Connected health

Connected health is a model for healthcare delivery that uses technology to provide healthcare remotely. Connected health aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses technology – often leveraging readily available consumer technologies – to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care (such as home care) and disease and lifestyle management, often leverages existing technologies such as connected devices using existing cellular networks and is associated with efforts to improve chronic care.

The United States and European Union are two dominant markets for the use of connected health in home care service, in part due to the high availability of telephone and Internet service as compared to other parts of the world. Within the United States, over 260 million people have a land line connected, over 190 million are cell phone users, and approximately 200 million are Internet users. The European Union has roughly an equivalent number of people connected to land lines, but prevails over the U.S. with more than 300 million cell phone users and 230 million Internet users. More recent data collected by Pew Internet: Americans and their Gadgets suggest that 86% of US residents own a mobile phone and this number is as high as 96% among Americans aged 18 to 29 years. According to the International Communications Union, it is predicted that there will be 4 billion mobile phone users worldwide by the end of 2008.[1]

The vision of the connected health model can be implicitly understood by contemplating the significant impact of technology on other industries, such as in banking, shopping, logistics and personal communications. Proponents of connected health believe that technology can transform healthcare delivery and address many inefficiencies especially in the area of work flow management, chronic disease management and patient compliance of the US and global healthcare systems.

History

Connected health has its roots in telemedicine, and its more recent relative, telehealth. The first telemedicine programs were primarily undertaken to address healthcare access and/or provider shortages. Connected health is distinguished from telemedicine by:

One of the first telemedicine clinics was founded by Dr. Kenneth Bird at Massachusetts General Hospital in 1967. The clinic addressed the fundamental problems of delivering occupational and emergency health services to employees and travellers at Boston's Logan International Airport, located three congested miles from the hospital. Over 1,000 patients are documented as having received remote treatment from doctors at MGH using the clinic's two-way audiovisual microwave circuit.[2] The timing of Dr. Bird's clinic more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts.[3] Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings.

Definition

There is no standard, accepted definition of Connected Health.[4] On a broader note "connected health is the “umbrella term arrived to lessen the confusion over the definitions of telemedicine, telehealth and mhealth”.[5] It is considered as the new lexicon for the term telemedicine.[6] The technology view of connected health focuses more on the connection methods between clients and the health care professional.

An alternative growing view is that of a socio-technical perspective in which connected health is considered as a combination of people, processes and technology. Connected health is defined as patient-centred care resulting from process-driven health care delivery undertaken by health care professionals, patients and/or carer who are supported by the use of technology (software and/or hardware).[7]

In operation

Two "core platforms" are emphasized in connected health, self-care and remote care, with programs primarily focused on monitoring and feedback for the chronically ill, elderly, and those patients located at an untenable distance from primary or specialty providers. Programs designed to improve patient-provider communication within an individual medical practice (for example, the use of email to communicate with patients between office visits) also fall within the purview of connected health. There are also lifestyle coaching programs, in which an individual receives healthcare information to facilitate behavior change to improve their fitness and/or general well being, (see wellness) or to reduce or eliminate the impact of a particular behavior that presents a risk to their health status.[8] Some of the most common types of connected health programs in operation today include:

The Center for Connected Health is implementing a range of programs in high-risk, chronic and remotely located populations.

Inherent in the concept of connected health is flexibility in terms of technological approaches to care delivery and specific program objectives. For instance, remote monitoring programs might use a combination of cell phone and smart phone technology, online communications or biosensors and may aim to increase patient-provider communication, involve patients in their care through regular feedback, or improve upon a health outcome measure in a defined patient population or individual. Digital pen technology, global positioning, videoconferencing and environmental sensors are all playing a role in connected health today.

Goals

Connected health is viewed by its proponents as a critical component of change in human healthcare. They envision:

Evolution

Healthcare is consistently cited in political polls and in surveys as a chief concern for consumers, administrators, employers and clinicians alike.[9]

The formal establishment of quality improvement organizations in 2002 and rise of independent organizations such as The National Committee for Quality Assurance, The Leapfrog Group and Bridges to Excellence - all of which are dedicated to promoting and monitoring healthcare quality - illustrate intense concern over inefficiency, safety, and customer service in healthcare.

In addition, skyrocketing costs, increases in chronic diseases, geographic dispersion of families, growing provider shortages, troubling ethnic disparities in care, better survival rates among patients fighting serious diseases, an aging U.S. population and longer lifespan are all factors pointing to a need for better ways of delivering healthcare.[10][11][12]

Consumer demand for better service and quality in healthcare is the latest source of pressure to improve the healthcare system. Experts speculate that, having acclimated to greater speed, efficiency and cost transparency - as well as vastly improved access to information about products and services - in other industries, consumers are calling for the same responsiveness from the healthcare system. Direct-to-consumer advertising is a demonstrated contributor to the rise in consumer demand, as is the mass availability of inexpensive technology and ubiquity of the Internet, cell phones and PDAs.[13][14] Connected health experts such as Joseph C. Kvedar, M.D., believe that consumer engagement in healthcare is on its way to becoming a major force for change.

