Today, patients can use their wearable or IoT devices to report data of physiological parameters and track their own health…
Nik Tehrani, Ph.D. International Technological University and DynoSense Corp. | Mar 20, 2018
Despite incremental progress in curing cancer it remains the second most common cause of death. Most, if not all, health…
Nik Tehrani, Ph.D. International Technological University and DynoSense Corp. | Mar 10, 2018
The future of healthcare is connected to multifaceted, advanced artificial intelligence (AI) which collects patient data that lead to providing…
Nik Tehrani, Ph.D. International Technological University and DynoSense Corp. | Feb 13, 2018
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. 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 . 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 . 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 . 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 . 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. . 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 . 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 . Pharma companies will need to provide third parties with access to their product data and become transparent about clinical trials . 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 . 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  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  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.
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 . 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.
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 . 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.
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.
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 .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 . 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 .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 .
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  . One-on-one text based communication imitates empathetic counseling to help steer a patient toward healthier options  . 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 .
Health Assisting AI: Diabetic Retinopathy
People who have diabetes are at risk for diabetic retinopathy, which can cause blindness if not treated properly . 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 . 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 .
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 . 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 . This approach will allow eye disease analysis to be faster and better, with positive benefits for diabetes care , since it would enable patients to receive ophthalmologic diagnostics without travelling to a specialist . It is predicted that, with better AI technology, a person could snap a cellphone selfie for a retinal eye screening .
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 . 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 . Such information might otherwise take lengthy research by the physician who does not have time to do so .
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 . 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 
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 . 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 . Data Mining, Business Intelligence, Sensing, Ubiquity, Intelligent Agents and Pervasiveness in Medicine, can put effort with new cures and new information for health experts   .
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.
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 . Technology is key in healthcare improvement due to (i) cost reduction, (ii) patient safety and satisfaction improvement, and (iii) reduction of potential errors . Recently, mobile technology has vastly evolved into an established platform, with up to 4.6 billion mobile phones being used globally . 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 . Pregnancy is one of the most common life situations that might intensify the need for more health related specifics among 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 . Current technologies can provide tips and alerts for preventive care, emergency-care, post-delivery support, and information about emerging risks . 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 . Patients and physicians can interact via a video monitor and discuss concerns and answer questions through the use of “pictures, diagrams, models or videos” , 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  .
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 . 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 . My Pregnancy app has features, such as fetal development images, which are shown by expert medical illustrators  . 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 . Internet-based behavioral programs can augment prenatal care which may lead to improved pregnancy outcomes .
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) . Pregnancies can be high-risk for many reasons, such as twins, triplets, or multiple fetuses, due to a heightened chance of premature labor  . Other conditions considered high-risk are high blood pressure, chronic illness, history of preterm labor, and gestational diabetes  . 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 .
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”   . Home bed rest creates less stress than hospitalization, which may lead to feelings of confinement, lack of privacy, depression, anxiety, and separation from family . Remote home health monitoring provides women with control over their lives and the ability to perform self-care activities . 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 . Telehealth equipment in the home can monitor preterm labor risks using home uterine activity monitors (HUAM) and non-stress test monitoring . The identification of early uterine contractions has been used for preterm birth prevention for the past twenty years . 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 . The physician can prescribe self-administered medications that stop contractions or advise the patient to go to the hospital for supplementary evaluation . HUAM research shows that home uterine activity monitoring can detect preterm labor, “pregnancy prolongation and improved pregnancy outcomes” , which leads to improved outcomes for the child, such as reduced nursery stays, “increased birth weights and gestational age “ . 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 . 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 . 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 . 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 . 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” . 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 . 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” . 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 .
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.
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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 , 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 . 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 .
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 . 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 . 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)  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 . 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 . 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 . Coca-Cola saved $500 per employee yearly, even though only 60% of its employees participated in a corporate wellness program . 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) , 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) . Zappos is admired for its employee wellness programs and healthy environment. 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 .
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)  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 .
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 . 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 . 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 . 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. 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 . 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 . 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 . 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 . 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 . HRMS can act as a preventative sentinel for corporate well-being as well.
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 . A harmonious, healthy workplace provides all employees with the benefits of corporate wellness.
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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 . In 2010, U.S. hospital discharges numbered over 35 million, and nearly 20 percent of Medicare patients were readmitted within the first month  . 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 . Unplanned readmissions costs billions; thus, they have to be avoided for the financial well-being of healthcare systems and patient quality-of-life . 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   . Thus, reducing adverse events post-discharge is essential for the U.S. health care system .
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 . This stems from patients leaving the hospital “quicker and sicker”  . 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  . 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 . 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 . 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 . For the caregiver, problems arise, such as time management, competing demands, physical and mental stress, and financial concerns . 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 . 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 . 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.
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 . 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 . Some effective approaches include preemptive monitoring, visits to the patient’s home, consultations by phone, and telemonitoring .
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 . 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 . 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 .
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 . At-home caregivers can help prevent readmissions by understanding prescribed dosage and adherence to medication schedules . 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 . Real-time monitoring with alerts can lead to intervention and prevent unnecessary trips to the hospital .
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” . 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  . HRMS may detect symptoms of “hypertension or hypotension, malaise, or requests for comfort or simple communication needs that can be relayed in real time” .
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 . 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) . 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 .). 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 . 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 .
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 . 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 .
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 . 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 .
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 . 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 . Swelling of the legs may be a sign of a serious disorder, such as a blood clot or heart disease .
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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The initial wave of Baby Boomers turned 65 in 2010, making the elderly the fastest-growing segment of the U.S. population . 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 . 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 . 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” . 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 . 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 . 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 . One solution to these concerns is a new paradigm in health care called Health Relationship Management Services (HRMS)  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 . Medical innovations, such as cancer vaccines and prevention of Alzheimer’s disease, may result in better health and longer life , 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)  . Coronary heart disease is the most prevalent condition that affects individuals 65 and older, followed by stroke, cancer, pneumonia, and the flu . 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  . Elders also are prone to weakened immune systems, which leaves them open to opportunistic bacteria, viruses and diseases . Other physiological concerns include fever, water retention, swelling of legs, diabetic conditions, dehydration, diet, and improper nutrition . Maintenance of physiological health among the aging is important, not only for the individual, but also from reducing burdens on medical services .
Achieving and maintaining good nutrition is essential for elderly health and quality of life . 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 . 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 . Malnutrition often goes undiagnosed due to diet and inconsistent caloric, energy, taste and access needs . Diet imbalances also can lead to lengthier hospital stays and possibility of readmission, physical, and cognitive function impairment .
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 . 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 . Nutrition and reduced metabolisms are directly related to both weight loss and weight gain in the elderly . Moreover, the elderly, especially those suffering from chronic conditions, sometimes have less energy . Thus, reduced activity can lead to obesity . Conversely, limited food access, a decrease in appetite, side-effects from medication, in addition to medical problems can create weight loss . Also, seniors tend to not purchase the foods that are rich in vitamins and minerals, due to fixed incomes or outright poverty .
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 . Furthermore, the elderly are more apt to lack proper hydration during illness and in warm-weather months . Dehydration is also caused by medications and chronic medical conditions . 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 .
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 . 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 . 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 . Problems with medication are very common, and deadly results can occur if too much medication is taken or if doses are missed . 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 . 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 . Elderly persons with hearing loss may not be able to hear the doctor or pharmacist’s instructions . 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 .
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 . 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 . 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 .
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 . 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     . Urban medical care is often avoided due to lack of safe accessible public transportation  . Many elderly people are justifiably fearful of becoming crime victims while using public transportation   .
A recent Dutch study suggests that loneliness is a risk factor for the dementia . 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 . 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.
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 . 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 . When equipped with the right information at the right time, caregivers now can reduce costs and increase senior independence .
Telemedicine technologies can help seniors face challenges linked to social connectivity, emotional health and cognitive and physical ability . 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 . 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 .
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 . 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 . 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) .
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  . 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 . 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 .
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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 “DynoTM” 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, DynoLifeTM, 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 (MDSATM), 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.
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There is an old saying that “necessity is the mother of invention.” However, the question arises is how that necessity is formed and prioritized to inspire a solution. While an invention is the application of a new idea, it takes innovation to make it marketable. There are many tools for innovation, such as creating a culture that nurtures innovation, reducing the risk of sharing ideas, having constraints (price, time frame), and risk-aversion . Innovation pioneers, like all innovators, have access to the same tools for innovation that all visionaries have access to, but some visionaries go beyond them to make a better world or by disrupting the current paradigm. Many innovative pioneers changed the future, first through invention followed by innovation.
