Wire­less de­vices and technology bring surge in ad­vanced ap­pli­ca­tions for health mon­i­tor­ing and treat­ment, but le­gal and pri­vacy is­sues re­main

Modern Healthcare - - Special Report - Shawn Rhea

The idea that med­i­cal providers would some­day have mo­bile de­vices that al­low them to monitor, di­ag­nose and com­mu­ni­cate with their pa­tients isn’t ex­actly a new one. It’s been more than four decades since the cast of Star Trek ap­peared on TV with fic­ti­tious “tri­corders” — hand­held de­vices that al­lowed crew mem­bers to scan for life signs and di­ag­nose pa­tients. Fast for­ward all these years and ad­vances in cel­lu­lar and wire­less In­ter­net technology have made such de­vices a re­al­ity for doc­tors and pa­tients.

A grow­ing num­ber of providers are adopt­ing technology that fa­cil­i­tates more cost-ef­fi­cient, timely and ef­fec­tive pa­tient care through de­vices as com­mon­place as Black­Ber­rys, Treos and iPhones. And the re­cent in­tro­duc­tion of the iPad—a por­ta­ble wire­less de­vice that is cer­tain to spawn knock­offs—pro­vides doc­tors and pa­tients with a more reader-friendly plat­form for send­ing and re­ceiv­ing more vis­ually de­mand­ing in­for­ma­tion than can be fa­cil­i­tated by smart phones.

For many providers, mo­bile health adop­tion is part of a nat­u­ral move­ment to­ward next-gen­er­a­tion technology.

Four years ago, New York City Health and Hos­pi­tals Corp.—the city agency re­spon­si­ble for run­ning 11 acute-care pub­lic hos­pi­tals and 90 clin­ics among other fa­cil­i­ties—launched a telemedicine pro­gram that al­lowed med­i­cal providers to re­motely monitor and in­stantly re­spond to di­a­betes pa­tients’ fluc­tu­at­ing in­sulin lev­els. The pro­gram, dubbed House Calls, pro­vided 500 di­a­bet­ics with flip-phone-sized modems equipped with de­tach­able glu­come­ters. Par­tic­i­pants use the glu­come­ters to test their blood sev­eral times daily, and each read­ing is im­me­di­ately sent via the mo­dem to the House Calls nurse as­signed to monitor the pa­tient.

“If it’s out­side of their high or low range, a mes­sage is trig­gered to the nurse’s Black­Berry, and the nurse makes a call to the pa­tient and goes through their ac­tiv­ity with them to de­ter­mine the cause and ef­fect rela-

Ap­pli­ca­tions by Airstrip Tech­nolo­gies turn iPhones into a va­ri­ety of health sta­tus mon­i­tor­ing de­vices, such as the one above.

tion­ships” of the in­ci­dent, says Ann Frisch, ex­ec­u­tive di­rec­tor of the New York sys­tem’s home-care di­vi­sion. “There’s im­me­di­ate feed­back, so the pa­tient knows what ac­tiv­ity led to that type of read­ing.”

Ac­cord­ing to Frisch, the sys­tem has seen sig­nif­i­cant im­prove­ment in dis­ease man­age­ment in more than 85% of di­a­bet­ics who have par­tic­i­pated in the pro­gram. So much so that in late 2009 the provider be­gan dis­tribut­ing a wire­less ver­sion of the de­vice for use by pa­tients who don’t have land lines. The wire­less ver­sion also has the ben­e­fit of be­ing por­ta­ble—al­low­ing pa­tients to take the de­vice with them and con­tinue hav­ing their glu­cose lev­els mon­i­tored by nurses while on the go.

“Peo­ple are mo­bile,” says Mitch Mor­ris, a physi­cian who’s na­tional leader of Health IT for Deloitte Con­sult­ing’s Life Sci­ences and Health Care di­vi­sion, dis­cussing health­care’s broad­en­ing adop­tion of mo­bile technology. “I may have In­ter­net ac­cess if I’m at home, but not if I’m at a res­tau­rant.”

While smart phones are help­ing to bridge the mo­bil­ity gap, the de­vices do have lim­i­ta­tions. Hand-helds “are small in­stru­ments, so it’s re­ally im­pos­si­ble to read cer­tain in­for­ma­tion” on them, says Mor­ris, who noted doc­tors are in­creas­ingly in­ter­ested in us­ing mo­bile technology to ac­cess pa­tient test re­sults, in­clud­ing view­ing imag­ing stud­ies. “So, there’s a lot of work be­ing done to make sure the info is be­ing trans­mit­ted in an ap­pro­pri­ate for­mat. In­stru­ments like the iPad are in-be­tween so­lu­tions, but the bat­tery life is a con­cern there, and for a busy physi­cian that can’t be a prob­lem.”

As a re­sult, Mor­ris and oth­ers say wire­less technology will have to over­come some sig­nif­i­cant hur­dles be­fore it be­comes a ubiq­ui­tous fa­cil­i­ta­tor of health­care ser­vices. But all also agree that it’s a ques­tion of when, not if, mo­bile-health technology will pro­lif­er­ate.

Two re­cent sur­veys show that the num­ber of physi­cians re­ly­ing on their smart phones and other mo­bile de­vices to con­duct day-to-day busi­ness is rapidly grow­ing. A March re­port is­sued by Man­hat­tan Re­search, a health­care mar­ket re­search com­pany, projects that by 2012 81% of physi­cians will have smart phones—up from 64% in 2009—and more than half of that group will use their de­vices for ad­min­is­tra­tive work,

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