Emerging technologies can play a prominent role in the way we keep people well. This focus on Connected Health ( www.connected-health.org ) technologies was very much in evidence at the 2009 CES. We are hopeful that it will be included in the US focus on improving access to healthcare and improving its quality and efficiency.
Healthcare is a very complex ecosystem in which end users and their families, medical professionals, health care institutions like hospitals, insurance companies and the government all play roles. Everyone asserts that they want to improve quality and access and reduce costs, but the incentives in the current system don't promote those goals. Doctors bill for treatments and consumers put much of the responsibility for healthcare on the provider, rather than assuming some accountability for their own behavior and health.
Many of the healthcare technologies which go beyond the traditional delivery of services are focused on better ways to manage chronic diseases and conditions. Some are focused on enabling seniors to live independently and safely in their homes longer. The goal of these systems is to provide better quality of life in the home as opposed to a nursing or clinical setting. These technologies can provide remote monitoring of vital signs, sleep and fall monitoring and in-home safety.
There are differing ways in which such healthcare can get paid for. On the one hand, there are traditional reimbursement and fee-for-service models. To the extent that these traditional models involve technologies for remote patient monitoring and interventions, the equipment has generally been termed "medical grade". Although we have been unable to find a formal definition of this term, it implies that it conforms to relevant regulations and has been more extensively tested --which results in equipment characterized as medical grade being relatively expensive.
An alternate model is for end users to pay for the equipment, either to promote their own wellness or to check on family members who may need assistance. Equipment in these instances is generally described as "consumer grade" which means that it is not represented as meeting specific standards or having regulatory agency approvals. Such equipment is frequently much less expensive--sometimes by factors of ten or more.
At CES we saw several systems approaches, as well as some of the separate end devices used for health monitoring and safety. In the Digital Health TechZone sponsored by Meridian Health we focused on systems approaches designed for seniors and their caregivers. Meridian is a New Jersey-based, not-for-profit health care services provider which is evaluating alternative ways to manage common problems associated with aging. They have been exploring how home-based technologies can promote safer and more efficient health care through the use of technology.
We looked at two systems focused on personal monitoring and alerting for seniors and their caregivers. In both the primary caregivers were typically family members; professional intervention was for emergency response. They had different assumptions about willingness to pay and level of functionality.
Halo Monitoring provides a Personal Health Monitoring and Alert System, which includes a chest strap transmitter, a home gateway appliance, a caregiver's personal monitoring portal and 24/7 professional alert response. A chest strap wirelessly transmits secure vital signs, activities of daily living, and critical event information (such as when a user falls). Information about potentially critical situations is transmitted without prompting by the senior. The Halo device is worn under clothing, and secure information can be viewed by assigned caregivers and authorized family members through a standard Web browser on any personal computer. The system is paid for on a monthly basis and is intended to be affordable by family members who are concerned about a loved one. Meridian Health is a reseller for Halo Monitoring.
GrandCare Systems offers a more comprehensive system, which entails a substantial upfront cost. It can provide not only monitoring of vital signs but also medication access, door openings, temperature, lights, etc. The person being cared for can receive all sorts of information and alerts as well as communication from their loved ones on their TV set--this can include appointments, medication minders and also pictures and messages from family. For installation, it requires wireless sensors for the items being monitored and a "communications station" (with processing and communications functionality) connected to the Internet and to a TV or dedicated monitor.
Another section of CES featured the Intel Health Guide PHS4000, as well as a number of individual monitoring devices. The Intel system is meant for connecting the patient with the healthcare professional--not the family member--and is intended for use under professional guidance. It seems to be positioned as a medical grade system. Its purposes are to facilitate communications between the patient and the professional, and to provide actionable individualized health data to the patient. The system includes an integrated video camera so that two-way video calls can take place.
A large number of individual monitoring devices were also shown at CES. These included many different blood pressure and weight monitoring devices with wired and/or wireless connectivity for communication to an access point. These endpoints for telemedicine systems are designed to predict and help reduce the risks of failing health.
Today's U.S. "healthcare" system is based on compensation for treating illness. The promise of systems and devices like those discussed above is that they can help transform "illness care" into a concerted effort attuned to keeping people well. We hope the new administration will craft its heathcare initiative to redress the balance between caring for the sick, helping those with chronic diseases manage them effectively, and providing support to help people maintain their health and independence.