COMMENTARY
by Jane Sarasohn-Kahn
Twitter: @healthpopuli
How can we get more health out of health IT? Getting more patients involved in their own health will help maximize providers’ investments in health IT. Let’s call this ROH (return on health).
Notwithstanding roughly 100,000 mobile health applications available in mobile phone stores, several dozen activity-tracking devices unveiled at the 2013 Consumer Electronics Show and the availability of patient portals built into the top-selling electronic health record systems in the nation, it’s hard to find the health return on investment in health IT in America.
Moving From ROI to ROH Through Patients
Evidence on the ROI for EHRs is mixed at best. It’s still early days during these first two years since the launch of HITECH incentives for EHRs, which are driving mainstream health providers — doctors and hospitals alike — past the tipping point of EHR adoption. In short, it’s tough to wring out an ROI from an EHR (yet).
A study published the September 2013 issue of the the Annals of Thoracic Surgery this month, titled, “Functional Recovery in the Elderly After Major Surgery: Assessment of Mobility Recovery Using Wireless Technology,” identifies a potential secret in the sauce for getting more value out of a providers’ investments in health IT: patient self-care via activity monitoring.
Researchers at the Mayo Clinic armed 149 heart patients with a Fitbit activity monitor once they moved from the cardiac unit to an acute inpatient bed. The researchers found that, per the study abstract, “Wireless monitoring of mobility after major surgery was easy and practical. There was a significant relationship between the number of steps taken in the early recovery period, length of stay and dismissal disposition.” The researchers concluded that using an activity monitor like a Fitbit could “affect post discharge outcomes.” Simply put: the health of patients.
Venture Funding for Remote Patient Monitoring Grows …
There was a big influx of venture funding into digital health technologies in 2012, topping $1.5 billion across 362 companies. In just the first half of 2013, $102 million went to remote patient monitoring technologies across 12 companies, according to Rock Health. These included:
BAM Labs, which markets a sensor that can be placed under a mattress to monitor presence, sleep, heart rate and breath patterns; and
iRhythm, which continuously monitors cardiac rhythm for up to 14 days via a patch to be worn on a person’s chest.
Analysts’ market forecasts are bullish on wearable technology (IMS Research forecasted up to $6 billion), with continuous glucose monitoring comprising the largest component of health care and medical applications, activity monitors making up more than two-thirds of fitness and wellness tools and smart watches driving growth in “infotainment.”
… And More Consumers Are Engaging More in Health With Technology
On the consumer side, there are more people/patients who are taking on the mantle of health care consumer. Popular media show paparazzi-shot photographs of movie stars wearing activity devices; Gwyneth Paltrow revealed her affection for the Jawbone wristband on her blog, Goop. In 2013, it’s become cool(er) to talk about activity tracking, which the BBC recently covered in an hour-long program, called Monitor Me.
Patients who are getting more mindful about their health also have begun to take charge in other technology-enabled ways, such as:
- Crowdsourcing cures by sharing stories, health expertise and raw data. eHealthMe is enabling patients to research outcomes from prescription drugs, vitamins and supplements, comparing their personal demographics with other people. PatientsLikeMe launched its Open Research Exchange looking into hypertension and diabetes, among other health issues.
- Wanting to share decisionmaking with doctors, but often are not given the opportunity or are intimidated from asserting their opinion in the exam room.
- Shopping for clinical trials, getting help from peer patients who are paying it forward and sharing their expertise as “professional patients.” SmartPatients — the start-up of Roni Zeiger, formerly of Google Health, and Gilles Frydman, founder of the Association of Cancer Online Resources — is focusing on this niche.
- Dealing with caregiving. Nearly four in 10 U.S. adults are caregivers, according to a June 2013 Pew Internet & American Life Project study. Susannah Fox, researcher for the survey, found that “family caregivers are wired for health.” Startups such as Unfrazzle and Careticker have been developed to address this growing consumer demand.
Come Together
Today, there are two silos of health IT adoption in the U.S. In one camp are providers, hustling to meet meaningful use requirements to receive HITECH incentives, as well as working to avoid penalties in the Affordable Care Act for hospital readmissions for specific groups of Medicare patients. In the other camp, consumers — patients and caregivers alike — are adopting personal health IT, scrambling to balance their lives, get well and stay well.
The biggest return-on-health can happen when these camps come together. Health is where people live, work, play and pray, as coined by former Surgeon General Regina Benjamin. That is, what happens outside of the health care system is at least as important to overall health as what happens inside doctors’ offices and hospitals.
Consumers are generating data outside of health care providers’ health IT systems. Most of this information can’t yet flow into EHRs as they are configured, nor is that likely to happen without incentives that may be codified in meaningful use Stage 3, which may not be implemented before 2016. But when peoples’ observations of daily living can combine with health care claims data, we’ll have a more complete view of total health and wellbeing.
That’s the vision. The regulatory aspects of this sanguine scenario will be heavy lifting. A new white paper from Epstein Becker & Green calls for the Federal Communications Commission, FDA and the Office of the National Coordinator for Health IT to work together to better coordinate efforts for eHealth. “In the case of e-health, the government didn’t set out to have multiple agencies regulating product development, but through the convergence of the technology, FDA, ONC and FCC can all now find themselves regulating the same products. … The market is moving toward integrated systems of drugs, medical devices and health IT, and that proper regulatory oversight needs to reflect that reality,” the paper notes.
Regulatory challenges notwithstanding, consumers are moving ahead to manage health in their own ways via personal health information technology. What should give providers some assurance in patients is that consumers have more positive impressions of doctors who use EHRs, and these people also believe that EHRs can improve communication with physicians, enable better coordination of care and give them more confidence in their health care.
As more patients take on self-care and caregiving, they’re looking to engage with providers — whom people continue to trust above all other health ecosystem stakeholders. This is a call to action for providers — and will surely bolster return on health.