ABSTRACT
Medical technology and patient data should have the same goal, which is the maximization of the usefulness of a historical trend for patient care improvement. Without the proper infrastructure and resources to take action on patient health data that indicates high certainty that something will occur, the full potential of connecting trends and patterns cannot be completely utilized. One method is to have a patient use a remote health monitoring device to transmit health data to the cloud for predictive analytics which, over time, can develop unique health patterns that can predict actionable data by caregivers. Medical prediction modelling techniques use artificial intelligence to generate a prediction profile (algorithm) from patient data that can be implemented, so that a new patient can get an instant prediction for an accurate diagnosis. Precision medicine, personalized medicine, and genomic medicine all describe medicine based on genomic makeup. These approaches are methods to determine unique disease risks that are based on predispositions in a person’s genome at birth, in combination with environment and lifestyle factors which can be monitored remotely. Predictive Analytics used in medicine, especially with remote health monitoring, can also reveal data associations, such as medications, hospital readmission rates, probability of disease, infection predictions, and prediction of future wellness. Predictive Analytics (PA) using patient data garnered from remote health monitoring can help in preventive medicine for diseases that can be prevented or ameliorated for at-risk patients by making lifestyle changes to avoid risks, resulting in lowering medical costs.
Keywords: patient data, remote health monitoring, predictive analytics, precision medicine, personalized medicine, and genomic medicine, pharmacogenomics
information to predict patient outcomes [3]. Remote health monitoring can ease this burden, since individual patient health data can be collected and analyzed for health changes that may require action. In the history of medicine, physicians have primarily focused on sick care, not healthcare, treating sickness instead of prevention. Predictors are valuable when data from past treatments and current medical research can be translated into preventive action [3]. Statistics and modeling can foresee future occurrence based on current and historical data by examining data patterns to determine if such patterns are apt to re-emerge [4]. Medical prediction modelling techniques use artificial intelligence to generate a prediction profile (algorithm) from patient data that can be implemented, so that a new patient can get an instant prediction for an accurate diagnosis [3]. Predictive Analytics used in medicine, especially with remote health monitoring, can also reveal data associations, such as medications, hospital readmission rates, probability of disease, infection predictions, and prediction of future wellness [3]
1.2 Lowering Costs and Admissions
The medical community is turning to channeling the power of Predictive Analytics of patient data to lower costs and readmissions, since predicting hospital readmissions is a very important issue in healthcare today [2]. One benefit of remote health monitoring and predictive analytics is meeting government regulations, such as those found in the Affordable Care Act, in which patients are not supposed to be readmitted within 30 days of hospital discharge [3]. Remote health monitoring will allow caregivers to have real-time access to a patient’s health data to create individual predictive analytics that can be used to improve patient care, while simultaneously controlling costs by avoiding hospital readmissions that contribute to financial and reimbursement penalties [2]. Hospitals and caregivers can also use Predictive Analytics to more accurately evaluate when a patient can safely be released [3].
1.3 Increased Accuracy of Diagnosis
Another benefit of Predictive Analytics is increasing accuracy of diagnoses. A patient admitted to the ER with chest pain can be assessed using PA algorithms to help determine of the patient should be hospitalized [3]. Also, evidence-based research has also indicated that certain conditions may be helpful in early determination of Alzheimer’s disease [3]. A patient can be prescribed appropriate exercise, nutrition, as well as memory tests, and brain game apps that can be downloaded on a smartphone for accumulation of
personal patient data. The results can be entered into the cloud for analytics or an electronic medical record (EMR) to which the patient can add weekly data via a remote health monitor that develops a predictive model that tracks any changes in memory maintenance [3].
1.4 Precision Medicine
Precision medicine, personalized medicine, and genomic medicine are terms used to describe medicine based on genomic makeup [5]. These approaches are methods to determine unique disease risks that are based on predispositions in a person’s genome at birth, in combination with environment and lifestyle factors which can be monitored remotely. Pharmacogenomics is a part of personalized medicine, and relates to drugs that might be personalized to an individual’s genetic makeup. This can lead to customized health care, with medical treatments tailored to individual patients [6]. Due to rapid growth of big data analytics, genomic sequencing, and backing from research and healthcare organizations, predictive analytics can be used by pharmaceutical companies to create personalized, or precision, medications that meet the needs of smaller groups. Researchers can use predictive analytics to develop prediction models that are more accurate over time without huge observational population studies which result in data that has statistically significant differences which are not necessarily clinically significant differences [3].
Facebook founder Mark Zuckerberg and his wife Dr. Priscilla Chan made a $10 million donation to UC San Francisco, one of the leading precision medicine research facilities, which will be used to research the potential of recycling data for personalized care [7]. This will be carried out by leading physician-scientist Atul Butte, who is researching the frontier of big data [8] advance research without requiring creation of brand new data sets whenever a researcher has an innovative idea, or a new drug requires safety testing and effectiveness [7]. This publicly available data can allow researchers to engender insights into innovative therapies for cancer and other diseases, precision treatments, and drug breakthroughs and repurposing [8].
Future medications may be advanced by relying on predictive analytics to conclude what is most effective for individuals with “similar subtypes and molecular pathways” [3]. Unwanted side effects of big bulk medications that do not meet the needs of most patients may lead to waste and risk if a large body of patients is treated with a medication that only saves a smaller number [3]. Remote health monitors that can contribute personal health data for an individual can lead to personalized care and, eventually, personalized
medications. In 2014, the FDA approved over twenty percent of the new drugs that targeted a specific biomarker predicting treatment effectiveness
2. CONCLUSION
Predictive Analytics (PA) using patient data garnered from remote health monitoring can help in preventive medicine for diseases that can be prevented or ameliorated for at-risk patients by making lifestyle changes to avoid risks, resulting in lowering medical costs [3]. The use of a remote health monitoring system that collects individual patient health data for analytics can predict a unique accessible health pattern for providing actionable data. Future medications may be developed by relying on PA to determine what works for individuals with “similar subtypes and molecular pathways” [3]. Using predictive analytic algorithms hospitals and employers can predict with future medical costs and synchronize databases and actuarial tables to create health models and tailored health plans [3]. Using PA, researchers can develop prediction models using small population studies that determine clinical significance and become more accurate over time [3]. Remote health monitors contributing an individual’s personal health data can lead to personalized care and, eventually, personalized medications.
3.REFERENCES
1. Srinivasan, S. (2016). Big Data and Predictive Analytics: Applications in the Care of Children. Pediatric Clinics of North America. Volume 63, Issue 2, April 2016, Pages 357-366. Retrieved from https://doi.org/10.1016/j.pcl.2015.12.007 2. Crockett, D. (2017). Predictive Analytics: Healthcare Hype or Reality? Retrieved from https://www.healthcatalyst.com/predictive-analyticshealthcare- technolog
Personalized Medicine Coalition (PMC) [9]. Personalized medicine is rapidly becoming an integral ingredient for clinical care, a trend that is expected to continue (PMC).
3. Winters-Miner, L. (2014). Seven ways predictive
analytics can improve healthcare. Elsevier. Retrieved
from https://www.elsevier.com/connect/seven-wayspredictive-
analytics-can-improve-healthcare
4. Investopedia. (2017). Predictive analytics. Retreived
from http://www.investopedia.com/terms/p/predictiveanalytics.
asp
5. Genome. (2014). What is personalized medicine?
Retrieved from http://genomemag.com/what-ispersonalized-
medicine/
6. Mayo Clinic. (2018). Personalized medicine and
pharmacogenomics. Retrieved from
https://www.mayoclinic.org/healthylifestyle/
consumer-health/in-depth/personalizedmedicine/
art-20044300
7. Bresnick, J. (2017). Chan, Zuckerberg Donate $10M
to UCSF Precision Medicine Lab. Retrieved from
Healthcare Analytics, Population Health Management,
Healthcare Big Data. Retrieved from
https://healthitanalytics.com/
8. Bresnick, J. (2015). Big Data Analytics Spurs
Development of Personalized Medicine. Healthcare
Analytics, Population Health Management, Healthcare
Big Data. Retrieved from
https://healthitanalytics.com/news/big-data-analyticsspurs-
development-of-personalized-medicine
9. Personalized Medicine Coalition (PMC). (2018).
Precision medicine. Retrieved from
www.personalizedmedicinecoalition.org
Abstract:
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.
Key Words: IoT, wearable technology, pharma
The Internet of Things (IoT) is a network of tangible devices, such as wearable technology, that have been embedded with software and sensors to create a connected network that collect and exchange data[1]. Digital health is the integration of digital and genomic technologies with health, healthcare, lifestyle, and social networks that enhance the efficiency of healthcare delivery and personal medicine [1]. Innovation in this field has improved clinical
outcomes and reduced cost of treatment. Advances in digital health have fundamentally changed the business model of the pharmaceutical industry, and has impacted all aspects of a pharma company’s structure—from sales and marketing, to R&D and business-to-business activities. As healthcare becomes more digitized, pharma companies are transforming to remain competitive by rethinking their business and operating models, their cultures and capabilities, and adopting policies that nurture innovation and courageous strategic moves [2].
Patients have become less passive recipients of
therapies, and are starting to control their own health treatments by providing their doctors with more information, home-measured parameters, which allows for an informed opinion about how they should be treated [3]. With individuals assuming more control over their own health, pharma companies must adapt to this new decision-making power and create more effective methods to engage them. This is difficult since it is challenging to determine exactly what engagement model appeals to their patients [2].
To drive better patient engagement, physicians can observe patient behaviour from a continuous daily stream of patient data from online communication, in-home visits, and quantitative methods to analyse trends and adjust treatments as needed. [2]. Data from wearable devices and other quantified self-technologies are evolving into research and clinical grade medical tools. Health devices can increase patient cost consciousness, allowing for comparisons of price points for various treatments [2]. Payers and
providers will have more health information to link drugs to outcomes and update value-based pricing [2]. Pharma companies will need to provide third parties with access to their product data and become transparent about clinical trials [2].
Today, patients can use their wearable devices to report data of physiological parameters and track their own health records. Researchers have observed that actively participating individuals experience results in less treatment cost and better adherence to prescribed medicines as compared to those who do not [3].
Patient education is essential for providing effective communication between patient and physician. With the use of digital techniques, patients are becoming more engaged and outcome based care is becoming a strategic healthcare goal by improving the patient-physician relationship at the lowest cost. Identification of the right initiatives allows pharmaceutical industries to bring about a digital revolution in health care. The pharmaceutical industry is utilizing such technologies for success and innovation. More information about product performance is available and process efficiency is improving. Digital development can bring innovation in personalised patient care. It has improved patient physician relationship and helps in decisionmaking. Marketing strategies can be well managed and planned by using latest techniques. Companies need to transform their commercial and innovative models in benefit of health care. In the pharmaceutical industries, these techniques are used in the form of sensors and digital apparatus to provide efficient performance [4]
Wearable technology is an important component of digital technologies. Wearables are wireless sensors worn on the body, which can accurately measure body physiological functions and alert
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
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 are in either early stages of development including clinic trials. For example, the Free 0Style Libre, manufactured by Abbott is a two component system that measures the blood glucose levels of diabetic patients. The sensor, a small disc, attaches to the patient’s body, measures the blood glucose level and sends information to a receiver or
Android phone. The new system allows for patients to see trends in their blood sugar and quickly make changes in diet when the trend is to high blood sugar levels [5]
The immediate and obvious application of wearable device for pharmaceuticals is in the clinical trial, in which recruiting patients and getting them to adhere their treatment regime are a constant challenges. Wearables can collect real-word data remotely (and, therefore, freeing participants from having to report on site) and then provide reminders so patients don’t forget to take their medication. These capabilities can save companies huge amounts of money by increasing the efficiency of costly and lengthy clinical trials. The ability to easily and quickly collect all of this patient data is particularly impressive and creates great opportunities to monitor the efficacy and
safety of drugs in real-time in patients and provide fast feedbacks to R & D. As of April 2017, over 250 trials in the UK and US incorporate wearables, with promising results for boosting participation and compliance[6].
In the long run, utilization of wearable technology techniques can generate an ecosystem that starts from drug production, drug use to monitor patient condition and reaches up to providing feedback to the patient after consultation. With such systems, everyday information of the patient can be monitored by the physician anywhere anytime. For example a patient suffering from Parkinson disease can provide information to the care provider on the basis of chip on pill technique. With this technique, a smart watch is provided to the patient which monitors drug taking schedule, send reminder to the patient for medication taking and send health status report to health provider. Specialist virtual care application is already in use by health providers for betterment of patients [7].
In research and development department of pharmaceutical industries, the wealth of data collected by wearable device offers more opportunity to better understand the action of medicine in individual patients and to translate back to more effective drug discovery and development tailored to personal medicine[8].
