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Challenges, Opportunities of Mobile Health Devices in the Hospital

Digital health tools and data are changing how clinicians manage and coordinate care with patients, both inside and outside the health system.

Digital health tools and data have the potential to propel America’s beleaguered healthcare system into a value-based care environment. The challenge comes in aligning incentives with workflow.

That’s not an easy road to travel.

New technology that promises but doesn’t deliver, data that can’t be verified as accurate, a reluctance at the federal level to approve or reimburse digital health platforms, and a general wariness among the healthcare community to accept new ways of doing things have combined to slow the pace of mHealth and telehealth adoption.

But advocates say the benefits outweigh the challenges.

“We in healthcare know that there are always drawbacks to technology,” Susan Peiffer, chair of the American Society for Quality’s healthcare division, said in remarks accompanying the ASQ’s September 2016 release of a healthcare quality improvement survey. “While not a panacea, technology can help engage patients, increase access to care, help improve safety, and make data collection easier.”

The survey of more than 170 quality improvement professionals in healthcare found that 80 percent see improved workflow efficiency as the key to new technology implementations, and more than 70 percent see digital health tools as having the most impact.

The top hindrance, according to the survey, is resistance to change from staff and physicians unwilling to learn new skills or fearing that the technology will impede their workflow; some 70 percent of those surveyed said that would be “very difficult” to overcome. Some 64 percent expressed concerns with the cost of new technology, and 61 percent cited complexity, poor integration and the fear of patient errors caused by “haphazard introduction of new devices.”

Peiffer, a performance improvement specialist at the Wisconsin-based Hospital Sisters Health System, said those barriers will fall as providers become more comfortable with digital health.

“Just as technology continues to evolve, we will continue to improve how we use technology and how we integrate it into our interactions with patients,” she said.

QUALITY OUTSIDE THE HOSPITAL SETTING

Healthcare providers are finding great value in connecting with patients outside the brick-and-mortar confines of the doctor’s office, clinic or hospital. And in this fast-paced, mobile environment, it’s all about the quality of the data.

Physicians are looking for data that enables them to keep track of their patients at home. They might want to know what a patient is doing in the days or hours leading up to surgery, or they’re keeping track of someone following discharge. Perhaps they want to monitor someone with a chronic condition, or they want to know how the environment – physical and social – plays into a patient’s ongoing health and care management.

In years past, a doctor would depend on the patient relaying that information. But with the advent of mHealth devices, that data can be captured electronically and sent to the care provider, who can then review that data, determine whether a care plan is working and make adjustments to improve that plan and keep the patient from suffering an adverse health issue.

The examples are endless. A doctor can monitor a diabetic patient’s blood sugar, insulin intake, diet, exercise, sleep patterns, even moods through connected devices. The same goes for patients with heart and breathing issues, those recovering from medical procedures, those undergoing treatment for disease like cancer and Parkinson’s, even those dealing with mental illnesses or addictions.

“Obviously you want information that is legally valid – you don’t want to be making some major medical evaluation on something that is flimsy,” says, Dr. Richard Milani, MD, chief clinical transformation officer at New Orleans-based Ochsner Health, one of the first health systems in the country to integrate mHealth devices into care management. “In the healthcare space, you have to have a higher level of reliability.”

“But that doesn’t mean the Fitbits and other (devices) don’t have value,” he added in a 2015 interview. “You can look for trends, and you can learn from these devices” in ways that promote and improve patient engagement. “They are a platform, and they’re being used by individuals who are thirsty for the ability to manage themselves.”

The challenge lies in making sure the provider gets the right data, and data that is accurate. Providers have been slow to accept consumer-facing products like fitness bands, smartwatches and sensor-embedded clothing because they don’t trust the data coming from those sensors, and inaccurate data could lead to ineffective or even dangerous treatment. Likewise, those devices require the user to collect and decide to send that data to a provider.

Instead of consumer-grade data, providers are looking for medical-grade data. That information is taken directly from devices and transmitted through the cloud to the clinician. The patient plays no part in that transfer of data, so the clinician knows the data is reliable. The challenge, again, is in finding devices that can capture and transmit accurate and reliable data.

“(I)f you’re going to make life-and-death decisions, you’re going to want to use a medical grade solution,” James Mault, Qualcomm Life’s chief medical officer, pointed out in a 2015 interview.

That said, providers are also interested in what the patient has to say, and patient-reported outcomes often give them valuable insight into how a patient perceives his or her treatment.

Patient-reported outcomes “have become more important than ever before,” says Jason C. Goldwater. MPA, MA, senior director of the National Quality Forum. He sees information collected from wearables, home devices and even social media as “a huge repository of data” that can help providers shape how they care for their patients.

And that data has value. Goldwater says an engaged patient is ten times more likely to comply with a doctor’s care plan, including adhering to medication protocols and following a more healthy lifestyle.

Once that data is collected, it has to be filtered through the patient’s medical record, so that the clinician receiving it knows it has value and can apply it to the patient’s care plan. Here lies another common roadblock – too much data coming in, not enough filtering taking place, leaving the doctor overwhelmed with information he or she doesn’t need.

“EMRs capture everything that happens within the hospital,” says Roy Schoenberg, MD, CEO of telehealth vendor American Well, whose latest efforts have been in integrating remote monitoring solutions at home with electronic health record platforms in the health system, “while telehealth has been designed to capture everything that happens outside the hospital. There is a recognition now that these two sides have to integrate.”

Remote monitoring, then, requires a set of checks and balances to achieve value for the clinician. The devices in the home have to be accurate and reliable, the data has to be reliable and directly related to the patient’s care plan, and that data has to be presented to the clinician in such a way that he or she can quickly interpret and apply it to the care plan.

If all works out as planned, those mHealth devices give the clinician a more complete picture of the patient at home, and that data can be used to refine and improve not only the care plan by the patient’s overall health and wellness. Adverse medical issues are reduced or eliminated, expensive medical treatments are avoided, and the doctor is free to focus on timely and important treatments.

This, in a nutshell, is quality-based care.