Health Care's New Home
Illustration by Jordon Cheung
When it comes to an annual checkup at the doctor’s office, we all know the drill: reflexes, breath tests, blood-pressure screenings. Until recently, doctors haven’t had much to go on beyond simple tests and general updates from patients themselves to gauge their overall health. Neither party takes away much actionable information.
But in the past few years, there has been a shift in the way people talk about and measure their health. Consumer-level wearables have given users easy access to measurements over time, such as heart rate and step count, which allow for insights to how their bodies handle certain activities. These devices also demonstrate that certain health decisions can be made by the patient without a visit to the doctor’s office.
That’s only one part of the industrywide shift, though. Hospitals and health care providers are also examining new approaches to care, called value-based programs, that reward doctors and organizations based on their ability to keep patients healthy, rather than the number of appointments they take, while lowering costs. In other words, they’re incentivized to provide effective care that deters patients from making needless return visits.
In early 2015, major health care players including insurance carriers Aetna and Blue Cross Blue Shield of Massachusetts, along with the health system Advocate Health Care, formed a private-sector alliance to accelerate the switch to value-based models in the United States. As part of their Health Care Transformation Task Force, they pledged to put 75% of their businesses into value-based programs by 2020.
Last year, major hospitals in Boston launched programs that send physicians, nurses, and medical equipment to patients’ homes. Similar plans already exist in England, France, and Australia, but the approach hasn’t become widespread in the United States yet—primarily because occupied beds here traditionally bring in more insurance reimbursement for hospitals than do home treatments, The Boston Globe reported. With early signs of success in other parts of the world and a renewed push for higher-quality care, we may see these programs become more common.
Referred to as a hospital-at-home program, these initiatives aim to reduce costs and provide a high level of care in the comfort of the patient’s home. According to research published last October in the journal JAMA Internal Medicine, systematic reviews of studies in the United States between January 1995 and February 2016 showed that mortality rates and disease-specific outcomes for hospital-at-home patients were lower than or equal to inpatient admissions. The research also found that hospital-at-home saved $2,000 on average per patient compared to a hospital stay.
Patients receiving care in their homes aren’t left on their own, either; they’re being remotely monitored. The Boston Globe described how doctors in one hospital-at-home program in Boston placed a small patch on a patient’s chest to wirelessly monitor a slew of vital and physical signs including heart and respiratory rates, skin temperature, steps walked, and sleep cycle. That information was transmitted wirelessly to the doctors’ tablet computers, allowing for text or video consultations and for any abnormalities to be triggered via an alarm on their phones.
Remote care, sometimes called telehealth, is useful for patients who live in rural areas or places that lack specialists. Patients can connect to a caregiver at a moment’s notice through an app such as Flex partner HealthTap’s and receive on-demand care—the “Uberization” of health care.
Hospital-at-home programs represent next-level care in which doctors receive accurate, up-to-the-moment, clinical-grade biometric data to treat patients. The more doctors know up front, the quicker they can respond and make informed decisions about whether a patient should visit the hospital or stay home. Making an appointment is no longer the default.
Hospital vs. Home
One company that’s making it easier for doctors to monitor patient health is Campbell, California–based Flex partner Vital Connect, the creator of two tiny smart patches that wirelessly detect vital signs and capture biometric measurements.
The company was cofounded in January 2011 by Nersi Nazari, a 30-year veteran of the semiconductor, medical device, and software industries. Vital Connect is applying the capabilities of Bluetooth low-energy data transmission and the Internet of Things to the world of medicine.
“The idea to design a patch that monitors vital signs has been around for some time,” says Nazari, who is now chairman and CEO of the company. “We thought that all of these pieces of technology are already here, and if we could integrate them into an ecosystem, we could make a wonderful health care solution.”
After starting Vital Connect, Nazari and a small team created a prototype and presented it to health care professionals and hospitals. Although initial feedback was positive, they were prompted to incorporate a crucial differentiator: disposability. “You want consumer products to be low cost and reusable,” Nazari says. “But for our medical products, it’s also important that no disease is transferred from one patient to the other.”
While disposable consumer products aren’t ideal for the environment, they represent the difference between life and death in a medical setting. Disposable medical tools can help prevent cross-contamination that might cause infection among patients.
That underscores the importance of keeping equipment sterile. According to a 2016 report from the Centers for Disease Control and Prevention, even though health care–associated infection rates have decreased in recent years, about one in 25 hospital patients in the U.S. contracts at least one infection during the course of his or her stay.
Vital Connect offers two separate solutions for the patients flowing in and out of a hospital and the remote-monitoring of patients at home: VitalPatch®, the single-use biosensor that is fully disposable, and HealthPatch® MD, which has reusable electronics that plug into a disposable adhesive patch.
The VitalPatch is designed to take the burden off clinical staff in a busy hospital environment. The patch’s quarter-sized computer chip helps streamline the workflow. The HealthPatch, however, is slightly less expensive. When workflow efficiency is not as relevant for, say, monitoring a chronic disease, the patient can keep the electronics and just put on a new patch when needed.
4.9 million patients were enrolled in mobile-health-care programs in 2015. That number is predicted to reach 36.1 million by 2020.
