Comparison of Different Contact Material on ECG Signal

ECG Leads Comparison of Dyno Series and its Behavior to Standard ECG leads Characterization

Abstract

How Advances in the Internet of Things (Iot) Devices and Wearable Technology Will Impact the Pharmaceutical Industry

Today, patients can use their wearable or IoT devices to report data of physiological parameters and track their own health records. IoT wearable technology has been embedded with software and sensors to create a connected network that collect and exchange data. Advances in digital health have fundamentally changed the business model of the pharmaceutical industry, and has impacted all aspects of a pharma company’s structure—from sales and marketing, to R&D and business-to-business activities. As healthcare becomes more digitized, pharma companies are transforming to remain competitive by rethinking their business and operating models, their cultures and capabilities, and adopting policies that nurture innovation and courageous strategic moves.

The Internet of Things (IoT) is a network of tangible devices, such as wearable technology, that have been embedded with software and sensors to create a connected network that collect  and exchange data[1]. Digital health is the integration of digital and genomic technologies with health, healthcare, lifestyle, and social networks that enhance the efficiency of healthcare  delivery and personal medicine [1]. Innovation in this field has improved clinical
outcomes and reduced cost of treatment. Advances in digital health have fundamentally changed the business model of the pharmaceutical industry, and has impacted all aspects of a pharma company’s structure—from sales and marketing, to R&D and business-to-business activities. As healthcare becomes more digitized, pharma companies are transforming to remain competitive by rethinking their business and operating models, their cultures and capabilities, and adopting policies that nurture innovation and courageous strategic moves [2].  Patients have become less passive recipients of therapies, and are starting to control their own health treatments by providing their doctors with more information, home-measured parameters, which allows for an informed opinion about how they should be treated [3]. With individuals assuming more control over their own health, pharma companies must adapt to this new decision-making power and create more effective methods to engage them. This is difficult since it is challenging to determine exactly what engagement model appeals to their patients [2]. To drive better patient engagement, physicians can observe patient behaviour from a continuous daily stream of patient data from online communication, in-home visits, and quantitative methods to analyse trends and adjust treatments as needed. [2]. Data from wearable devices and other quantified self-technologies are evolving into research and clinical grade medical tools. Health devices can increase patient cost consciousness, allowing for comparisons of price points for various treatments [2]. Payers and  users whenever abnormal parameter readings or fluctuations occur. Wearable

technology can greatly benefit pharmaceutical companies in many  aspects such as speeding drug research and development, streamlining clinical trials, improving efficiency of drug delivery, and enhancing patient engagement and adherence. providers will have more health information to link drugs to outcomes and update value-based pricing [2]. Pharma companies will need to provide third parties with access to their product data and become transparent about clinical trials [2]. Today, patients can use their wearable devices to report data of physiological parameters and track their own health records. Researchers have observed that actively participating individuals experience results in less treatment cost and better adherence to prescribed medicines as compared to those who do not [3].
Patient education is essential for providing effective communication between patient and physician. With the use of digital techniques, patients are becoming more engaged and outcome based care is becoming a strategic healthcare goal by improving the patient-physician relationship at the lowest cost. Identification of the right initiatives allows pharmaceutical industries to bring about a digital revolution in health care. The pharmaceutical industry is utilizing such technologies for success and innovation. More information about product performance is available and process efficiency is improving. Digital development can bring innovation in personalised patient care. It has improved patient physician relationship and helps in decision- making. Marketing strategies can be well managed and planned by using latest techniques. Companies need to transform their commercial and innovative models in benefit of health care. In the pharmaceutical industries, these techniques are used in the form of sensors and digital apparatus to provide efficient performance [4] Wearable technology is an important component of digital technologies.

The global market for IoT devices and wearable technology is projected to be $41 billion by 2020 and the market will grow to with an astonishing compounded annual growth rate of 65%. However, the majority of this wearable technology is currently dominated by wellness, fitness and sports wearables. Devices specifically designed for medical wearables are relatively fewer and most of them a

the Free 0Style Libre, manufactured by Abbott is a two component system that measures the blood glucose levels of diabetic patients. The sensor, a small disc, attaches to the patient’s body, measures the blood glucose level and sends information to a receiver or
Android phone. The new system allows for patients to see trends in their blood sugar and quickly make changes in diet when the trend is to high blood sugar levels [5]
The immediate and obvious application of wearable device for pharmaceuticals is in the clinical trial, in which recruiting patients and getting them to adhere their treatment regime are a constant challenges. Wearables can collect real-word data remotely (and, therefore, freeing participants from having to report on site) and then provide reminders so patients don’t forget to take their medication. These capabilities can save companies huge amounts of money by increasing the efficiency of costly and lengthy clinical trials. The ability to easily and quickly collect all of this patient data is particularly impressive and creates great opportunities to monitor the efficacy and are in either early stages of development including clinic trials. For example, sensors worn on the body, which can accurately Wearables are wireless measure body physiological functions and alert participation and compliance[6].

In the long run, utilization of wearable technology techniques can generate an ecosystem that starts from drug production, drug use to monitor patient condition and reaches up to providing feedback to the patient after consultation. With such systems, everyday information of the patient can be monitored by the physician anywhere anytime. For example a patient suffering from Parkinson disease can provide information to the care provider on the basis of chip on pill technique. With this technique, a smart watch is provided to the patient which monitors drug taking schedule, send reminder to the patient for medication taking and send health status report to health provider. Specialist virtual care application is already in use  by health providers for betterment of patients [7]. In research and development department of pharmaceutical industries, the wealth of data collected by wearable device offers more opportunity to better understand the action of medicine in individual patients and to translate back to more effective drug discovery and development tailored to personal medicine[8].

The Dyno developed by DynoSense Corp., is a fully integrated multi-function health scanner technology that can capture more than 33 health metrics in less than 60 seconds with a single user action. The captured health data is securely and wirelessly uploaded to the company’s cloud computing platform for further analytics and processing, and is then communicated with healthcare professionals [9]. This device can be readily applied for monitoring patients with cardiovascular disease in clinical trials, and the quality of the data collected will be more accurate than the data provided by patient logs or diaries during clinical trials.

The Impact of Artificial Intelligence on Cancer

Despite incremental progress in curing cancer it remains the second most common cause of death.  Most, if not all, health professionals agree that early detection of cancer offers the greatest chance of a cure or control of the disease. Skin cancers are highly treatable if they are caught early. Unfortunately, skin cancer doctors (dermatologists) are often not readily available in remote or third-world countries. Today, with the advancement of Artificial Intelligence (AI) doctors hope to provide patients with machines that can early diagnose skin cancers and thus save lives through early detection. Early results are promising as the machines are providing up to 85% accuracy in detecting skin cancers. The use of Artificial Intelligence in medicine is expanding with the experimental use of AI machines reading radiographic breast images (mammograms). Again, the early results are promising. Computer power is increasing dramatically and is the key to more use of advanced AI machines. The use of AI can dramatically reduce the cost of medicine while providing quicker diagnoses. However, AI, at least at this time, is not intended to replace physicians. The best minds in the field of medicine believe the combination of physicians working with AI will provide patients with the greatest opportunity to successfully survive their diseases.

Each year, a great number of people die of cancer. Fortunately, when the disease is detected early the cure rate is high, which has led to the development of many forms of cancer screening tests. For example, in the case of breast cancer mammography is one of the most effective screening tests available. The problem is that screening tests remain imperfect, which can lead to some false positive results, which in turn can lead to unnecessary surgeries and biopsies. A common cause of false positive diagnoses is the category high-risk lesions, which look suspicious on a screening mammogram and have abnormal cells when analyzed by needle biopsy.

Artificial intelligence (AI) has brought change to the diagnosis of cancer, just like it has to many other aspects of our lives (Pannu, 2015). The general purpose of AI technologies is to make it possible for a society to improve and progress its quality of life. Advances in studies with automatic diagnoses of cancer specimens using AI were beginning to produce results that were sometimes superior to human analysis as early as 2006 and continue to the present day (Deepa & Aruna, 2011; Lisboa & Taktak, 2006; Pannu, 2015).

Artificial intelligence advances and with it the field of medicine. In 2011, IBM introduced their supercomputer Watson to the world on the game show Jeopardy where it beat accomplished Jeopardy champions (Ferucci, D. A., 2012). By 2017 Watson was able to diagnose some types of skin cancer, after the technology was improved to match the diagnostic ability of a dermatologist. The improvement came from the creation of an automatic learning algorithm – called machine learning – by the team of Professor Sebastian Thrun from Stanford University.  Thrun’s team trained artificial neural networks using a total of 129,450 images and data from about 2,032 different cases of diagnosed diseases. They tested their performance against a score of dermatologists, and the result was that clearly both obtained the same diagnostic results (Esteva, Kuprel, Novoa, Ko, Swetter, …&Thrun, 2017).

