Modern communications technology is starting to have a real impact on the way patients are managing their diseases and the delivery of healthcare. By collecting and transmitting real-time data, it is now possible to get a much better picture of a patient’s health and how it is changing. Electronic health records, too, enable more accurate information to be available to each provider involved in a patient’s care.
It is even possible to alter the parameters on medical devices remotely to ensure they are providing the maximum possible benefit. Artificial heart pacemakers, for example, have been used to control irregular heartbeats for half a century, and are now available in forms that allow wireless control.
Similarly, the first insulin pumps were developed in the 1960s, and these allow the continuous infusion of insulin in diabetic patients. In the 1990s, computer control was introduced to programme pumps and collect data, and subsequently companies such as Medtronic have introduced versions that use RF communication technology which enables the pump to be connected to a continuous glucose monitoring sensor.
Bluetooth connections are now being used to connect the pump and meter, for example in devices supplied by AccuChek, allowing patients and caregivers to monitor and control the pump. In future, it is not unreasonable to expect that this will go one step further, with real-time feedback from the glucose sensor automatically controlling the amount of insulin being delivered by the pump. This would, in effect, create an artificial pancreas.
One issue with remote control of devices is the potential for unwanted interference with the device’s operation, whether accidental or deliberate. A group of US academics reported at the 2008 IEEE Symposium on Security and Privacy that the RF controls of pacemakers could be hacked. Similarly, IBM researchers have shown it is possible to hack into an insulin pump’s control system. This patient risk is something that companies developing wirelessly controlled devices will have to pay more attention to in future.
Another area ripe for future development is the implementation of wireless communications technology to monitor residents in care centres.
The authorities are already taking these devices seriously. The US Federal Communications Commission, for example, has now allocated part of the radio spectrum for medical uses. The introduction of medical body area networks, or MBANs, that operate on these frequencies will facilitate the widespread adoption of wearable sensors that continuously transmit data from patients to providers, and allow both to monitor their condition. This is encouraging the development of new types of sensor, with numerous companies such as Philips and GE already active in the area.
The penetration of smartphones into the consumer market is already significant – in the US, for example, comScore estimates it is nearing 60% – and this will continue to grow. And Deloitte data suggests that the number of smartphone owners who downloaded at least one mobile health app doubled from 2011 to 2012.
Smartphone apps offer huge benefits in terms of patient empowerment, enabling them to access health records, for example, and gain encouragement and support in their treatment plans. They also offer the potential for a sea-change in healthcare provision, giving patients faster access to healthcare and health information, while allowing providers to respond with more personalised care.
Imaginative use of the smartphone (or wireless-enabled tablet) might enhance healthcare in many ways. It can serve as a repository of data from wearable sensors. It can provide information about conditions and care plans, and offer a simple communication route between patient and provider. Data can be automatically transmitted to doctors, who can then act on it by altering meds regimens, or give a consultation via videoconference on the phone. It could give reminders when it’s time to take tablets, or motivate a patient to exercise, or maybe support smokers participating in a cessation plan. And game apps can motivate and encourage children to take control of long-term conditions such as diabetes or asthma.
Remote monitoring is also predicted to give significant cost savings to providers, payers, and even patients. Analysis by the Brookings Institution in 2008 suggested that nearly $200M in savings might be made in the US over the subsequent 25 years by the uptake of remote monitoring technologies, particularly for patients with chronic conditions such as congestive heart failure and diabetes.
The overall uptake of IT solutions in healthcare is increasing. A recent survey by Accenture of 3,700 doctors in eight countries shows that almost half now routinely access clinical data about their patients from other providers, showing that many doctors are already taking on board one of the major advantages of electronic health records (EHRs). About 60% were using such records within their own practice.
However, many patients remain concerned about the potential for their health records to be seen by their employers, life insurance providers or other people who might take advantage of this confidential information. A survey by Blue Chip Patient Recruitment also suggests that 45% of users are worried about the security of their health information when using mobile devices.
There remain a number of barriers to the widespread adoption of health information technology by medical providers. A 2013 survey of US physicians by the Deloitte Center for Health Solutions found that while most of those questioned think there will be efficiency advantages, more than half of those who have yet to implement electronic health records in their practices have no current plans to do so. The main reasons cited include cost, added complexity, and ongoing maintenance costs.
Properly implemented, EHRs have the potential to reduce duplication in test procedures by different providers, while giving more accurate monitoring of symptoms and outcomes, and better disease management. Allied to the power of remote monitoring and patient-centred apps, technology is set to make major inroads in improving patient care in the future.
