Will Technology Change How Doctors Treat You in 2010?

With the federal government aggressively pushing for electronic health records (EHR), 2010 could be the year telehealth technology finally allows doctors to monitor their patients' health wirelessly in real time -- no matter where the patient is.

Of the billions of dollars spent on health care each year, 75% to 80% of it goes for patients with chronic illnesses such as diabetes, heart disease, asthma and Alzheimer's Disease, according to Dadong Wan, who leads the health innovation program at Accenture Technology Labs.

Monitoring a patient's condition in real time and using the information to develop a more detailed medical history could eliminate the need for some emergency treatment or hospital re-admissions by heading off health problems early.

According to a recent report from Accenture (download PDF), the rise of inexpensive Internet connectivity and smaller, cheaper and "smarter" health electronics should deliver better, more efficient health care.

Wireless health monitoring

The emergence of consumer health electronics such as portable ECG devices, blood pressure monitors or weight scales can allow the seamless capture and sharing of patient information from home, at work or even on the road. Portable ECGs, for instance, weigh just 3.5 ounces and allow outpatients to record electrical heart signals and transmit the results to doctors who can monitor them for trouble down the road. Advances in microprocessors will allow such devices to connect wirelessly with home computers, mobile phones or even remote Internet applications.

Other technologies expected to emerge include bandages or bracelets that monitor and transmit vital signs and patient locations as well as blood sugar monitors that -- after taking their readings -- transmit the data to central databases. Database-enabled tools can then alert doctors and their patients to improve treatment of chronic illnesses.

In addition, patients will soon be able to carry a USB stick or other electronic device that provides access to an online database detailing their medical history, as well as X-rays, recent test results or prescriptions. The patients can then make that information available to hospitals, doctors and emergency services.

For example, the the American Ambulance Association (AAA) announced last month that it will back a virtual medical ID system that allows paramedics to access a patient's health history in an emergency. The medical alert technology would also send a text message to the patient's relatives informing them that medical care is under way.

InvisibleBracelet.org is a Web registry that started in Oklahoma, where the local government made it available as a health benefit for state employees. The ambulance group plans to begin training medical crews on the use of the bracelets later this month.

Personal health records

"I'm a big proponent of finding out as much health information as we can and keeping on top of," said Christine Chang, a Health IT analyst with research firm Ovum. "Personal health records are just starting to be adopted now, so not many people know about them. But in the heat of an accident, they'll be invaluable."

In the first quarter of 2010, people in the service areas supported by AAA-affiliated EMS providers will be able to register and maintain unlimited access to a secure online account that holds their vital health information and up to 10 "In Case of Emergency" contacts. The service costs $5 a year, and users can maintain an account that's accessible by certified medics and dispatchers during emergencies.

When emergency care is needed, authorized EMS responders get temporary, read-only access to the information using a HIPAA-compliant search engine. If ambulance transport is required, medics can then generate text messages or e-mails to the person's designated emergency contacts.

Other online EHRs that will be accessible by both patients and doctors include the HealthVault betaprogram launched by Microsoft in 2007 and Google Health, which was launched last year. HealthVault recently partnered with Kaiser Permanente and the American Heart Association on an accessible database of health information and some clinics are already using the sites as a cheap alternative to deploying their own EHR systems.

Federal health care dollars

Hospitals and doctors must begin rolling out EHR systems this year or risk losing federal reimbursement money that will be paid out next year. As part of the American Recovery and Reinvestment Act of 2009, about $19 billion in incentives have been earmarked for electronic health records (EHR) systems. The Health Information Technology for Economic and Clinical Health (HITECH) Act allows for payments of up to $64,000 to each health care operation that deploys an EHR system and proves it's being used effectively by January 2011.

Each year after that, the reimbursements through the Office of the National Coordinator (ONC) drop, so it behooves hospitals and physician practices to roll out systems as quickly as possible.

Larry Leisure, managing director for Ingenix Consulting, said EHR systems will be the driving force behind many of the wireless monitoring technologies soon to be available.

"They create a longitudinal health record," he said. "One big benefit of EHRs is the e-visit. Imagine a patient and doctor having an e-mail conversation with bio-monitoring equipment transmitting data. They can have a conversation with shared information available to both. It enables patients and physicians to have a different relationship. Think about the cost avoidance in that."

The Alzheimer's Association recently unveiled a new Web-based application that works with mobile devices to track people suffering from dementia who wander off. The association's Comfort Zone service is powered by Omnilink tracking services and is the first comprehensive location management system designed specifically for Alzheimer's patients.

Corventis Inc., a wireless monitoring device vendor, developed a wireless cardiovascular reader that looks a lot like a typical Band-Aid. The PiiX is water-resistant, adheres to the skin and automatically collects and transmits health data to a second, portable device that wirelessly sends the information to Corventis. It can then aggregate the data for analysis or pass it along securely to physicians or for inclusion in a personal health record.

Health data uploads

Health monitoring vendor iMetrikus offers an aggregation service called MediCompass Connect. It is a telehealth gateway members can use to upload biometric data from over 50 personal health monitoring devices, including glucose monitors, insulin pumps, blood pressure monitors, digital spirometers, pedometers and weight scales. The system transfers data via a standard phone line or PC using a single-click connectivity hub. The data is then integrated with health management systems, such as disease and wellness programs, EHRs, provider practice tools and predictive modeling applications.

"Now, all of a sudden a patient is checking [their own] readings and uploading them into their patient medical record as well as an electronic medical record," Leisure said. "And now the physician has a way to see if a patient is being compliant with care instructions and can see spikes in health trending data. I think this will lead to a more compliant patient, too."

Managed care providers such as Kaiser Permanente and Group Health Cooperative in Washington already offer eHealth visits with physicians. The virtual interactions are more affordable because physicians are prepaid before ever seeing patients.

"You'll see the benefits of [electronic medical records] in a clearer and more measurable way in prepaid health systems than in fee-for-service systems," he said.

Evidence-based medicine

Electronic records help support "evidence-based medicine," which allows the federal government to monitor how doctors treat patients based on policies and practices derived from the systematic, scientific study of standardized treatments. For example, it's been known for years that patients should be prescribed aspirin after a heart attack, but there is currently no way of making sure that happens.

Standardizing on evidence-based order systems in order to qualify for federal money, or opening up access to personal health records on cloud computing networks, will allow doctors and patients to make better choices for care, said Kurt Miller, the global lead for Accenture's health management solutions practice.

"We've known for decades, or certainly [for] many years, [that] you need to be doing certain best practices post event.... But it's interesting how often those best practices are not followed," Miller said. "I believe that these technologies will begin to change those behaviors without a significant investment. It's just a matter of people doing it."

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