Perhaps the most important aspect of Thun’s study was that AI used the same method of diagnosing skin cancer as that performed by a specialized doctor: visual observation. Thus, using simple photographs of skin lesions, the algorithm could reveal if the patient suffered from some type of tumor in the skin, and if it was benign or malignant (Esteva et al., 2017). This technological and medical breakthrough was an important milestone both for its reliability, which is very important not to delay the diagnosis of the disease and its severity, and because it starts the path towards the possibility that mobile devices with cameras can expand the reach of a patient’s dermatologists outside the medical or hospital center (Esteva et al., 2017).

Arriving at a complete diagnosis to give the correct treatment to patients with cancer requires a complex process where accuracy and speed play a fundamental role. Looking for alternatives to the conventional methods applied in these clinical cases, a team from Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School worked on a project that sought to exploit the potential of artificial intelligence. According to the report shared by the researchers, after participating in the ISBI (The International Symposium on Biomedical Imaging), their AI was able to be accurate 92% of the time, compared to 96% of the pathologists’ effectiveness (BIDMC, 2016).

But what is really interesting, as the BIDMC study emphasizes, is that combining the work of the pathologist with the identification of the AI, up to 99.5% accuracy could be achieved. And this is just one example of the potential of deep learning to improve the objectivity and accuracy of diagnoses, and as a result to provide patients with the right treatment without losing time. They created a system based on deep learning so that machines can learn and interpret patterns based on the analysis of histopathological images. And so, for example, in patients with breast cancer, identify the presence or absence of metastatic cancer in the lymph nodes (Zheng, Yoon, & Lam, 2014). This melding of the physician with machine is called computer-aided diagnosis (CAD) and is the wave of the future because it can streamline the diagnostic process and increase accuracy (Amato, López, Peña-Méndez, Vaňhara, Hampl & Havel, 2013; Deepa & Aruna, 2011; Esteva et al., 2017).

Artificial Intelligence appears to be limited only by the power of the computer. The long-held anecdotal theory (1965, Moore’s Law, n.d.) proposed by Intel founder Gordon Moore postulated that every 18 months computer power will double and the cost of production will be halved.  With increases in computer power, AI will surely provide more robust decisions in the medical field. Through a process known as “Reinforcement Learning” computers can acquire additional skills for AI by teaching themselves beyond what humans can input.  In spite of this unchecked learning ability, there remain obstacles such as AI interpreting simple cartoons to determine if they are funny or not (Granter, Beck, & Papke, 2017).  This leads to a discussion of the ability of AI to surpass the skill of pathologists and radiologists in medical diagnoses. However, there is little chance that your doctor will be replaced by a computer anytime soon.

In a somewhat bizarre and unconventional study Levenson, Krupinski, Navarro and Wasserman (2015), while researching AI, the researchers trained pigeons to discriminate between radiographic pictures of benign and malignant breast tissue with a 85% accuracy. At the time, this compared favorably to AI diagnosing where algorithms were developed for the same purpose.  Rest easy, pigeons will not be reading your next mammogram.

As computers self-whirr to expand their knowledge, another interesting question arises. Have microscopes outlived their ingenuity when a single drop of blood placed into a machine can give results that are undetectable with visual examinations (Granter, 2016)?  The answer is still up for grabs. However, Rosai (2007) writes that the trained pathologist will not be replaced as best-practice medicine.  Rosai explains that the dependence of microscopic and molecular science complement each other and reside harmoniously to generate new and improved modalities to treat disease.

While diagnosis of disease through artificial intelligence would mean significant savings in health costs and human resources, as well as universal access to medical care, there are issues that go beyond the appearance of the injuries, such as the stage of the disease, the depth it has reached, or its possible evolution. As of now, physicians, i.e. humans, are still the most important part of medical care when it comes to cancer.

How Personalized Artificial Intelligence is Advancing Treatment of Diabetes

The future of healthcare is connected to multifaceted, advanced artificial intelligence (AI)  which collects patient data that lead to providing personalized, interactive health solutions This is directly relevant to the over 30 million people (9.4% of the US population) who have been diagnosed with type 2 diabetes in the United States. The future of health has to do with multi-layered, advanced personalization.  AI has the potential to analyze massive amounts of patient information that would otherwise take a large staff and resources to accomplish. An immense system of data can connect indications to causes can allow AI to create an intricate guide of the individual’s condition and give a customized solution for clinical procedures. Deep learning ophthalmology AI technology can diagnose diabetic retinopathy, AI has the potential to better identify selection of diabetic patients for clinical trials to help identify safety and efficacy issues of new medications.

Keywords: AI artificial intelligence, diabetes, remote health monitoring, deep learning technology, eye disease, diabetic retinopathy

The future of healthcare is connected to multifaceted, advanced artificial intelligence (AI)  which collects patient data that lead to providing personalized, interactive health solutions ^[1].This is directly relevant to the over 30 million people (9.4% of the US population) who have been diagnosed with type 2 diabetes in the United States ^{[1] [2]}.  The future of health has to do with multi-layered, advanced personalization ^[1].  The type of personalization is not only physiological and biological, but also involves understanding who the patient is in terms of lifestyle, i.e., behavior, culture, actions and motivations ^[1].By gaining understanding of the total person, caregivers can holistically match the patient with specific possibilities in scientific knowledge gleaned from scientific and medical papers and guidelines and interventions used to treat diabetes ^[1].

AI Diabetic Health Monitoring

New uses for artificial intelligence to diagnose and treat diabetes have risen in the health care industry, such as IBM’s Watson Health system, which assesses massive quantities of patient data to provide guidance on medical decisions, as well as DynoSense Corp.’s remote health monitoring system that gathers cloud-based personalized patient data that can help predict changes in health that would require a need for action by caregivers. Other companies have also developed AI technologies that provide adaptive learning and medical knowledge that offer guidance to caregivers based on patients’ health profiles. Peer-reviewed research suggests that Lark Health Coach, an AI chronic disease platform can aide in the prevention of diabetes. Lark provides disease prevention and management by monitoring a patient’s health using phone sensors and integrated health devices ^{[3] [4]}. One-on-one text based communication imitates empathetic counseling to help steer a patient toward healthier options ^{[3] [4]}.  AI has the potential to analyze massive amounts of patient information that would otherwise take a large staff and resources to accomplish. For diabetic patients, and others, this is tantamount to receiving a doctor’s care every day ^[1].

Health Assisting AI: Diabetic Retinopathy

People who have diabetes are at risk for diabetic retinopathy, which can cause blindness if not treated properly ^[5].  Artificial intelligence, such as Google Brain, Machine Learning, and Microsoft Intelligent Network for Eye care (MINE) can detect diabetic retinopathy through dilated eye exams, even if there are not vision related symptoms ^[6]. A doctor can use a camera to take images of the back of the eye (retina) to look for signs of diabetic retinopathy, such as lesions or hemorrhages ^[5].

Deep learning ophthalmology technology used for eye care can diagnose and treat patients more efficiently, since without deep learning technology for diseases of the eye, doctors would have to review a multitude of photos ^[5]. Also, eye doctors in remote areas can use telemedicine to take images of their patients’ retinas and transmit the images to ophthalmologists in other locations for diagnostics ^[5].  This approach will allow eye disease analysis to be faster and better, with positive benefits for diabetes care ^[5], since it would enable patients to receive ophthalmologic diagnostics without travelling to a specialist ^[5].  It is predicted that, with better AI technology, a person could snap a cellphone selfie for a retinal eye screening ^[5].

AI and Clinical Procedures

Presently, AI portable applications can cover a vast piece of outpatient and clinical administrations, allowing for specialists to take care of more basic cases.  AI can help make patient diagnoses faster by finding relevant data that doctors need to treat a patient and present it in a succinct, easily understandable format ^[7]. AI can comb through a patient’s history related to a particular disease and link to that patient’s other histories such as high blood pressure, coronary blockages, history of smoking, and prior pulmonary embolism ^[7]. Such information might otherwise take lengthy research by the physician who does not have time to do so ^[7].

AI provides essential health care by analyzing patient data, and once it is actionable and meaningful, the information is transmitted to the patient and a caregiver.  This results in an immense system of data that connects indications to causes. The machine learning calculations create an intricate guide of the individual’s condition and give a customized solution. AI proposes steps and measures to cure the ailment, including cautioning and notifying the individuals when they have to see a specialist.