The Dyno developed by DynoSense Corp., is a fully integrated multi-function health scanner technology that can capture more than 33 health metrics in less than 60 seconds with a single user action. The captured health data is securely and wirelessly uploaded to the company’s cloud computing platform for further analytics and processing, and is then communicated with healthcare professionals [9]. This device can be readily applied for monitoring patients with cardiovascular disease in clinical trials, and the
quality of the data collected will be more accurate than the data provided by patient logs or diaries during clinical trials.
References
1. SAP. (2018). What is the Internet of Things? Retrieved from https://www.sap.com/india/trends/internetof- things.html3.
2. Champagne, D., Hung, A., Leclerc, O. (2015). How pharma can win in a digital world David Retrieved from https://www.mckinsey.com/industries/pharm aceuticals-and- medical-products/ourinsights/ how-pharma-can-win-in-a-digitalworld
3. Mesko, B. (2015). My Health: Upgraded. Webicina, Retrieved from https://www.mckinsey.com/industries/pharm aceuticals-and-medical-products/ourinsights/ how-pharma-can-win-in-a-digitalworld
4. Lerer, L., & Piper, M. (2003). Digital strategies in the pharmaceutical industry. Basingstoke: Palgrave Macmillan.
5. Baker, D., & Evans, W. Digital information strategies. 1st Edition. Chandos Publishing. Retrieved from https://www.elsevier.com/books/digitalinformation- strategies/baker/978-0-08- 100251-3
6. Mukku, S. (2012). PHP111 Global Evidence Generation – Challenges for the Pharma Industry. Value In Health, 15(4), A33. http://dx.doi.org/10.1016/j.jval.2012.03.187
7. Digital revolution. (2017). Chemistry & Industry, 81(7), 40-40. http://dx.doi.org/10.1002/cind.817_12.x
8. Bhavnani, S. Narula, J., Sengupta, P. (2016). Mobile technology and the digitization of
healthcare. European Heart Journal. 37 (18):
1428–38.
doi:10.1093/eurheartj/ehv770
PMID 26873093
9. Tehrani, N. (2015). Taking Control of
Health Care. Zenith International Journal of
Multidisciplinary Research.
Abstract Due to the aging American population, healthcare patients and providers are seeking new solutions to lower costs. Today’s patients, including those with chronic maladies, have taken on the role of the consumer who looks for affordable prices for their healthcare. This has created new opportunities for chronic health care management, such as remote health monitoring for home use.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
INTRODUCTION
The American population is aging, and persistent chronic diseases such as asthma, diabetes, and hypertension are ubiquitous. Thus, healthcare providers and patients are lookingfor 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 forsignificant 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).
SOLUTIONS
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 addedintellectual 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 connectspatient 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, aclinician can bill for any specific patient,but at this point, it may be required to link coordination with subspecialists 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,
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 motivatedpatients 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 havinglong-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 achronic 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). Abeneficial 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.
CONCLUSION
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.
REFERENCES
[1]. AAFP. (2014). New Chronic Care Management Payment Included in Proposed 2015 Medicare Fee Schedule. Retrieved from http://www.aafp.org/news/governmentmedicine/ 201407092015mpfs.html
[2]. Bresnick, J. (2014). Remote monitoring brings chronic disease management home. HER Intelligence. Retrieved from https://ehrintelligence.com/2014/03/05/remotemonitoring- brings-chronic-disease-managementhome/ DynoSense. (2015). DynoSensor. Retrieved from
https://dynosense.com/products/
[3]. Halsted, H. Lorig, K. (2004).Patient self-management as a
key to effective and efficient chronic disease care. Public
Health Reports.119 (3), 239-243.
[4]. Hudon, C. Fortin, M. Haggetry, J. (2012).A thematic
analysis of family medicine in literature and patient centered
care in chronic disease management. Patient Education and
Counseling.88 (2), 170-176.
[5]. Julie, A, Stephen, M. Rundall, T. (2006).Impact of primary
health care orientation and chronic care management.Annals
of Family Medicine.4 (2), 117-123.
[6]. PYA. (2015). Providing and billing medicare for chronic
care management. Retrieved from
http://www.pyapc.com/resources/collateral/whitepapers/
Chronic-Care-Whitepaper-PYA.pdf
[7]. Sanctis. M. (2015). Mercy to open new chronic care unit.
Springfield news sun. Saturday, May 2, 2015 | 1:50 p.m.
Retrieved from
http://www.springfieldnewssun.com/news/news/mercy-toopen-
new-chronic-care-unit/nk6bR/
[8]. Stellefson, M. Krishna, D. Stopka, C. (2013).A systematic
review of chronic are model management in primary care
settings in the U.S.Preventing chronic disease.Patient
Education and Counseling10 (1), 3-26.
[9]. Vogeli, C. Sheilds. A. Lee, T. Teresa, G. (2007).Multiple
chronic conditions in the prevalence, health outcomes and
quality implications in care management and costs. Journal
of General Internal Medicine.22 (3), 391-395.
Abstract
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. Due to the trend of aging Americans, 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. As a result, many elders may require a home system to monitor their safety and their health. To effectively care for patients across a range of settings, remote monitoring of people with chronic diseases, and more, is a promising technology. 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.
Keywords: Digital, Health, Remote, Monitoring, Sensors, ECG, Blood Pressure.
INTRODUCTION
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 ischemicheart disease and 51% of deaths due to stroke, which together account for 14 million deaths globally each year” (Nagai, 2010, p. 116). Additionally, hypertension isthe 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
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).
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.,& 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 couldreverse 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 settingscharacterized 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 noaccess 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 respiratory 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 toeducate the public how to be in control of individual health by remotely monitoring health care in person at homeand 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 readmissions (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 allthe 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.
Dyno is a great example illustrating what remote health monitoring can do today.The benefits will help provide better treatment as physicians will have access to real-time patient data.
REFERENCES
Dunker, A, & Greenberg, S. (2000). A profile of older Americans: 2000. February 1,2001. Administration on Aging, http: www.aoa.gov/aoa/ stats/profile/default.htm
Ellis, C. S. (1992). A boom time for home health care: Home care growth area for hospitals. Boulder County Business Report, 11(7), 13. Retrieved from http://search.proquest.com/docview/221209211?accountid=38235
Health Devices. (2012). Matching patient association to workflow. Retrieved from https://www.ecri.org/Documents/HIT/Making_Connections_Integrating_Medical_Devices_with_Electronic_Medical_Records%28Health_Devices_Journal%29.pdfNagai, M., S. Hoshide, and K. Kario, Hypertension and dementia. Am J Hypertens, 2010. 23(2): p. 116-24
Leventhal, R. (2013). Remote patient monitoring: can it be a solution to a key healthcare problem? Retrieved from http://www.healthcare-informatics.com/blogs/rajiv-leventhal/remote-patient-monitoring-can-it-be-solution-key-healthcare-problem?page=3&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A%20healthcare-informatics%20%28Healthcare%20Informatics%29
Mann, William C,O.T.R., PhD., Marchant, T., M.O.T.S., Tomita, M., PhD., Fraas, Linda,O.T.R., M.A., & Stanton, Kathleen,M.S., R.N. (2002). Elder acceptance of health monitoring devices in the home. Care Management Journals, 3(2), 91-8. Retrieved from http://search.proquest.com/docview/198021614?accountid=38235
Rising cost is next health care challenge. (2008, Apr 26). The Berkshire Eagle Retrieved from http://search.proquest.com/docview/379955936?accountid=38235
Sensors in Medicine.(2014). Royal geographic society, i kensington gore, london sw7 2ar. Retrieved from http://www.sensor100.com/SensMed2014/Conference.html
Thusu, R. (2011). Medical sensors facilitate health monitoring. Retrieved from http://www.sensorsmag.com/specialty-markets/medical/sensors-facilitate-health-monitoring-8365
Tinker, A., Wright, E, McCreadie, C., Askham, J., Hancock, R., & Holmans, A. (1999). Royal commission on long term care. Alternative models of care for older people. The main report. London: HMSO.
World Health Organization. (2014a). Top 10 causes of death. Retrieved from: http://www.who.int/mediacentre/factsheets/fs310/en/index2.html.
World Health Organization: Guidelines for primary health care in low-resource settings.(2014b). Retrieved from: http://apps.who.int/iris/bitstream/10665/76173/1/9789241548397_eng.pdf?ua=1#page=1&zoom=auto,375,127
Dr. Nik Tehrani
39270 Paseo Padre PKWY, Suite 424
Fremont, CA 94538
Phone: 510.676.5606 Fax: 510.550.4456 Email: nik@niktehrani.com
Abstract The Universal Declaration of Human Rights, an international human rights law, requires governments to provide right-to-health systems. One solution for reaching patients in remote locations to avoid costs associated with transporting health workers, and the sheer numbers of patients, is a remote health monitoring device. Also, the increase in the occurrence of chronic disease in an aging population ages leads to immobility, increasing the need for remote health monitoring devices as well. Results of cardiac rhythm disorders such as “atrial fibrillation (AF), bradycardia, atrioventricular (AV) block and sudden cardiac death” (Thibault and Guerra, 2010, para. 2) can be remotely gathered using digital technologies, such as wireless biosensors, integrated with traditional medical data and made accessible to doctors. Dyno Sense Corporation has developed a fully integrated multi-scan health scanner using nine sensors to measure 33 different health metrics using a new device called Dyno that 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 or in a remote area. The Dyno has been proven in clinical trials to successfully monitor health conditions.
Keywords: Digital, Health, Remote, Monitoring, Sensors, ECG, Blood Pressure
INTRODUCTION
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).
HEART
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).
Dyno Sense 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).
REFERENCES
1. Backman, G., Hunt, P., Khosla, R., Jaramillo-Strouss, C., Fikre, B. M., Rumble, C., Vladescu, C. (2008). Health systems and the right to health: An assessment of 194 countries. The Lancet, 372(9655), 2047-85. Retrieved from http://search.proquest.com/docview/199013899?accountid=38235
2. China-Japan Friendship Hospital Trial (2014). DynoSense. San Jose, CA
3. Continua health alliance commends the FCC for health care provisions in its national broadband plan. (2010, Mar 17). Business Wire Retrieved from http://search.proquest.com/docview/443528849?accountid=38235
4. Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, DevereauxPJ, Beyene J, Sam J, Haynes RB: Effects of computerized clinical systematic review. JAMA 2005;293:1223–1238.
5. Kaufman DR, Patel VL, Hilliman C, Morin PC, Pevzner J, Weinstock RS, Goland R, Shea S, Starren J: Usability in the real world: assessing medical information technologies in patients’ homes.
6. Logan, A. G., McIsaac, W. J., Tisler, A., Irvine, M. J., Saunders, A., Dunai, A., Cafazzo, J. A. (2007). Mobile phonebased remote patient monitoring system for management of hypertension in diabetic patients*. American Journal of Hypertension, 20(9), 942-8. doi:http://dx.doi.org/10.1016/j.amjhyper.2007.03.020
7. Peking University First Trial. (2014). DynoSense. San Jose, CA
8. Rothman AA, Wagner EH: Chronic illness management: what is the role of primary care? Ann Intern Med 2003;138:256 –261.
9. Rouse, M. (2014). Remote patient monitoring (RPM). Retrieved from http://searchhealthit.techtarget.com/definition/remote-patient-monitoring-RPM
10. Sara-Care of Campbell. (2014). DynoSense. San Jose, CA
11. Spinsante, S., & Gambi, E. (2012). Remote health monitoring for elderly through interactive television. Biomedical Engineering Online, 11, 54. doi:http://dx.doi.org/10.1186/1475-925X-11-54 12. Sund, Z. M., Powell, T., Greenwood, R., & Jarad, N. A. (2009). Remote daily real-time monitoring in patients with COPD – A feasibility study using a novel device. Respiratory Medicine, 103(9), 1320-8. doi:http://dx.doi.org/10.1016/j.rmed.2009.03.017
13. Tehrani, N. (2015). Taking control of health care Zenith international journal of multidisciplinary research. ISSN 2231- 5780
14. Thibault, B., & Guerra, P. G. (2010). Implanted cardiac devices with remote monitoring capacity: “it’s like having a physician follow me on a daily basis”. Expert review of cardiovascular therapy, 8(5), 617-9. doi:http://dx.doi.org/10.1586/erc.10.393.
15. Topol, E. J. (2012). The creative destruction of medicine: How the digital revolution will create better health care. New York: Basic Books.
The American healthcare industry has been impacted by Information Technology (IT) digitization, making healthcare more accessible and affordable. This will not be successful unless patient engagement is encouraged to advance innovative digitized healthcare. Healthcare providers must work in partnership with the patients to ensure that the target is achieved. Digitally engaging patients does not rely on face-to-face meetings, but rather will allow for remote diagnoses and treatment recommendations. An Infosys study (2013) indicates that a high number of patients favor electronically sharing personal health information with their physicians and feel confident that their personal medical data will not be compromised. Many patients share personal medical information online and on mobile devices, and even use their mobile apps to communicate with physicians. Patient engagement occurs when they understand the benefits of services offered by the healthcare systems through marketing campaigns and promotional offers. Patients will be empowered once they are educated on the programs that allow them to manage their own healthcare, including patients who are not technologically savvy and are reluctant to use digitized healthcare systems.
