by Carlos Cardenas
"Digital health services can provide crucial emotional, social and community support to maintain long-term healthy habits."
Health care costs have been rising at an alarming rate in the US, growing faster than the economy for many years. National health expenditure
reports indicate that more than 16% of the US gross domestic product (GDP) is spent on health care, while more than 47 million Americans have
no health insurance and millions more are under-insured. They also show that about half of these costs are due to hospital care and
physician/clinical services. As medical sciences improve and life expectancy is extended, increasingly larger demands are placed on the health
care system, particularly due to the treatment of ongoing chronic illnesses and long- term care services for the elderly. This has caused a
decrease in service quality as health care facilities are understaffed, providers are overworked and spread thin amongst patients. Patient-centric
health care experiences are focused on creating a more efficient and cost-effective health care system by actively engaging people in the management
of their own health, particularly with the expanded use of mobile, communication and information technologies.
In this model, the patient becomes the center of an integrated system that provides complete access and control over personal health information, leveraging integrated mobile apps, home and body sensing devices, online communities and health data resources. A multi-disciplinary team -which includes medical staff as well as family members- shares all treatment, care and health management with the patient.
Priority so far has been given to disease prevention and wellness, and to improved self-management of chronic illnesses, all of which have long-term health benefits and represent large cost reductions to the system. Another way in which patient-centric solutions are creating efficiencies is by turning the patient's home into a "health hub", where relevant care activities are moved from the hospital to the home.
The development of specialized patient-centric technologies and applications are gradually transforming our current health care delivery systems, but still need to be evaluated for their long-term economic impact and the degree of improvement in patient care quality that they provide.
Empowering people to manage their behavior patterns can make a big difference in keeping a healthy life style. Under this
premise, multiple services are using personal data visualization, community support through social networks, game mechanics and motivation strategies
to promote healthier habits. Simple tracking devices such as pedometers simplify data collection and focus the benefits on analysis, social experience
and emotional support. FitBit is a web service that uses a wireless pedometer to keep track of daily exercise and sleep patterns. Detailed data
records are accessible online and synchronized with nutrition information for individual or shared fitness planning and support. Users can also
keep track of alternative goals (i.e. quit smoking or reducing caffeine). Zamzee is an online rewards program focused on youth that also uses pedometer
data and game mechanics (points, rewards) to generate incentives, challenges and playful competition that increase members' exercise levels.
How might tracking and management of personal behaviors improve prevention of health issues?
Continuous monitoring and access to up-to-date patient information is critical in management and treatment of long-term conditions, chronic illnesses
and health care for the elderly. Home based telemedicine provides patients with medical supervision in a comfortable environment, and gives health
care providers real-time information about how they feel, diet, and medication. It makes regular patient management more efficient while reducing
Health Buddy System (Bosch) and Care Innovations Guide (Intel-GE) are two home care management systems based on easy to use devices that allow improved patient status assessment. They provide simple interfaces to monitor vital signs, participate in medical consultation surveys and video conferences. Quiet Care by GE focuses on the elderly by using motion sensors installed at the patients home, -including appliance and cabinet doors-, to track unusual movement or behavior patterns that may signal potential risks or emergency situations, alerting care providers.
How might direct communication and motion sensor technology at home improve patient care efficiency?
Particular diseases such as diabetes or hypertension require patients to constantly monitor specific vital signs or other health indicators, in order
to regulate their diets or medicine intake. Traditional devices usually require complex manipulation and collected data is not easily stored or processed.
Withings has developed a portable blood pressure monitor for iOS enabled devices (iPhone, iPad, iPod) that simplifies the measurement process, and automatically stores the data, keeping track of the time of day for each reading. An app allows patients to easily visualize, make comparisons and track patterns on any mobile device or PC. It also provides easy ways to synchronize with health record services such as Microsoft Health Vault or Google Health, or to share with social networks for peer support. OmniPod is an insulin management system that uses a discrete wireless attachable pump to deliver doses without any tubing. It synchronizes with a Personal Diabetes Manager, -a handheld device with a blood glucose meter and carb intake manager- that recommends insulin dosage and automatically updates personal health records.
How can portable devices and accessories provide patients independence and convenience in continuous self monitoring and treatment of chronic disease?
The 1966 film Fantastic Voyage presented an intriguing vision of the future of medicine as a submarine and its crew was shrunk to microscopic scale
and injected into the patients blood stream to provide medical care within the body. Echoing this vision, emerging technologies are taking advantage
of miniaturized electronics and wearable sensors to track physiologic parameters, gather data on disease symptoms, medication intake and response to
Ingestible Event Markers -developed by swiss pharmaceutical company Novartis AG- are small edible sensors that react to stomach fluids, creating a very low digital signal that can be received by a microelectronic device on a skin patch or inserted under the skin. It records behaviors, therapeutic and physiologic activity -such as heart or respiratory rate, stress levels and sleep patterns- and sends the data to the patients' mobile devices, to their care givers and to their medical team. Although still in development, the technology promises to offer solutions to critical treatment management problems, such as avoiding organ rejection in transplant patients, by cautiously monitoring anti-rejection drug dosage and intake timing.
How might electronic, sensing and chemical technologies integrate with the body to provide better patient monitoring and medical treatment?