Many innovators have gone beyond universal basic tools with imagination in their thinking. They have seen potential in the world that did not previously exist and harnessed technology to make it a reality, sometimes being successful and sometimes not. So, then, is it possible that the innovation of visionaries goes beyond basic tools and still have a strong motivation that keeps them going in the face of failures? Might there be another factor or factors that keep them on track until they reach their goals? Is it possible that love and passion are intangible factors that drive success?
Thomas Edison once remarked about his lengthy trial and error toward a working lightbulb that he had not failed, but rather “just found 10,000 ways that didn’t work” . Even before reaching 10,000 frustrating failing attempts, many potential innovators might have thrown up their hands and given up, but Edison’s passion for finding the right electric lightbulb was stronger than his unsuccessful attempts. Nikola Tesla, who devoted all of his energy to science, is best known as the father of alternating current. He had many ideas that simply did not work the way he wanted them to, yet he kept on going. Tesla was also often ridiculed for suggesting inventions that seemed impossible, but, out of passionate belief that they would work, he invented them anyway .
Passion is the driving source on the road to success of startup companies and gives the ability to resist naysayers and stay focused in the face of adversity and failures. If one is not passionate about one’s idea, how would he/she be able to successfully communicate the vision and mission of the company to others ? Passion is the fuel of the innovative fire and the burning desire to share that passion, but it’s inadequate to just love the process; it is essential to have a burning desire to share that passion . Tesla’s Elon Musk shared his passion for electric cars by opening the company’s technology patents to the automotive industry. According to Musk, Tesla could not conceivably manufacture electric vehicles quickly enough to alleviate the carbon crisis, so he allowed his company to embrace an open-source policy to provide entire industry with proprietary technology to fight the problem together .
Musk showed his entrepreneurial spirit early in his life. While a student attending the University of Pennsylvania, he paid his own tuition and expenses by converting his house into a party club and throwing huge parties. Musk went on later to invent Pay Pal, which he sold to eBay in 2002 for $1.5 billion. Since then, Musk has used creating and innovating as his life’s purpose by working an average of 100 hours a week. But is hard work what drives Musk toward innovation? . It has been said that Musk is driven by ideas that promise to profoundly alter life today as we know it: space, clean energy and the internet. As a result, his passion has been to create businesses that focus on the commercialization of innovations that have impacted, or will impact all three . Modern-day innovator, Steve Jobs changed the face of modern technology. In 1997, Jobs said, “Apple is not about making boxes for people to get their jobs done, although we do that well. Apple is about something more. Its core value is that we believe that people with passion can change the world for the better” . The one quality of all successful entrepreneurs is that they don’t do it for the money. They’re passionate about their mission.  Other innovators also have had a relationship with love and passion. Dan Bricklin, inventor of VisiCalc, known as the father of electronic spreadsheet, once said that unless one finds a true calling and love for the craft, the “risks may outweigh the rewards” . It takes more than training or talent, because unless the timing is good, it isn’t enough. An innovator needs to have a true passion for the challenges ahead and to be prepared for when the time is right for new ideas. Virgin Group’s Richard Branson has said that “innovation begins with either a passion or a problem” . Passion motivates innovation that, in turn, transforms that “passionate idea into a tangible business” . Like Musk, Branson shares innovation with others. “Passions that lead to world-changing insights are rarely self-centered, navel-gazing activities” . Instead, says Branson, sometimes the passions focus on making a positive effect for others.
Undeniably, the power of passion and love is immeasurable and unpredictable. There are no other forces that can be compared to their powerful hold on humans, but they are ignored in most scientific discussions. The language of science has evolved to make personal and subjective themes such as love and passion inconsequential . But, is it through love or passion that human beings achieve the inspiration to innovate? Innovation has been described as doing what you love to do. But, can innovation also spring, not only from what one loves to do, but also from love felt for another human being? Many innovations are centered on passion on love of humanity by creating medical breakthroughs that alleviate certain kinds of human suffering. The article “Monitor Diabetes From Your Smart Watch”  is the story of a father, John Costik, who, out of love for his young son, Evan who was diagnosed with type-I diabetes, altered a smart watch to help him monitor Evan’s glucose. Costik and his wife had to keep tabs on Evan at 5 minute intervals because it was difficult to determine the correct dose of insulin for a meal’s carbohydrate content, as Evan’s blood sugar could shoot up or decrease drastically without warning. Costik and his wife were paranoid and afraid for Evan’s life, which made the experience of the disease a lot more restricting for the boy. Not only was Evan missing out on many childhood pleasures, like the freedom to go outside and play, he was also under constant observation and was felt different from his friends. Moreover, Costik and his wife could not keep watch on him every minute of every day, even though they tried. Even when Costik dropped Evan off at the daycare, he wanted school nurse check Evan’s glucose level at all times and be alerted when it was progressing out of the acceptable range.
Costik, an engineer, came up with the innovative idea of connecting a Dexicom G4 CGM to a Motorola phone which uploaded all of his son’s glucose information to a spreadsheet that viewable in Google with the help of a simple C# program. This allowed the family to receive and monitor all of their son’s health data, such as glucose levels, without having to be with him personally all the time. When Costik announced his innovation on Twitter, Lane Desborough, another dad whose child had diabetes, responded. Out of love for his son also, Desborough asked Costik for the C# program and eventually developed Nightscout, a predictive system that could alert glucose levels by accessing essential information compiled in a database. Desborough made the software open-sourced out of love, so others could benefit from it. Desborough, Costik and others continued to collaborate, and in early 2014, they provided an Android app, Pebble watch, and Nightscout code open source, improving the code and making it easier to use.
Love is a strong emotion that motivates humans and has the power to influence physical change. Medical solutions are most often inspired by the innovator’s experience with the disease or illness, just as in Costik’s case. It was Costik’s love for his son to give him as much of a normal life as possible, despite his condition that inspired him to invent a system which could provide his son with the freedom to live a normal life like other children without constant surveillance.
Long  correlates the commitment and dedication to get the job done to passion and love for the mission. “You only get out what you put in. It’s easy to dedicate everything you have to something you love”. He states that most failed ventures do not necessarily fail because of a bad idea but due to lack of passion in their mission. In 2005, Steve Jobs said in a Stanford commencement speech: “You’ve got to find what you love. The only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it” . Costik is a father who followed his heart through love to help improve his child’s health through innovation, shared his idea, and had the passion to follow it through.
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Photo Courtesy Rocío García Ledo, Barcelona, Spain
“A story has no beginning or end: arbitrarily one chooses that moment of experience from which to look back or from which to look ahead.” Stories are very important because “there is an intense longing for human connection” . Telling stories creates opportunities to share and learn from each other’s experiences, arouse emotions, and build new friendships. From the perspective of healthcare, stories not also bring doctors, nurses care givers together with patients, but they can also link patients and a sympathetic audience together by sharing stories to create a sense of community. Hearing the voices both of the reticent and those who are ignored when they do speak up has become of the most essential, but presently “underappreciated, tasks in health care ethics today” .
The leader in transforming healthcare today is ‘patient engagement’ which has been labeled “the blockbuster drug of the century” . This is creating new collaborative possibilities for patients who want to relate their health experiences . Patient Health Narratives is an innovative concept designed to open communication online between patients and an interested and sympathetic audience to build a sense of belonging to a community that cares. The new paradigm builds on the concept of narrative ethics developed from doctors, nurses, and ethicists who began to listen with interest to patient pathographies, which are narratives that offer “voice and face to the illness experience” . Pathographies transpose the person behind a disease to the forefront to provide a learning experience for caregivers and fellow sufferers , for not only do the “human qualities of the affected individual persist, the self persists” . A patient’s desire to be valued as a whole person with feelings and hopes is always present.
The unifying element of narrative ethics was the initial recognition that narratives are significant in health care . The narrative dimensions of how patients relate their experiences about their illnesses, how doctors or ethicists translate those experiences into their own words, how interns frame the experiences when they move about their rounds , all evoke emotions and conclusions from listeners. These narratives are profound and define the importance in ethics and patient care . The difference between Narrative Ethics and Patient Health Narratives is that the former involves patient interaction with caregivers. The latter presents a patient’s written story, intermixed with patient digital storytelling (video) , and interaction with an online audience.
In the healthcare industry, there are few options to for patients to share their emancipating stories and allow others to step into their lives. Patient Health Narratives allow patients to share, acknowledge and honor their illness experiences . Hence, the importance of Patient Health Narratives is that they open a vista of information and experience by online sharing and videos. Additionally, there is also interaction and feedback which may lead to the formation of an online community of patients. Individuals can bond through their experiences outside of a hospital or clinical setting. This is accomplished through deep meaningful conversations and patient story-telling that articulate patients’ health goals and challenges. These patient dialogues become a ‘living’ document filled with personal details. Sharing stories allows patients to engage in interactive social support while concurrently dissuading feelings of isolation.