Both patches are discreetly applied to a patient’s chest and detect the same vital and physical signs: heart rate, heart rate variability, respiratory rate, skin temperature, body posture, fall detection, and activity such as the number of steps taken. The patches have medical certifications and clearances for distribution in the United States, the European Union, Japan, and Canada. They are produced in different adhesive grades based on activity and perspiration levels. With the support of Flex’s Sketch-to-Scale™ capabilities, Vital Connect is prepared to ship millions of its patches every month.
The patches are powered by zinc-air batteries, with each battery lasting up to four days before requiring replacement or disposal. For medical professionals and patients, this solution is roughly the size of a Band-Aid and works without annoying wires. “If doctors and caregivers can get information on patients remotely, then they can save lives,” says Vital Connect Chief Commercial Officer Bill Brodie. “But how do you enable that and make it easy for everyone to use? That’s where the fully disposable idea came from. A patient can put it on, wear it for four or five days, throw it out, and not have to worry about it.”
“As far as we know, we’re the only company that manufactures a fully disposable product with this amount of flexibility and measurements,” Nazari adds.
Care Around the Clock
The flexibility of choosing between a hospital or care at home is of growing importance as the number of remotely monitored patients rises. In 2015, that number was 4.9 million, according to a report from the Swedish research firm Berg Insight. All of those patients were enrolled in mobile-health-care programs that used connected medical devices as part of their treatment. (The total excluded people who used personal health-tracking devices.) Berg Insight predicts that the number of patients enrolled in remote monitoring worldwide will reach 36.1 million by 2020.
When a patient undergoes an invasive procedure in the hospital, such as open heart surgery or an organ transplant, he is often monitored for days afterward to ensure a smooth recovery. If a patient is sent home and feels any discomfort, he may be inclined to head back to the hospital for treatment, even though that might not be necessary. A driving force of the shift toward value-based care is to make sure that when patients leave the hospital, they won’t need to come back.
While keeping people healthy is always the goal, patients returning to the hospital without sufficient cause for concern can cost them—and the entire health care system—money. The Centers for Medicare and Medicaid Services, a U.S. federal agency, estimated that in September 2015 hospital readmissions cost Medicare $26 billion annually, with potentially unavoidable visits accounting for $17 billion of that. With Vital Connect patches, doctors can look remotely at patients’ data and consult with them via text or video to make a diagnosis.
Last April, Vital Connect partnered with the web-based medical platform company BePatient for a study at the John Muir Medical Center in Walnut Creek, California, where cardiologists plan to monitor heart-failure patients with Vital Connect patches. The idea: Detect heart attacks before they happen, allowing doctors to see how patients respond to medication or treatment.
In that kind of scenario, if a physician suspects a problem or simply wants more information, she can look at information beyond what the patient is experiencing at that moment, drawing insights from data that has been gathered over a few days or a week, Nazari points out.
The company is also working on developing detection for sleep apnea, which can be difficult to diagnose. Currently people who might have it may need to undergo sleep testing, which requires bulky equipment and can be expensive to administer.
Instead, a Vital Connect patch could eventually allow doctors to diagnose the condition more easily via the company’s secure VitalCloud platform, which stores all data transmitted from the patches, creating an on-demand file that patients and doctors can access. “Rather than going to the physician and saying, ‘I don’t feel well when I sleep,’” Brodie says, “the patient can actually go back in time and look at all the data.”
Unobtrusively collecting comprehensive data can eliminate misleading outlier readings that could be caused by factors such as the testing time changing between shifts or doctors. “We’ve heard from different cardiologists who say they take blood-pressure measurements when their patient visits,” Nazari says. But the person could be nervous, causing that one blood-pressure measurement to be off, he explains. Nazari and his team believe that having contextual, over-time measurements instead will be more useful for patient care.
“Rather than going to the physician and saying, ‘I don’t feel well when I sleep,’ the patient can actually go back in time and look at all the data.” Bill Brodie, Chief Commercial Officer, Vital Connect
New Data, New Treatments
Reliable, easy-to-access data can make doctors’ jobs easier and help improve the overall quality of care, but it may also be a catalyst for the researchers and companies that are developing new, innovative treatments for diseases.
“In the long term, based on these contextual, long pieces of data, maybe new science can be developed,” Nazari says. “Right now, we are essentially doing measurements in lieu of somebody waking you up in the middle of the night and taking them. But over time, there are going to be new insights.”
Brodie says American health care costs are currently growing at an unsustainable rate and he’s right. In 2015, total U.S. spending on health care reached $3.2 trillion, constituting 17.8% of the country’s gross domestic product, which is more than any other country in the world. For that money to work harder, using data from devices such as Vital Connect’s could help lead to better overall care.
A collaboration among Carnegie Mellon University, the University of Pittsburgh, and the University of Pittsburgh Medical Center, called the Pittsburgh Health Data Alliance, aims to change the practice of medicine by turning data into improved health outcomes. Data gathered from sources such as medical or insurance records, wearables, and genetics will be analyzed to detect patterns that may indicate specific health problems before they set in. One goal is to compare data and develop predictive modeling.
In this scenario, personalized health care packages could be offered to patients suffering from the same symptoms, and Nazari believes that researchers may even be able to use the information to develop new treatment protocols.
“For patients with a known condition like CHF [congestive heart failure] or COPD [chronic obstructive pulmonary disease], the question is, under the therapies they’re getting, are they moving in the right direction, flat, or going in the wrong direction? Vital Connect has produced the sort of device with the analytics and the cloud that give us the capability to see what the trends are,” Nazari says. “That is extremely valuable. It can save a patient’s life.”