-founder of StartUp Health, recognizes both the challenges and the potential for innovation that can significantly improve people’s lives:
“Unlike other industries, healthcare is plagued by regulation and longer product development timelines. Bringing successful products to market is challenging for both large industry players and digital health entrepreneurs. Startups need access to advisors, peers and dollars, while large companies need ‘batteries included’ entrepreneurs fueling innovation. The unprecedented level of change gripping the healthcare industry today presents both challenges and opportunities for both.”
There is recognition both within the healthcare industry and among technology companies that monitoring tools and other applications of wearable and mobile technology offer an opportunity to substantially change healthcare and the lives of people who suffer with chronic illnesses.
According to a recent study from the Health Research Industry, 42 percent of healthcare providers are comfortable relying on at-home test results for prescriptions. Sixty-six percent thought mobile solutions have the potential to help with the management of chronic diseases. And as we’ve discussed on this blog several times before, mobile technology and wearables are helping caregivers better collaborate and coordinate care.