Pervasive Healthcare

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Accenture

The global healthcare industry is facing a crisis in chroniccare that soon will be exacerbated as the baby boomergeneration ages. This growing demand for chronic care isplacing a tremendous economic burden on governments, privateemployers and individual consumers, and it is straining thecapacity of skilled care professionals and nursing homes. Meanwhile,technologies, like miniaturized sensors, wireless networksand mobile devices, are enabling telehealth and remote monitoringof patients, and redefining the new healthcare reality.

The global healthcare industry is facing a crisis in chronic care that soon will be exacerbated as the baby boomer generation ages. This growing demand for chronic care is placing a tremendous economic burden on governments, private employers and individual consumers, and it is straining the capacity of skilled care professionals and nursing homes. Meanwhile, technologies, like miniaturized sensors, wireless networks and mobile devices, are enabling telehealth and remote monitoring of patients, and redefining the new healthcare reality. These technologies are transforming the healthcare landscape by helping to contain costs, improve the quality of care and enable new classes of service.

The recent rise of disease management is a direct response to deficiencies in the current healthcare system that has made it difficult to adequately manage chronic, heavy users of healthcare services. Most disease management companies today rely on a “high-touch” approach by having specially trained nurses call individual patients on a periodic basis, providing them necessary counseling, coaching and education. Although this approach has led to significant improvements in compliance and reduction in hospitalization, its effectiveness is somewhat limited by the lack of more timely and visible monitoring of a patient’s current condition.

Until recently, the cost of providing a continuous flow of patient data from patient homes to care providers was prohibitive, largely because it requires dedicated communication and device infrastructure. With the increasing availability of home broadband, wireless networks and a wide range of consumer health electronics, an actual end-to-end infrastructure has begun to emerge. The availability of these networks and the widespread use of mobile devices make it feasible to carry out two-way, continuous interactions between patients and their care providers, regardless of their physical location. This new reality, dubbed “pervasive healthcare,” encompasses a broad range of telehealth applications that are always on, always active and always aware. This emergence of pervasive healthcare presents both opportunities and challenges for key players in the healthcare arena.

Key Enabling Technologies

Beyond today’s inexpensive computing and broad network connectivity, three new groups of technologies promise to have tremendous impact on the healthcare workforce. First, the emergence of consumer health electronics will allow the seamless capture of vital patient information from any location. Devices like blood pressure cuffs and weight scales have been used in homes for years, but now, thanks to advances in computer chip technology, these devices are becoming smaller, cheaper and smarter. They can interface wirelessly with home computers, cell phones or even remote Internet applications. New devices are coming to the market at a rapid rate. For example, a smart shirt with embedded sensors can unobtrusively monitor more than 30 physiological signs, including respiration, posture and cardiac function. An armband can continuously gather detailed data about body movements, heat flux, skin temperature and galvanic skin response, from which inferences can be made about important lifestyle patterns.

The second technology group offers better ways to combine and interpret data about an individual’s health and environment so that appropriate interventions can be made before an acute situation develops. For example, with cameras at home, an elderly person’s activities can be monitored and, using analytics that interpret the raw visual input from the cameras and other sensory sources, events such as a fall can be anticipated.

The third promising new technology group covers a broad range of tools – including user modeling, advanced visualization, decision support and collaboration – that support better use of information to enable effective decisions and actions by individuals and organizations. For example, new communication tools such as multimedia instant messaging allow more effective information sharing and richer interactions between caregivers and patients, which can eventually lead to better care.

The Business Case

Despite recent progress, these technologies are unlikely to gain widespread acceptance unless the healthcare industry is shown that they help improve clinical outcomes and provide positive return on investment.We believe pervasive healthcare offers a promising means for reducing healthcare cost and for addressing the shortage of provider resources. More importantly, it will be a key enabler for a new model of care that is necessary to address the root cause of the current global healthcare crisis.

Perhaps the most important force behind the current and potential widespread use of pervasive healthcare is the need to reduce, or at least contain, the skyrocketing healthcare costs that affect everyone. Even when private businesses are willing to take on their fair share of healthcare costs, employees must still shoulder significant increases in both health premiums and out-of-pocket payments in the form of deductibles and co-pays. Healthcare premiums in the United States continue to grow at double-digit rates, far exceeding that of overall inflation and the compensation of workers.

