Healthcare goes consumer
Healthcare technology is tapping into consumer electronics as it waits for the professional market to mature.
Healthcare is the new frontier for electronics systems, but it is taking longer to colonise than many players expected. Two sets of difficulties have emerged.
First, who will pay? Providers – be they monolithic public health services or private insurers – are wary of IT-related investments when they face a combination of budget cuts and the prospect of high capital spending on infrastructure. The fact that some recent IT projects have gone badly has not helped. The National Health Service Programme for IT was judged to have provided 'little clinical functionality to date' as recently as 2009.
Second, there is the approvals regime. Healthcare providers are expected to be risk averse. As a result, debate still rages as to which devices should be seen as merely providing information (and subject to a more liberal approvals process) and which are diagnostic (with more rigourous inspection).
To get a return on investments so far, many companies are seeking to get around these obstacles by going directly to the consumer, launching products that are 'advisory'.
The data so far
The greatest activity is in remote monitoring technology and is driven by the need to improve care while reducing expenditure. According to the Veterans Health Administration, which provides medical services for members of the US armed forces, it costs $77,745 a year to provide nursing home care for an individual.
By contrast, a primary care service delivered at home – one that requires regular visits by nurses and doctors – costs $13,121. But a telehealth service based on remotely performing as many of those nursing tasks as possible can cost just $1,600.
Then, there is the rate at which populations are ageing. The 'baby boomer' generation is typically defined as those born in the 20 years following the end of the Second World War (1 January 1946 - 31 December 1964). In the US, there were 78 million births over this period meaning that one American turns 50 every seven seconds.
In addition, eight out of 10 older Americans suffer from one or more chronic diseases. Such conditions account for 80 per cent of hospital bed occupations and 96 per cent of home care visits. This data is broadly reflective of the pattern in western Europe.
Meanwhile, there are other burgeoning healthcare challenges, the best known being obesity and allied rises in the incidence of diabetes. According to Diabetes UK, Type 2 diagnoses worryingly grew from 3.5 per cent of the population in 2006 (2.2 million) to 4.3 per cent in 2010 (2.8 million).
Remote healthcare can potentially help a lot. Much of the in-home care provided to chronic patients focuses on gathering and monitoring data for medical analysis (blood pressure, glucose level, weight, etc). At a more basic level, it can involve ensuring that an infirm patient simply takes a particular drug on time.
For conditions such as diabetes, a large part of the consulting process revolves around effecting and maintaining behavioural change (better diet, increased exercise, etc) to stop or slow the progression of the disease.
The metrics needed to provide basic oversight of these conditions can be self-gathered by the patient. Lightweight, easy-to-use blood pressure cuffs can wirelessly connect to a home hub that then sends a reading to a doctor over a traditional or broadband network. The same is true for scales and blood meters.
There is further interest in techniques that help change lifestyles. Good old text messaging is one platform being researched. It can be used to send an alert that a dose of medicine is due but some services are overlaying this with regular hints and tips.
'Text4Baby' is a programme undergoing US trials until 2012 with backing from healthcare giant Johnson & Johnson. It sends three SMS messages every week to pregnant woman through term and the first year of a baby's life. These contain advice on how they can maintain their own health and follow a healthy regimen for their child.
The practical challenge
'If a system gathers information and sends that to a doctor or nurse, and they then make a decision that treatment or some kind of intervention is required, you can say that you are just providing information and what you have to do is guarantee that you are doing that in a secure way which doesn't compromise patient confidentiality,' says Jason Goldberg, president of Ideal Life, a provider of wireless health management.
'But if the system uses that information itself to respond that the patient should take a pill or take other medical action then it's become diagnostic, and what you have are two different approvals systems.
'Of course, there is a space between those two more defined scenarios that quite a number of systems fall into and it varies from country to country as to where they draw the line. You have to get this right, but it is a complicated situation – and typically you're dealing with people who's background is medical as opposed to technological.'
Goldberg is well positioned to see the challenge. Ideal Life's products are those that bring together a number of healthcare functions via a single communications hub because it is what doctors say they require. There are numerous standalone blood pressure readers, yet for many conditions that is only one of the readings that a medical professional requires to reach a proper diagnosis. But the more you add to a system, the more complex it becomes with inevitable implications for how it is viewed by regulators.