©2015, IJMHS, All Right Reserved
PATIENT ENGAGEMENT IN DIGITAL HEALTHCARE
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.
Patient-Centric approach
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).
Outcome Oriented
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
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).
1. Bala, V. (2014). Consumer Engagement. Retrieved from http://www.infosyspublicservices.com/insights/Documents/consumer-engagement.pdf
2. Berger, S. (2014, March 26). The Patient Information Journey. Retrieved from blue latitude: http://bluelatitude.net/the-patient-information-journey/
3. Dolgin, G. (2013, November). Consumer Engagement is the Future of Healthcare. Retrieved from Endeavour partners: http://endeavourpartners.net/consumer-engagement-is-the-future-of-healthcare/
4. Healthcare, D. (2014). Customers. Digital Healthcare. Retrieved from http://www.digital-healthcare.co.uk/customers.aspx
5. Infosys (2013). Engaging with Digital Consumers. Retrieved from http://www.infosyspublicservices.com/industries/healthcare/white-papers/Documents/engaging-digital-healthcare-consumers.pdf)
6. Moon, J., Mccombie, D., Dhillon, M., Banet, M. (2015). Body-worn pulse oximeter. W
a. 2010148205 A. Patents. Retrieved from http://www.google.com/patents/WO2010148205A1?cl=en
7. Ritu Agarwal, G. (2010). The Digital Transformation of Healthcare: Current Status and the Road Ahead. Information System research, 796 – 809.
How to cite this article: TEHRANI, Majid Nik. Patient Engagement in Digital Healthcare. Innovative Journal of Medical and Health Science, [S.l.], v. 5, n. 2, p. 37-38, mar. 2015. ISSN 2277-4939.
Available at: <http://innovativejournal.in/ijmhs/index.php/ijmhs/article/view/50>. Date accessed: 09 Apr. 2015. doi:10.15520/ijmhs.2015.vol5.iss2.50.37-38.
Innovations are heavily influenced by both love and passion. First, innovation happens for the love of what one does, but
passion keeps it going. Hence, it is through love and passion by which innovations are both born and nurtured. Human passions
fuel innovations, and without these emotions, innovation would be impossible. Passionate innovators share their passion with
others. (Int J Biomed. 2015;5(4):235-237.)
Keywords: Love; passion; innovation.
Abstract:
Yousef lives in a remote area of Pakistan with limited access to healthcare. As a result of not having proper disagnoses, care or medication, Yousef’s hypertension has begun to damage his heart. A major barrier for Yousef getting good healthcare is the long distance between the village and quality care hospitals that are miles away, so he becomes a patient at the local village quack clinic that is not qualified to treat Yousef’s complicated health condition. Telemedicine in the form of Health Relationship Management Services (HRMS) has come to the village, so now, Yousef can receive proper diagnoses, advice, medication and treatment without having to travel afar. Telemedicine allows specialists that are miles away to access Yousef’s personal health data to make meaningful decisions about his healthcare. (Int J Biomed. 2016;6(2):xx-xx.).
Key Words: telemedicine ● health relationship management services ● health condition ● healthcare
Yousef is a 60-year old man living in a very small village in the Baluchistan province of Pakistan known as Sofia. He is the only income provider for his family of a wife and two daughters. Yousef has been suffering from hypertension for many years, but he has never been able to get the proper treatment for it due to living in the remote mountainous region in Pakistan. The health services in Sofia are low-quality, while quality health services are located in the nearest city almost 100 km away. Initially, Yousef went to the local health clinic to cure his hypertension because he lacked transportation and could not afford the quality care in distant healthcare facilities. Unfortunaely, the clinic was staffed by untrained and underexperienced people. As a result of receiving erroneous healthcare in his village, Yousef’s health was seriously damaged and propelled his hypertension into a full-blown heart problem. Yousef did finally visit the nearest government hospital, but he was told that the hospital was not equipped with the necessary technology or health specialists needed to deal with his acute health condition. Yousef was told that he needed further assessment by a heart specialist, but the nearest one was inaccessible due to to the remoteness of the village. Soon, his daughters heard that there was something new being introduced in their village clinic that could help their beloved father. They were informed that the clinic was incorporating Health Relationship Management Services (HRMS), which is
Corresponding author: Nik Tehrani, PhD. DynoSense
Academy, CA, USA. E-mail: ntehrani@dynosense.com
an advanced form of telemedicine services.[1,2] Yousef’s main barrier that has kept him from getting appropriate quality healthcare is the long distance between his village and good hospitals and qualified specialists. Now, with telemedicine, Yousef can get expert long-distance advice from professionals who can recommend the proper treatment for his condition.
Now that Yousef’s issue is resolved, he no longer needs to travel a long way to the main city for health services. With quality healthcare so close to home, Yousef is able to visit the local hospital for HRMS to care for his condition. A care specialist is assigned to Yousef’s case for diagnosis and treatment through telemedicine, which offers medical services to remote locations. After having the proper professional medical care, Yousef is now experiencing a different lifestyle. Through the use of a health monitoring system that captures his personal health data, Yousef now can immediately know the result of his health metrics. Yousef’s health data is collected daily and stored in the cloud where it is restructured by analytics software for evaluation. This analyzed data, in an aggregated form, is represented by an individualized health scoring and demographic grading system. The meaningful data is analyzed by the heart specialist who monitors Yousef’s health condition. In essence, the health data captured by the system each day is measured against Yousef’s health database, and if a change should occur, his care-provider is immediately alerted and can now access his health information in order to recommend treatment and lifestyle changes for optimum health. The care specialist discussed Yousef’s case with physicians at
the provincial hospital many miles away, who then diagnosed Yousef with chronic hypertension and diabetes. As a result, the care specialist has prescribed a different course of treatment plan for Yousef. Now, Yousef and his family are very satisfied with HRMS benefits he receives at the local clinic. Yousef’s daughters are relieved that their father’s life is in safe hands, and are pleased that they can now communicate with the specialist remotely, due to availability of the telemedicine treatment.
The stigma that was once associated with the rural areas that lacked quality health services are just a dim memory, and the dream of quality healthcare in remote areas is now a reality. At the outset, Yousef and his family were given the basic information about HRMS: what it consists of, and every step that is involved. It was very comforting for the family to know the status of Yousef’s condition immediately in their own home without having to travel 100 km for the treatment. It was very educational and a relief for the family to know that solutions to many chronic medical health conditions are now available to them in their own locale. Now, the last step is to continue using the system for continous monitoring of Yousef’s health condition. This is the real benefit of this advanced telemedicine service. Day-by-day, Yousef’s health has improved; he started taking his prescribed medications on a regular basis to treat his chronic condition. The results are apparent, and he has resumed his business in his village. The medical care that once was out of reach to remote villagers like Yousef is now within reach.[3]
Yousef’s family was astonished at how a physician a hundred miles away could prove to be so helpful by connecting to a telemedicine system in their own village. They spread awareness to the other villagers, so that they,
too, can also improve their health and their relatives simply just by availing the services of HRMS. As a result, the local villagers patronize the local hospital where the HRMS system was put in place by health officials. In turn, many people have been diagnosed with chronic conditions that were once misdiagnosed by the unexperienced set of so-called doctors in the village. Telemedicine made such a positive impact on the inhabitants in the village, that it is a widely-accepted fact that the HRMS benefits are effective. Patients can be in touch with any specialist thousands of miles away, while in their own homes or village. Health Relationship Management Services helped Yousef and his local villagers by resolving their health problems.[4]
REFERENCES
1.Tehrani N. Health Relationship Management Services (HRMS): A new healthcare paradigm using the 5Rs. Int J Biomed. 2016; 6(1):87-89. doi: 10.21103/Article6(1)_CC1
2.Kahn JM.Virtual visits–confronting the challenges of telemedicine. N Engl J Med. 2015 Apr 30; 372(18):1684-5. doi: 10.1056/NEJMp1500533.
3.Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health. 2012 Jan-Feb;18(1):48-53. doi: 10.1089/tmj.2011.0071.
4.Levin K, Madsen JR, Petersen I, Wanscher CE, Hangaard J. Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment: 7-year results from the Svendborg Telemedicine Diabetes Project. J Diabetes Sci Technol. 2013 May 1;7(3):587-95.
Vol. 2, No. 01; 2018
http://ijsernet.org/
International Technological University and DynoSense Corp.
Corresponding Author:
39270 Paseo Padre PKWY #424
Fremont, CA 94538
Email: nik@niktehrani.com
ABSTRACT
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
Vol. 2, No. 01; 2018
http://ijsernet.org/
gleaned from scientific and medical papers and guidelines and interventions used to treat diabetes[1].
AI Diabetic Health Monitoring
New uses for artificial intelligence to diagnose and treat diabetes have risen in the health care industry, such as IBM’s Watson Health system, which assesses massive quantities of patient data to provide guidance on medical decisions, as well as DynoSense Corp.’s remote health monitoring system that gathers cloud-based personalized patient data that can help predict changes in health that would require a need for action by caregivers. Other companies have also developed AI technologies that provide adaptive learning and medical knowledge that offer guidance to caregivers based on patients’ health profiles. Peer-reviewed research suggests that Lark Health Coach, an AI chronic disease platformcan aide in the prevention of diabetes. Lark provides disease prevention and managementby monitoring a patient’s health using phone sensors and integrated health devices[3] [4]. One-on-one text based communication imitatesempathetic counseling to help steer a patient toward healthier options[3] [4].AI has the potential to analyze massive amounts of patient information that would otherwise take a large staff and resources to accomplish. For diabetic patients, and others, this is tantamount to receiving a doctor’s care every day [1].
Health Assisting AI: Diabetic Retinopathy
People who have diabetes are at risk for diabetic retinopathy, which can cause blindness if not treated properly [5]. Artificial intelligence, such as Google Brain, Machine Learning, and Microsoft Intelligent Network for Eye care (MINE)can detect diabetic retinopathy through dilated eye exams, even if there are not vision related symptoms[6]. A doctor can use a camera to take images of the back of the eye (retina) to look for signs of diabetic retinopathy, such as lesions or hemorrhages[5].
Deep learning ophthalmology technology used for eye care can diagnose and treat patients more efficiently, since without deep learning technology for diseases of the eye, doctors would have toreview a multitude of photos[5]. Also, eye doctors in remote areas can use telemedicine to take images of their patients’ retinas and transmit the images to ophthalmologists in other locationsfor diagnostics[5]. This approach will allow eye disease analysis to be faster and better, with positive benefits for diabetes care [5], since it would enable patients to receive ophthalmologic diagnostics without travelling to a specialist[5].It is predicted that, with better AI technology, a person could snap a cellphone selfie for a retinal eye screening[5].
AI and Clinical Procedures
Presently, AI portable applications can cover a vast piece of outpatient and clinical administrations, allowing for specialists to take care of more basic cases. AIcan help make patient diagnoses fasterby finding relevant data that doctors need to treat a patient and present it in a succinct, easily understandable format[7]. AI can comb through a patient’s history related to a particular disease and link to that patient’s other histories such as high blood pressure, coronary
Vol. 2, No. 01; 2018
http://ijsernet.org/
blockages, history of smoking, and prior pulmonary embolism[7]. Such information might otherwise take lengthy research by the physician who does not have time to do so[7].
AI provides essential healthcare by analyzing patient data, and once it is actionable and meaningful, the information istransmitted to the patient and a caregiver.This results in an immense system of data that connects indications to causes. The machine learning calculationscreate an intricate guide of the individual’s condition and give a customized solution. AI proposes steps and measures to cure the ailment, including cautioning and notifying the individuals when they have to see a specialist. Many technologies have been implemented in health monitoring systems and devices. DynoSense Corp. has developed a unique and efficient preventive care solution to help consumers, providers, and insurance companies to make smarter decisions, improve health, enhance productivity, and save lives[8].DynoSense’s technology allows patients to monitor 33 health metrics at home with a single action in less than 60 seconds, including all the critical vital signs [8]
AI and New Drug Discovery
New uses for AI and machine learning in drug discovery are continually being developed. This technology has the potential for providing mechanistic insights to many diseases, including diabetes, thereby leading to better identification of selection of patients for clinical trials to help identify safety and efficacy issues with compounds[9]. The ability to tap into a wider chemical space to select the best molecules for drug discovery can lead to innovative compound design and a maintainable channel of new medicines[9]. Data Mining, Business Intelligence, Sensing, Ubiquity, Intelligent Agents and Pervasiveness in Medicine, can put effort with new cures and new information for health experts[10] [11].
Conclusion
In general, data innovation can help enhancing human health and life span. AI intelligent software can be conveyed with the end goal to enhance medicalresearch, illness counteractive action, and healthcare benefit delivery.