Early evidence shows that pervasive healthcare can significantly reduce the cost of care by reducing potential emergency room visits and hospitalizations. An analysis by the New England Healthcare Institute found that, compared to standard outpatient care, using remote monitoring for heart failure patients reduced the readmittance rate by 32 percent following a heart failure hospitalization, resulting in net savings of more than $1,861 per patient.[1]

The second driver for pervasive healthcare is the improvement in productivity among provider organizations by addressing increasing shortages of healthcare professionals. The most visible and perhaps most critical of these, the worldwide nursing shortage, is especially acute in long-term care. According to the Centers for Medicare and Medicaid Services, 90 percent of longterm care organizations lack sufficient nursing staff to provide even the most basic care.[2] Pervasive healthcare technology can play a vital role in improving caregiver productivity. Because homebound patients can take their own vital signs before a care professional arrives, each visit can be shortened by 15 to 20 minutes and needless weekly visits can be eliminated. Pervasive healthcare can also reduce the number of caregivers necessary to provide quality care. Remote monitoring enables home care agencies and cardiac clinics to handle significantly more patients with the same or fewer staff.

The third driver for pervasive healthcare relates to quality patient care. Hospital discharge often signals an abrupt drop in care quality because patients frequently lack the means, information, discipline and/or oversight necessary to care for themselves. A UCLA study of patients immediately after hospital discharge reveals that 73 percent failed to use at least one medication according to the physician’s instructions and, of all the drugs ordered at discharge, only 32 percent were taken at all.[3] Such noncompliant behaviors can result in delayed recoveries, complications and rehospitalization.

In this continuous care environment, real-time remote monitoring devices can diminish noncompliance, promptly detect abnormal physiological developments and quickly take appropriate intervention action. A recent study conducted by the Veterans Health Administration (VHA) demonstrated that remote monitoring resulted in significant cost savings.[4] In addition, patients reported they were more educated, secure and better able to manage their own healthcare needs.

Figure 1 summarizes the market forces behind the adoption of pervasive healthcare. Although rising healthcare costs, provider resource shortages and care quality are the most visible drivers, a closer examination reveals two deeper forces underlying the current crisis: the prevalence of chronic diseases and an aging global population. Because most chronic patients also are elderly, the latter trend will only exacerbate the former.

Calls for a Continuous Care Model

More than 75 percent of U.S. healthcare spending goes to the care of people with chronic conditions, including heart disease, diabetes and asthma. In 2004, nearly half of Americans were diagnosed with one or more chronic conditions. This number is expected to increase dramatically as the baby boomer generation ages, yet the current healthcare system is poorly equipped to meet the needs of this rapid growth. The current episodic model of care, which focuses on treating patients when they have an acute problem, works well for people with a broken leg or in need of open-heart surgery, but not for patients with Alzheimer’s disease or diabetes. Chronic illnesses require daily management, self-care and coordinated and timely interventions from healthcare providers. Without appropriate guidance, a chronically ill patient’s status can deteriorate from manageable symptoms into a more serious condition that requires an emergency room visit or hospitalization.

Chronic conditions such as congestive heart failure and Alzheimer’s disease are especially prevalent among the elderly. Congestive heart failure accounts for over a quarter of a million deaths each year, and an estimated 4.5 million older Americans currently suffer from Alzheimer’s disease, a number expected to rise dramatically by 2050. Because patients with these conditions are often frail and unable to care for themselves, they require more support and participation from caregivers than patients with other chronic diseases.

The growing prevalence of chronic diseases calls for a continuous care model that empowers patients to engage in self-care, and it provides ongoing education and proactive interventions from healthcare providers – this is the essence of pervasive healthcare. With remote monitoring and alwayson connectivity available, real-time alerts and numerous other telehealth capabilities become possible. This continuous care model can effectively manage patients at any location, resulting in less patient suffering, lower costs and better use of scarce professional care resources.