In some instances, when patients tell their stories, they reveal concealed barriers to their health and recovery . A patient’s anxiety and fear of surgery (tomophobia)  can be so terrifying that he/she can exhibit physical symptoms, “such as a racing heart, nausea, and chest pain . These patient fears can emanate from the fear of the unknown, having unpleasant experiences with previous surgeries, high-risk of awareness (waking up) during surgery , fear of an alteration in the body’s appearance (mastectomy), or, in the case of prostate surgery, a loss in sexual function. The worst patient fear is mortality . These fears and anxieties are particularly acute when the patient is on a waiting list for surgery or transplant . “Being able to discuss concerns openly with someone who is not directly involved” such as a patient who has already undergone a similar procedure and can give answers, explanations, and assurances, “can be very therapeutic” .
Patient Health Narratives would assist preoperative groups to provide patients with the opportunity to discuss their potential fears and concerns regarding their upcoming surgery. Discussing this with other group members allows patients’ own concerns to be normalized. It also provides the therapist an opportunity to dispel some myths that the patient may have regarding surgery, and to help the patient use cognitive strategies to cope with anxiety-provoking thoughts. 
Story-telling is nothing new. “We live by stories, and they’re what give sense to our lives” . The disciplines of psychology and law have long respected the power of narrative and how it affects lives, and now medicine is following suit . When story-telling becomes an interactive process, as in Patient Health Narratives, it can provide individuals a means to talk about “pivotal life events, justify choices, examine reality and find meaning in experiences” . Storytelling is also emancipating, allows “bonding with others, validating and affirming experiences, venting and catharsis, resisting oppression and educating others” . Top marketers and communicators use storytelling to connect and motivate audiences to act . The Center for Digital Storytelling created a process in the 1990s to generate 3-to-5-minute short films by synthesizing “still images, video, voice recordings, music or sound, and text . Even the Web of Stories offers listeners the opportunity to hear some of the most notable people of our time relating their life stories . In 2011, Chen  suggests one possible method for story-sharing, in which doctors and patients would have access to Web sites that would “match patients to videos of similar patients recounting their own experiences with the same disease.”
Sometimes when everything in life is going right, something goes wrong, such as being suddenly diagnosed with an illness. In literature, this reversal of circumstances is called ‘peripeteia’ . Coping with peripeteia and life’s sometimes challenging reality by story-telling helps restore legitimacy and expectancy to peoples’ lives . Narrative is indispensable in learning how patients got to their present condition just as much as the story of moving toward the future . Building a patient relationship can be made tangible by using a convenient, user-friendly interactive online platform where patients can tell their stories through print and/or videos. The interactive capability can elicit a broader picture of patients’ experiences with feedback through a peer-to-peer system of reviews and opinions. According to Socrates, the greatest peril in our lives is the failure of people to participate in the “dialogue between reader and text or between the self and other, to immerse themselves in the stories that surround them” . This dialogue is where humans practice the “rhythms of asking and answering, speaking and listening, feeling and thinking, [and] giving and receiving” .
“A story is inside of us all. Each word and sentence is alive and we grace the pages to keep it from dying.” ― Aisha Mirza 
Patient Health Narratives is a new paradigm using an interactive online approach to engage, empower and inspire patients by allowing them to share their stories and experiences. The new paradigm will provide an opportunity to get and give advice, and offer encouragement to others in similar health situations.
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Published in ZENITH International Journal of Multidisciplinary Research ISSN 2231-5780 Vol.5 (1), JANUARY (2015)
To lower health care costs, it is necessary to improve the care of patients who suffer from chronic diseases such as diabetes and heart disease to help them remain in good health, out of emergency rooms and out of hospitals where patients often contract infections which cost “between $200 and $400 million each year” (Rising Cost, 2008, para. 15). Globally, 68% of deaths in 2012 were from 4 primary non-communicable diseases: “cardiovascular diseases, cancers, diabetes and chronic lung diseases” (WHO, 2014a, para. 1). Various studies show that hypertension is the single greatest attributable risk factor for death and disease burden worldwide. It is responsible for “at least 45% of deaths due to ischemic heart disease and 51% of deaths due to stroke, which together account for 14 million deaths globally each year” (Nagai, 2010, p. 116). Additionally, hypertension is the key“contributor to dementia, which affects 8% of the population today but is expected to triple by 2050, with 70% of cases expected to be in low-and middle-income countries” (Nagai, 2010, p. 116).
To effectively care for patients across a range of settings, remote monitoring of people with chronic diseases and more is a promising technology. Twenty five years ago, monitoring health of people was limited to laboratory measurement of blood gases and electrolytes, but today sensor applications can be used to remotely measure and link the data to any mobile device and/or the cloud (Sensors in Medicine, 2014). According to Dunker & Greenberg (2000), the growth in the aging American population is expected to rise through 2030, which will double the 2002 category of Americans over the age of 65 (Mann, W., Marchant, T., Tomita, M., Fraas, L.,2 & Stanton, K, 2002). Simultaneously, with this aging trend, health care costs are rising due to aging adults experiencing changes in chronic health conditions which often limit activities. Yet, despite physical limitations, elderly Americans prefer to live in their own homes, which could reverse increasing health care costs (Tinker, Wright, McCreadie, Askham, Hancock, & Holmans, 1999). As a result, many elders may require a home system to monitor their safety (Mann et al., 2002) and their health. Globally, health care needs differ between the high resource settings and low-resource settings characterized by chronic poverty. According to Taylor, Merritt, & Mullany (2011), studies on low-resource settings indicate a deficiency of safe “access to adequate nutrition, clean water, and sanitation, together with little or no access to health care services” (Taylor et al., 2011). Consequently, some patients become ill or die from medical circumstances (Taylor et al., 2011). Thereby, the implementation plan of the Global Strategy for Prevention and Control of Non-Communicable Diseases (NCDs) was endorsed by the World Health Assembly in May 2008.
One of the action plans of World Health Organization (WHO, 2014b) to member states is to “implement and monitor cost-effective approaches for the early detection of cancers, diabetes, hypertension and other cardiovascular risk factors” and institute “standards of health care for common conditions like cardiovascular disease (CVD), cancers, diabetes and chronic respirator diseases, integrating, whenever feasible, their management into primary health care” (WHO, 2014b). Due to the aging population in America, the fast-growing home healthcare market is creating opportunities for hospitals, private firms, (Ellis, 1992) and providers of digital health products and services. Population growth is creating a need for efficient and practical healthcare services, particularly in low resource settings with inadequate delivery of health care, and home health monitoring to reduce health-care costs. It is important to educate the public how to be in control of individual health by remotely monitoring health care in person at home and communicating the results directly to a doctor using advanced technology.
Remote patient monitoring faces some huge difficulties, however. The technology is an unfamiliar space for the older patients, and people of all ages still have to be persuaded to use it. In addition, there is little standardization among the devices because of the number of companies in the market, so digital technology is faced with the difficulty of getting new devices to integrate with existing electronic records (Health Devices, 2012, p.107).
It is important to note that in 2010, the Affordable Care Act required the Department of Health and Human Services to establish a readmission-reduction program. Remote patient monitoring done right could significantly reduce the likelihood of readmission by heading off small problems before they become critical. Thereby, it’s in the best interest of hospitals to prevent readmission (Leventhal, 2013).
DynoSense Corporation, a medical device company and creator of the world’s first fully integrated multi-scan health scanner, has developed a product called “Dyno,” a device that fits well within the new paradigm of preventive healthcare delivery. With this device, patients and their medical professionals can monitor all the critical vitals (ECG, heart rate, blood oxygen, respiration rate, breathing efficiency, blood pressure change, body temperature, plus others in development) at home. With very little effort, this information can be forwarded to healthcare professionals on-demand or routinely for the purpose of early detection and prevention or as a follow-up maintenance to care that has already been given.
Health care professionals require real-time and accurate data in order to better diagnose their patients, but there is a lack of technology awareness among physicians. As such, sensor and device manufacturers need to apply greater promotion and education in this area (Thusu, 2011).
To solve this problem, the Dyno device uses an array of nine sensors, in which it collects 33 different health metrics which are measuring hemoglobin pulmonary vein isolation in just 60 seconds, using analytics to alert users to potential health problems.
About the Sponsor: DynoSense Corp. is a medical device company and creator of world’s first fully integrated multi-scan health scanner.