Many technologies have been implemented in health monitoring systems and devices. DynoSense Corp. has developed a unique and efficient preventive care solution to help consumers, providers, and insurance companies to make smarter decisions, improve health, enhance productivity, and save lives ^[8]. DynoSense’s technology allows patients to monitor 33 health metrics at home with a single action in less than 60 seconds, including all the critical vital signs ^[8]

AI and New Drug Discovery

New uses for AI and machine learning in drug discovery are continually being developed.  This technology has the potential for providing mechanistic insights to many diseases, including diabetes, thereby leading to better identification of selection of patients for clinical trials to help identify safety and efficacy issues with compounds ^[9].  The ability to tap into a wider chemical space to select the best molecules for drug discovery can lead to innovative compound design and a maintainable channel of new medicines ^[9].  Data Mining, Business Intelligence, Sensing, Ubiquity, Intelligent Agents and Pervasiveness in Medicine, can put effort with new cures and new information for health experts ^{[10] [11]} .

Conclusion

In general, data innovation can help enhancing human health and life span. AI intelligent software can be conveyed with the end goal to enhance medical research, illness counteractive action, and healthcare benefit delivery. AI is upgrading human endeavors to enhance the general quality and accessibility of health administration.

How Advances in Digital Health Benefit Pregnant Women

Pregnant women can use Smartphone apps, social media, and remote health monitoring devices to provide security, confidence, and information about the condition of not only their own health but also that of the baby. Pregnant women can easily gain information about nutrition, complications, and fetal development using current technologies that can provide tips and alerts for preventive care, emergency care, post-delivery support, and information about emerging risks.  Remote monitoring of high-risk pregnancy and prevention of preterm labor can now be done in the patient’s home using telehealth devices.  Remote monitoring of high-risk pregnancy and prevention of preterm labor can now be done in the patient’s home using telehealth, as well as the non-stress test (NST) is a common test done on patients with a high-risk pregnancy to identify fetus heart rate (FHR) for fetuses that are in immediate danger. Several apps are available on smartphones for pregnant women that offer support and track the health of both the mother and the fetus.  The Dyno, a remote health monitoring system can track the mother’s health and alert caregivers if action is required.

Keywords: Smartphone apps, remote health monitoring devices, high-risk pregnancy, non-stress test (NST), fetus heart rate (FHR), Dyno.

I. INTRODUCTION The rapid advances of internet and communication technologies have evolved into an essential need, and both city-dwellers and those living in remote areas have equal opportunities to use these technologies to improve their health [1]. Technology is key in healthcare improvement due to (i) cost reduction, (ii) patient safety and satisfaction improvement, and (iii) reduction of potential errors [1]. Recently, mobile technology has vastly evolved into an established platform, with up to 4.6 billion mobile phones being used globally [1]. Thus, many experts in the healthcare industry and health organizations, such as the World Health Organization, are seeking to tap into mobile technology’s potential to reform healthcare management and delivery, especially that which is vital to pregnant women [1]. Pregnancy is one of the most common life situations that might intensify the need for more health related specifics among women [2]. Pregnant women can use Smartphone apps, social media [1], and remote health monitoring devices, to provide security, confidence, and information about the condition of not only their own health, but also that of the baby. Pregnant women can easily gain information about nutrition, complications, and fetal development [2]. Current technologies can provide tips and alerts for preventive care, emergency-care, post-delivery support, and information about emerging risks [1]. Women undergoing complicated pregnancies often have a lot of concerns and questions. One solution is teleconsultation, which may provide immediate answers and creation of a personal healthcare plan [3]. Patients and physicians can interact via a video monitor and discuss concerns and answer questions through the use of “pictures, diagrams, models or videos” [3], including advice about nutrition. A number of pregnancy complications, such as anemia, miscarriage or stillbirth, can be avoided by proper nutrition and maintenance of an active lifestyle [1] [4].

II. APPS Several apps are available on smartphones for pregnant women that offer support and track the health of both the mother and the fetus. The Yukon Baby smartphone app engages women, men and their families and supports them during pregnancy [1]. Pregnant women can also benefit from Bloomlife, an application and device that detects the intensity of each contraction, as well as creating a history of all the changes that have occurred in the long term [5]. My Pregnancy app has features, such as fetal development images, which are shown by expert medical illustrators [2] [6]. Daily use of apps available on smart phones, iPhone, iPod Touch and Android guide women to prepare for their baby’s birth by providing answers based on the child’s due date [2]. Internet-based behavioral programs can augment prenatal care which may lead to improved pregnancy outcomes [1].

III. HIGH RISK PREGNANCY AND REMOTE HEALTH MONITORING Remote monitoring of high risk pregnancy and prevention of preterm labor can now be done in the patient’s home using telehealth for tracking (1) uterine activity, (2) management of obstetrical diabetes (blood sugar testing and administering insulin), and (3) management of obstetrical hypertension (blood pressure and urine collection) [1]. Pregnancies can be high-risk for many reasons, such as twins, triplets, or multiple fetuses, due to a heightened chance of premature labor [2] [9]. Other conditions considered high-risk are high blood pressure, chronic illness, history of preterm labor, and gestational diabetes [2] [9]. The risk of premature labor, which is uncontrolled uterine contractions causing cervical dilation, can be identified early on in the pregnancy and can be monitored in the home by using telehealth devices [2].
Physicians advise women with high risk pregnancies to have complete bed rest in their homes because it may lower “the gravitational stress on the uterus and cervix and increases blood flow” [10] [11] . Home bed rest creates less stress than hospitalization, which may lead to feelings of confinement, lack of privacy, depression, anxiety, and separation from family [10]. Remote home health monitoring provides women with control over their lives and the ability to perform self-care activities [10]. Previously, women who were prescribed bed rest at home could not participate in support groups with fellow patients; however, due to advanced technologies, patients can connect with online support groups from the comfort of their own homes [2]. Telehealth equipment in the home can monitor preterm labor risks using home uterine activity monitors (HUAM) and non-stress test monitoring [2]. The identification of early uterine contractions has been used for preterm birth prevention for the past twenty years [12]. Home monitoring systems transmits data that is collected two or three times daily to a round-the-clock nurse who reads uterine contractions and all data that is collected is transmitted to the woman’s primary physician [13]. The physician can prescribe self-administered medications that stop contractions or advise the patient to go to the hospital for supplementary evaluation [13]. HUAM research shows that home uterine activity monitoring can detect preterm labor, “pregnancy prolongation and improved pregnancy outcomes” [13], which leads to improved outcomes for the child, such as reduced nursery stays, “increased birth weights and gestational age “ [13]. The advancement of technology has made possible a more detailed and precise follow-up, used at the request of specialists, since they are essential to determine in the first months of gestation, if the child has a genetic disease, and thus be warned, for the entire gestational process [7]. Remote health monitoring provides mothers with real-time data on their child’s heart activity; collected data can be processed live into the cloud using proprietary algorithms. Users can access the data on their smartphone or on the website of the company where they can record and then share the heartbeat of the baby with family and friends. Each device contains a set of sensors that provides doctors with a wide range of statistics, from the heartbeat rates of the mother and baby, kicks, sleep state and contractions [8]. The Dyno, from DynoSense Corp., is an integrated remote health scanner which can capture a wide range of health metrics from the pregnant woman in her home [8]. It can track up to 33 health metrics containing all basic vitals, for example (i) ECG (electrocardiogram), for all the irregularities related to heart and heart parameters, (ii) photoplethysmography which extracts blood oxygen, (iii) pulmonary plethysmography which extracts the respiration rate, breathing efficiency, and breathing volume, (iv) oral body temperature, (v) and non-cuff blood pressure tracking [8]. The Dyno can do all this easily in less than 60 seconds just with one action by the user.

IV. HOME NON-STRESS TEST The non-stress test (NST) is a common test done on patients with high risk pregnancy to identify fetus heart rate (FHR) for fetuses that are in “immediate danger of deterioration and compromise” [14]. Patients can perform the NST in the home daily using a FHR monitor and transmit the data to a caregiver who can reassure the patient that there is no risk or refer the patient to the hospital for further observation [14]. Studies show that home FHR monitoring is safe at all stages of gestation and is so easy to use that it can benefit even “socioeconomically disadvantaged patients” [14]. Home monitoring alleviates patients having to find transportation to a physician’s office, and also encourages them to comply and be an active participant in their own health care [14].

V. CONCLUSION Pregnant women can benefit from current digital technologies for finding apps that monitor health, provide information, or connect to caregivers. High-risk pregnant women benefit from home bed rest and enjoy self-control of their pregnancy health using home remote health monitoring devices. Smartphone and other devices that provide pregnancy monitoring and information apps help connect patients to others in similar circumstances. Remote health monitoring devices that can easily be used in the comfort of a patient’s own home are a preferred alternative to hospitalization that is costly, isolating, and depressing. Today’s advances in digital and remote health monitoring are becoming more sophisticated, easy to use, and turn a pregnant woman’s health data and that of her fetus into actionable and meaningful information for caregivers. All pregnancies can benefit from continuity of care, continuous monitoring, data collection, and access by physicians.

