The patient in the centre of care: the role of technology in revolutionising healthcare

Involving patients in their own treatment and implementing technology to support this will have positive impact on healthcare, according to Kevin Lamb

In recent years, medicine has encountered a number of obstacles en route to providing quality care. These bulwarks are the creation of pay sources, both government and private. Complex in nature, they have been compounded by our clinicians’ increasing bureaucratic responsibilities and the explosive rise in disease due to our incredibly irresponsible lifestyles.  No one, neither rich nor poor, is immune to these intricate blockages to care in the US healthcare system.

Unfortunately, this trend in problematic complexity is only getting worse with each regulation passed that puts the interests of everyone but the patient first.

As the internet has become more available and relevant in our everyday life, so has the patient in the process of their own care. Government policy makers have provided guidance to the primary care practitioner to include the patient, and where possible the patient’s family, in their healthcare treatment plan/journey. This overdue approach replaces the costly and inefficient model of the need for the medical community to manage the patient. This need for constant control has an inverse correlation to the patient’s knowledge of their condition.

This new model of patient engagement has been made possible by the vast amount of information on the internet. Websites and sources such as Web MD and Healthline Media, along with a plethora of online hospital information about diseases, injuries and treatments, have given patients the ability to self-educate and self-diagnose. Access to this data has provided the groundwork for the next phase for healthcare. Patients that are seeking information have a tendency to be more responsive to a clinicians treatment plan.

Self-awareness, together with an understanding of what is to be expected, creates an empowerment of the patient, resulting in efficiency, better outcomes and lower costs overall.

The use of video to advise the post-surgical patient of ‘what to expect’ after surgery provides the ultimate patient engagement. Most patients are less than attentive when they are discharged from the hospital; being responsive and receptive to complex new information at such juncture is to be expected. A two-hour explanation supported by a poorly written instruction sheet will leave them none the wiser – and may even be more confusing than helpful.

Over the past several years, the government has begun to hold hospitals accountable for readmission after discharge, especially when the patient was admitted for specific conditions or surgical procedures such as heart surgery. In fact, there are four buckets of codes across this issue. The collective fines being levied for readmission within 30 days of discharge are currently north of $600 million. By contrast, the use of a self-care or advisory video explaining what to expect has led to a remarkable improvement on readmission numbers. This obviously creates a more empowered patient who makes more informed decisions, rather than running to the ER every time something ‘doesn’t feel right’.  The cost saving is material – both for the patient and the hospital.

The most understanding patients are also the most likely to have a positive outcome from their treatment. This patient involvement model has also increased the research and development of off-site monitoring. Specifically, KCI/3M have produced a negative pressure device that assists in wound closure. The ‘Vac’ has a built in monitoring system that alerts a healthcare professional to non-compliance or improper use. The monitor notifies the on-call staff that there is inconsistency in usage, prompting a call to the patient to provide guidance and accountability. 

The results are impressive for most patients as by providing one to one interaction with a therapy specialist increases adherence to therapy by 88%. The overall use of this device allied with consistent professional care is designed to reduce the number of amputations, restores a patient’s quality of life and reduce the cost of therapy. All are accomplished when the patient is empowered with information unique to their therapy. 

Other examples, less connected to clinicians, are found in the diabetic patient’s life. The diabetic patient has a tethered lifestyle, always beholden to the amount of sugar in their blood: too much is bad and too little is really bad. The premium is on information. The old style of checking was done through finger pricks and disposable test strips that sometimes required several sticks per day. Not only was this cumbersome, it was expensive and inaccurate causing ER visits, missed work, accidents etc. The advent of CGM (Continuous Glucose Monitoring) has provided many patients a freedom they have not had since their diagnoses. 

There are several devices available that measure constantly, sending the results to up to four cell phones. There are also devices that monitor intermittently, and those that have an integrated pump to dose insulin when the CGM detects the need. The CGM operates on disposable disks that are supplied by companies like CCS Medical. In order to supply the devices they will obtain the doctor’s order and ship the disposable to the patient’s home and then bill the patient’s insurance. The availability of this type of technology has dramatically reduced the complications related to those with both Type 1 and Type 2 diabetes. 

Another innovation is the Podimetrics Smart Mat that can measure the patient’s propensity for obtaining a foot wound. These types of devices are valuable in providing patients and physicians with advanced notifications of imminent conditions that can be avoided with proper advice and lifestyle changes. The device is designed to measure the feet’s temperature, with the reading being sent to the patient and provider.

The device is reported to have provided a five-week advance notice of possible diabetic foot ulcers (DFUs). Due to the early detection, approximately 97% of the ulcers never formed due to lifestyle changes that were suggested by the clinicians who received the monitoring information. The cost of DFUs exceeds $100 billion annually, with over 1 million new incidents reported each year, so any measurable improvement creates incredible savings.

The ability of small technological adjustments to make large improvements to the health, efficiency and bank balance of patients and carers is seen elsewhere too.  

As we age and our health diminishes, many often become incontinent (can’t urinate without assistance), often because of a disease or injury. MediTech firm D Free recently developed a wearable monitor that notifies the patient when their bladder needs emptying, similar to the gauge on a gas tank. The device detects the volume of urine in the bladder then sends a message to the patient’s phone advising them that the time to empty their bladder is approaching. This simple but critical information can save a patient from an incredibly embarrassing episode of emptying their bladder unexpectedly.

This use of technology outside of the hospital is providing patient and carer training, non-proximity healthcare and patient engaged outcomes. As we all grow older, care becomes of paramount importance. The ability to remain independent, according to surveys of those over 65, is the most important aspect of the later part of life.

The era of a patient playing the victim so they may receive care equal to royalty has evaporated, and replaced with the promotion of self-reliance. The rapid development of software and devices that enable each of us to know and understand our self-care responsibility has had an incredible financial impact on patients and employers. Keeping a workforce healthy provides both productivity in the workplace, along with significant cost savings for companies.

For over 30 years, Kevin Lamb has been working to deliver better health outcomes for people across the US. He is the Founder and CEO of Medical Expectations, Inc, using the power of video to give patients the information they need to take charge of their conditions.

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