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Published in Innovative Journal of Medical & Health Science 10.15520/ijmhs.2015.vol5.iss2.50
The impact of Information Technology (IT) on the American healthcare industry has resulted in the digitization of the healthcare system. This has helped it to become safer, more affordable and accessible. This digitized sector has provided the chance to practice theory and obtain in-depth knowledge about the patient (Ritu Agarwal, 2010). With technological advances, digital healthcare quality has been improved, and also has helped to reduce costs by overcoming many challenges, such as providing medical care in remote locations. However, patient engagement must be promoted to advance the success of innovative healthcare digitization.
To achieve digital healthcare success, patient satisfaction must be the primary goal, which can only be achieved when they are fully engaged with the system. To achieve this, healthcare providers must work in partnership with the patients to ensure that the target is achieved (Healthcare, 2014). Patients must take ownership and responsibility for change in their behavior which will improve health outcomes and lower costs. Patient engagement in the healthcare means continuously creating positive experiences that make stronger, more rewarding patient/healthcare relationships that can be provided by technology companies.
Engaging patients does not mean physically meeting with them and having face-to-face interactive sessions. Rather, the digitized healthcare system will provide an outstanding experience for the patients by allowing for remote diagnosis and treatment by storing patient data and health insurance plans that can be accessed remotely (Bala, 2014).
Patient engagement can also be achieved by guaranteeing outcome delivery to avoid problems created by physical interactions of healthcare providers and patients when outcomes are delayed or do not live up to patient needs or expectations.
Infosys (2013) conducted a study between the digitally aware consumers and the businesses that serve them. Some findings for the U.S. portion of the survey showed that:
92 percent of patients favor physicians having their personal health information electronically
80 percent of patients have confidence that their physicians protect personal medical data
98 percent comfortably share health data personally with physicians
77 percent share personal health data online
66 percent of patients share health data on mobile devices
Approximately 80% will use mobile apps to communicate with their physicians
Patient engagement can be achieved when the services offered by the healthcare systems revolve around the benefits achieved by consumers. This approach can be exercised when customers are acquired and retained on the basis of micro-segmentation, and are reached through marketing campaigns and promotional offers. Consumer consultation in this system also helps in not only guiding the patients to the right plan, but also having them select a plan that is helpful in the future. Patients must be clearly informed about the plan in order to maintain transparency and quality. Personalized correspondence over the digital network will help resolve issues and fulfill patient needs. The patients will feel more empowered when they are educated on the programs that are committed to managing their own healthcare. This will help patients who are not technologically savvy and often feel reluctant to use these healthcare systems.
Since patients can be connected by social media to voice their opinions, it is important for the digital healthcare system to delight their patients through an effective customer response structure (Dolgin, 2013), such as noted in Table 1.
Vital Signs Motion State Modified Threshold for Alarms/Alerts Heuristic Rules for Alarms/Alerts
Blood Pressure (SYS, DIA) Walking Increase (+10-30%) Ignore Threshold; Do Not Alarm/Alert
Heart Rate Walking Increase (+10-300%) Use Modified Threshold; Alarm/Alert if Value Exceeds Threshold
Respiratory Rate Walking Increase (+10-300%) Ignore Threshold; Do Not Alarm/Alert
SpO2 Walking No Change Ignore Threshold; Do Not Alarm/Alert
Temperature Walking Increase (+10-300%) Use Original Threshold; Alarm/Alert if Value Exceeds Threshold
Table 1. Example of customer response structure. Motion-dependent alarm/alert thresholds and heuristic rules for a walking patient (Moon, J., Mccombie, D., Dhillon, M., Banet, M. 2015).
Patients will value the importance of the digital healthcare system if they view it as compatible, simple to use, sees other using it, and are enthusiastic about trying it. The medical journey of the patient must be properly administered to improve customer engagement (Berger, 2014).
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Published in Journal of Pharmaceutical Research & Opinion (JPRO) 2015.vol5.iss5.16
Several innovative trends are transforming the healthcare industry. Since costs for specialty medications and generics are spiraling, and advanced genomic-based screenings are available at pharmacies and retail clinics, patients are moving away from traditional primary care sites. Patients now have access to tele-health and wearable high-tech devices that monitor and transmit real-time health conditions (Frederick, 2015). The impetus behind this new health model is the Affordable Care Act, which is fully implementing health reform, combined with an “aging population, a genomics revolution, nanotechnology, data management and other technologies” (Eder, 2015). Fortunately, over the past twenty years, the pharmacy profession has transformed into a position of offering “new and innovative solutions to some of the nation’s most urgent healthcare issues” (Johnsen, 2015).
However, the rapidly transforming health system in the U.S. is facing challenges, such as accountability, cost-effectiveness and a coherent system of care. The most formidable challenge is the escalating “$2.5 trillion annual healthcare bill, which now consumes roughly 18% of the GDP” (Frederick, 2015). Another challenge is the critical shortage of primary care physicians which makes it difficult for patients to have timely access to health services. Finally, there is mounting pressure on “federal and state health resources as aging boomers and newly insured Americans” take advantage of Medicare and Medicaid.
PricewaterhouseCoopers, in a recent report on the new health economy, indicates that companies are empowering consumers with innovative healthcare solutions that are changing the entire industry (Eder, 2015). One leading trend influencing pharmacies and the nation’s health system is the community pharmacy which until now has been an underutilized part of the nation’s healthcare system. Providing patient easier access to healthcare will decrease costs of healthcare and improve health outcomes. Community pharmacies allow “patient access, lower costs, accountability and collaborative care,” making them the “true face of neighborhood healthcare” (Frederick, 2015).
Pharmacists are an important part of building the “healthcare delivery system of tomorrow…in partnership with doctors, nurses and others,” according to Steve Anderson, president and CEO of the National Association of Chain Drug Stores. By collaborating with other healthcare professionals, pharmacists are in the unique position of providing patient services in “under-served communities where healthcare may not be readily available” (Frederick, 2015). Community pharmacists, as professionals who dispense prescription drugs, provide counseling, and manage medication therapy on a daily basis, are a critical segment delivering healthcare. “An estimated 82% of Americans use daily medications to manage their health, and 29% take five or more medications, according to the Centers for Disease Control and Prevention” (Frederick, 2015). “Over 2.7 billion prescriptions” are filled by chain store pharmacies every year, offering assistance to patients with the proper and safe use of medications that improve health and affordability (Frederick, 2015). Allowing pharmacists to “provide state-approved health services to underserved Medicare beneficiaries couldn’t come at a better time” (Frederick, 2015). Community pharmacists can meet patient needs by integrating services such as “immunizations, health screenings, medication therapy management, and diabetes management” using face-to-face encounters with patients (Frederick 2015). By using just one consultation, the local pharmacist can administer one vaccination, “medication synchronization, and a health screening,” making Americans beneficiaries of this growing effort to achieve the overall potential of neighborhood pharmacies as providers of healthcare (Frederick, 2015).
Many pharmacies are also turning to remote care platforms (telemedicine) for their customers to engage them in their own health, “reducing risk for unplanned utilization of costly services” (Johnsen, 2015). Home care devices can monitor biometric data, such as blood pressure, allowing for customized daily patient care. If a clinical condition should worsen, the patient’s physician is immediately alerted to intervene if necessary (Johnsen, 2015). This next-generation of consumer care joins cloud computing with “consumer-grade electronics” and an interface that is user-friendly to facilitate use by all demographics, even patients with limited technical ability. This will enable patient monitoring in the home, reducing the necessity for “hospital admissions and re-admissions” (Johnsen, 2015).
Some remote healthcare devices (telemedicine) are already in place in community pharmacies, such as Vivify Health, (Johnsen, 2015), and others are on the horizon, such as the Dyno from DynoSense Corporation, Sunnyvale, CA. “Dyno is the world’s first fully integrated multi-function health scanner technology that can capture more than 33 critical 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” (DynoSense, 2015). This device can be easily used in the home for immediate and daily health monitoring.
The community pharmacy is positioned to alleviate the nation’ overburdened healthcare system using front-line consulting and health management, along with telemedicine platforms using remote healthcare monitoring devices.
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Improvements in social conditions and medical care in the Western world, in addition to advances in “pharmacologic and interventional management of patients,” (Thibault and Guerra, 2010, para. 2) have led to a significant increase in human longevity, allowing people to survive up to 80 years and beyond, often resulting in added health problems attributed to advanced age (Thibault and Guerra, 2010). As the population ages, the occurrence of chronic disease increases, creating problems for the health care system
The Universal Declaration of Human Rights is an international human rights law that obliges governments to provide right-to-health systems (Backman, Hunt, Khosla, Jaramillo-Strouss, Fikre, Rumble, Vladescu, 2008). Remote health monitoring is a solution for certain groups of patients in remote locations, due to complications and costs of transporting health workers and the large quantity of patients requiring health care (Spinsante and Gambi, 2012). Remote health monitoring interaction of patients with chronical diseases that have not undergone a physician’s medical examination can be achieved using remote health monitoring devices. Such remote health monitoring systems can be tailored to address a wide range of needs, according with each patient’s conditions (Spinsante and Gambi, 2012).