AI is upgrading human endeavors to enhance the general quality and accessibility of health administration.
References
1. Santos, L. (2016). Using artificial intelligence to revolutionize diabetes treatment. https://www.devex.com/news/using-artificial-intelligence-to-revolutionize-diabetes-treatment-87989
2. Center for Disease Control. (2017).Diabetes. Retrieved from https://www.cdc.gov
3. Pennic, J. (2017). Research Reveals AI Health Coaches As Effective as In-Person Professionals for Diabetes Prevention. http://hitconsultant.net/2017/11/10/research-ai-health-coaches-diabetes-prevention/
4. Stein, N. MPH, MSc Nutrition ; Brooks, K. MS, PhD. (2017). “A Fully Automated Conversational Artificial Intelligence for Weight Loss: Longitudinal Observational Study Among Overweight and Obese Adults” DOI: 10.2196/diabetes.8590
5. Caceres, V. (2017). Could Artificial Intelligence Detect Your Diabetic Retinopathy? Technology looks promising for diagnosis of this eye problem. https://health.usnews.com/health-care/patient-advice/articles/2017-10-05/could-artificial-intelligence-detect-your-diabetic-retinopathy
6. Janakiram, M. (2017)/ Google’s Research In Artificial Intelligence Helps In Preventing Blindness Caused by Diabetes. https://www.forbes.com/sites/janakirammsv/2017/09/05/googles-research-in-artificial-intelligence-helps-in-preventing-blindness-caused-by-diabetes/#38872ba856e1
7. Fornell, D. (2017). How Artificial Intelligence Will Change Medical Imaging. Imaging Technology News. Retrieved from https://www.itnonline.com/article/how-artificial-intelligence-will-change-medical-imaging
8. Tehrani, N. (2015). Taking Control of Health Care. Zenith International Journal of Multidisciplinary Research, 2015Kostas Metaxiotis, K. (2011). Health Care Knowledge Management. Encyclopedia of Knowledge Management, Second Edition. DOI: 10.4018/978-1-59904-931-1.ch035
9. Hunter, J. (2017). How artificial intelligence is the future of pharma. Drug Target Review. https://www.drugtargetreview.com/article/15400/artificial-intelligence-drug-discovery/
10. Furmankiewicz, M., Sołtysik-Piorunkiewicz, A., & Ziuziański, P. (2014). Artificial intelligence systems for knowledge management in e-health: the study of intelligent software agents. Latest Trends on Systems. 2, 551-556.
11. Karam, A. (2014). Artificial Intelligence in Health Care.azikar24.com/artificial-intelligence-in-health-care
Abstract:
There is so much health and medical information available today that physicians cannot be expected to know it all. Thus, advances in technology have become a necessity for doctors to track patient information and care, and add to patient databases for reference and to conduct research. It is important to understand the new language of digital health, such as Personal Health Record (PHR), Electronic Medical Record (EMR) and Electronic Health Record (EHR), all of which sound similar, but are not interchangeable. The ideal comprehensive IT system would empower patients, advance healthcare delivery and transform patient data into life-saving research (Kaiser, 2015). OmniFluent Health is language translation software that will allow for better patient/ practitioner communication and avoid errors. Digital technology employs the use of big data that is shared, accessed, compiled and applied using analytics. However, 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 health care field with upgrades that are necessary, electronic files and health records, from mobile apps, and remote monitoring devices.
Keywords: Personal Health Record (PHR); Electronic Health Record (EHR); digital health; remote monitoring.
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 lifesaving research [1]. 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
*Corresponding author: Nik Tehrani, PhD. Argosy University,
CA, USA E-mail: nik@niktehrani.com ntehrani@dynosense.com
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 [1], 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 [1].
Digital technologies enable analysis of patient data to present better and quicker treatment and diagnoses. E. Lee [2] 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 [3].
According to V. Kaptelinin [4] 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. R. Symthe [5] 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.
E. Topol [6] 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 [7]. One social network tailored for physicians is Doximity. According to E. Lee [2], 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 [7]. Most of the “HIPAA-compliant one-to-one messages and discussion forums focus on business challenges or diagnoses” [7].
G. Eyesenbach [3] 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. V. Kaptelinin [4] 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 [5]. 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 [2]. As digital technology continues to expand the scope of medical interactions and medicine, a new revolution in the health care setting is on the horizon, such as remote health monitoring for elderly through interactive television [8] 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 [4]. 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 health care 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.
REFERENCES
1.Kaiser Permanente. (2015). Papers to pixels. Understanding the language of digital health. Retrieved from https://businessresources.kaiserpermanente.org/Global/FileLib/kp-toolkits/Kaiser_Permanente-_EMR_infographic.pdf.
2.Lee E. 5 ways Technology is Transforming Health Care. Forbes, 2013; 15 (4):9-10
3.
Eysenbach G. What is e-health? J Med Internet Res 2005; 3(2):20.
4.Kaptelinin V. Activity theory: implications for human-computer interaction. Cambridge, MA: MIT Press; 2008:103-116.
5.Smythe R. Is technology dumbing down your doctor? Forbes, 2015; 75(2): 8-10.
6.Topol E. The creative destruction of medicine: how the digital revolution will create better health care. New York: Basic Books; 2014:63-98.
7.Diana A. (2014). Information week healthcare. Healthcare social networks: New choices for doctors, patients. Retrieved from http://www.informationweek.com/healthcare/patient-tools/healthcare-social-networks-new-choices-for-doctors-patients/d/d-id/1234884.
8.Spinsante S, Gambi E. Remote health monitoring for elderly through interactive television. Biomedical Engineering Online 2012; 11, 54. doi: http://dx.doi.org/10.1186/1475-925X-11-54.
Abstract:
The typical worker spends about 47 hours a week commuting sitting in cars, trains, buses, or sitting at their desks. These statistics show that maintaining a healthy work and life balance has become progressively important. Workplace wellness and health promotion are of central importance for any organization in today’s world. People are becoming highly conscious about their health and seek to ensure that they are provided with best medical services and facilities in case of any health issue. Organizations have switched to proactive strategies for the healthcare of their employees. Billions of dollars are spent on the workforce only after illnesses or injuries have occurred. Over the past several decades, healthcare services have drastically changed, altering the manner in which healthcare was previously managed. Technological advancements in medical systems have revolutionized the healthcare industry, and digital health tracking has been quite successful in monitoring patients’ health. Since patients are continuously monitored, no matter where they are, these systems can indicate patients’ adherence to medical protocols and act as a warning sign for such diseases as heart problems, Alzheimer’s disease, and many others. Health Relationship Management Services (HRMS) is a new paradigm which defines comprehensive healthcare for an individual. HRMS is a complete health ecosystem suitable for the workplace, which enables healthcare providers to collect personal health data from various sources, analyze it for positive outcomes, and take action to preserve an employee’s good health to reduce absenteeism or turnover. HRMS can act as a preventative sentinel for corporate well-being as well. (Int J Biomed. 2016;6(2):xx-xx.).
Key Words: corporate wellness ● health relationship management services ● patient health data ● lifestyle
Many employees spend more hours at their workplace than anywhere else, not to mention the time spent commuting. The typical worker spends about 47 hours a week in these activities,[1] many of them sitting in cars, trains, buses, or at their desks. A recent study found that a person who spends long hours sitting down each day, has a higher risk of premature death, even if he or she engages in regular daily exercise.[2] Urban environments often require behavior that requires sitting down: commuting, in the workplace, or even during time spent at leisure, such as watching television or movies. These statistics show that maintaining a healthy work and life balance has become progressively important.[2]
Traditional corporate wellness programs encourage employees to stop smoking, lose weight, or get more exercise, with the goal of decreasing the company’s overall healthcare costs by having healthier employees. However, such programs have not always met those goals, as research shows that cost increases have either stayed steady or even
Corresponding author: Nik Tehrani, PhD. DynoSense
Academy, CA, USA. E-mail: ntehrani@dynosense.com
increased.[1] Wellness is not merely the absence of illness, but also includes the concept of total well-being of the individual embodying social, spiritual, emotional and intellectual health, to include physical health. It also encompasses a lifestyle of healthy behavior and healthy environments that are supportive not only at work, but also in the home and community.[3] Thus, many organizations are turning toward promoting a healthier work environment and health promotion policies for their employees. Corporate wellness programs are effective ways to establish this balance. Programs emphasizing corporate wellness benefits can be instituted in several ways. One new health paradigm that is providing a total health ecosystem is Health Relationship Management Services (HRMS)[4] that combines remote health monitoring that captures individual health data, sends it to the cloud for restructuring into actionable information that can be used to anticipate changes in health and allow access for caregivers to provide solutions or treatment. HRMS allows individuals to engage in their own healthcare and encourages lifestyle changes for better wellbeing. The common goal for all corporate wellness programs is to promote employee, employer, and organizational well-being.
Employees who do not have the opportunity to engage in corporate wellness programs may be susceptible to serious illnesses, which may lead to long-term disability or discontinuing their employment. A primary benefit of corporate wellness is reducing rates of injuries and illnesses among workers, since many employees experience work-related injuries as well as development of health complications such as heart disease, diabetes, or stroke.[2] Prevention of employee illness can also lead to reducing employee absenteeism, since people who are unhealthy, stressed, or overworked have a tendency to experience illness more so that employees who are healthy.[2] Programs focusing on corporate wellness benefits can drastically reduce these problems. As an example, Coors Brewing Company decreased employee absenteeism 18 percent after introducing a corporate wellness program.[2] Coca-Cola saved $500 per employee yearly, even though only 60% of its employees participated in a corporate wellness program.[2] Also, retention of key employees is enhanced, leading to less turnover.
Corporate wellness is also the process of enabling employees to control and improve their own health. On average, half of an employee’s waking hours are spent on the worksite, resulting in stress and lack of physical activity that constitutes to health problems. Many organizations have developed strategies to align their goals and objectives to bring about the sustained performance of business by having effective relationships with their employees. One such strategy is the implementation of Health Relationship Management Services (HRMS),[4] which is a health ecosystem that continuously monitors an employee’s health data for prevention and/or treatment.
As an example, Zappos, an online e-business selling shoes, clothing and many other products to its customers, has rapidly expanded its operations over a short period of time because of successful implementation of a similar method as HRMS.[4] Zappos is admired for its employee wellness programs and healthy environment.[5] Zappos’ workplace is an efficient LEED certified building constructed for the benefit of Zappos employees. This has made the workplace a happier, healthier, and more productive milieu for employees, which translates into happier customer service and customers.[6]
New healthcare technologies can now monitor an individual’s personal health data continuously with services that provide health alerts when the data deviates from a healthy pattern. Such technologies can engage an employee in his/her own health care and encourage a healthy lifestyle. Health Relationship Management Services (HRMS)[4] is such a system that is ideal for employee wellness as it makes it fun and engaging for individuals. Instead of adhering to traditional approaches and methodologies for employee wellness, Zappos focused on making its employees happy by encouraging them to participate in an environment that encourages healthy activities and programs. Zappos believed that motivation is the key to success and values its employees’ feelings and their viewpoints, rather than forcing rigid and overly-planned corporate goals on them.[9]
Healthcare services have drastically changed over the past few decades, and the technological advancements in
medical systems have revolutionized the healthcare industry. Zappos took the risk of incorporating such new systems of healthcare, which has definitely paid off for the company and employees since most employees now love working there.[6] One such similar paradigm is HRMS in which individuals can engage in their own healthcare and lifestyle changes. Along the principles of this new paradigm, Zappos promotes fitness by monitoring employee health, providing a health station so employees can check their blood pressure, weigh in, and receive a body fat percentage reading. Employees can also log their fitness activities to earn rewards for their physical activity. Zappos also offers free on-site fitness classes and boot camp-style training.[9] Employees can participate in endurance events, such as 5Ks and marathons, and if they finish the race, they are rewarded by being reimbursed for their entry fees.[9] All of these activities are similar to the HRMS paradigm that engages individuals to improve their own healthcare and observe wellness. Employees at another company, VISTA Staffing Solutions, spend on average 10-12 hours a day sitting. The company decided that its previous wellness programs did not work, so they switched to “stand-up desks, wireless head sets and walking treadmills” to create a healthier work environment.[2] The goal was to promote healthy eating habits and weight loss to boost employee productivity.
Research has shown a link between employee nutrition and exercise and how it affects their overall productivity.[7] Obesity and related diseases, have led to a significant increase in healthcare costs for many organizations. Zappos was aware that obesity is one of the largest contributors to health problems linked to diseases such as diabetes, hypertension, cardiovascular disease, and cancers. Moreover, these health problems resulted in lower employee productivity, higher absenteeism and an increase in employee turnover. Additional costs aside from medical claims occur when employees are not performing at optimal level. Technological systems can indicate patients’ adherence to medical protocols and acts as a warning sign in many cases such as hypertension, cardiac disease, and many other diseases, as patients are continuously monitored no matter where they are.