The Opportunities

Based on results from the VHA study, that agency is instituting programs designed to help veterans “age in place,” by providing disease management, care coordination and remote monitoring in their homes. The goal is to make this service available to 500,000 veterans by 2008. Pervasive healthcare applications offer key stakeholders great opportunities to address their respective priorities. By increasing patient visibility and enabling care providers to take early actions, pervasive healthcare can reduce costs, enhance work productivity and improve quality of care, resulting in a winning proposition for everyone involved in healthcare. In addition, health plans could reduce insurance premiums and payouts by ensuring that patients are treated proactively. Through unobtrusive monitoring and objective documentation, pervasive healthcare could also help increase compliance and prevent fraudulent claims.

Pervasive healthcare also provides a tremendous business opportunity for technology companies. The demand for innovative wearable and home-health devices and services likely will continue to grow at a rapid rate. To fully leverage their technology prowess and brand power, many well-established firms have been aggressively expanding into the health device market, and some retailers have opened separate stores to sell these devices. In addition, many start-up companies are offering a wide range of niche solutions, while traditional medical device manufacturers also have added telemetry capabilities to their new generation of devices.

The Challenges

Despite the vast potential of pervasive healthcare, a number of major challenges still lie ahead, the most daunting of which may be reimbursement. As long as doctors and hospitals remain unsure about whether they will get paid for these new services, pervasive healthcare is unlikely to be widely adopted. In the current system, the logical answer is funding through health plans and insurers. However, these parties generally are slow in providing coverage for new technologies. Flexible spending and medical savings accounts give consumers increasing control over healthcare dollars, but recent studies show that consumers are reluctant to pay for these services out of their own pockets.

In addition to the financing hurdle, pervasive healthcare faces a cultural challenge because many doctors and other caregivers have shown resistance to change, particularly changes in work flow. Also, some patients, especially the elderly and frail, may feel uncomfortable with technology and prefer having doctors and nurses physically present.

There also are a number of technical obstacles, including standards, data security and usability. Because a large number of parties are involved in healthcare delivery, standards are critical to achieving interdisciplinary cooperation and seamless delivery of services. There currently is no standardization in many areas, including wireless communications among home and wearable devices, data privacy and data formats governing information sharing among patients, clinicians and health plans. As a result, healthcare organizations have to choose among currently available incompatible solutions without knowing what the standards will be and which devices will meet those standards. This uncertainty discourages early adopters and delays the acceptance of these technologies. The other major technical barrier is related to usability – especially important for pervasive healthcare applications because the typical user is an elderly patient with a chronic illness who may be unable or unwilling to learn new technologies.

Conclusions

Available evidence about the value of pervasive healthcare suggests that its technologies eventually will take hold in the marketplace. With the continuing growth and popularity of consumer electronics and the maturation of sensory devices, these technologies will become increasingly versatile and affordable. Recognizing the tremendous economic potential of these products, hightech companies are making huge investments. Pressured by rising healthcare costs, all levels of governments and private employers also are finally beginning to take action. The chronic care improvement program at the VHA is just one example. However, the key driving force behind consumer-centered healthcare and the broad adoption of pervasive healthcare will be the aging baby boomers.

More than any previous generation, baby boomers are welleducated, health-conscious, self-reliant and demanding. Because they have been surrounded by electronic devices during most of their working years, they also are more technologically savvy. Perhaps most importantly, their control of the purse strings is expected to expand significantly as employers and governments continue to shift a larger share of healthcare costs to consumers. All these factors ultimately will help make pervasive healthcare a way of life.

Endnotes

1. New England Healthcare Institute. Remote Physiological Monitoring: Innovation in the Management of Health Failure. July 2004.
2. Centers for Medicare and Medicaid Services. Minimum Nurse Staffing Ratios in Nursing Homes, April 2002.
3. Beers MH, Sliwkowski J, Brooks J. Compliance with medication orders among the elderly after hospital discharge. Hospital Formulary. 1992; 27(7): 720-724.
4. Meyer M, Robb R, Ryan P. Virtually healthy: Chronic disease management at the home. Disease Management. 2001, 5(2): 87-94.