The previous section of this article talked about making health a routine part of everyday life, particularly where consumer devices are concerned. We’ll continue in this section with other considerations aired at the symposium.
Tullman’s principles of simplicity, cited in the previous section, can be applied to a wide range of health IT. For instance, AdhereTech pill bottles can notify the patient with a phone call or text message if she misses a dose. Another example of a technology that is easily integrated into everyday life is a thermometer built into a vaginal ring that a woman can insert and use without special activation. This device was mentioned by Costantini during her keynote. The device can alert a woman–and, if she wants, her partner–to when she is most fertile.
Super-compact devices and fancy interfaces are not always necessary for a useful intervention. In a keynote, John Dwyer, Jr., President of the Global Alzheimer’s Platform Foundation, discussed a simple survey that his organization got large numbers of people to take. They uncovered a lot of undiagnosed cases of mental decline. I imagine that the people who chose to take the survey were experiencing possible symptoms and therefore were concerned about their mental abilities. Yet they apparently had not expressed concerns to their doctors; instead they responded to the online suggestion to take a survey.
Most of us spend a large chunk of our day at work, so wellness programs there are theoretically promising. A panel on workplace-connected health solutions talked about some of the barriers:
Inadequate communications. Employees need to be informed regularly that a program is available, and its benefits
Privacy guarantees. Employees must feel assured of a firewall between their employer and the organization handling their sensitive data.
Clear goals. A wellness program is not just a check-off box. Employers must know what they want to achieve and design programs around these goals.
I would add that employers should examine their own environment honestly before setting up a wellness program. It’s pretty hypocritical to offer a wellness program on the one hand while subjecting employees to stress, overwork, and bad ergonomics on the other.
Telehealth is also likely to grow, and in fact, 200 bills to improve regulation of telehealth are pending in Congress. A speaker at a panel on preserving the human touch said that the Centers for Medicare & Medicaid Services are held back by uncertainty about how to measure telehealth’s value. Another speaker pointed out that we have a severe shortage of mental health professionals, and that many areas lack access to them. Telehealth may improve access.
It all comes down to the environment
Health care has to fully acknowledge the role of environmental factors in creating sickness. These include the marketing of fatty and sugary foods, the trapping of poor and minority people in areas with air and water pollution, the barriers to getting health care (sick leave, geography, insurance gaps, ignorance of gender issues, and so forth), the government subsidization of gambling, and much more. Similar issues came up during a keynote by David Torchiana, President & CEO and Partners HealthCare.
In her keynote, Jo Ann Jenkins, the CEO of AARP, quoted Atul Gawande as saying that we have medicalized aging and are failing to support the elderly. We have to see them as functioning individuals and help to support their health instead of focusing on when things go wrong. This includes focusing on prevention and ensuring that they have access to professional health care while they are still well. It also means restructuring our living spaces and lifestyles so the elderly can remain safely in their homes, get regular exercise, and eat well.
These problems call for a massive legislative and regulatory effort. But as a participant said on the panel of disruptive women in health care, plenty of money goes into promoting the interests of large hospitals, insurers, and device manufacturers, but nobody knows how to actually lobby for health care. Look at the barriers reached by Michelle Obama’s Let’s Move campaign, which fell short of ambitious goals in improving American’s nutrition.
Grounding devices on a firm foundation
A repeated theme at this symposium was making data collection by patients easier–so easy in fact that they can just launch data collection and not think about it. To be sure, some people are comfortable with health technology: according to Costantini, 60 percent of US smartphone users manage their health in some way through those devices. Nevertheless, if people have to consciously choose when to send data–even a click of a button–many will drop out of the program.
At a break-out session during the 2015 Health Datapalooza, I heard prospective device makers express anxiety over the gargantuan task of getting their products accepted by the industry. The gold standard for health care adoption, of course, is FDA approval based on rigorous clinical trials. One participant in the Datapalooza workshop assured the others that he had gotten his device through the FDA process, and that they could to.
Attitudes seem to have shifted over the past year, and many more manufacturers are treating FDA approval as a natural step in their development process, keeping their eyes on the prize of clinical adoption. Keith Carlton, CEO of HUINNO, in a panel on wearables, said that accuracy is critical to stand out in the marketplace and to counter the confusion caused by manufacturers that substitute hype for good performance.
Clinical trials for devices don’t have to be the billion-dollar, drawn-out ordeals suffered by pharma companies. Devices are rarely responsible for side effects (except for implantables) and therefore can be approved after a few months of testing.
A representative of BewellConnect told me that their road to approval took 9-12 months, and involved comparing the results of their devices to those of robust medical devices that had been previously approved. Typical BewellConnect devices include blood pressure cuffs and an infrared thermometer that quickly shows the patient’s temperature after being held near his temple. This thermometer has been used around the world in situations where it’s important to avoid contact with patients, such as in Ebola-plagued regions.
What’s new over the past three years is Bluetooth-enabled devices that can transmit their results over the network. BewellConnect includes this networking capability in 17 current devices. The company tries to provide a supremely easy path for the patient to transmit the device over a phone app to the cloud. The patient can register multiple family members on the app, and is prompted twice to indicate who was using the device so as to prevent errors. BewellConnect is working on an alert system for providers, a simple use case for data collection.
Many products from BewellConnect are in widespread use in France, where the company is based, and they have launched a major entry into the US market. I asked BewellConnect’s CEO, Olivier Hua, whether the US market presents greater problems than France. He said that the two markets are more similar than we think.
Health care in the US has historically been fragmented, whereas in France it was unified under government control. But the Affordable Care Act in the US has brought more regulation to the market here, whereas private health care providers (combining insurance and treatment) have been growing in France. As of January 1 of this year, France has required all employers to include a private option in their health care offerings. For the first time, French individuals are being hit with the copays and deductibles familiar to Americans, and are weighing how often to go to the doctor. Although the US market is still more diverse, and burdened by continuing fee-for-service plans, it is comparable to the French market for a vendor such as BewellConnect.
The next section of this article will continue with a discussion of barriers in the use of patient data, and other insights from the Connected Health symposium.