Giving attention to overall employee wellness, Zappos designed policies to facilitate employee health by offering healthy food options and allowing for exercise time. Zappos focused on employees’ happiness by encouraging them to engage in a flexible, fun approach to wellness, such as Wellness Adventures, March Madness, and Recess Tuesdays, that recruits employees from different departments and encourages them to mix and have fun away from work, doing such activities as laser tag, playing basketball or jumping on a trampoline.[6] To encourage participation, there are incentives to wellness events. By using a similar concept as HRMS, Zappos can monitor the employees’ health records through online portals and can determine whether its employees are following healthy lifestyles and are getting proper healthcare. This is why there is an increased need for employee wellness programs, and systems, such as HRMS, are becoming fundamental to many businesses such as Zappos.
Zappos considered how responsibility for action on health determinants and health behaviors was balanced
between employers and employees. The development of systems, such as HRMS, promotes and fosters health and well-being of individuals, corporations, and communities. HRMS helps to develop plans to increase physical activities and increase awareness of health problems and education. Furthermore, applications and services which use the internet as a platform have allowed gathering and sharing of medical, health, clinical records and data that can be analyzed, stored, and made easily available to different participants in the healthcare system.[10] This will encourage employees to willingly provide personal health data that will result in job satisfaction, as satisfied employees are more likely to contribute as a consequence of increased duty, responsibility and obligation to employers. Zappos has adopted employee wellness strategies and found that its employees performed better than before as they are more confident, fresh and active while performing their jobs.[6] Zappos wellness coordinator Kelly Maher has remarked that it is all about encouraging people to engage in wellness voluntarily, not by force. Programs that are successful are ones that engage team members to become energized on their own.[2] HRMS can act as a preventative sentinel for corporate well-being as well.
Zappo’s, Coors Brewing Company, Coca-Cola, and VISTA created a unique wellness program to engage employees in unique health-through-fun health activities, as well as healthy workplace environments. Benefits of corporate wellness combined with the benefits of HRMS can lead to happier, healthier employees who like their working environment. Companies should take advantage of corporate wellness and HRMS benefits to avoid stressed, sick, or unhappy employees who experience illness, absenteeism, injuries and increased healthcare costs. Instead, companies can experience an increase in employee productivity and retention. A monitoring system, such as HRMS, can standardize patient health data, and continuously follow-up with relevant feedback to actionable data. Therefore, as companies adopt HRMS, health-related costs may decrease while providing better quality services to employees who can receive health services
as a product.[11] A harmonious, healthy workplace provides all employees with the benefits of corporate wellness
1.Wellness Proposals. What is corporate wellness? 2016. Retrieved from http://wellnessproposals.com/
2.Glatter R. Why sitting increases your risk of dying sooner Forbes. (2013). Retrieved from http://208.71.46.190/search/srpcache?p=statistics+employees+sitting+desks+commuting&type=C014US91043D20150326&fr=mcafee&ei=UTF-8&u=http://cc.bingj.com/cache.aspx?q=statistics+employees+sitting+desks+commuting&d=4594078983520481&mkt=en-US&setlang=en-US&w=PDoMUTz29BQpJRZ_5g6OKiZjYF8uVOWQ&icp=1&.intl=us&sig=KgylfBRyPBfdhvkuqd92Eg–
3.NICHM. Building a stronger evidence base for employee wellness programs. (2011). Retrieved from http://www.nihcm.org/pdf/Wellness%20FINAL%20electonic%20version.pdf
4.Tehrani N. Health Relationship Management Services (HRMS): A new healthcare paradigm using the 5Rs. Int JBiomed. 2016; 6(1:87-89. doi: 10.21103/Article6(1)_CC1
5.Ki EJ, Kim JN, Ledingham JA. Public relations as relationship management: A relational approach to the study and practice of public relations. Routledge;2015.
6.Zappo’s. (2016). Wellness. Retrieved from http://www.healthyworksofpa.com/wellness-case-study-zappos/
7.Elberson KL, Daniels KK, Miller PM. Structured and nonstructured exercise in a corporate wellness program. A comparison of physiological outcomes. Outcomes Manag Nurs Pract. 2001 Apr-Jun;5(2):82-6.
8.Parks KM, Steelman LA. Organizational wellness programs: a meta-analysis. J Occup Health Psychol. 2008 Jan;13(1):58-68. doi: 10.1037/1076-8998.13.1.58.
9.Zappo’s Insights. Health and wellness. (2016). Retrieved from https://www.zapposinsights.com/about/zappos/higher-purpose/health-and-wellness
10.Helmer DC, Dunn LM, Eaton K, Macedonio C, Lubritz L. Implementing corporate wellness programs: a business approach to program planning. AAOHN J. 1995 Nov;43(11):558-63.
11.Alaee M, Sergeant DB, Ikonomou MG, Luross JM. A gas chromatography/high-resolution mass spectrometry (GC/HRMS) method for determination of polybrominated diphenyl ethers in fish. Chemosphere. 2001 Sep;44(6):1489-95.
Abstract:
In the U.S., the number of individuals aged 50 and older who are living with HIV has increased, leading to a phenomenon called the graying of the HIV/AIDS epidemic. Advances in treating HIV have brought about a large growing population of seniors with HIV who are simultaneously facing social, psychological, and physical challenges correlated with the aging process. The stigma against HIV/AIDS has been linked to poor health, depression, and loneliness. In a recent study, about 39.1% of HIV/AIDS patients showed symptoms of major depression (C. Grov et al, 2010). Consequently, to reduce lasting effects of major depressive symptoms, there is a vital need for service providers to employ innovative efforts to confront the stigma and psychosocial and physical health problems that are characteristic of an older HIV/AIDS population. The new technological approaches to healthcare delivery have resulted in faster, more accurate diagnosis and monitoring, in more sophisticated coordination across regions and agencies, and in sophisticated risk-checking procedures. New healthcare technology that can help the AIDS/HIV patient is called Health Information Technology, a basic element of Health Relationship Management Services (HRMS), which is a new approach to healthcare. HRMS can assist individuals with HIV/AIDS in managing not only their physical, but also their mental health. (Int J Biomed. 2016; 6(4):303-304.)
Key Words: HIV/AIDS ● IoT● Health Relationship Management Services ● Remote Health Monitoring
With all of the advances in medical technology, is there anything that can help the AIDS/HIV patient? AIDS is a chronic disease that is typified by suppression of an individual’s immune system. The clinical materialization of AIDS is characterized by the presence of opportunistic infections, dementia, wasting, and AIDS-related cancers. The number of U.S. individuals aged 50 and older who are living with HIV has increased, leading to a phenomenon that has been described as the graying of the HIV/AIDS epidemic (Gorman, 2006; Shah & Mildvan, 2006). Advances in treating HIV have brought about a large growing population of seniors with HIV who are simultaneously facing social, psychological, and physical challenges correlated with the aging process. In addition, the HIV/AIDS-related stigma has been linked to health, depression and loneliness. A recent study found that 39.1% of HIV/AIDS patients showed symptoms of major depression.[1] Consequently, to reduce lasting effects of
*Corresponding author: Nik Tehrani, PhD. International
Technological University, San Jose, CA, USA. E-mail: nik@
niktehrani.com
major depressive symptoms, there is a vital need for service providers to employ innovative efforts to confront the stigma and psychosocial and physical health problems that are characteristic of an older AIDS/HIV population.[1]
However, the question remains, “Is there any healthcare technology that can help the AIDS/HIV patient?” The answer is, yes, and it is called Health Information Technology, a basic element of HRMS,[2] which is a new approach to health care. Information is essential to high quality health care; therefore, it is important to have nationwide, reciprocal, interchangeable health information available wherever and whenever it is needed, in private, secure electronic form.[3] The largest population of beneficiaries of this innovative system is chronically ill individuals, especially HIV/AIDS patients.
Individuals who are living with AIDS or HIV have health problems in addition to adhering to a complicated medication regime. To ensure that all caregivers and nurses are getting the complete picture for these chronically ill patients, it is important to be able to collect AIDS/HIV patient information. Information Technology (IT) and eHealth technologies and resources for HIV/AIDS patients are rapidly changing due to the influx of new media, such as interactive internet communication that allows them to create, alter, and share
content using simple, inexpensive, or free tools. All that is needed is a computer or mobile device with Internet access.[4] HRMS is an innovative technical approach to delivering health care. By using a remote health monitoring system as part of HRMS, an individual’s personal health data are collected and sent immediately to the cloud for restructuring into actionable information that can be acted on when needed.
HRMS can assist individuals with HIV/AIDS in managing not only their physical, but also their mental health. Patients can join online networks, comment on blogs, and receive medication reminders on their mobile phones. Such health IT tools can connect HIV/AIDS with other HIV/AIDS patients and experts, friends, family, and caregivers to share their medical information and experiences and connect with others who are in similar positions to share their health stories and obtain emotional and social support.
The most ideal method of making information available at the right time at the right place is through electronic systems, which HRMS can provide,[2] to convert traditional paper records into electronic form. This Electronic Health Record (EHR) information can be easily transmitted, displayed in a variety of ways, and be combined with information from many sources, which is sent to caregivers and care-friends. A patient can keep his/her own personal health records, either on a personal computer, on Google or Microsoft, or even on a hospital computer. The main idea is that the patient maintains and controls personal health data, and the more health issues a chronically ill individual has, the more crucial it is that this information be made available. [3]
Advances in technology, such as remote health monitoring systems and HRMS, are being used to improve healthcare service delivery and make it possible to help providers and patients conduct 24/7 health monitoring. An estimated 70% of U.S. doctors already utilize some aspect of new medical (or health) technology; however, only about one quarter 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.[4]
Healthcare technology has come a long way, and many innovations can now benefit AIDS and HIV patients. The new technological approaches to healthcare delivery have resulted in faster, more accurate diagnosis and monitoring, in more sophisticated coordination across regions and agencies, and in sophisticated risk-checking procedures. Over 70 million people worldwide have been diagnosed with HIV. To lower healthcare costs, it is necessary to improve the care of patients who suffer from HIV/AIDS disease and help them remain in good health and out of emergency rooms and hospitals, where patients often contract infections, resulting in millions of dollars in healthcare costs. Remote monitoring of health can improve healthcare delivery and improve patient involvement and adherence. Many HIV/AIDS patients find themselves isolated
and lonely, which can lead to dementia.[1] To avoid this, HRMS provides a patient platform wherein HIV/AIDS patients can join online networks to interact with others on social network sites, share personal health stories, offer commentaries, watch videos or news, and discuss issues of relevance to people with similar experiences. Health-related online communities, such as HRMS, offer social and emotional support by connecting with others who are experiencing similar challenges to exchange information, while at the same time keeping their privacy. Facebook and MySpace allow people to connect by creating a personal page or group. Blogs, which are frequently updated websites that combine images and text with links to other websites, allow HIV/AIDS patients to participate in discussions on HIV/AIDS issues, share personal health stories and experiences, ask questions, and share opinions and other information. HRMS and certain blogs encourage dialogue by allowing people to leave comments and receive HIV policy information, news media, health news, and HIV/AIDS research updates.[4]
Cellular phones and other wireless devices make viewing, sending, messaging, and receiving information easy. The benefits of HRMS, coupled with mobile health assistance, enable AIDS/HIV patients to set up medical and medication reminders, and receive alerts for these reminders via email or text messages (Short Message Service, SMS) (HRSA, 2016). Mobile health applications (apps) on iPhones or other smartphones support healthcare management, and through a weight tracker, HIV/AIDS patients can set weight gain or loss goals, which are especially important for individuals dealing with this illness.
Remote health monitoring devices, such as the one used in HRMS, are used to track and store health metrics, which can be used to manage and monitor a wide range of health conditions. Some devices can collect an individual’s blood pressure, glucose, and oxygen and send the data by phone or internet to a provider or to the cloud for analysis to support patient engagement and physician-patient communication
REFERENCES
1.Grov C, Golub SA, Parsons JT, Brennan M, Karpiak SE. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care. 2010; 22(5), 630-9.
2.Tehrani N. Health Relationship Management Services (HRMS): A New Healthcare Paradigm Using the 5Rs. Int J Biomed. 2016;6(1):87-9.
3.Harper E. Can big data transform electronic health records into learning health systems? Stud Health Technol Inform. 2014;201:470-5.
4.Macrae J, Morris T. Foreword from Acting Administrator of the Health Resources and Services Administration (HRSA) and Associate Administrator of the Federal Office of Rural Health Policy (FORHP), U.S. Department of Health and Human Services. J Health Care Poor Underserved. 2016;27(4A):vii-viii.
Abstract:
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 high risk pregnancy to identify fetus heart rate (FHR) for fetuses that are in immediate danger . Several apps are available on smartphones for pregnant women that offer support and track the health of both the mother and the fetus. The Dyno, a remote health monitoring system can track the mother’s health and alert caregivers if action is required.
