Recently I attended the mHealth Summit to see what was happening at the intersection of technology and healthcare. The conference brought together stakeholders from all corners of the healthcare industry including medical staff, hospital administrators, insurance providers, technologists and VCs. My goal was straight forward – to identify and understand the key trends impacting the future of healthcare. Save for some extreme examples, the issue is not do we have the technology, it’s how do we integrate and implement it? As a technologist trying to understand the future of healthcare, here was what I found.
In the coming years, people will take greater responsibility for their health, engaging in a model where they seek support and help, and resist medicalization. As generations X, Y and Z engage more frequently with the healthcare systems, this will not only be necessary to support sustainable healthcare, but will be demanded as the status quo. These generations have grown up with information at their fingertips that drives expectations of choice, freedom and control. Rest assured, they will transfer these expectations to healthcare.
The latest generations will expect a collaborative care environment, where they work with medical practitioners to decide the best method of care. They will choose their own specialists, learn from the Internet and have their own technology to bring to the table. They will socially share healthcare information, blurring expectations of privacy. Ultimately, they want to be empowered to make informed decisions based on their preferences.
Also, there is much for healthcare to learn from retailers. These organizations know their customers intimately and the most astute ones create delightful and personalized experiences. We need to think about how customer intimacy can translate to healthcare – as one speaker put it “know me, engage me on my terms, empower me”.
For the longest time, the healthcare has been working in a fee-for-service model, where there are ongoing incentives to have the patient remain in the system. This is now changing - no longer can the system cope with the fee-for-service approach. Growing and aging populations are creating demand for healthcare that outstrips supply. We are seeing the emergence of incentives and penalties to keep people out of primary care, saving readmission and accelerating people back to health where possible.
Care plans are a key component in outcome-based medicine. As patients transition out of primary care and return home, the care plan defines what the patient needs to do to improve and maintain health - in detail. Care plans cover everything from taking medicines, to exercise, diet and follow-up outpatient care. Manually preparing a large number of patient care plans is extremely time consuming, so automated care plan generation will happen and adaptable plans will follow.
Care plan compliance is the next issue to be addressed. Once the plan is written, the challenge is getting patients to comply, which is driving the development of technology-based solutions to help both medical staff and patients alike. The focus is on developing and administering care plans, remote monitoring and medication compliance. There is an acknowledgement by providers and payers that spending money in this area will help save money in other areas – a 3x benefit was mentioned on more than one occasion as a good savings yardstick.
Measuring our bodies for health parameters has gone from days to seconds, and we are now moving into the era of real time monitoring for diagnosis and treatment. Over the next five years, remote patient monitoring will result in cost savings of up to $36 billion worldwide, according to a recent report on the mHealth market from Juniper Research.
There are a staggering number of medical use cases that can benefit from remote monitoring. Pharmaceutical companies can use remote monitoring in drug trials to continuously monitor subjects to build a better assessment of drug efficacy. For people with chronic conditions, capturing data at the point of the problem is crucial. Continuous remote monitoring enables a better understanding patient status through precursors to an acute event, or better still detecting the early warning signs that can trigger intervention early enough to prevent an acute event.
Such a course of action not only applies to physical heath, but also mental health. By monitoring people suffering mental health conditions in real time and detecting variations in typical behavioral patterns, it could be possible to detect early onset in at-risk populations, and prevent injury and even death in existing patients. Using remote monitoring, family and friends can keep track of loved ones from afar and know when to offer support and encouragement. In almost any scenario remote monitoring can reduce costs and/or improve outcomes.
Undoubtedly we have entered the era of the quantified self with people from all walks of life collecting biological data about themselves. However throughout the mHealth conference any talk of data was quickly followed an emphatic plea for insight and actions - not just more data.
People are using apps on their mobile devices like Strava, RunKeeper and SleepCycle, wearable devices both consumer and medical grade, and implantable devices such as pacemakers and pressure sensors. Augmenting this is personal non-biological data such as location, and environmental data like weather and pollen counts. The challenge is making use of the data by turning it into knowledge and actions across the care continuum.
Providing people with data about themselves is interesting for a while, however for a majority of the population knowing what action to take based on the data and remaining motivated to do so is highly unlikely in the long term. For example, within six months, a third of all fitness devices are no longer used and 80% of health apps are abandoned within 2 weeks. After a while you believe you know what the data is going to be so you get fatigued and stop using it.
On the clinical side, physicians and nursing staff are already over burdened. They do not have time to look through more data and are instead asking for alerts that identify people who require assistance or intervention along with suggested actions and decision support that augment their own knowledge and thinking. Furthermore the analytics need to fit into the right ecosystem/workflow. The key is to understand how people think once they are presented with meaningful healthcare data.
Healthcare is extremely personal and so as the latest digital technology is used to improve healthcare outcomes, there must be a focus on engagement. There are several factors to consider here as illustrated below.
Within the healthcare setting, there is an impending collision of consumer and medical grade devices. Within the context of this article, a FitBit, Jawbone, Garmin or other fitness device is considered a consumer device. A medical grade (or clinical) device has some form of medical regulatory approval (in the USA this would be done by the FDA and in Europe through CE). Today’s consumer grade devices have a happy home amongst people who are generally healthy – they are not called fitness devices by chance. These devices help people run more, cycle faster and get stronger. Clinical devices such as blood glucose monitors, insulin pumps, and pacemakers help keep people alive. These technologies are currently separate personal from clinical in their visibility and usage - however the winds of change are blowing.
A range of startups are integrating consumer devices to help in clinical situations. The data collected by these devices is being presented on dashboards to help clinicians better understand their patients throughout activities of daily living. They are being used to create new intervention methodologies that help assure care plan compliance. These current innovations are considered version 1, and whilst they may not be perfect, they are creating the momentum that will eventually see widespread use of consumer fitness devices in clinical environments.
A few things will need to occur for this transition to hit the mass market.
These are but a few if the hurdles to cross, and so I’ll close this section with a quote from one the presenters: “Design for consumer, pivot towards clinical and be deliberate about the process”.
Clearly the intersection of technology and healthcare at this point in time presents a unique opportunity for technologists and healthcare professionals to collaboratively change the face of healthcare for the better. This opportunity must be grasped as society grapples with providing sustainable healthcare to a growing and aging population. This shift will evolve to include a more consumer-centric approach to healthcare, a shift to outcome-based medicine underpinned by new technologies, a focus on using data and deep analytics to help determine best courses of actions, new methods of engaging patients and ever increasing numbers of devices that blur the lines between medical and consumer applications.