Broadband will be key to “supporting health care delivery in America” (Continua, 2010, para. 5) in the future. “The National Broadband Plan drafted earlier this year by the Federal Communications Commission (FCC),” could save the health care industry “$700 billion over 15 to 20 years” (Rouse, 2014) through the implementation of “remote patient monitoring technology in conjunction with electronic health records (EHR)” (Rouse, 2014, para. 4).
Advancing age of the populace has led to an avalanche of cardiac rhythm disorders such as “atrial fibrillation (AF), bradycardia, atrioventricular (AV) block and sudden cardiac death” (Thibault and Guerra, 2010, para. 2). Increased incidences of AF can be attributed not only to the aging of the population, but also to co-existing illnesses and the ability to detect “asymptomatic episodes” using the “diagnostic capabilities of pacemakers and defibrillators” (Thibault and Guerra, 2010, para. 3). Along with advancing age and incapacitating medical conditions come problems with mobility, s it has become necessary to collect information in a way that reduces patient necessity to visit a physician’s office (Thibault and Guerra, 2010).
Technology allows digital communication and wireless transmission of patient information to be “integrated into implantable devices” (Thibault and Guerra, 2010, para. 9), that require regular follow up anywhere between and one to four times annually to evaluate the patient’s medical condition and how the device is functioning (Thibault and Guerra, 2010). This has been a challenge for large medical facilities and for those in remote areas. Recent technological advances have helped to improve safety for both patients and devices, permitting information to be transmitted directly to the physician, eliminating the need for patients to travel (Thibault and Guerra).
This digitizing of information about individuals could not have occurred if not for the maturation of world digital technologies, such as wireless biosensors integrated with traditional medical data which can be constantly updated (Topol , 2012).
Figure 1. “The transformation from medicine today (old, dumbed down) to new, individualized medicine that is enabled by digitizing humans” (Topol, 2012, p. vii).
DynoSense Corporation is a new company that has developed a fully integrated multi-scan health scanner using nine sensors to measure 33 different health metrics (Tehrani, 2015). The device, called Dyno, monitors all the critical vitals (ECG, heart rate, blood oxygen, respiration rate, breathing efficiency, blood pressure change, body temperature, plus others in development) remotely, essential for at home monitoring.
To validate and verify Dyno’s capabilities, DynoSense was invited to travel to China to run a clinical test on patients to compare results with standard hospital equipment. The China Trial was performed at China-Japan Friendship Hospital in August 2014 (China-Japan Friendship Hospital, 2014). Since the testing was to be done in a hospital setting, the trial sponsor was concerned about the Dyno device sanitization. Therefore, the device had to be modified to have the temperature probe removed. As a result, data from the China-Japan Friendship Hospital Trial was shown without the temperature data (China-Japan Friendship Hospital, 2014).
China-Japan Friendship Hospital tested and monitored 5 people using the Dyno, most of whom had heart conditions. The trial sponsor wanted to view, in particular, the ECG results of the heart problems in Dyno’s report. The doctors also compared the blood pressure measurement from hospital equipment and the measurement resulting from the Dyno test. The result was within the AAMI (Association for the Advancement of Medical Instrumentation) standard (China-Japan Friendship Hospital Trial, 2014).
DynoSense also conducted another test at an elderly care facility, SarahCare of Campbell, a leading provider of adult and elder day care services in the south Bay Area. Testing of the Dyno was performed over a four-day period, initially testing 14 people, and tracking 6 for the entire 4 days, with an average of 3 times per day per person. The purpose of this trial was to validate the Dyno results against commercially available gold standard equipment results. Out of the 6 people who were tracked, the Dyno reported that two women in their 70s had heart conditions, one with PVC and one with arrhythmia. DynoSense then used an FDA approved ECG device to verify the findings, which confirmed that the Dyno findings are valid (Sara-Care of Campbell, 2014).
Hypertension and Remote Health Monitoring
A broad range of advanced communication methods are available for patient self-management of hypertension (Rothman, Wagner, 2003; Logan, McIssac, Tisler, Irvine, Saunder, Dunai…Cafazzo, 2007), such as home blood pressure (BP) monitoring devices and tele-management (Kaufman, Patel, Hilliman, Morin, Pevzner, Weinstock, Goland, Shea, and Starren, 2003; Logan et al, 2000). However, attempts to better BP control have not been very effective, due to tele-management systems requirements for wired connections, lack of expertise of elders using the Internet, the interference of physician work flow, and lack of personal communication between patient and physician.
The Logan et al. (2000) study concentrated on developing and “pilot-testing a mobile phone–based remote patient monitoring system to improve BP control of hypertensive patients with diabetes” (p. 946). The findings concluded that use of this system was highly accepted by patients, and physicians who received reliable data were able to reduce BP of diabetic patients with uncontrolled hypertension without disrupting their workflow. However, new solutions still need to be researched and developed (Garg, Adhikari, McDonald, Rosas-Arellano, Devereaux, Beyene, Sam, and Haynes, 2005; Logan et al., 2000).
Chronic Obstructive Pulmonary disease (COPD)
A key goal of the respiratory community is the early detection of “Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)” (Sund, Powell, Greenwood and Jarad, 2009, p. 1321) in COPD patients. AECOPD is a significant characteristic of the disease. Health status, such as quality of life, (Sund et al., 2009) often deteriorates due to recurrent pulmonary exacerbations (Sund, et al., 2009). AECOPD is often connected to an escalation in “symptoms, including cough, sputum volume/purulence and shortness of breath,” (Sund, et al., 2009, p. 1321) causing patients to seek medical help that often results in physicians intensifying treatment.
If AECOPD goes untreated, the condition may gradually result in a drop in lung function. Early treatment of AECOPD is believed to result in shortened periods of symptoms and a chance to improve recovery; however, to manage AECOPD, patients must be diagnosed by their physicians at the early stages of symptoms. “Interventions aimed at delaying the progression of COPD and improve access to healthcare are considered high priority areas” (Sund, et al., 2009, p. 1328).
On August 28, 2014, Peking University First Hospital tested and monitored one person diagnosed with COPD who needed to wear an oxygen mask (Peking University First Hospital Trial, 2014). The patient had been admitted to the hospital multiple times in the past with the same problem. DynoSense Corporation was invited again to run the test. The doctor asked the patient to remove the oxygen mask for a moment to see how well the Dyno could track the patient’s condition.
The patient’s blood Oxygen measured by the hospital equipment dropped down to approximately 78% within a few minutes, and Dyno also tracked that rapid change in blood. A key vital that the doctor wanted to check was blood pressure. One interesting finding was that within minutes, multiple blood pressure measurements using a traditional cuff had large variations (14 mmHg variations in diastolic blood pressure when patient is in stable condition), while Dyno reported consistent blood pressure measurements across the different sessions (Peking University First Hospital Trial, 2014). .
Dyno is a user friendly device that can be used as required with little effort and the information captured is securely stored. Dyno is the premier example of current advances in remote health monitoring devices. Physicians will be able to access real-time patient data, creating improved patient treatment (Tehrani, 2015).
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The American population is aging, and persistent chronic diseases such as asthma, diabetes, and hypertension are ubiquitous. Thus, healthcare providers and patients are looking for new solutions to lower their healthcare costs. Healthcare today is driven by patients who are acting more like consumers as they seek the best care at the most affordable prices. This also applies to patients with chronic maladies. This evolution has created new opportunities and conditions in chronic care management such as remote health monitoring using devices for use in the home, a successful strategy for maintaining medication adherence and ensuring that patients view management of their disease seriously (Bresnick, 2014). In the last few years, varied forms of managed care have emerged as an approach toward healthcare improvement, as well as controlling spiraling costs. However, the focus on costs, as well as failures in addressing the complexities of chronic conditions, is also compounded by the coordination of care spread over multiple environments (Halsted & Lorig, 2004). These entail the efforts of either healthcare improvement or cost control, but the objective of chronic care management remains the same. Non-face-to-face services, such as medication reconciliation, provider coordination, social services, and remote patient monitoring, is available to beneficiaries of Medicare for significant chronic health conditions. However, payments are not sufficient to pay for staffing and technological investments that are a necessity for chronic care management, so providers normally do not provide such services (PYA, 2015). This results in patients with chronic diseases having to fend for themselves between necessitated care, which translates into distressed patients and higher costs. Remote Health monitoring from the home can alleviate costs and eliminate trips to the doctor or hospital.
