   |
| See Site Index by Topic |
 |
|
| CENTRAL home | REPORT home | About/Contact Us | Subscribe | Index by Topic |
|
|
|
|
||||
|
||||||
|
Transforming Disease Care Into Health Care: Can Broadband Help?We've talked for years about applying broadband in ways that help make people's lives better. At the recent Healthcare Unbound Conference in Boston, hearing about how broadband contributes to keeping people alive and functioning longer and better was pretty exciting stuff. Speakers included those on the front lines of health care, who have conducted studies about how broadband, along with several other key technologies, is producing measurable results.
The title of the conference derives from a study by Forrester in 2002. Its basic premise is that we can improve access to, the quality of and the cost effectiveness of healthcare by moving it away from institutions and doctor's offices and into wherever people live and work. Telemedicine is a related term and concept. One succinct definition of healthcare unbound is "technology in, on, and around the body that frees care from formal institutions". Framing the Problem: It's More Than Technology We suspect that many of our readers who have dealt with the US healthcare system for themselves or their aging relatives have come away, as we did, shaking our heads. It's tragic but true that the US spends so much money on "healthcare," has such great technologies that could be applied, and yet has so fundamentally broken a system--see a recent Washington Post article on this. A line we heard repeatedly at the conference is that ours is not really a "healthcare" system, but rather a "sickness care" system.
He described healthcare as being in the early stages of a sea change, during which the human body will become the focus of technology applications for the next decade. The raw ingredients are mostly in place. These include pervasive computing, non-invasive measurements and communications technologies to create the "body area network" or BAN. Those familiar with the hierarchy of networking, starting from the wide area and working toward the person, will understand this is the next step in the logical progression from wide area network (WAN) to metropolitan area network (MAN) to local area network (LAN) to personal area network (PAN).
Technology still has some challenges in getting to really "usable technologies", which Dr. Kvedar defined as reliable, "wear and forget" (fully integrated so there is no user interface) and disposable. Other speakers noted that at least two more things would have to change to make healthcare unbound a reality. First, people need to learn how to do things differently--and people's behavior does not change easily. Second, the economics for a sustainable economic model need to look at the total costs of patient care--not just looking in "silos" as many health organizations do now. For example, the ROI of homecare taken by itself may not look that good, but if you count the cost savings from reducing emergency room visits and hospital readmissions, the ROI looks great. The talk by Drs. Moore and Woodbridge (see below) clearly illustrated this point.
He pointed out that new technology products and services can negate these equations:
Case Studies Dr. Kvedar observed that a study of his own organization's healthcare costs showed that 3% of the patients account for 40% of the costs and 1/2% account for 20%; this is similar to what other organizations have found. Kuraitis and others focused on the understanding that if you can determine which diseases and chronic conditions account for most of the illness, disability and cost, there is a logical path to attacking the problem: identify which value propositions most effectively address them, which technologies we need to create those value propositions, and which environments they work in. This is the path that much of today's work is focused on. Several of the case studies showed credible and convincing outcomes focused on leading diseases and conditions. Let's look at three to see what actually happened. Diabetes The essence of a talk by Dr. Larry Gottlieb, Chief Medical Officer of Intermed Advisors was the need to transform the management of chronic diseases such as diabetes from "episodic" (providing treatment when something goes wrong or happens to get caught) to "continuous". The work he reported on involved people with diabetes and was done in conjunction with Joslin Diabetes Center in Boston. The statistics indicate that there were 15 million people in the US with diabetes (in 2002) and 177 million worldwide (in 2000). His technique involves the use of home monitoring devices (for diabetes it includes measuring blood pressure, glucose, oxygen saturation and weight) and the automatic transmission of biometric data from those devices to physicians and care managers. A key in this work has been sophisticated mathematical time-series analysis to characterize each patient's individual pattern. The mathematics plus the continuous monitoring can quickly and accurately discover trends by looking at the stability of results and the variance. The key is to decrease the cycle time between evaluations and interventions and use the information to make behavioral changes which prevent future adverse events. The second part of making such a program successful is to make it self-care oriented. Intermed has developed a simple personal interface using a Web pad, or a PC for users who already have one and are comfortable with it. A "virtual nurse" provides frequent positive feedback to the subject--in the form of a human sounding voice, pictures and animation, and simple progress charts to encourage improvements and make suggestions. The keys to the success of this program are that it is frequent, personalized, self-care oriented and affordable. The subjects generally see participation as an excellent way to avoid the complications of diabetes which can include stroke, eye disease and amputations. Chronic Heart Failure
Veterans Administration A third study was described by Doctors Randall Moore of American Telecare and Peter Woodbridge of the Roudebush Veterans Affairs Medical Center. It involved care coordination and telehealth for the US Veterans Administration (VA). Although US Veterans Hospitals were at one time at the trailing edge of technology and innovation, they are currently a bright example of its success. By re-engineering their clinical and operational processes, and employing video (systems and phones) plus monitoring and messaging devices, they saw improvement in diabetic control and chronic heart failure.