REFERENCES [1] Jayaseelan R, Pichandy C, Rushandramani D (2015) Usage of Smartphone Apps by Women on their Maternal Life. J Mass Communicat Journalism 5:267. doi:10.4172/2165-7912.1000267 [2] Lum, B. (2004). Telehealth in High Risk Pregnancy. Information Systems in Healthcare. University of Hawaii at Manoa, Retrieved from www2.hawaii.edu/~bettyl/finalpaper.doc
[3] Telemedicine Links High-Risk Pregnant Women & Specialists. (2005). Article ID: 51353. Source Newsroom: University of Maryland Medical Center/School of Medicine. Retrieved from http://www.newswise.com/articles/telemedicine-links-high-risk-pregnant-women-specialists [4] O’Brien, O. A., McCarthy, M., Gibney, E. R., & McAuliffe, F. M. (2014). Technology-supported dietary and lifestyle interventions in healthy pregnant women: a systematic review. European journal of clinical nutrition, 68(7), 760-766.
[5] Bloomlife. (2017). Smart Pregnancy Wearable. Retrieved from https://bloomlife.com

[6] My Pregnancy Today App. (2017. itunes.apple.com. Retrieved from https://itunes.apple.com/us/app/pregnancy-tracker-baby-development… [7] Kraschnewski, J. L., Chuang, C. H., Poole, E. S., Peyton, T., Blubaugh, I., Pauli, J., Reddy, M. (2014). Paging “Dr. Google”: does technology fill the gap created by the prenatal care visit structure? Qualitative focus group study with pregnant women. Journal of medical Internet research, 16(6), e147. [8] Tehrani, N. (2016). How Health Relationship Management Services (HRMS) Benefits Corporate Wellness. International Journal of Biomedicine, 6(2), 143-145. [9] Smith, Dr. Medical library (1999-2003). High risk pregnancy. Retrieved December 14, 2004, from http://www.chclibrary.org/micromed/00051310.html [10] Heaman, M., & Gupton, A. (1998, December). Perceptions of bed rest by women with high-risk pregnancies: a comparison between home and hospital. BIRTH, 25(4), 252-258. [11] Maloni, J. A. (1994, October). Home care of the high-risk pregnant woman requiring bed rest. JOGNN, 23(8), 696-706. [12] Moore, M. L. (2003, September/October). Preterm labor and birth: what have we learned in the past two decades? Journal of Obstetrical Gynecological Neonatal Nursing, 32(5), 638-647 [13] Matria Healthcare (n.d.). [Womens Health]. Retrieved November 19, 2004, from http://www.matria.com [14] Kerner, R., Yogev, Y., Belkin, A., Ben-Haroush, A., Zeevi, B., & Hod, M. (2004). Maternal self-administered fetal heart rate monitoring and transmission from home in high-risk pregnancies. International Journal of Gynecology & Obstetrics, 84, 33-39.

Corporate Wellness and Health Relationship Management Services

Many employees spend more hours at their workplace than anywhere else, not to mention the time spent commuting. The typical worker spends about 47 hours a week in these activities ^[1], many of them sitting in cars, trains, buses, or at their desks.  A recent study found that a person who spends long hours sitting down each day, has a higher risk of premature death, even if he or she engages in regular daily exercise ^[2].  Urban environments often require behavior that requires sitting down:  commuting, in the workplace, or even during time spent at leisure, such as watching television or movies.  These statistics show that maintaining a healthy work and life balance has become progressively important ^[2].

Traditional corporate wellness programs encourage employees to stop smoking, lose weight, or get more exercise, with the goal of decreasing the company’s overall healthcare costs by having healthier employees.  However, such programs have not always met those goals, as research shows that cost increases have either stayed steady or even increased ^[1].  Wellness is not merely the absence of illness, but also includes the concept of total well-being of the individual embodying social, spiritual, emotional and intellectual health, to include physical health. It also encompasses a lifestyle of healthy behavior and healthy environments that are supportive not only at work, but also in the home and community ^[3].  Thus, many organizations are turning toward promoting a healthier work environment and health promotion policies for their employees.  Corporate wellness programs are effective ways to establish this balance. Programs emphasizing corporate wellness benefits can be instituted in several ways.  One new health paradigm that is providing a total health ecosystem is Health Relationship Management Services (HRMS) ^[4] that combines remote health monitoring that captures individual health data, sends it to the cloud for restructuring into actionable information that can be used to anticipate changes in health and allow access for caregivers to provide solutions or treatment.  HRMS allows individuals to engage in their own healthcare and encourages lifestyle changes for better well-being.  The common goal for all corporate wellness programs is to promote employee, employer, and organizational well-being.

Employees who do not have the opportunity to engage in corporate wellness programs may be susceptible to serious illnesses, which may lead to long-term disability or discontinuing their employment.  A primary benefit of corporate wellness is reducing rates of injuries and illnesses among workers, since many employees experience work-related injuries as well as development of health complications such as heart disease, diabetes, or stroke ^[2].   Prevention of employee illness can also lead to reducing employee absenteeism, since people who are unhealthy, stressed, or overworked have a tendency to experience illness more so that employees who are healthy ^[2].  Programs focusing on corporate wellness benefits can drastically reduce these problems.  As an example, Coors Brewing Company decreased employee absenteeism 18 percent after introducing a corporate wellness program ^[2].  Coca-Cola saved $500 per employee yearly, even though only 60% of its employees participated in a corporate wellness program ^[2].  Also, retention of key employees is enhanced, leading to less turnover.

Corporate wellness is also the process of enabling employees to control and improve their own health. On average, half of an employee’s waking hours are spent on the worksite, resulting in stress and lack of physical activity that constitutes to health problems.  Many organizations have developed strategies to align their goals and objectives to bring about the sustained performance of business by having effective relationships with their employees. One such strategy is the implementation of Health Relationship Management Services (HRMS) ^[4], which is a health ecosystem that continuously monitors an employee’s health data for prevention and/or treatment.

As an example, Zappos, an online e-business selling shoes, clothing and many other products to its customers,  has rapidly expanded its operations over a short period of time because of successful implementation of a similar method as Health Relationship Management Services (HRMS) ^[4].   Zappos is admired for its employee wellness programs and healthy environment^[5]. Zappos’ workplace is an efficient LEED certified building constructed for the benefit of Zappos employees.  This has made the workplace a happier, healthier, and more productive milieu for employees, which translates into happier customer service and customers ^[6].

New healthcare technologies can now monitor an individual’s personal health data continuously with services that provide health alerts when the data deviates from a healthy pattern.  Such technologies can engage an employee in his/her own health care and encourage a healthy lifestyle.  Health Relationship Management Services (HRMS) ^[4] is such a system that is ideal for employee wellness as it makes it fun and engaging for individuals.  Instead of adhering to traditional approaches and methodologies for employee wellness, Zappos focused on making its employees happy by encouraging them to participate in an environment that encourages healthy activities and programs. Zappos believed that motivation is the key to success and values its employees’ feelings and their viewpoints, rather than forcing rigid and overly-planned corporate goals on them ^[9].

Healthcare services have drastically changed over the past few decades, and the technological advancements in medical systems have revolutionized the healthcare industry. Zappos took the risk of incorporating such new systems of healthcare, which has definitely paid off for the company and employees since most employees now love working there ^[6].  One such similar paradigm is HRMS in which individuals can engage in their own healthcare and lifestyle changes.  Along the principles of this new paradigm, Zappos promotes fitness by monitoring employee health, providing a health station so employees can check their blood pressure, weigh in, and receive a body fat percentage reading.  Employees can also log their fitness activities to earn rewards for their physical activity.  Zappos also offers free on-site fitness classes and boot camp-style training ^[9]. Employees can participate in endurance events, such as 5Ks and marathons, and if they finish the race, they are rewarded by being reimbursed for their entry fees ^[9].   All of these activities are similar to the HRMS paradigm that engages individuals to improve their own healthcare and observe wellness.  Employees at another company, VISTA Staffing Solutions, spend on average 10-12 hours a day sitting.  The company decided that its previous wellness programs did not work, so they switched to “stand-up desks, wireless head sets and walking treadmills” to create a healthier work environment^[2].  The goal was to promote healthy eating habits and weight loss to boost employee productivity.