Then there are standards. 'There is a lot of proprietary technology,' notes Duncan Smith, commercial director for Cambridge Consultants (CC), which is developing a range of health platforms and devices. 'Now sometimes that's because you have a system that was developed to meet the needs of one particular healthcare provider and whatever the state of their national set-up was – but it isn't necessarily what another country or provider has settled on, assuming it's settled on anything at all. That is changing. One example is [the] Continua [Health Alliance], and it's bringing a lot more stability to the market.'
CC has developed one of the early Continua-compliant systems. Minder is based on CC's Vena platform and, like Ideal Life, draws input from multiple sources and integrates a display with 'to do' activities. Qualcomm supplies the wearable mobile communications technology while Continua, an alliance of e-healthcare companies, has delivered the connectivity standard.
But even with Continua providing one agreed core technology that might help regulators make quicker decisions, the question of getting a return on investments to date is seeing these technologies offered first for purchase by individuals.
SecuraTrac offers this type of product, LifeTrac, a wearable GSM/GPS device. The user can pre-programme it with emergency numbers and the unit monitors location, checks for inactivity that might indicate a fall or other problem and notifies a caregiver if the wearer goes beyond a pre-defined area or may be in distress.
'We've got two markets,' explains SecuraTrac sales director Robert Tomlinson. 'The users themselves and their families. It's common now for people to have an elderly parent based some way away from them, so we give people a means to keep an eye on them.'
LifeTrac is an extension of existing technology, tailored within a device ergonomically designed for the infirm. It also follows the mobile communications model with a small one-off cost and a subscription fee.
The grey area here is illustrated by another interesting new product. TabSafe is an automated drug caddy. A pharmacist loads medicines into cartridges that are released into a separate draw according to a timer. The device emits audible and visual notifications when a dosage is due and then checks that the patient takes the medicine. If he or she does not after 30 minutes, TabSafe phones and alerts a care provider. It also retains a record of patient activity that can be accessed via a secure website.
Growing computer literacy
'We've had a lot of interest in areas where patients live in very remote locations, potentially miles from their doctor, as you can load up the device far in advance,' explains founder Stephen Axelrod, himself an MD. 'And by controlling the distribution of the medicine we're also able to help prevent medicines being taken incorrectly.'
Dr Axelrod identifies a serious issue. Research shows that 51 per cent of drugs are wrongly taken by patients, leading to 125,000 deaths and a million hospitalisations every year. Strong, convincing data, but TabSafe is taking a dual healthcare provider/consumer approach. It has slogged through getting more than a dozen US state public-health Medicare systems to fund the device, and also worked with insurers.
'But that is a lot of people to go through. It's a very tough process, just in terms of time,' says Dr Axelrod. 'Going consumer, though, has an interesting side to it.
'What has changed is that as the population has aged, you have more people going into retirement who are familiar with technology. The baby boomers were also the first IT generation. So, if you have something that presents a convincing technological case, they understand it better than the generation before.'
Dr Axelrod's argument about being able to present these devices to a more savvy marketplace is echoed generally. Already, you might have loaded exercise programmes and weight loss aids on a smartphone. These 'wellness' products establish a link between mobile devices and healthcare that is being extended for more formal medical purposes. But in the end, the bigger systems will depend on the providers' willingness to engage.
'In the US, the big insurers see a value in promoting better behaviour, and so do organisations like the NHS,' says CC's Smith. 'And what you can get from that is more evidence that these technologies can work by going deeper into the system. So, selling consumer products doesn't just have to be about getting something out of what you've developed to date economically. It's also a way of getting the data, the justifications for really exploiting the potential.'
Common barriers to adoption
It is true that today’s pensioners feel more comfortable with technology than their predecessors, but there is still some suspicion. In a January survey by AARP, the US equivalent to Age Concern, only 41 per cent of a sample aged 50 or above “believed mobile health technologies would improve their health”.
Their main objections did not concern the reliability or even usability of the kinds of device being proposed. Cost, maintenance and privacy led the way.
Consumer marketing may help to address this. Health services have a poor record on communication to the elderly, but a critical difference with the consumer model is that companies are reaching out to relatives and caregivers. They may simply be better able to understand the message and also willing to foot the bill for these devices.
“If you are trying to help someone with Alzheimer’s, dementia, even just someone who feels insecure because of their condition, change can be daunting,” says SecuraTrac’s Robert Tomlinson. “If you can demonstrate the device to someone younger, a son or a daughter, then they can play a much stronger role in advocating it.”
However, the cost issue is a big one. People living on pensions – even relatively generous ones – have to be careful with their spending. They will look to medical providers to foot many of e-healthcare’s hardware bills on the basis of savings elsewhere.
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