Challenges of Chronic Illness
The costs of chronic illness to the economy have doubled to exceed $1 trillion annually, due to the number of cases of chronic disease diagnosed from 2007 with the expectation being held of an increment by 42 percent in the coming 15 years. The healthcare expenditure by Americans was $1.6 trillion, equal to nearly 15 percent of the gross domestic product, as compared to 11 percent in the past 15 years. Furthermore, the costs of health insurance have increased to an average of 12.5 percent on an annual rate. Since patients with chronic diseases have a 100 percent likelihood of having preventable hospitalization, the implementation of health prevention and wellness strategies is still the approach that is most viable for raising the quality of health care and cost control (Vogeli, et al. 2007).
The 2015 Sunshine Act Medicare proposed fee schedule includes a “per patient, per month payment for chronic care management (CCM) services for patients with two or more chronic conditions” (AAFP, 2014). Beginning in 2015, Medicare will make a separate payment of $41.92 no more than once a month to physicians for CCM services. Also, supervision of clinical staff that provides CCM services will be more flexible. Many elderly and incapacitated patients have multifaceted, chronic health conditions that require individual medical attention from a primary care physician. The new code places value on added intellectual and office work occurring outside the exam room, but necessary for all-inclusive, synchronized healthcare (AAFP, 2014). In other areas, services, such as patient communication and other health professionals offering treatment can be augmented by visits to a medical practitioner that are billed separately. Medication prescriptions are available via the phone or electronically, and patients have access to health care providers or other clinical staff 24/7 (Stellefson, Krishna & Stopka, 2013).
Partly in response to workplace absenteeism which, as in Ohio cost an estimated $27 billion in 2010, hospitals are now providing outpatient services to chronic care patients to reduce the necessity of costly hospital visits. Mercy Memorial Hospital, Urbana, Ohio, has opened a new Chronic Care Clinic that will provide patients with options to manage their chronic conditions, such as diabetes, congestive heart failure and chronic obstructive pulmonary disease. The goal is to achieve better healthcare management and lower costs (Sanctis, 2015).
Eighty percent of health system issues today are related to chronic diseases, so transitioning healthcare from the hospital to the home is key to lowering costs (Bresnick, 2014). The development of electronic healthcare is a major aspect of chronic care management. Chronic care management clinicians are required to place, implement, revise or monitor and manage within the electronic care plan that connects patient physical, mental, cognitive, and psychosocial needs with functional and environmental requirements. Thus, if healthcare can shift to the population level, quality and costs of care will be favorably impacted. There is a chronic disease epidemic, so the focus is on how to keep patients out of hospitals and clinics, yet allow them to stay in contact with their healthcare provider. Patients need to take responsibility of taking care of themselves and stay in contact with their doctors so if an emergency arises or care is needed, the physician can step in immediately and resolve the situation (Bresnick, 2014).
Utilizing the EHR management codes for billing of chronic care, a clinician can bill for any specific patient, but at this point, it may be required to link coordination with sub-specialists who provide a significant measure of care, as well as treatment for one to more of the medical conditions of the patient (Julie, Stephen & Rundall, 2006). Overall, these management codes have been established with the intention of being applied by clinicians that are providing the major part of the services of care coordination. Often, these can be elementary care internists, although particular specialists can possibly provide the required services for qualification for billing of chronic care management codes, but not within the same month as the elementary care physician.
More than 75 percent of the complete health care expenditure in the U.S. places emphasis on chronic care with improvements to health care purchasers. This includes health care plans that are aggressive in the form of profiling and benchmarking in practice and performance of medical institutions. Medicare precedes private payment in the directional shift of the value based purchases of medical institutions and the services of physicians (Hudon, Fortin, & Haggetry, 2012). Traditionally, chronic care management meant that the providers of professional health care provided oversight, as well as education in assistance to patients with chronic diseases to live their lives with an understanding of their conditions. It also motivated patients to sustain required therapies as well as interventions that would assist in moving forward towards a better quality of life.
Increasingly, employers are taking an interest in the provision of chronic care management to their employees because chronic conditions account for 25 percent of medical costs. This is due to employees having long-lasting illnesses, increasing healthcare expenses and reduced productivity (Vogeli, Sheilds. Lee & Teresa, 2007). Currently, nearly all companies provide some form of chronic care initiatives, but not all of these programs are equal. Certain companies can contract with their insurers or an external vendor, to ensure that medical care is available if an employee needs help for a chronic illness.
Prevention using Robust Care Management
Chronic care management entails the convergence of several medical tactics in proper application to the particular population. These are comprised of stratified medical risks in the population health plan, clinical guidelines, preventative health in primary and secondary care, case management, use of predictive models, plan design, and incentives for the provider in augmentation of prescription drug management (Halsted & Lorig, 2004). A beneficial system should be developed on the basis of integration of claims payment, management of care, reimbursement of providers, identification of members with no screening of claims data, patient data sharing with providers, and incentive model sharing with providers.
Care for chronically ill patients is expensive, and overall leads to unnecessary hospitalizations, augmented by placements in nursing homes, as well as duplication of diagnostic tests. The greatest portion of costly and preventable maladies can be managed with simplified and affordable measures. The major portion of these measures as effective approaches is the control of chronic illness, as well as revamped reimbursement based models to providers through behavior that is an incentive to the patient and the physician (Halsted & Lorig, 2004). This leads to improved health management in combination with technological investment that delivers a snapshot of robust health data. With this information, health care providers can identify of shortcomings in care, as well as have a positive effect on patient behavior and lifestyle.
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The embracing of health information technology by physicians has increased, which has resulted in better patient care. But with so much new medical oriented technology, it is important to understand of the language of digital health. Personal Health Record (PHR), Electronic Medical Record (EMR) and Electronic Health Record (EHR) sound quite similar, but they are not identical and are not interchangeable. Each has its own function separate from the other. An estimated 70 percent of U.S. doctors already utilize some aspect of EHR, however, only about one quarter of those subscribe to a sophisticated multifunctional system. Ideally, a comprehensive IT system should empower patients, advance healthcare delivery and transform patient data into life-saving research (Kaiser, 2015). The new technological approaches to healthcare delivery have resulted in faster and more accurate diagnostic and monitoring, more sophisticated coordination across regions and agencies and sophisticated risk-checking procedures.
A patient’s Personal Health Record (PHR) is a secure portal by which he/she can access the EMR to make and change appointments, check lab results, order prescriptions and modify personal information. The EMR is the electronic version of a patient’s medical record that connects doctors and other caregivers with patient data from every point of healthcare, such as x-rays, prescriptions and MRI’s. The EHR is a secure electronic database information from all of a patient’s EMRs under one umbrella to avoid redundant testing and errors in prescription medication (Kaiser, 2015), and also allows doctors to create a large patient database from which they can conduct research. The EMR enables doctors to electronically exchange key clinical information with other caregivers to get the broader picture of a patient’s medical history (Kaiser, 2015).
Digital technologies enable analysis of patient data to present better and quicker treatment and diagnoses. Lee (2013) points out that Dr. Watson, a computer developed by IBM, helps medical practitioners formulate more accurate diagnoses and recommend treatment. Dr. Watson helps doctors monitor the history of their patients, refer to the latest medical studies and analyze up-to-date treatment alternatives, enhancing doctors’ abilities to diagnose and monitor patient health using current information, (Eysenbach, 2005).
According to Kaptelinin (2008) translation technologies are making doctors more effective because they can communicate with their patients more easily by overcoming language barriers. OmniFluent Health, a product from Science Applications International Corporation (SAIC), is translation software for all medical practitioners. The software includes a mobile application (app) which allows a practitioner to ask, for example, if a patient is allergic to a certain drug. The app translates to a language that is the patient understands, lessening the possibility of prescribing the wrong medication. Symthe (2015) points out that, in the United States, approximately forty seven million residents do not speak English fluently. Hence, clarifying the communication between patients and their doctors more easily will increase the doctor’s patient knowledge and avoid errors.
Topol (2014) indicates that digital technologies will allow medical practitioners to easily link up with each other without meeting face-to-face. Nearly one-third of healthcare professionals use exclusive healthcare mainstream social media networks where they can collaborate with colleagues and share resources online (Diana, 2015). One social network tailored for physicians is Doximity. According to Lee (2013), this platform allows doctors in the United States to collaborate online and discuss difficult cases. Doximity has 250,000 members, representing approximately 40 percent of all U.S. doctors who exchange information (Diana, 2014). Most of the “HIPAA-compliant one-to-one messages and discussion forums focus on business challenges or diagnoses” (Diana, 2014).