Research has shown a link between employee nutrition and exercise and how it affects their overall productivity ^[7].  Obesity and related diseases, have led to a significant increase in healthcare costs for many organizations. Zappos was aware that obesity is one of the largest contributors to health problems linked to diseases such as diabetes, hypertension, cardiovascular disease, and cancers.  Moreover, these health problems resulted in lower employee productivity, higher absenteeism and an increase in employee turnover.  Additional costs aside from medical claims occur when employees are not performing at optimal level.  Technological systems can indicate patients’ adherence to medical protocols and acts as a warning sign in many cases such as hypertension, cardiac disease, and many other diseases, as patients are continuously monitored no matter where they are.

Giving attention to overall employee wellness, Zappos designed policies to facilitate employee health by offering healthy food options and allowing for exercise time.  Zappos focused on employees’ happiness by encouraging them to engage in a flexible, fun approach to wellness, such as Wellness Adventures, March Madness, and Recess Tuesdays, that recruits employees from different departments and encourages them to mix and have fun away from work, doing such activities as laser tag, playing basketball or jumping on a trampoline ^[6].  To encourage participation, there are incentives to wellness events.  By using a similar concept as HRMS, Zappos can monitor the employees’ health records through online portals and can determine whether its employees are following healthy lifestyles and are getting proper healthcare. This is why there is an increased need for employee wellness programs, and systems, such as HRMS, are becoming fundamental to many businesses such as Zappos.

Zappos considered how responsibility for action on health determinants and health behaviors was balanced between employers and employees.   The development of systems, such as HRMS, promotes and fosters health and well-being of individuals, corporations, and communities.  HRMS helps to develop plans to increase physical activities and increase awareness of health problems and education.  Furthermore, applications and services which use the internet as a platform have allowed gathering and sharing of medical, health, clinical records and data that can be analyzed, stored, and made easily available to different participants in the healthcare system ^[10].  This will encourage employees to willingly provide personal health data that will result in job satisfaction, as satisfied employees are more likely to contribute as a consequence of increased duty, responsibility and obligation to employers.  Zappos has adopted employee wellness strategies and found that its employees performed better than before as they are more confident, fresh and active while performing their jobs ^[6].  Zappos wellness coordinator Kelly Maher has remarked that it is all about encouraging people to engage in wellness voluntarily, not by force.  Programs that are successful are ones that engage team members to become energized on their own ^[2].  HRMS can act as a preventative sentinel for corporate well-being as well.

Conclusion

Zappo’s, Coors Brewing Company, Coca-Cola, and VISTA created a unique wellness program to engage employees in unique health-through-fun health activities, as well as healthy workplace environments.  Benefits of corporate wellness combined with the benefits of HRMS can lead to happier, healthier employees who like their working environment.  Companies should take advantage of corporate wellness and HRMS benefits to avoid stressed, sick, or unhappy employees who experience illness, absenteeism, injuries and increased healthcare costs.  Instead, companies can experience an increase in employee productivity and retention.  A monitoring system, such as HRMS, can standardize patient health data, and continuously follow-up with relevant feedback to actionable data.  Therefore, as companies adopt HRMS, health-related costs may decrease while providing better quality services to employees who can receive health services as a product ^[11].  A harmonious, healthy workplace provides all employees with the benefits of corporate wellness.

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Hospital Discharge and Health Relationship Management Services

Patient hospital discharge readmissions has become a major problem for the healthcare industry.Studies show that that almost 20% of patients have adverse events within 3 weeks of being discharged, of which close to three-quarters could have been improved or prevented [1].  In 2010, U.S. hospital discharges numbered over 35 million, and nearly 20 percent of Medicare patients were readmitted within the first month [2] [3].   Research shows that, in the U.S., nearly 25 percent of discharged patients are readmitted to the hospital within 90 days.  Many such readmissions originate from errors due to discontinuous, fragmented care after discharge [4].  Unplanned readmissions costs billions; thus, they have to be avoided for the financial well-being of healthcare systems and patient quality-of-life [3].  Hospitals are financially motivated to reduce readmissions, since the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) Centers for Medicare & Medicaid Services (CMS) poses a penalty on hospitals having high readmission rates that can mount to a considerable expense [5] [6] [7].  Thus, reducing adverse events post-discharge is essential for the U.S. health care system [8].

Patients may be especially vulnerable during the transition period from discharge and home care because they may be still functionally impaired during the transition from critical care to ambulatory care [9].  This stems from patients leaving the hospital “quicker and sicker” [10] [11].  Discharge patients who receive home-care are vulnerable because they generally do not receive the same around-the-clock professional monitoring they did in the hospital [12] [13].  Research shows that one in five patients had an adverse event transitioning from hospital to the home; some were preventable, while others were correctable, but could have been lowered by timely corrective actions [11].  Other studies have shown that at-home patients with undetected deteriorating physical conditions can result in adverse secondary conditions, such as developing infections that bring a person into the Emergency Room.

Due to pressure from Medicare and other payers, patients are being discharged as soon as possible, where they often return home with little or no professional assistance, and where difficult and complex care often falls under the responsibility of family members who have no training [14].  Hospitalized patients’ conditions are assessed routinely, but once they go home, they are monitored only by a caregiver who is a family member or someone other than a hospital care provider [11].  For the caregiver, problems arise, such as time management, competing demands, physical and mental stress, and financial concerns [15].  Some problems also may arise due to incompetent or fraudulent caregivers.

The most common post-discharge complications are: (i) an adverse drug event (ADE), (ii) infections acquired in the hospital, (iii) procedural complications, as well as, (iv) pneumonia, (v) depression and loneliness [16].  The somewhat higher rate of ADEs after discharge may be due to patients not being monitored as closely following discharge as they were in the hospital [11].  Another condition of a discharged patient that often develops is the feeling of isolation, depression, or lack of awareness of a supporting community of care friends.  Although social isolation is more prevalent in the elderly, young adults, such as those who are disabled and confined to their homes due to a disease such as multiple sclerosis, or a young single mother who may experience loneliness and social isolation as well.

Possible Solutions

There are a number of interventions that can be used to reduce readmissions, to include prompt identification and response to symptoms signaling a worsening condition and avoidance of adverse events that result in readmission [17].  Some current suggestions for readmission prevention have included post-discharge activities, such as home visits, follow-up phone calls, and connections to the physician between inpatient and outpatient surroundings [2].  Some effective approaches include preemptive monitoring, visits to the patient’s home, consultations by phone, and telemonitoring [17].

Remote monitoring technology that combines all of these elements may significantly impact a decrease in hospital readmissions by using sensors to detect key wellness indicators, such as quality of sleep, adherence to medications, and physiological information [17].  Sensors used in a patient’s own home can continuously monitor daily living activities and detect subtle clues to potential health problems, notifying caregivers to potential developing health conditions [17].  Research shows that, due to monitoring, for example, patients having heart failure reduced emergency department visits and exhibited a tendency toward reducing readmissions and overall costs [18].

Patients who receive social support from family or friends have healthy beneficial impacts on the “cardiovascular, endocrine, and immune systems” which serve as protective barriers against disease [19].  At-home caregivers can help prevent readmissions by understanding prescribed dosage and adherence to medication schedules [20].  Caregivers should be aware of and be able to recognize risk factors, such as COPD or heart failure.  Also, potentially adverse events can be avoided by tracking small changes in the patient’s day-to-day behavior, such as sleep patterns, eating, clinical vital signs and mental state [20].  Real-time monitoring with alerts can lead to intervention and prevent unnecessary trips to the hospital [20].

Real Solutions: Health Relationship Management Services HRMS

A comprehensive solution to these problems is a new paradigm in patient healthcare called Health Relationship Management Services (HRMS), which is a daily system of patient remote health monitoring, patient health data analytics, follow-up and response.   HRMS helps decrease hospital readmissions, healthcare costs, increase access, and provide “anywhere, anytime monitoring diagnosis and treatment” [21].  HRMS reads patient health data and immediately sends this raw data to the cloud for restructuring into information that can be accessed and interpreted by a caregiver over time.  If there is a change in the patient’s health data that requires immediate action, the patient is contacted to see what might be causing the change.  When repeated, the continuous use of the monitor adds more personalized patient health data into the system.

Constant remote health monitoring of a patient can also detect patient disconnect or inactivity, indicating conditions such as a fever, pneumonia, or medication misuse that may need to be followed-up on.  HRMS may also be an effective strategy for disease management in high-risk heart failure discharge patients because it monitors physiological conditions [18] [23].  HRMS may detect symptoms of “hypertension or hypotension, malaise, or requests for comfort or simple communication needs that can be relayed in real time” [24].

Since patients are provided access to real-time personal health information in an understandable format, they now have the ability to contribute, correct or amend information in their own Electronic Health Records (EHR), which can accept patient generated data.   By actively capturing and centralizing personal health data, hospital discharge patients are encouraged to become involved in their health with user-friendly access via friendly portals [25]. Patients will also be provided with outbound motivational messages, reminders, and opportunities to further engage in their own health care.