Keywords: Smartphone apps, remote health monitoring devices, high-risk pregnancy, non-stress test (NST), fetus heart rate (FHR), Dyno.
I. INTRODUCTION
The rapid advances of internet and communication technologies have evolved into an essential need, and both city-dwellers and those living in remote areas have equal opportunities to use these technologies to improve their health [1]. Technology is key in healthcare improvement due to (i) cost reduction, (ii) patient safety and satisfaction improvement, and (iii) reduction of potential errors [1]. Recently, mobile technology has vastly evolved into an established platform, with up to 4.6 billion mobile phones being used globally [1]. Thus, many experts in the healthcare industry and health organizations, such as the World Health Organization, are seeking to tap into mobile technology’s potential to reform healthcare management and delivery, especially that which is vital to pregnant women [1]. Pregnancy is one of the most common life situations that might intensify the need for more health related specifics among women [2]. Pregnant women can use Smartphone apps, social media [1], and remote health monitoring devices, to provide security, confidence, and information about the condition of not only their own health, but also that of the baby. Pregnant women can easily gain information about nutrition, complications, and fetal development [2]. Current technologies can provide tips and alerts for preventive care, emergency-care, post-delivery support, and information about emerging risks [1].
Women undergoing complicated pregnancies often have a lot of concerns and questions. One solution is teleconsultation, which may provide immediate answers and creation of a personal healthcare plan [3]. Patients and physicians can interact via a video monitor and discuss concerns and answer questions through the use of “pictures, diagrams, models or videos” [3], including advice about nutrition. A number of pregnancy complications, such as anemia, miscarriage or stillbirth, can be avoided by proper nutrition and maintenance of an active lifestyle [1] [4].
II. APPS
Several apps are available on smartphones for pregnant women that offer support and track the health of both the mother and the fetus. The Yukon Baby smartphone app engages women, men and their families and supports them during pregnancy [1]. Pregnant women can also benefit from Bloomlife, an application and device that detects the intensity of each contraction, as well as creating a history of all the changes that have occurred in the long term [5]. My Pregnancy app has features, such as fetal development images, which are shown by expert medical illustrators [2] [6]. Daily use of apps available on smart phones, iPhone, iPod Touch and Android guide women to prepare for their baby’s birth by providing answers based on the child’s due date [2]. Internet-based behavioral programs can augment prenatal care which may lead to improved pregnancy outcomes [1].
III. HIGH RISK PREGNANCY AND REMOTE HEALTH MONITORING
Remote monitoring of high risk pregnancy and prevention of preterm labor can now be done in the patient’s home using telehealth for tracking (1) uterine activity, (2) management of obstetrical diabetes (blood sugar testing and administering insulin), and (3) management of obstetrical hypertension (blood pressure and urine collection) [1]. Pregnancies can be high-risk for many reasons, such as twins, triplets, or multiple fetuses, due to a heightened chance of premature labor [2] [9]. Other conditions considered high-risk are high blood pressure, chronic illness, history of preterm labor, and gestational diabetes [2] [9]. The risk of premature labor, which is uncontrolled uterine contractions causing
cervical dilation, can be identified early on in the pregnancy and can be monitored in the home by using telehealth devices [2].
Physicians advise women with high risk pregnancies to have complete bed rest in their homes because it may lower “the gravitational stress on the uterus and cervix and increases blood flow” [10] [11] . Home bed rest creates less stress than hospitalization, which may lead to feelings of confinement, lack of privacy, depression, anxiety, and separation from family [10]. Remote home health monitoring provides women with control over their lives and the ability to perform self-care activities [10]. Previously, women who were prescribed bed rest at home could not participate in support groups with fellow patients; however, due to advanced technologies, patients can connect with online support groups from the comfort of their own homes [2]. Telehealth equipment in the home can monitor preterm labor risks using home uterine activity monitors (HUAM) and non-stress test monitoring [2]. The identification of early uterine contractions has been used for preterm birth prevention for the past twenty years [12]. Home monitoring systems transmits data that is collected two or three times daily to a round-the-clock nurse who reads uterine contractions and all data that is collected is transmitted to the woman’s primary physician [13]. The physician can prescribe self-administered medications that stop contractions or advise the patient to go to the hospital for supplementary evaluation [13]. HUAM research shows that home uterine activity monitoring can detect preterm labor, “pregnancy prolongation and improved pregnancy outcomes” [13], which leads to improved outcomes for the child, such as reduced nursery stays, “increased birth weights and gestational age “ [13]. The advancement of technology has made possible a more detailed and precise follow-up, used at the request of specialists, since they are essential to determine in the first months of gestation, if the child has a genetic disease, and thus be warned, for the entire gestational process [7]. Remote health monitoring provides mothers with real-time data on their child’s heart activity; collected data can be processed live into the cloud using proprietary algorithms. Users can access the data on their smartphone or on the website of the company where they can record and then share the heartbeat of the baby with family and friends. Each device contains a set of sensors that provides doctors with a wide range of statistics, from the heartbeat rates of the mother and baby, kicks, sleep state and contractions [8]. The Dyno, from DynoSense Corp., is an integrated remote health scanner which can capture a wide range of health metrics from the pregnant woman in her home [8]. It can track up to 33 health metrics containing all basic vitals, for example (i) ECG (electrocardiogram), for all the irregularities related to heart and heart parameters, (ii) photoplethysmography which extracts blood oxygen, (iii) pulmonary plethysmography which extracts the respiration rate, breathing efficiency, and breathing volume, (iv) oral body temperature, (v) and non-cuff blood pressure tracking [8]. The Dyno can do all this easily in less than 60 seconds just with one action by the user.
IV. HOME NON-STRESS TEST
The non-stress test (NST) is a common test done on patients with high risk pregnancy to identify fetus heart rate (FHR) for fetuses that are in “immediate danger of deterioration and compromise” [14]. Patients can perform the NST in the home daily using a FHR monitor and transmit the data to a caregiver who can reassure the patient that there is no risk or refer the patient to the hospital for further observation [14]. Studies show that home FHR monitoring is safe at all stages of gestation and is so easy to use that it can benefit even “socioeconomically disadvantaged patients” [14]. Home monitoring alleviates patients having to find transportation to a physician’s office, and also encourages them to comply and be an active participant in their own health care [14].
REFERENCES
[1] Jayaseelan R, Pichandy C, Rushandramani D (2015) Usage of Smartphone Apps by Women on their Maternal Life. J Mass Communicat Journalism 5:267. doi:10.4172/2165-7912.1000267
[2] Lum, B. (2004). Telehealth in High Risk Pregnancy. Information Systems in Healthcare. University of Hawaii at Manoa, Retrieved from www2.hawaii.edu/~bettyl/finalpaper.doc
[3] Telemedicine Links High-Risk Pregnant Women & Specialists. (2005). Article ID: 51353. Source Newsroom: University of Maryland Medical Center/School of Medicine. Retrieved from http://www.newswise.com/articles/telemedicine-links-high-risk-pregnant-women-specialists
[4] O’Brien, O. A., McCarthy, M., Gibney, E. R., & McAuliffe, F. M. (2014). Technology-supported dietary and lifestyle interventions in healthy pregnant women: a systematic review. European journal of clinical nutrition, 68(7), 760-766.
[5] Bloomlife. (2017). Smart Pregnancy Wearable. Retrieved from https://bloomlife.com
© 2017, IJERMT All Rights Reserved Page | 10
[6] My Pregnancy Today App. (2017. itunes.apple.com. Retrieved from https://itunes.apple.com/us/app/pregnancy-tracker-baby-development…
[7] Kraschnewski, J. L., Chuang, C. H., Poole, E. S., Peyton, T., Blubaugh, I., Pauli, J., Reddy, M. (2014). Paging “Dr. Google”: does technology fill the gap created by the prenatal care visit structure? Qualitative focus group study with pregnant women. Journal of medical Internet research, 16(6), e147.
[8] Tehrani, N. (2016). How Health Relationship Management Services (HRMS) Benefits Corporate Wellness. International Journal of Biomedicine, 6(2), 143-145.
[9] Smith, Dr. Medical library (1999-2003). High risk pregnancy. Retrieved December 14, 2004, from http://www.chclibrary.org/micromed/00051310.html
[10] Heaman, M., & Gupton, A. (1998, December). Perceptions of bed rest by women with high-risk pregnancies: a comparison between home and hospital. BIRTH, 25(4), 252-258.
[11] Maloni, J. A. (1994, October). Home care of the high-risk pregnant woman requiring bed rest. JOGNN, 23(8), 696-706.
[12] Moore, M. L. (2003, September/October). Preterm labor and birth: what have we learned in the past two decades? Journal of Obstetrical Gynecological Neonatal Nursing, 32(5), 638-647
[13] Matria Healthcare (n.d.). [Womens Health]. Retrieved November 19, 2004, from http://www.matria.com
[14] Kerner, R., Yogev, Y., Belkin, A., Ben-Haroush, A., Zeevi, B., & Hod, M. (2004). Maternal self-administered fetal heart rate monitoring and transmission from home in high-risk pregnancies. International Journal of Gynecology & Obstetrics, 84, 33-39.
Health Relationship Management Services (HRMS) is a new paradigm comprised of the 5Rs which define a comprehensive patient healthcare system in the digital health age. This service uses a health monitoring system with sensors and a patient application portal that can Read data and securely send it to the cloud with amended data from Electronic Health Records (EHR). The read data is Restructured by analytics software for evaluation and personalization in an aggregated form represented by an individualized health scoring and demographic grading system. The Results are previously restructured data that must become actionable to lead to an escalation path to the Communication Center for a Response. 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. Providers can leverage the HRMS platform to generate data-driven approaches fostering a positive and lasting impact on their patient’s health. Payers can track data to ensure a more healthy patient population and review meaningful outcomes. (Int J Biomed. 2016;6(1):87-89.).
Keywords: Health Relationship Management Services (HRMS); new health paradigm; 5Rs; Patient Health Narratives (PHN); Patient Engagement.
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 [1]. 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 [2] 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” [2]. 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 [2]. Similar to something out of science fiction, new technological devices now can remotely
*Corresponding author: Nik Tehrani, PhD. DynoSense
Academy, CA, USA. E-mail: ntehrani@dynosense.com
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” [2] [3] 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” [4]. To improve patient care, the health sector is using data and technology [5]. 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” [6] to gather and manage information required for every patient’s care. This paradigm is confronted by (i) the accumulation of obligations
Nik Tehrani / International Journal of Biomedicine 6(1) (2016) 87-89
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” [6]. Refinements within the old paradigm of medical care may not solve such challenges, suggesting the need for a new paradigm [6]. 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 [4] [7]. 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, and Repeat. 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 (Figure 1). Read turns the Restructure, which turns Results, which turns Response, and Repeat completes and enhances the overall service.
Read is defined as compilation of raw captured data from a variety of sources such as: (i) a health monitoring system with sensors, (ii) an interactive patient application portal, (iii) Electronic Health Records (EHR), (iv) care specialist feedback, and (v) care friends responses. Read data is securely sent to the cloud to ensure patients’ health data privacy.
An example of a health monitoring system is the “Dyno™” from DynoSense Corp., [8] which is able to measure, at home, various health metrics such as ECG, heart rate, blood O2, respiration rate, breathing efficiency, blood pressure change, body temperature, breath gases, and body compositions. Taking readings efficiently depends on the quality of the sensors and simplicity of usage. Furthermore, the patient portal, DynoLife™, 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 [9].
Read patient data stored in the cloud is a raw format where it is required to be Restructured 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
Once the restructuring has been completed, actionable Results must be generated for proper response through an escalation path which indicates all of the individual’s significant health data. This is exhibited by examples such as (i) individualized health scoring and demographic grading; (ii) Health Indexing (HI), which captures health data over a period of time to create better understanding of the true health condition of the individual; (iii) Medical Decision Support Algorithm (MDSA™), 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.
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)
Nik Tehrani / International Journal of Biomedicine 6(1) (2016) 87-89
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 [10] (iii) and an interactive online magazine encouraging individuals to share their Patient Health Narratives (PHN) and become a member of a healthcare community [11]. 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.
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.