Eyesenbach (2005) maintains that medical digital technology, Sherpaa, helps patients and doctors connect via the phone or online, avoiding a trip to the emergency room. Reliable advice is rapidly provided to patients from medical specialists. Kaptelinin (2008) points out that digital technology employs the use of big data that is shared, accessed, compiled and applied using analytics. The medical setting benefits by having a robust and efficient clinical and business decision-making platform. For instance, medical practitioners can leverage huge amounts of patient information collected from a number of sources to establish the clinical validity of particular managements and how to improve them (Symthe, 2015). In addition, doctors can access and share patient medical records to eliminate unnecessary medication and/or testing.
The doctor/patient experience is enhanced by technology, due to ease in cooperating with experts and physicians in innovative ways and utilizing computers that analyze patients’ medical information to provide more efficient and better treatment for the patients (Lee, 2013). As digital technology continues to expand the scope of medical interactions and medicine, a new revolution in the healthcare setting is on the horizon, such as remote health monitoring for elderly through interactive television (Spinsante, 2012) and other types of hand-held remote monitoring devices.
Digital tools have, however, been found to be incompatible with changing patient needs. Ideally, the current area of research in molecular technology, including laser guided surgeries, has fallen short of the necessary transmission of information needed to help in completing diagnostics. However, innovative diagnostics which involve extreme reliance of technology have in some instances led to misdiagnosis, leading to fatalities (Kaptelinin, 2008). Further, information transfer, especially as mandated by current ethics of use of technology, has resulted into breach of patient privacy.
Improved digital technology is providing the healthcare field with upgrades that are necessary, electronic files and health records, from mobile apps, remote monitoring devices, and medical translation tools which help individuals to have healthier lives. All of the advancements in digital technologies are increasingly more sophisticated and are becoming a necessity. Doctors cannot avoid the rush of new advancements. And why should they? There is so much information available that physicians cannot be expected to know everything (Smythe, 2015). Digital technologies are there to help doctors work smarter and more efficiently; hence digital technology has become essential in the healthcare context.
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When assessing basic bodily functions, healthcare providers assess body temperature, blood pressure, heart rate, or pulse, and respiratory rate using tools that directly and indirectly provide the relevant measurements.1,2 Five crucial measurements are: 1) core temperature, 2) blood pressure, 3) electrocardiogram, 4) photoplethysmography, and 5) pulmonary plethysmography. With the combination of these measurements comes a comprehensive profile of a person’s physiology. Specifically, these techniques provide information about heart rate, heart rhythms, heart and lung function, as well as information about oxygen content in the blood. This information provides physicians and patients with a basic understanding of the current function of the body’s vital organs.
Each of the five measurements mentioned above provides essential information about the current health of the patient. For example, raised temperatures occur in response to heightened immunological activity and can therefore indicate infection or inflammation.3 Blood pressure results from the heart’s pumping action.4-6 Blood pressure results from several variables including blood volume, resistance of blood vessels, and blood viscosity or thickness, and variations in blood pressure can therefore occur for a number of reasons. However, one consistent variation is known: high blood pressure, or hypertension, is often associated with cardiovascular problems.7 Electrocardiograms provide an opportunity to noninvasively interpret electrical activity in the heart and are thus particularly useful for patients with cardiovascular symptoms or high risk of coronary heart disease.8 This technique can help identify cardiovascular dysfunction, including heart attacks and pulmonary embolisms.9,10 Photoplethysmography provides information about heart rate, the cardiac cycle, and respiration,11 whereas pulmonary plethysmography provides specific information about lung capacity.12 Respiratory rate may provide some information about respiratory function,13 but it is more useful in indicating acidotic states because expiration removes carbon dioxide, a byproduct of acidosis. It is therefore also often measured during a vitals assessment.
Though there are several published statistics on the average numbers associated with each of the measurements used to assess vitals, the application of those statistics to individual patients can lead to inaccurate interpretations. It is generally more important that an individual’s vitals stay consistent than that they adhere to population averages.14 Several factors independent of physiological state, such as posture during the taking of measurements, can influence readings.15 It is thus important that individuals be monitored often so that an accurate idea of their physiological state can be globally obtained. Just as important is the personalization of healthcare, as similar vital measurements can justify separate diagnoses and treatment regimens in different patients.16 Additionally, personalization allows for the integration of patients’ risk factors and preferences. Current technologies, that allow for regular monitoring of patients’ vitals make personalized care truly feasible.4,16-24
monitoring of patients’ vitals make personalized care truly feasible.4,16-24
The DynoSense Corp technology is at the forefront of efforts to monitor health and personalize medicine. Their tool, the Dynosensor or Dyno for short, provides a simple and reliable way to obtain all five critical physiological measurements at once and as often as recommended by healthcare providers. The Dyno provides benefits not offered by other medical monitoring technologies. Specifically, it is small, noninvasive, intuitive to use, and versatile, allowing for medical tests outside the scope of basic vitals. This versatility makes the Dyno an ideal tool for personalized medicine. Data from the device is securely collected and available for patients to share at their discretion with, for example, their physicians. The collected data provides information that cannot be obtained during a visit to the physician and can therefore facilitate personalization of patients’ treatment plans. The Dyno is amenable to easy use and does not pose health risks, nor is it conducive to adverse side effects. It takes measurements in less than a minute with the simple placement of a wand in the patient’s mouth, and it sanitizes itself between uses. The Dynosensor can provide feedback on vital signs as often as healthcare providers deem necessary, and, as vitals are not continuously measured, the Dynosensor does not require high power batteries or high levels of energy consumption.
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As the size of the elderly population grows in most developed countries and our collective health status evolves with changing lifestyles, there is an increased demand on healthcare and thus increased pressure for medical efficiency. As a consequence, home healthcare is fast growing1 and confers several advantages to patients, as well as to the population.1 Technology that allows patients to be medically monitored from home reduces the burden of traveling to physicians’ offices and waiting for physician availability. Such technology therefore provides flexibility in health management.2 Medical monitoring also has several specific health benefits. For example, its use improves diagnostics and treatments and lowers costs associated with medical care.3,4 The financial advantages of medical monitoring are likely to grow as the relevant capabilities of mobile technology flourish.5 It has been estimated that medical monitoring will save the United States about $197 billion by preventing adverse effects of chronic disease over the next 25 years.6
Importantly, people who use medical monitoring tend to take on more responsibility for their own health. As patients are able to track their health metrics and self-manage conditions, they tend to comply more with their preventative health and treatment regimens, resulting in better health.7,8 Self-monitoring is thus quite effective.9A recent meta-analysis demonstrated that medical monitoring improved therapeutic compliance in patients with hypertension and significantly reduced systolic and diastolic blood pressure.8 Medical monitoring has also been shown to be effective in blood glucose control in patients with diabetes10and to reduce embolism when combined with anticoagulants.9 In addition to the benefits that result from added patient responsibility, medical monitoring may provide more accurate information related to patients’ health than information collected from physician office visits. For example, remote monitoring may prevent effects such as the white coat effect, wherein patients demonstrate blood pressure measurements inconsistent with their average blood pressure because of the stress of the clinical environment.10 For effective medical monitoring, certain physiological metrics must be obtained. Unfortunately, many devices developed for this purpose have practical limitations, including high costs and low reliability. In addition, many devices are large and heavy, consume large amounts of energy, have sensors that are difficult to connect or implement, and have limited functions.11-13 Some devices are designed to continuously monitor patients, and these devices have been claimed to be intrusive and to prevent privacy, as well as to raise ethical and legal concerns.13 It has been argued that effective medical monitoring systems must be unobtrusive and efficient, incorporating multiple functions, and provide real-time feedback and wireless communication with data evaluation systems.14,15
Devices for monitoring blood pressure provide examples for non-ideal monitoring devices. One common technique for blood pressure monitoring is the oscillometric technique, which involves inflating a cuff around the patient’s wrist. Though this method avoids the white coat effect, it can cause skin irritations and interrupt blood flow. Continuous use of this type of device can also cause sleep disruptions and enhance stress levels.16 Recently, cuff-less methods have been developed to determine blood pressure using sensors.16-19 However, these methods are not particular accurate because changing the position of the hand relative to the heart destabilizes hydrostatic pressure.