For the isolated patient, the interactive app will provide an outlet to the outside world which may limit a sense of loneliness and isolation by discussing health issues with others through Patient Health Narratives (PHN) [26]. Care management platforms incorporate community resources to support patients giving patients access to organization supported social media, games, etc., that encourage engagement and positive behavior change [25].).  By connecting to a caring, supportive, health care community through an online patient portal app, the patient can share stories to better understand health conditions, prescription medications, and alleviate psychological health problems.

HRMS has other benefits, such as providing quality end-of-life care by honoring patient wishes regarding life-sustaining treatment.  HRMS can incorporate patients’ advanced directives wishes and links to Medical Orders for Life-Sustaining Treatment (MOLST) information and forms accessible by health care practitioners and facilities [27].  Also, since the needs of foreign-born patients may be considerably different from American-born patients, HRMS assessment and care planning now includes culturally sensitive care that meets the patients’ needs, irrespective of their background [28].

Case Study

This case study is about Carolyn, a baby-boomer aged mother, who is discharged from the hospital after abdominal surgery. She has been hospitalized for several days, and is still in constant pain, requiring regular doses of pain medication.  Carolyn is facing at least two weeks of recovery and recuperation at home, after which time, she will be able to return to her job.  At the time of discharge from a hospital, a discharge nurse prints out several pages of instructions for Carolyn delineating what type of procedure was done, what to expect at home, and how and when to take prescribed medication.  This procedure is often lengthy and confusing to many patients when instructions are given to them, and research indicates that, not only do many discharge patients misunderstand discharge instructions, some even appear to be unaware that they don’t understand them [29].   Now it is okay for Carolyn not to remember everything the nurse tells her at this point of discharge because HRMS has shown that she can access this information through an HRMS remote patient portal later in the comfort of her own home.

Caregivers are called upon to perform certain routine caregiving tasks once a patient goes home.  Carolyn’s daughter, Megan, will help her bathe, prepare meals, administer medication, and change wound dressings.  However, since Megan has received very little advice or training from the nurse to care for her mother, these are activities that Megan is not trained to do.  Although she is loving and supportive, she also works full-time, so her free time is limited. Hospital staff often does not provide education for these tasks until the day of discharge, which may or may not be the best time for the caregiver to learn their responsibilities. As a result, Megan feels overwhelmed and stressed over this responsibility of caring for her mother, and because of her job commitment, she cannot be readily available, even in an emergency [30].

After Carolyn’s formal discharge at the hospital, Megan escorts her to the hospital pharmacy where she is given her prescribed medications, is educated about their use, and has her questions satisfactorily answered.  Carolyn is also set-up with a unique account with HRMS, a prescribed at-home health monitoring system.  Carolyn is provided with the HRMS remote monitoring unit that comes with case that automatically will connect her to the internet and the patient portal through a customized android system with access to all instructions for medications and other healthcare instructions.  It is crucial for Carolyn’s recovery and health safety that she clearly understand her medication instructions, as well as how to use the remote health monitoring system that will provide her and Megan with health related information at a later date.  HRMS will allow Megan to access current information about her mother’s health, medication, and at-home instructions even while she is at work.

Automatic reminders are sent for important instructions that must be done at certain times, such as drinking water to avoid dehydration and taking medication at the proper time.  Since the HRMS system can also capture all of Carolyn’s vital health metrics to assess physiological changes, Carolyn’s physician can get feedback about her state of mind and physiological and psychological conditions. Upon arriving at home, Megan places the monitoring system alongside Carolyn’s medication on her nightstand, so she can use it every morning when she rises and every night before she goes to bed.  She can view video instruction on her screen how to use the system, which, when used according to directions, captures Carolyn’s personal health data that is immediately sent to the cloud for analytics.  Typically, twice a day at the time Carolyn brushes her teeth, she can see a screen on her cradle that will show her health metrics with every use, so she knows her health progress every day.

While Carolyn is recovering, she is left alone quite frequently.  Research shows that loneliness is a widespread social problem with severe physiological and health implications, and appears to be a risk factor for raised Systolic Blood Pressure (SBP) and escalations in SBP over time [32].  So, in-between Megan’s visits, Carolyn engages with the patient app that is part of the monitoring platform to pass the time by reading an interactive online magazine with patient health stories and health newsfeeds, and playing games that reward her with points that can be cashed in for prizes. This will help her understand how to recover faster, which at the time of discharge may not have been understood.  Now, Carolyn has an HRMS remote caregiver that is part of the community who supports her and will avoid a sense of loneliness when Megan is not around.  HRMS, as a contact to the outside world, will help alleviate that sense of isolation that is important for recovery [32].

HRMS tries to capture as much information about Carolyn as possible, so if she has not understood her discharge instructions, she may receive reminders followed by calls from the Communication Center later on.  If Carolyn does not respond to the patient portal, calls or messages, this may be an indication that something is wrong.  HRMS can track when Carolyn takes her medications and can tell if there is a change in her pattern.  Lack of attentiveness may indicate that she is not taking her medication properly or may not be exercising per her physician’s orders, and the HRMS system will want to know why.  Physiological parameters can be tracked for normalcy, and if they appear abnormal (for example, if Carolyn seems to be developing a fever which indicates a post-surgery sign of inflammation), action can be taken.  Although incidences of post-op surgery infections are low, individuals who have undergone surgery are the most vulnerable to infections caused by bacteria that resists some antibiotics [33]. Also, if Carolyn should experience swelling of her legs, feet, ankles, calves or thighs, it may be the result of fluid buildup (fluid retention) or from inflammation in tissues or joints [34]. Swelling of the legs may be a sign of a serious disorder, such as a blood clot or heart disease [34].

If any of these conditions are present indicating a deteriorating condition, a patient advocate in the Communication Center, who has been alerted by the analytic engine of HRMS, will place a call to Carolyn to find out if there is an underlying cause that needs action and determine whether further escalation is necessary. This information is recorded in her secured personal data file for later review by her physician. The next level of escalation is to contact her personal care friend, whom, in this case, is her daughter, Megan. There is a constant update in Carolyn’s status, and last level of the escalation path would be an emergency call to her physician or to the ER.

Because of HRMS, Carolyn has become an integral part of a new health care delivery model of point-of-care analysis and self-testing system.  Carolyn is encouraged to be more engaged in her own healthcare by having access to her own health information and caregivers.  Through connected monitoring systems, Carolyn’s daughter now can track her post discharge condition to reduce chances of readmission.  Carolyn can stay in touch with others within a caring, interactive, health community through her HRMS patient portal app, a platform that allows her to become personally involved by viewing and contributing to her own health record, providing her with a sense of ownership over her own health outcome.  By having a “doctor in a box,” any health alerts will be immediately followed-up on, so Carolyn can avoid readmission to the hospital.

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Elderly Care and Health Relationship Management Services (HRMS)

The initial wave of Baby Boomers turned 65 in 2010, making the elderly the fastest-growing segment of the U.S. population [1]. A key public policy concern in the field of long-term care is the impending burden an aging society will impact the care-giving system and public finances [2]. This is called the year 2030 problem, which questions whether enough resources and an operative service system will be available in 2030, fourteen years from now when the elderly population is greater than what it is today [2]. This growth will be stimulated by Baby Boomers, who in the year “2030 will be aged 66 to 84—the ‘young old’— and will number 61 million people. In addition to the Baby Boomers, those born prior to 1946—the ‘oldest old’—will number 9 million people in 2030” [2]. This population has a higher risk of dependency stemming from chronic conditions and will use up a disparate allocation of health care resources and dollars, both public and private [3]. A recent study shows that the economic burden of elderly care by the year 2030 will require making changes now, before the day arrives when Baby Boomers start needing long-term care [2]. This involves taking advantage of medical and behavioral health advances to allow seniors to remain as active and healthy as possible, and to change the cultural view of growing old to ensure that all ages integrate into community life [2]. One solution to these concerns is a new paradigm in health care called Health Relationship Management Services (HRMS) [4] as it addresses problems associated with aging, living alone, and elder health risks, such as diet, dehydration, and medication misuse.
In the past decade, there have been many efforts to reduce health spending, yet the costs of health care continue to escalate [3]. Medical innovations, such as cancer vaccines and prevention of Alzheimer’s disease, may result in better health and longer life [1], due to new medications and innovative surgical procedures that allow people to live longer. However, with age, many new health issues have arisen, such as the combination of physical symptoms, poor eyesight, minor safety hazards, medication management issues, social isolation, forgetting appointments, mental health, and poor nutrition or malnutrition, which can be alleviated by a new healthcare paradigm called Health Relationship Management Services (HRMS) [5] [4]. Coronary heart disease is the most prevalent condition that affects individuals 65 and older, followed by stroke, cancer, pneumonia, and the flu [5]. Many seniors cope with heart conditions, such as coronary artery disease, high blood pressure, atherosclerosis, vascular disease, irregular heart rhythm, hypertension and congestive heart failure, as well as breathing problems and diabetes [5] [6]. Elders also are prone to weakened immune systems, which leaves them open to opportunistic bacteria, viruses and diseases [5]. Other physiological concerns include fever, water retention, swelling of legs, diabetic conditions, dehydration, diet, and improper nutrition [7]. Maintenance of physiological health among the aging is important, not only for the individual, but also from reducing burdens on medical services [7].