1.Health. (2015). Digital Health Funding Soars To Record $2.3 Billion, But Crowdfunding Tumbles – See more at: http://nuviun.com/content/digital-health-funding-soars-to-record-23-billion-but-crowdfunding-tumbles#sthash.3vxkm3LZ.dpuf. Retrieved from http://nuviun.com/: http://nuviun.com/content/digital-health-funding-soars-to-record-23-billion-but-crowdfunding-tumbles
2.Morrisey J. (2015). The medical technologies that are changing health care. New, eye-popping medical technology provides earlier diagnoses, personalized treatments and a breathtaking range of other benefits for both patients and health care professionals. Retrieved from HYPERLINK “http://www.hhnmag.com/articles/3580-the-medical-technologies-that-are-changing-health-care” http://www.hhnmag.com/articles/3580-the-medical-technologies-that-are-changing-health-care
3.Steinhubl S. (2016). Steven Steinhubl, M.D., director of digital medicine at the Scripps Translational Science Institute, shares his perspectives on the current opportunities in mobile health. IHT2. Institute for health technology transformation. Retrieved from http://ihealthtran.com/wordpress/2014/01/steven-steinhubl-md-director-of-digital-medicine-scripps-translational-science-institute-clinical-cardiologist-scripps-health/
4.Cassano C. (2014). The right balance –technology and patient care. OJNI Volume 18, Number 3. Retrieved from http://www.himss.org/ResourceLibrary/GenResourceDetail.aspx?ItemNumber=33541
5.PWC. (2015). Healthcare and innovation. Retrieved from http://www.pwc.com/us/en/health-industries/top-health-industry-issues/healthcare-technology-and-innovation.html
6.White. (2008). Health information technology will shift the medical care paradigm. J Gen Intern Med. 2008 Apr;23(4):495-9. doi: 10.1007/s11606-007-0394-y.
7.Schmittdiel J. (2015). Using technology to improve health. research scientists study the intersection of technology and health. Kaiser permanente. Retrieved from https://www.dor.kaiser.org/external/DORExternal/research_report/research_technology.aspx
8.Tehrani N, Meckl-Sloan C. Remote health monitoring in action. International Journal of Business Management and Economic Research (IJBMER). 2015;6(1):111-4.
9.Lupton D. (2013). Donna Haraway: The digital cyborg assemblage and the new digital health technologies. The Palgrave handbook of social theory in health, illness and medicine, 567-581.
10.Merriam-Webster. (2015). Gamification. Retrieved from http://www.merriam-webster.com/dictionary/gamification
11.Meckl-Sloan C. (2015). A new healthcare paradigm: patient health narratives: enhancing patient engagement through sharing stories. Retrieved from http://www.gjar.org/publishpaper/vol2issue9/d288r70.pdf
Abstract
Non-pharmaceutical Interventions (NPIs), also known as community mitigation strategies, are additional approaches for slowing the spread of pandemic diseases and other illnesses until preferred COVID-19 elimination strategies (vaccinations) and/or preventative medications are fully implemented. NPIs are personal, community and environmental activities to sanitize and allow for proactive protection from the COVID-19 virus and its variants. To avoid infection, it is important to adhere to the 4 W’s to avoid COVID-19: Wear a Mask, Wash Your Hands, Watch Your Distance, and Watch Your Vitals (Warning Signs) using a Vital Sign Monitor. Should individuals get exposed or diagnosed as having the virus, when home-bound or in quarantine, they can benefit from the use of remote health monitoring devices, such as the Dyno50. These devices monitor vital signs, such as (1) changes in blood pressure (BP), (2) respiration rate for breathing function, (3) accurate blood oxygen saturation levels (Spo2), (4) high-resolution oral body temperature for fever and basal temperature, and (5) instant medical-grade ECG, tracking of the heart’s electrical pattern. These vitals can be monitored multiple times daily in the home and digitally transmit data frequently to physicians, healthcare professionals or caregivers.
Keywords: The 4 W’s, NPI’s, Non-pharmaceutical Interventions, Vaccinations, SpO2 Low Oxygen Levels, COVID-19 elimination strategies, remote health monitoring of vitals, remote health monitoring devices, Dyno50.
I. Introduction
The year 2020 introduced the COVID-19 pandemic which overwhelmed health-care systems and forced school and business closings, leading to a global negative economic impact. The year 2021 will continue to be problematic as multiple variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that are emerging (1). New mutations have emerged from Brazil, South Africa, and others. A key concern is whether COVID-19 vaccines can safeguard against infection or disease from the new SARS-CoV-2 variants (2). Recent COVID-19 vaccines have been developed with efficacy of 94–95% (1). One disadvantage for some of these vaccines is the requirement of low temperature storage. Other new vaccines that do not have temperature requirements can be delivered more easily (2) (3) (4) and perhaps less effective. Vaccinating the world’s population must address this pathogen’s ever-changing evolution to evade immunity.
A COVID-19 elimination strategy of vaccination is the preferred option. However, until the population can be vaccinated, one measure is to combine vaccines with the 4-W’s (Non-Pharmaceutical Interventions NPIs): Wear a Mask, Wash Your Hands, Watch Your Distance, and Watch Your Vitals (Warning Signs) using a Vital Sign Monitor (5). Individuals who are exposed or diagnosed as having the virus, when home-bound or in quarantine, can benefit from the use of Remote Health Monitoring (RHM) devices, such as the Dyno50 (5) (a product of DynoSense Corp.). RHM devices monitor vital signs, such as (1) changes in blood pressure (BP), (2) respiration rate for breathing function, (3) accurate blood oxygen saturation levels (Spo2), (4) high-resolution oral body temperature for fever and basal temperature, and (5) instant medical-grade ECG, tracking of the heart’s electrical pattern (5). These vitals can be monitored multiple times daily in the home and digitally transmit data frequently to physicians, healthcare professionals or caregivers in hospitals. Medical research combined with personal responsibility in the form of the 4-W’s is recommended a solution to end this world-wide pandemic (5) (6).
Patients who are diagnosed with COVID-19 are required to self-isolate usually for at least two weeks until the infection is clear. During this period, some of these patients will still be at risk for complications, so they need comprehensive home support (7). Others who have been exposed despite following recommended NPI observance may be quarantined in their homes for a specified period of time. RHM devices can monitor vital signs and keep the patients digitally connected to nurses, doctors, caregivers, and medical staff.
The 4-W’s, which are Non-pharmaceutical Interventions (NPIs), also known as community mitigation strategies, are alternate options to vaccinations and medications (8) for slowing the spread of pandemic diseases and other illnesses. A new virus spreading quickly among the population worldwide is a pandemic flu which causes illness among those with little or no immunity to fight it. The 4-W’s, both personal and community, are ways of controlling pandemic flu and respiratory illnesses until vaccines or cures are more readily available (8).
The impact of a pandemic can be reduced using the 4-W’s by delaying the effects of the pandemic to allow time for preparedness and response efforts. The 4-W’s can reduce the number of individuals who are exposed and infected. By decreasing the number of infected individuals, fewer people will contract the virus and die, allowing doctors and hospitals to better handle the case loads. If people can avoid contracting the virus, they can continue working and keep businesses and public utilities in operation (8).
Protecting one’s self and others from respiratory illnesses like the flu starts with the individual. It is important for individuals to adhere to the 4-W’s (5) (6).
Environmental NPIs include routine surface cleaning to help eliminate viruses and bacteria from frequently touched objects and surfaces (8). When sick or infected individuals cough, sneeze, or talk, they can spread viruses to others through droplets that emanate from the nose and mouth. Viruses also may spread when by touching contaminated surfaces or objects, and then touching eyes, nose, or mouth. A flu virus on a surface can live for up to 48 hours, while on the hands for just 3-5 minutes. Routine surface cleaning is a non-pharmaceutical effort that provides an extra layer of protection even if people are vaccinated (6).
To reduce the spread of COVID or other respiratory illnesses, it has been necessary to limit indoor attendees in such as places of worship, childcare centers, schools, concerts, festivals, sporting events, conferences, and other settings where people gather in close contact (5)
A recent study showed that patients with COVID-19 deteriorate more rapidly than in other viral pneumonias (9) (10) (11). Some individuals who have COVID-19 have dangerously low levels of oxygen. The study suggests that early warning systems could be enhanced by accounting for the degree of oxygen usage for patients with COVID-19 (9) (10) (11). This has potential implications for the ability of early warning scores to identify deteriorating patients (9). RHM’s, such as the Dyno50, can be a valuable aid in tracking health vitals for home-bound patients (5). Results are accurate, clinically tested, completed in 30 seconds, and AI algorithms have personalized health insights by synchronizing with the DynoLife app (5).
To detect changes in blood oxygen levels, medical devices can be sent to a patient’s home to monitor vital signs to daily assess symptoms. Data from these remote health monitoring devices can be sent to health professionals for consistent monitoring (7). There are two tracks for patients with COVID-19: one for lower-risk patients, and one for patients with moderate to high-risk comorbidities for complications (7) (8). High risk patients use RHM devices several times daily at home to measure vital signs. To assess any changes in their biometric data, patients are monitored 24/7 with one goal being detection of significant changes in the patients’ vitals as soon as possible. COVID-19 patients living at home self-isolate as they recover, so they need to stay connected with their health care team, especially if a concerning diagnosis is detected (7) (8)
A combination of careful observance of the 4-W’s (NPIs), Wear a Mask, Wash Your Hands, Watch Your Distance, and Watch Your Vitals using a Vital Sign Monitor, whether
personal, environmental, or community may stave off the exposure and contraction of the COVID-19 virus. For individuals who are exposed or are diagnosed as having the virus and are home-bound or in quarantine can benefit from the use of remote health monitoring devices, such as the Dyno50. Interactions with health care teams reassure patients and affirm that they are being monitored and cared for (7) (8).
[1]. Fontanet, A., Autran, B., Lina, B., Kieny, M., Karim., S., Sidhar, D. (2021).
[2]. SARS-CoV-2 variants and ending the COVID-19 pandemic. The Lancet.
[3]. DOI:https://doi.org/10.1016/S0140-6736(21)00370-6 [4]. Baden, L., El Sahly, H., Essink, B., et al. (2021). Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021; 384: 403-416. PMID: 33301246. PMCID: PMC7745181. DOI: 10.1056/NEJMoa2034577 [5]. Polack, F., Thomas, S., Kichin, N., et al. (2020). Safety and efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020; 383: 2603-2615. 1. [6]. Voysey, M., Costa Clemens, S., Madhi, S., et al., (2020). Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2020; 397: 99-111. https://doi.org/10.1016/S0140-6736(21)00234-8 [7]. DynoSense. (2021). Vital sign monitor essential for Covid 19. Dyno 50. Trifold brochure.
[8]. CDC. (2021). Non-Pharmaceutical Interventions. Centers for disease control. Retrieved from CDC.gov/non-pharmaceutical-interventions/index.html
[9]. CDC. (2021). Community interventions for infection control unit. Retrieved from https://www.cdc.gov/ncezid/pdf/Community-Interventions-Infection-Control-H.pdf
[10]. Mayo clinic. (2021). Remote patient monitoring: Comprehensive care at home. Retrieved from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/remote-patient-monitoring-comprehensive-care-at-home
[11]. Non-pharmaceutical interventions (npis): actions to limit the spread of the pandemic in your municipality. (2021). Retrieved from https://www.paho.org/disasters/index.php?option=com_docman&view=download&category_slug=tools&alias=530-pandinflu-leadershipduring-tool-4&Itemid=1179&lang=en [12]. Pimentel, M., Oliver C. Redfern, O., Robert Hatch, R., Young, J.D., Tarassenko,L., Watkinson, P. (2020). Trajectories of vital signs in patients with COVID-19. Resuscitation. 2020 Nov; 156: 99–106. doi: 10.1016/j.resuscitation.2020.09.002. PMCID: PMC7481128. PMID: 32918984
[13]. Ali Amer, A., Leuven, K., Wouters, Fm., Vranken, J., deKorte-deBoer, D. (2020). Vital signs prediction and early warning score calculation based on continuous monitoring of hospitalised patients using wearable technology. DOI: 10.3390/s20226593
Nik Tehrani, Ph.D.. “Enhanced Covid Avoidance Approach.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 20(03), 2021, pp. 35-37.
Abstract The purpose of this report is to characterize Dyno 100/50 ECG leads and compare its behavior to standard ECG leads. The standard ECG leads considered are lead 1 to VI and unipolar leads aVL, aVR and aVF. The goal is to demonstrate how close Dyno 100/50 ECG leads are to traditional ECG leads and quantify its similarity/differences. Two approaches were taken to quantify similarities and differences between classical ECG leads and the Device lip lead. The first method focuses on quantifying the degree of similarity based on beat by beat analysis of 7 fiducial points of an ECG beat. These points are shown in an example comparing fiducial points between a synchronized beat from Device and -aVR lead of a classical ECG. In the second analysis method the fiducial points are derived from the template rather than beat by beat analysis. The difference between the two methods would be in the standard deviation since template is a beat average and averaging process is a linear operation. Based on the comparison of 7 fiducial points of the QRS complex and the analysis of results from 10 different subjects and 30 records, Device acquires a lead I with a high probability (70%). The true characteristics of the lip lead is a variation of lead I as the lip lead is located between the contacts of a standard lead I however, it closely resembles a lead I when compared to all standard ECG leads.