"Smart Homes and Smart Phones" Connecting Consumers To Create Healthcare Unbound We spoke in a post-conference workshop moderated by Michael Barrett of Critical Mass Consulting that also included presenters from the University of Virginia Health Sciences Center, MIT and Qualcomm. Our only concern about speaking in this session was its title, which talked about "smart homes"--a phrase we generally try to avoid. Steven Intille, Technology Director of Changing Places/House_n at MIT was on the same wavelength, saying in his talk that there is no such thing as a "smart home", only "smarter people" who are properly enabled. Stephen's talk focused on the difference between teaching and controlling. He believes that technologies that people will appreciate are those which are fundamentally useful and/or provide the user with lots of benefits. He distinguished between four levels at which technology might operate in a home setting:
Stephen is testing his premise in an electronically-mediated house at MIT, where volunteer subjects move in for a 10 day stay. The idea behind what happens in the house is that user empowerment is very important. This is quite different than the "smart" home which acts automatically. We hope to see the outcomes of these studies to understand the results and implications. We wonder if the application of this theory may be quite appropriate in some circumstances--such as diabetes control--and inappropriate in others--such as dementia care.
Our talk focused on the broadband home and how healthcare ready it is. We described the infrastructure—-to and in the home-—that home healthcare products can assume in the future. We discussed how this infrastructure was used in some current home healthcare applications, and referred to the work by Telefonica in Spain we looked at last year. In looking at today's healthcare technology prototypes and products, we observed that most fail to assume the future will include a persistent connection to the home (broadband) or a home networking infrastructure, both of which are becoming more widespread. Comparing what exists in healthcare today with other applications/products that have reached mass market proportions (such as PCs, cellular telephony and Wi-Fi), it appears that the prerequisites for mass deployments are still some time in the future. In our experience, these prerequisites include both an appropriate target architecture and the development of a technology ecosystem. Each of the home healthcare systems we’ve seen appear to be complete end-to-end solutions. In the absence of an appropriate "home healthcare ecosystem" this is probably "the only way to do it today". We suggested the audience think about what will it take to get there from here and what efforts are underway to facilitate the development of a successful technology ecosystem for home healthcare. Exhibits Like most conferences, Healthcare Unbound had a good-sized exhibit floor, demonstrating a variety of products and services. Many of these contained some variety of monitoring devices, communications capabilities, and processing; these facilitate interactivity between those who have some type of illness or condition requiring medical oversight and the health professionals who care for them. Products from HomMed and FitSense illustrated the range of products and services in the exhibit area.
Reflecting back on all that we learned during Healthcare Unbound, we're unclear as to how fast what is possible via technology will be translated into what will be available and affordable. As with many significant changes in how people live and work, home healthcare requires some very basic changes in consumer expectations, government policies, and business and personal incentives. These fundamentally influence the rate of progress and vary from country to country. There is no question that "healthcare unbound" will come to pass in the next 10 to 15 years, but many of the keys to change lie in government policies regarding healthcare and the associated reimbursement systems. ( www.tcbi.org/hu2004 ) ( www.bhtinfo.com ) ( www.forrester.com ) ( telemedicine.partners.org ) ( www.atmeda.org ) ( www.intermedinc.net ) ( www.ochsner.org ) ( www.americantelecare.com ) ( www1.va.gov/directory/guide/facility.asp?ID=62&divisionId=ALL&map=1 ) ( architecture.mit.edu/house_n/ ) ( marc.med.virginia.edu ) ( www.hommed.com ) ( www.bodylan.com )
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
RSS Feeds