Achieving and maintaining good nutrition is essential for elderly health and quality of life [8]. At the root of dietary intake is availability, preparation and consumption of the proper quality and amount of foods, which may be impacted by several factors, to include social isolation and depression [8]. Imbalances of necessary nutrients and energy gained from food increases the vulnerability of the elderly to unfavorable health outcomes, such as decreasing energy levels and chronic health complications, such as type 2 diabetes, high blood pressure, heart disease, stroke, and osteoporosis [9]. Malnutrition often goes undiagnosed due to diet and inconsistent caloric, energy, taste and access needs [9]. Diet imbalances also can lead to lengthier hospital stays and possibility of readmission, physical, and cognitive function impairment [8].
Seniors sometimes have difficulty recognizing bitter and salty tastes, which result in an increase in salt intake in the diet, which can lead to high blood pressure [9]. Also, many elderly retain their capacity to appreciate sweet tastes, thus consume too many sugary snacks, beverages or desserts, which cause weight gain due to a slowing of metabolisms [9]. Nutrition and reduced metabolisms are directly related to both weight loss and weight gain in the elderly [9]. Moreover, the elderly, especially those suffering from chronic conditions, sometimes have less energy [9]. Thus, reduced activity can lead to obesity [9]. Conversely, limited food access, a decrease in appetite, side-effects from medication, in addition to medical problems can create weight loss [9]. Also, seniors tend to not purchase the foods that are rich in vitamins and minerals, due to fixed incomes or outright poverty [9].

A common problem among the elderly is dehydration because: (1) they have a limited capacity to conserve water, (2) are not aware of their thirst, and (3) often avoid drinking fluids due to overactive bladder problems [9]. Furthermore, the elderly are more apt to lack proper hydration during illness and in warm-weather months [9]. Dehydration is also caused by medications and chronic medical conditions [9]. Mild dehydration symptoms include constipation, headache, dizziness, low blood pressure, rapid heartbeat, and loss of consciousness, while more severe complications include seizures, kidney failure, swelling of the brain, heat injury, and death [9].

Almost 90% of individuals over the age of 65 wish to live at home for as long as they can because staying in familiar surroundings offers emotional well-being [10]. However, studies indicate that a high number of elderly who really ought to be in an assisted living care facility still live at home, and often live alone [10]. No matter the severity of a disability or dependence, elders are encouraged to be independent at home rather than being institutionalized. There are problems associated with such an arrangement aside from health problems, among which are medication, transportation issues, depression, and loneliness. For the elderly who live at home, medication can either be a health lifeline, or it can be a calamity waiting to happen [11]. Problems with medication are very common, and deadly results can occur if too much medication is taken or if doses are missed [11]. There are many reasons why the elderly do not take their medications properly. Misuse of pills often occurs with seniors who have vision problems and cannot read small print on labels [11]. Memory loss for elderly suffering from Alzheimer’s disease or dementia may forget to take their medication or cause an overdose when they cannot remember whether they took their medication already. Also, seniors on fixed incomes, or are low-income, may cut back on the prescribed dose by cutting their pills in half or simply take no medication for long periods of time [11]. Elderly persons with hearing loss may not be able to hear the doctor or pharmacist’s instructions [11]. For seniors who have trouble swallowing a capsule or tablet, they tend to crush or break them, or mix the medication in with their food, but some long-acting medications may be released too fast, or won’t work as intended and could cause sickness [11].

Most elderly individuals prefer self-sufficiency and would prefer to depend on their family as principal caretakers only in times of need which can take place in the home by family or caregivers [12]. The family is, and has been, the primary means of elderly care and assistance in which elders are allowed to live at home in familiar surroundings. Family support is one social network that positively affects an elderly person’s self-image, sense of importance, and feelings of being loved and respected. Home-care services provide quality of life services, such as personal care, housework assistance and help with daily tasks. Whether home care or day care, such services contribute to a sense of security and well-being, and prevent feelings of social detachment [13]. These alternatives to institutionalizing the elderly contribute to better physical and mental capacities since elders can participate in decision-making, maintain their home life, have a sense of control over their lives, and establish social ties [13].

Not all elderly, however, are fortunate enough to have family or day care. Some elderly persons have a negative day-to-day existence due to lack of income, poor health, lack of accessible and safe transportation, fear of being a crime victim, loneliness, social isolation, and limited family contact [11]. Although they are eligible for health services and outreach medical care programs, many elderly people do not use them due to a lack of knowledge about how to access these services and restricted mobility because they cannot reciprocate transportation favors provided by friends or families. Community-based transportation services for seniors often require advance approval and arrangements [11] [14] [15] [16] [17]. Urban medical care is often avoided due to lack of safe accessible public transportation [11] [18]. Many elderly people are justifiably fearful of becoming crime victims while using public transportation [11] [19] [20].

A recent Dutch study suggests that loneliness is a risk factor for the dementia [21]. The study’s findings suggest that feelings of loneliness contribute independently to the risk of dementia in later life. Individuals who feel lonely in old age are much more prone to develop dementia than those who do not feel lonely. People suffering from loneliness have a 64% greater risk of dementia, but this risk is dependent upon having those feelings and not simply because someone lives alone or is socially isolated, unmarried, or without social support [21]. Additional risks for the elderly are Alzheimer’s disease and other dementias that may be caused by other conditions that include depression and mild cognitive impairment.

Solutions

Homecare telemedicine for geriatric disease management is being used for many medical illnesses, such as chronic conditions and heart disease. Home telemonitoring of elderly patients with congestive heart failure confirmed a reduction of the rehospitalization rate and an improved monitoring of drug consumption by the patients [22]. Makers of remote monitoring technology solutions for senior care empower providers to proactively provide the utmost quality care possible by gathering critical health information. Hospitals, doctor’s offices, home healthcare facilities, and nursing homes are embracing wireless remote monitoring devices to communicate patient data [23]. When equipped with the right information at the right time, caregivers now can reduce costs and increase senior independence [24].
Telemedicine technologies can help seniors face challenges linked to social connectivity, emotional health and cognitive and physical ability [25]. Since many seniors want to live in their homes for as long as they can, technology, such as prosthetics, wearable sensors, and other tools for daily living make it feasible [25]. New technology is making it a possibility for adult children to monitor the activities and routines of their aging parents every day, making it possible for seniors to live in their homes rather than being transferred into an assisted living facility [25].

The risk of seniors of being socially isolated or lonely is increasing, possibly due to living alone, retirement, poor health, and death of friends and family members [26]. Research shows that remote monitoring shows promise for geriatric depression, and has become a key factor in helping the elderly and chronically ill live independently and safely in their homes while reducing heath care costs [24]. Many of the problems associated with long-term elder care now and in the future can be addressed by a new healthcare paradigm called Health Relationship Management Services (HRMS) [4].

Health Relationship Management Services (HRMS) Solutions
Health Relationship Management Services (HRMS) as a solution allows the elderly to self-monitor in the safety of their own homes, thus diminishing doctor’s visits, which will eliminate fears of reliance on public transportation, becoming crime victims at bus stops, or being injured while entering or exiting their own homes. Medication misuse that often leads to severe consequences can be monitored remotely, allowing advocates to step in and correct it. Essential nutrient imbalances gained from food that increases the elderly vulnerability to undesirable health outcomes can be minimized, since diet, dehydration, nutrition and dietary intake can be tracked and intervention can take place if problems arise. Seniors’ independence and self-sufficiency increases, since they have empowerment over their own healthcare.

HRMS supports the diverse and changing needs of the elderly by empowering them to take control of their own health [27] [4]. HRMS can lead to lower medical costs for hospital and doctor’s visits, allowing the elderly to remain independent in their own homes. An online patient portal app connects patients to the outside world to minimize isolation and loneliness. HRMS is designed to monitor an individual’s health daily to detect changes in health data that would require immediate attention. New remote health care monitoring technology and HRMS is a solution to these rising health care costs, transportation worries, isolation, and barriers to health care access [4]. HRMS can help allay those feelings by providing elderly individuals with a sense of belonging to a supportive health community in which someone is watching over them every minute of every day and monitoring their health [4].