Keywords Dyno 100/50 ECG leads, standard ECG leads, device lip lead, beat by beat analysis
Introduction The purpose of this report is to characterize Dyno 100/50 ECG leads (designed and manufactured by DynoSense Corp.) and compare its behavior to standard ECG leads. The standard ECG leads considered are lead 1 to VI and unipolar leads aVL, aVR and aVF. The goal is to demonstrate how close Dyno 100/50 ECG leads are to traditional ECG leads and quantify its similarity/differences.
1. Device ECG Lead Characterization Test Setup
The device will output an ECG signal between that expected from Lead I or Lead II, due to the direction of electrical conduction from lip to thumb. Considering Einthoven’s triangle, the Device ECG signal is expected to bear more similarity to a Lead that is placed between lead I and II [1].
2. Test Setup and Data Collection:
The data was collected from a standard six lead ECG device with hydro gel. The lead configuration for the baseline measurement is shown above. The leads from the lip, left arm and the ground (left hand index finger) correspond to the lead configuration of the device. This configuration allows for a simultaneous measurement of all standard leads (Lead I-VI) and the lip lead. The sampling rate was set to 500 Hz to be compatible with Device. Hydro gel was used in all the leads, lip, left arm and the ground contacts for Device.
3. Population and sample size
The setup was used on 10 participants that consist of male and female above 21 at different age groups. Three data sets were collected from each participant, a total of 30 records. Table 1 shows the demographic of the study population.
The sample size calculation is based on a binomial distribution that corresponds to number of successes X in N independent and identically distributed (iid) Bernoulli trials. The sample size calculation based on the Bernoulli distribution trial is estimated using the following formula
Sample size of 10 (10 subjects) is toward the upper limit.
The goal of this study is to analyze and quantify similarities and differences between ECG signals from standard ECG leads vs. Device leads. We have taken two approaches to quantify similarities and differences between classical ECG leads and the Device lip lead.
The goal of this study is to analyze and quantify similarities and differences between ECG signals from standard ECG leads vs. Device leads. We have taken two approaches to quantify similarities and differences between classical ECG leads and the Device lip lead.
The points on the QRS complex are: P-wave Start, P-wave Peak, Q point, R point, S point, T-wave Peak & Twave end point.
These points are used for different ECG QRS complex characterization and feature extraction such as measurement of PR interval, QT interval, QRS width etc [3]. In our analysis we use the same points to quantify the differences and similarities between Device ECG lead and a classical ECG lead. The difference between coordinates of each point in x and y directions (time and ECG amplitude from Device and a classical ECG lead) are measured automatically and stored as delta t and delta_h parameters [4]. We use delta_t and delta_h to calculate the difference between same fiducial points between leads and the Euclidean distance of the QRS complex. The mean, variance and the Euclidean distance from all beats (beat by beat) are calculated and stored for further analysis. Similar analysis methodology is applied to other fiducial points and the same statistics are calculated. Table 1 shows the average delta_t and delta_h (statistical mean) for user1 and dataset 1 between the lip lead and standard ECG leads for each fiducial point. The rows in the table show delta_t and delta_h between lip and a standard ECG lead while the columns show delta_t and delta_h value for each fiducial point. A table with more details that includes, mean, standard deviation and Euclidean distance for all points, all users and all datasets are stored in Results ALL.xlxs available in our secure server (Google Drive: Google Drive\FDA_docs\ECG\LeadMappingUpdate_Nov2016).
Applying this analysis technique between the lip lead (Device) and different classical ECG leads quantify the difference at that particular point. The lead configuration with the smallest mean value and Euclidean distance indicates the most similar lead to the lip lead at that particular point. The standard deviation shows the variability around the mean at each point from beat to beat for the all the beats in the data. A large standard deviation indicates bigger noise and baseline variation in that dataset.
In order to characterize the overall similarity of a classical ECG lead to Device lead (leap lead) we can use different methodologies. One approach is to compare the difference at each point between the means to find the closest match between the lip lead (Device) and a standard lead. This approach reveals how close two leads are on a point-wise basis. The compared leads can be very close at some points but differ in some other parts of the QRS complex. The overall Euclidean distance is a single measure that can quantify how close two functions or signals are. Comparison of the two ECG leads (Device vs. standard lead) on the basis of seven fiducial points
can be considered as calculating the distance between two points in a seven dimensional space [5]. The smaller
the overall Euclidean distance the closer the lip lead is to the classical ECG lead.
We have also used the correlation analysis as a second method to further confirm the results obtained by comparison of the beat by beat fiducial points.
The second method of analysis is to use the concept of average beat or template beat to calculate fiducial points of the QRS complex. The template calculation is based on an algorithm that determines the dominant RR interval to determine the beat length. The average beat/template can be defined as the expectation of all beats when they are all aligned at the R peak.
ECG Template E(All beats aligned at R peak)
The template method is used in Device to eliminate corrupt or invalid beats due to distortion caused by severe baseline movement or DC offset. This methodology safeguards Device’s heart rate calculation algorithm by identifying and eliminating highly distorted beats.
In the second analysis method we derive the fiducial points from the template rather than beat by beat analysis. The difference between the two methods would be in the standard deviation since template is a beat average and averaging process is a linear operation. We expect the mean of fiducial points of the QRS complex from beat to beat analysis to be close to that of the template while the standard deviation can vary due to larger variation from beat to beat.
Table 3 shows the results of beat by beat analysis between seven fiducial points between lip lead (Device) and standard ECG leads. The values in the table show the mean values of time differences (delta_t) and amplitude differences (delta_h) for each fiducial point along with Euclidean distance and correlation coefficient for all points and the QRS complex (beat).
Table 4 shows the results of differences between lip and a standard ECG lead for every point in time, amplitude for every point and the Euclidean distance of all points and correlation coefficient of the QRS complex (beat) using the template method.
Label p1_1 in the left most column identifies participant 1 and dataset 1. The first numerical index refers to the participate code and the second index refers to the dataset for that participant. Each user has three datasets.
The information presented in table 3 and 4 is used to quantify the resemblance of the lip lead to the standard ECG leads. Since the point by point comparison of the fiducial points only allow for localized comparison, we use the total Euclidean distance as a measure of how close the two leads are. In the localized comparison the two ECG signals may be close at few points but far on other points. The Euclidean distance is a comprehensive measure of distance between all points. The Euclidean distance can be considered as a distance measure of two
functions/signals in a seven dimensional space (7 fiducial points). This method is used in both analysis schemes (beat by beat and template base) to determine the mapping of the lip lead to the standard ECG lead. The correlation is only provided as a confirmation of the Euclidean measure technique. The comparison of the lip lead to V1 – V6 leads showed a large Euclidean distance and a low correlation. An example of P1_1 between lip lead and V1 is shown below based on the template scheme
Table 5 shows the results for Euclidean distance calculation between the lip lead and standard ECG leads (unipolar leads and V1-V6) for all 30 records. Some of the entries in the table are marked as X. The X’s refer to cases where the leads’ data were omitted from the analysis due to low quality. Since all unusable data were from leads V1 – V6 (two cases, subject 5 and 10) and our preliminary analysis showed dissimilarity between the lip lead and V1-V6 leads the rest of the data for these subjects i.e. data from the main and the unipolar leads, were included in the analysis despite the fact that V1-V6 lead data was not usable. All the leads with the lowest Euclidean distance are highlighted indicating the closest match between the lip lead and the standard ECG lead. The results of table 5 shows that 7 out of 10 subjects (21 records out of 30 total records) the lip lead maps to lead I and 3 out of 10 maps to –aVR (9 records out of 30 total records). Examples of plots of the lip lead template vs. standard ECG leads are provided in Appendix A.
Based on the comparison of 7 fiducial points of the QRS complex and the analysis of results from 10 different subjects and 30 records we have determined that Device acquires a lead I with a high probability (70%). The true characteristics of the lip lead is a variation of lead I as the lip lead is located between the contacts of a standard lead I however, it closely resembles a lead I when compared to all standard ECG leads.
Examples of plots of comparison of 7 fiducial points for all study subjects based on the template technique to demonstrate the applicability of the analysis technique used across different types of QRS morphologies.
[1]. ECG Learning Center. (2018). Characteristics of the Normal ECG. Retrieved from https://ecg.utah.edu/lesson/3
[2]. Fiducial Points & Contours. (2018). MBF bioscience. Retrieved from http://www.mbfbioscience.com/help/ml/Content/Concepts/fiduc_contours.htm [3]. Clinical ECG interpretation. (2018). ECG interpretation: Characteristics of the normal ECG (P-wave, QRS complex, ST segment, T-wave). Retrieved from https://ecgwaves.com/ecg-normal-p-wave-qrs-complex-st-segment-t-wave-j-point/
[4]. QRS Morphology. (2018). ECG Pedia. Retrieved from https://en.ecgpedia.org/wiki/QRS_Morphology
[5]. Peng, L., Yang, L., (1999). The curl in seven dimensional space and its applications. Approximation Theory and its Applications. Volume 15, Issue 3, pp 66–80. DOI https://doi.org/10.1007/BF02837124
Abstract This test is designed to characterize and compare the signal quality of traditional wet (gel) electrode contact material vs. the dry (stainless steel) electrode contact material used in the device after post processing of collected raw data from each electrode type. Two types of contact electrode materials were used: 1) Electrode Pair A- Hydrogel Electrodes: MEDI-TRACE(R) 500 ECG ELECTRODE (K945479), and 2) Electrode Pair B- Stainless Steel Electrodes: 136 SS of final device.After frontend filtering and baseline removal, both pairs (A&B) are qualitatively similar. This is mainly due to the fact that SS tends to have more differential baseline movement caused by higher contact resistance to the skin. Results show that after signal processing (including bandpass filtering and additional baseline removal), two simultaneously captured ECG signals, the first one using HG electrodes, and the second using SS electrodes, are equivalent in terms of SNR and correlation. Although both this device (K172654) and predicate (K150869) use as dry electrodes and are equivalent, this report provides additional comparison of wet (gel) electrode with dry (stainless steel).
In response to the Affordable Care Act, innovations are taking place in the healthcare industry to improve patient healthcare and reduce costs. Over the past twenty years, the pharmacy profession has transformed into a position of offering innovative solutions forthe nation’s most critical healthcare issues (Johnsen, 2015). Neighborhood pharmacies are becoming the new face of healthcare, with one-on-one consulting, medication dispensing and management, and vaccinations. Remote healthcare monitoring devices (telemedicine), such as the Dyno, can allow patients to take charge of their personal healthcare at home, reducing or eliminating trips to the physician’s office or the hospital. These innovations are leading to more efficiency in healthcare and reductions in healthcare costs, and can provide healthcare to underserved communities.
©2015, JPRO, All Right Reserved.
INTRODUCTION
Several innovative trends are transforming thehealthcareindustry. 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 health care 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 effortto 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 alleviatethe nation’ overburdened healthcare system using front-line consulting and health management, along with telemedicine platforms using remote healthcare monitoring devices.
1. DynoSense. (2014). DynoSense Debuts World-First Digital Health Innovation at TechCrunch Disrupt SF 2014. Retrieved from https://dynosense.com/2014/09/09/dynosense-debuts-world-first-digital-health-innovation-at-techcrunch-disrupt-sf-2014/
2. Eder, R. (2015). Rx Impact: DSN special report examines role of community pharmacy as face of healthcare in America. Drug store news. Retrieved from http://www.drugstorenews.com/article/rximpact-2015-community-pharmacy
3. Frederick, J. (2015). As ‘face of neighborhood healthcare,’ America’s pharmacies offer new solutions. Drug store news. Retrieved from http://www.drugstorenews.com/article/%E2%80%98face-neighborhood-health-care%E2%80%99-america%E2%80%99s-pharmacies-offer-new-solutions
4. Johnsen, M. (2015). Alignment healthcare, vivify health partner on telemedicine platform. Drug store news. Retrieved from http://www.drugstorenews.com /article/alignment-healthcare-vivify-health-partner-telemedicine-platform
How
How to cite this article: TEHRANI, Nik; MECKL-SLOAN, Cynthia. Community Pharmacies, the Future of Healthcare in the U.S.. Journal of Pharmaceutical Research and Opinion, [S.l.], v. 5, n. 5, may. 2015. ISSN 2249 –1953. Available at: <http://innovativejournal.in/jpro/index.php/jpro/article/view/16>. Date accessed: 25 May. 2015. doi:10.15520/jpro.2015.vol5.iss5.16. ©2015, JPRO, All Right Reserved.
Dr Jenny Jiang, MD, Medical Adviser, holds an MBA degree from Stanford University and a medical doctorate degree from Sun Yat-sen University. Before starting Tiger Lifescience, she worked for Johnson & Johnson in US and China. Jenny also has rich experience in academia and successfully commercialized innovative technologies as she worked at the South China University of Technology as a lecturer and as a founder of her first startup over ten years ago. In addition, Jenny has rich entrepreneurial experience as well as multi-national managerial skills. She is very insightful in the biotech industry along with medical devices.
Loading...