The Dynosensor, or Dyno for short by DynoSense Corp provides a practical solution to medical monitoring, overcoming several of the practical limitations of other medical monitoring devices. The DynoSensor is a versatile device. It not only measures all fundamental vitals, including electrocardiogram, photoplethysmography, polumonary plethysmography, temperature, and blood pressure in less than one minute, but it can also integrate other tests, such as those for hydration and influenza virus A/B, according to patients’ specific needs. Unlike many other medical monitoring devices, the Dyno is a small, lightweight hand-held device that noninvasively measures vitals with the placement of a wand inside the patient’s mouth. The system is intuitive, with all measurements taken simultaneously without the use of additional components. The system does not require high power and can be used when needed and automatically sanitizes between uses. The Dynosensor overcomes privacy concerns by securely capturing all data. However, the data is available for sharing and can thus provide physicians with information to monitor patients remotely. An additional benefit of the data storage and share system is the potential to combine the data with patient records and decision support systems to optimize medical care. Such an integration of data has been highly recommended1,20-22
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Leading high-tech companies, from Apple and Google to Qualcomm, have embarked on a monumental effort to push for new concepts and product development in the field of digital health. One digital health technology at the center of the radar, the smart sensor, is certain to shape the healthcare landscape this century. In fact, according to Deloitte, the smart sensor market is growing rapidly and the market for wireless health monitoring devices will grow to $22 billion by next year. A significant portion of that market is driven by increasing segments of people facing health problems, such as the elderly, those with chronic conditions or even individuals in remote locations who need access to affordable care. What do smart sensors offer that is so powerful for healthcare? Here’s a list of the top five reasons sensors are game changers:
1) Better monitoring –The convergence of newly mature technologies – power networks, cloud, miniaturization, and nanotechnology – create a perfect palette from which developers can create useful, easy to operate devices at an affordable cost. Studies show that users are more likely to adopt inexpensive technologies that offer them a sense of independence and can send data from anywhere at regular intervals with little effort from the user. Technologies can feed into software and even a patient’s Electronic Health Record (EHR) to monitor and track trends. A physician can enter preset parameters based on a patients’ profile or allow systems to utilize adaptive algorithms that learn what is normal for the individual and create alerts in the event of an anomaly. The patient could then be directed to take a certain medication or go to a hospital if necessary.
2) Telemedicine applications – Today, 3 percent of pediatric critical care specialists live in rural areas that serve 21 percent of the population of U.S. children. To address this discrepancy, noted academic hospitals, such as the UC Davis Children’s Hospital, have employed telemedicine and remote monitoring solutions to improve outcomes for rural pediatric emergency department patients. With sensor technology, these benefits can extend to even more places such as villages in underdeveloped countries or even Antarctic outposts. For example the DynoSensor™, or Dyno™ for short, from the company DynoSense™ Corporation, measures heart rate, blood oxygen content or blood pressure change by having a user hold the device in the mouth for sixty seconds. No clinicians or doctors are required. It then immediately transmits the data via network and cloud to the centralized medical office. Based on the information, a physician can prescribe medication, or suggest further testing. The simplicity offered by sensor technology holds great promise in supporting communities in undeveloped countries to improve global health overall.
3) Lower costs – Many factors are impacting the cost of healthcare. Medicare is moving to accountability measures; liability and malpractice insurance are increasing; more complex procedures are developed every day and, most importantly, our population is aging and developing more chronic diseases. Because sensors improve health monitoring and disease management overall, they create better quality of care which is the answer to these rising cost factors.
4) Improved care – A recent study found that those with COPD and congestive heart failure benefit from sensor monitoring technology because it provides a way for healthcare providers to address their issues before their condition becomes acute. It gives people a better tool to be aware of their bodies, communicate with their doctors and improve the level of care they receive. The sensor can be a convenient proxy that easily transmits important data, avoiding unnecessary doctor and hospital interactions, making life easier. In a way, sensors are the “guardian angels” of health because they are always there but are never in the way, capturing important information and stepping in when appropriate.
5) Personalized medicine – Sensors empower people to learn more about their own health. Equipped with more knowledge, individuals can better participate in decision-making with their doctors. For instance, today many people track their own health through technology and other measures, and use this information to make important health decisions, including seeking a second opinion from another doctor. This added control and awareness helps to avoid costly procedures and specialist visits while, at the same time, allow an individual to know when to seek professional help.
Advances are being made in the sensor space every day at the intersection of technology and the body, and the possibilities are open ended.
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We don’t normally equate emerging tech devices with elderly people – our older population is not known for being early adopters. But when it comes to their personal health, people become more flexible and quick to latch on to things that make them feel secure and comfortable. That’s why smart sensors, devices for the tech hardcore, are actually the perfect answer for our aging demographic.
According to the Centers for Disease Control (CDC), 80 percent of elderly people in the US have a chronic condition and half are impacted by two or more diseases. And by 2030 the number of people over the age of 65 will double to 71 million . There is no doubt the healthcare system is facing a daunting challenge to manage the care of these individuals. By looking to digital health solutions a few innovative companies are responding by taking smart sensors, used today mostly in hospital settings, and placing them in the hands of the consumers, including the elderly, to offer remote health oversight from virtually anywhere.
How do these sensors work? They can, from most any location, conveniently capture vital health measurements and feed that data directly into a patient’s Electronic Health Record (EHR). They utilize advances in power and computing seen in smart phones to capture and manage highly complex data. Information can be transmitted via an array of networks, including 3G, WiFi, and Bluetooth, and because many solutions are cloud based, the data can be accessed anywhere.
To be embraced by consumers and providers alike, sensors need to be easy to use and support patient care without “too much information” overwhelming the physician. For example, an elderly patient has congestive heart failure. That individual might be on at least a dozen medications to keep their health stable . They may also have other conditions such as COPD or even cancer. Using a sensor, such as the DynoSensor™, or Dyno for short, from DynoSense™, they can take periodic readings by placing a device in their mouth for just sixty seconds, measuring heart rate, breathing, SPO2, blood pressure change and other key vital functions. Not only can they see the data themselves, but it can be sent back to physicians or even a family member. The physician is not required to read every single data point, only to rely on preset parameters that can trigger notifications of trends.
The result? Medication can be adjusted to avoid a complication from escalating into a hospital visit, regular check-ups become less frequent and the elderly person can feel comfortable and secure knowing that their information is always there ready to be accessed when needed. Patients are more likely to take medicine when they can see the results for themselves and the monitoring can help recognize when pills are missed. “When you make it easy for people to capture information from their lives and share it with their clinicians, they feel empowered to take a more active role in their health – and this engagement can lead to better outcomes,” confirms Stephen J. Downs, chief technology officer of the Robert Woods Johnson Foundation which sponsored studies on the effects of utilizing personal technologies in healthcare. And the elderly population is but one segment of the market, the DynoSensor for example can be used by anyone with a chronic condition, in a remote location, upon discharge from a hospital or even a person who just has a strong desire to learn more about their own health.
Companies like DynoSense are working hard to increase accessibility to medicine for everyone by using the latest technologies in sensory hardware, algorithms, device design and software to create an answer to the challenges of this century. And they are achieving it with a device so simple and elegant even your grandmother will love to use it.
You can download a PDF copy from link below that includes listing of all references.
The primary vital signs are (i) Electrocardiogram (ECG or EKG), for heart electrical parameters; (ii) Photoplethysmography (PPG), for blood content analysis; (iii) Blood Pressure; (iv) Pulmonary Plethysmography for respiration parameters; (v) Core Body Temperature, and (vi) Auscultation for breathing sound. Collectively, they are basic measures of life and good health that are frequently being examined in medicine. When linked with weight, age, race, gender, activity, medication, life style choices and overall state of a person over a period of time, they are very powerful indicators OF WHAT? Also, as the quality of medicine is being continually improved, population life expectancies are growing longer. This trend is accelerating in prosperous societies, and with it comes the dilemma of longer care of aging populations who demand quality and responsiveness from care givers while Providers tackle the costs.
Most physicians today allocate about 15 minutes per patient, yet quality data is required to improve routine examinations into quality interactions.
Americans spent the equivalent of 16% of GDP on health care in 2012. This is also a global phenomenon. The accompanying chart shows that many other nations are spending more of their budgets on health care related products. According to many studies, personal knowledge, education, easy access to primary health care and preventive methods can drastically improve quality of health while reducing spending. The goals are to deliver affordable, value-based care. Advanced development of miniaturized in-home or at point-of-care devices with wireless communication, will change the role patients take in their own health care. Health care will become more personalized through tailoring of interventions to individual patients. This digitization of health to gather patient information can be coupled with analysis, education, tracking and training at each individual level. The massive growth of the volume, velocity, and variety of digital health data creates both opportunities for greater patient insights and faster response to Change of Conditions (COC).
At Dynosense Corp., we are innovating health technology through passion, diligence and our visionary view that the digital health revolution is the future of medicine.