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Health Relationship Management Services (HRMS)

Digital health has been quite successful in monitoring patients’ health and, according to a latest finding, U.S. investments in digital health have reached $2.3 billion for the first six months of this year, which has broken all past records (Health, 2015).  Healthcare, today, is one of the sectors that is most influenced by advanced technology. Developments in medical technology have progressed from digital wristbands that measure heart rates and other health data to a new generation of products that are improving healthcare delivery and outcomes (Morrisey, 2015) by enabling providers to remain continuously connected with their patients no matter where they are.  These innovative systems can indicate a patient’s adherence to protocols and, in some cases, may even act as an early-warning system for “degenerative illnesses such as Alzheimer’s and Parkinson’s disease” (Morrisey, 2015).  High-tech sensors can now “monitor the at-home cardiac patient’s heart every minute of every day” without being hooked up to a monitor (Morrisey, 2015).  Similar to something out of science fiction, new technological devices now can remotely scan a human body to detect a myriad of symptoms, with the results available to patients, physicians, care providers and relatives.  The patient data that is read by the sensors is more valuable than an intermittent “snapshot” (Morrisey, 2015; Steinhubl, 2015) because it is uninterrupted and it is sent instantaneously to the cloud for restructuring by analytics.  For instance, Steinhubl is working on a “continuous blood pressure measurement watch” to monitor blood pressure over time, not just when a patient is at the doctor’s office.  According to Steinhubl, there is a lack of “synchronicity—there are asynchronous appointments for doctor visits, and so on; so most of healthcare hasn’t really been designed around the patient to make sure their blood pressure, lipids, diabetes, are well-controlled.”    “Patient care has become a primary focus in the development of new concepts and knowledge in healthcare technology” (Cassano, 2014). To improve patient care, the health sector is using data and technology (PWC, 2015).  The core idea is that  digital technology ought to be planned to help manage patients more efficiently and that manufacturers should provide, if need be through strategic alliances, more than just a device by also offering patient healthcare services and solutions in one coordinated platform. The current paradigm of medical care relies on the “autonomous and highly trained doctor”

(White, 2008) to gather and manage information required for every patient’s care.  This paradigm is confronted by (i) the accumulation of obligations for knowledge by patients and physicians; (ii) by the demand to evaluate patients not part of a physician’s practice; (iii) “by consistently unmet quality of care expectations; (iv) by the expense of outmoded, fragmented, and suboptimal care; (v) and by a seemingly insurmountable demand for chronic disease care” (White, 2008).  Refinements within the old paradigm of medical care may not solve such challenges, suggesting the need for a new paradigm (White, 2008).  There is a need for a unified definition of digital healthcare, or connected health, in which everyone can speak the same language.

Health Relationship Management Services (HRMS) is this new paradigm which defines comprehensive patient healthcare in the digital health age for individualized patient care, engagement, and managed outcomes.  An obvious benefit of this technology paradigm is the generation of quality clinical data, since up until recently, was raw data that may not have been transferred to a care provider in a way it could be actionable (Cassano, 2014; Schmittdiel, 2015).  HRMS is a revolutionary new definition to place all digital health activities and technologies within one cohesive cyclical system where patient data is collected from variety of sources, analyzed, made actionable, acted upon, and repeated. HRMS is a complete health ecosystem that produces positive outcomes as a comprehensive service, much as having a physician at home monitoring the patient on a daily basis to minimize health risk while reducing cost of care.

An example of one part of HRMS is a health monitoring system that can measure physiological parameters such as ECG, blood pressure, respiration, heart rate, and other vitals to safeguard a patient’s good health. This digital healthcare comes in the forms of small devices or limited smartphone applications.  HRMS works on the principle of five services known as the 5Rs, which are Read, Restructure, Results, Response, andRepeat.  Metaphorically speaking, these services are “turning gears,” with the first one turning, causing the next one to turn, and so on, as one related collaborative routine (as shown).  Read turns the Restructure, which turns Results, which turnsResponse, and Repeat completes and enhances the overall service.

Read is defined as compilation of raw captured data from a variety of sources such as: (i) a health monitoring system with sensors, (ii) an interactive patient application portal, (iii) Electronic Health Records (EHR), (iv) care specialist feedback,  and (v) care friends responses. Read data is securely sent to the cloud to ensure patients’ health data privacy.

An example of a health monitoring system is the “Dyno^TM” from DynoSense Corp., (Tehrani & Meckl-Sloan, 2015) which is able to measure, at home, various health metrics such as ECG, heart rate, blood O2, respiration rate, breathing efficiency, blood pressure change, body temperature, breath gases, and body compositions.  Taking readings efficiently depends on the quality of the sensors and simplicity of usage. Furthermore, the patient portal, DynoLife^TM, interactively engages the patient for psychological and behavioral feedback among a community of care experts and care friends. Read data are stored in the cloud and are ready to be restructured as required (Lupton, 2013).

Restructure  patient data stored in the cloud is a raw format where it is required to beRestructured by analytics software for evaluation and personalization. This analyzed data in an aggregated form is represented by an individualized health scoring and demographic grading system.  Restructure of the data is a vital step as it involves the data analysis and interpretation of the measurement obtained.  There can be many ways to interpret the readings, but the best systems are based on proven medical standards identified by sources, such as the AMA (American Medical Association). By a solid interpretation, HRMS is able to convert the acquired reading into valuable and meaningful data, not just an accumulation of meaningless Big Data, which can be used for an overall evaluation of the patient.

Results Once the restructuring has been completed, actionable Results must be generated for proper response through an escalation path which indicates all of the individual’s significant health data. This is exhibited by examples such as (i) individualized health scoring and demographic grading; (ii) Health Indexing (HI), which captures health data over a period of time to create better understanding of the true health condition of the individual; (iii) Medical Decision Support Algorithm (MDSA^TM), which filters unnecessary data for the physicians and care providers; and (iv) medication effectiveness. The validity of this system can be cross-checked to confirm if the results indicate a health risk that the care specialist and/or care provider can verify.

Response From the results, a series of actions are identified that are required to be further qualified by the Response system. Such a quantifying process takes many forms, such as (i) interactive questionnaires or surveys through the patient portal application platform, (ii) text or email messaging, (iii) automated robocalls, and (iv) live video or voice interactions with a health specialist from the Communication Center.   Following the quantifying process, an appropriate response is developed.   Examples of appropriate responses are (i) escalation to a care specialist for further intervention, (ii) scheduling a clinic or hospital visit, (iii) Emergency room visit, (iv) entry into EHR/EMR records of the individual, or (v) updated individualized status for further personalized activities.  Activities may include  (i)  news feeds with  up-to-the minute health information, (ii) gamification, which is health recognition games with a reward system to encourage participation, (iii) and an interactive online magazine encouraging individuals to share their Patient Health Narratives (PHN) and become a member of a healthcare community (Meckl-Sloan, 2015). Patient Health Narratives (PHN) is an emergent trend of providing a platform for patients to share their health related stories and dialogues.  This delivers a voice to the experiences of illness, to avoid feelings of isolation, and alleviate concerns and fears of chronic conditions and medical procedures.  This interactive patient application portal may create a sense of community and support for the patient.

Repeat is the Continuous Health Management (CHM) of an individual’s status passing through the entire cycle.  On a periodic basis, Repeat of the cycle will improve patient health outcomes through an interconnected link of services for optimal continuous health relationship management. Individuals are empowered by this continuous process not only by the up-to-the minute availability of their health information, but also, in a meaningful and actionable process,  they become part of the customized social health community of care experts and care friends.   The HRMS platform can be leveraged to produce data-driven approaches to advance a positive and long-term influence on their patient’s health.  Data can be tracked by payers to assure a more healthy patient population and to review meaningful outcomes.

Conclusion Health Relationship Management Services (HRMS) works on the principle of five services known as the 5Rs, which are Read, Restructure, Results, Response, and Repeat.  The combined 5Rs complete the cycle of HRMS through a continuous cyclic HRMS process in that one element is dependent upon the others.  Through patient engagement, the individual becomes part of the solution with continuous personalized feedback, encouragement, empowerment, inspiration, and inclusion in a health community that ultimately may lead to lifestyle changes. HRMS was conceived to define and standardize the entire health ecosystem with continuous follow-up and feedback to the patient, providers, and payers.  As companies adopt the entire patient experience of HRMS, patients will receive health services as a product.   Health related costs will decrease, especially for providers visits while improving quality of care.

You can download a PDF copy from link below that includes listing of all references