In summary, connected health has arisen from: 1) a desire on the part of individual physicians and healthcare organizations to provide better access, quality and efficiency of care 2) dynamics of the healthcare economy (such as rising costs and changing demographics) 3) consumerism in health care and a drive towards patient centric healthcare. Together, these factors are providing impetus for connected healthcare in the United States and many other industrialised nations and forcing innovation both from within and outside the system.

Evidence

While connected health is yet emerging, there is evidence of its benefit. For example, in a program being implemented by the Center for Connected Health and Partners Home Care, over 500 heart failure patients have now been monitored remotely through the collection of vital signs, including heart rate, blood pressure and weight, using simple devices in the patient's home. The information is sent daily to a home health nurse, who can identify early warning signs, notify the patient's primary care physician, and intervene to avert potential health crises. A pilot of this program demonstrated reduced hospitalizations.[15] Another initiative at the Center for Connected Health uses cellular telephone technology and a "smart" pill bottle to detect when a patient has not taken their scheduled medication. A signal is then sent that lights up an ambient orb device in the patient's home to remind them to take their medication.

Funding and implementation

Today, it appears that connected health programs are operated and funded primarily by home care agencies and large healthcare systems. However, insurers and employers, who bear enormous cost to insure their employees, are increasingly interested in connected health for its potential to reduce direct and indirect healthcare costs. For example, EMC Corporation recently launched the first employer-sponsored connected health program, currently in the beta phase of implementation, which is aimed at improving outcomes and cost of care for patients with high blood pressure.[16]

US government

Government agencies involved in connected health include:

Personal health records

Personal health records, or PHRS, (see personal health record) – are essentially medical records controlled and maintained by the healthcare consumer. PHRs intersect with connected health in that they attempt to increase the involvement of healthcare consumers in their care.[18] By contrast, electronic medical records (EMRs) (see electronic medical record) are digital medical records or medical records systems maintained by hospitals or medical practices and are not part of connected health delivery.

References

  1. ↑ International Telecommunications Union website (Accessed December 10, 2008)
  2. ↑ "Highlights from the Eighth Annual Meeting of the American Telemedicine Association" (Accessed December 10, 2008),Medscape website
  3. ↑ "A Brief History of Telemedicine" , Telemedicine Information Exchange website, (Accessed December 10, 2008)
  4. ↑ "Definition of Connected Health, e-health, m-health, tele-". Connected Health Ireland. Retrieved 2016-04-18.
  5. ↑ Iglehart, John K. (2014-02-01). "Connected health: emerging disruptive technologies". Health Affairs (Project Hope). 33 (2): 190. doi:10.1377/hlthaff.2014.0042. ISSN 1544-5208. PMID 24493758.
  6. ↑ Barr, Paul J.; McElnay, James C.; Hughes, Carmel M. (2012-02-01). "Connected health care: the future of health care and the role of the pharmacist". Journal of Evaluation in Clinical Practice. 18 (1): 56–62. doi:10.1111/j.1365-2753.2010.01522.x. ISSN 1365-2753.
  7. ↑ Richardson, Ita (2015). "Connected Health: People, Technology and Processes" (PDF). Lero – the Irish Software Research Centre. www.lero.ie. Retrieved April 19, 2016.
  8. ↑ "Radar walking speed measurements of seniors in their apartments: Technology for fall prevention". IEEE EMBC 2012.
  9. ↑ "Gallup's Pulse of Democracy", Gallup website, (Accessed December 10, 2008)
  10. ↑ "The Health Care Crisis and What to Do About It", The New York Review of Books website, (Accessed December 10, 2008)
  11. ↑ Americans for Healthcare website(Accessed December 10, 2008)
  12. ↑ "Health Care Costs: Why Do They Increase? What Can We Do?", Agency for Healthcare Research and Quality website, (Accessed December 10, 2008)
  13. ↑ PriceWaterhouseCoopers. 2006. The Factors Fueling Rising Healthcare Costs 2006, Prepared for America's Health Insurance Plans, 2006
  14. ↑ "How Changes in Medical Technology Affect Health Care Costs" Kaiser Family Foundation website, March 2007 (Accessed December 10, 2008)
  15. ↑ bmj 2007; 334: 942 (5 may)
  16. ↑ Kowalczyk, L. Employees to get an online checkup: Care provider, EMC will test a program to cut health costs, The Boston Globe, March 3, 2007
  17. ↑ Brailer, David J. Your Medical History, To Go. The New York Times. September 19, 2006.
  18. ↑ http://thenextweb.com/microsoft/2013/05/11/microsofts-sean-nolan-on-electronic-medical-records-their-storage-and-the-future-of-healing/

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