The healthcare business is a complex one because of its moving parts. Among them are hospitals’ involvement, government regulations (FCC and FDA compliance), insurance which plays a vital role in reimbursement, the device and technology companies that drive innovation and patients who are becoming more educated and influential. Recently, I attended the 4th Connected Health Summit 2017 held in San Diego to find out what is new.

By John W. Koon, Editor-in-Chief

Attendees came from various segments including health/drug, finance, consumer hardware, smart home, semiconductor and software to attend the summit and it was a good opportunity for me to network and learn. Panelists and presenters representing insurance, hospitals, device companies and solution providers and consultants gather here to share their knowledge and experiences. A great deal of materials has been presented over two-and-half days and the key learnings can be summarized as follow.

  • Outcome-based philosophy continues to drive the connected health industry and create new market opportunities.
  • There is a shift from device to data/cloud centric.
  • Emerging technologies such as Artificial Intelligence (AI) and Internet-of-Things (IoT) start to impact the industry.Key LearningsOutcome-based philosophy continues to drive the connected health industry and create new market opportunities.
  • One of the most important factors in the connected health industry is reimbursement. Solution providers face the hurdle of developing good medical devices that people want but fail to “get paid”. Without insurance companies covering the costs of the devices, most users are hesitant to pay form their own pockets. To convince the insurance company that a potential healthcare solution or medical device would mitigate risk and help monitor compliance for a better outcome is easier said than done. It was reported that a company has taken seven years and millions of dollars to finally get the reimbursement approval in key states. Not every company can afford that. It takes a lot of time and patience to achieve reimbursement results. But the reward can be long term.

    State Medicaid incentives help create new opportunities for inventors. As an illustration, consider Medicaid specifies a onetime payment for certain hospitalization. For a care facility, such as a hospital, readmission of patients will increase costs and negatively impact the bottom line. This happens when high-risk patients are overlooked and end up in readmission. To reduce such risks, Vivify provides a SaaS-based software solution to monitor high-risk patients in real-time so proactive actions can be taken by the caregivers and not wait for an emergency to occur. Users of the software report a decrease of readmission by as much as 50%. It is expected that similar solutions that help monitor patients remotely will emerge.

    The aging population is expected to create a big market. According to the Population Reference Bureau report, “Aging in the United States,” (2016), the number of Americans 65 and older was projected to be 98 million by 2060 up from 46 million, corresponding to 24 percent and 15 percent of the population. Since the frequency of hospital visit is directly proportional to the age and the health condition of an individual, as the aging population grows, hospital visits will also increase. To reduce healthcare costs, both insurance companies and hospitals are motivated to keep patients away from the hospitals. This has created a demand for services to help individuals to live independently and healthily. Solution provider such as Systech, a maker of sensor gateway, came up with an idea. The gateway-centric device which interfaces with multiple medical devices and sensors to monitor bed pressure, bed moisture, blood pressure, weight, room motion and door contact to make sure activities of daily living (ADL) of individuals are normal. Caregivers will be informed of any activities outside the norm and take early actions. The IBM Research division is conducting multiple studies in using technologies to aid the aging population to live lives on its own terms. I expect in the next few years, many companies will offer solutions to capitalize on this growing market.

    There is a shift from device to data/cloud centric.
    I noticed a shift from device to data/cloud centric over the years. Here are a few examples to illustrate the point. Omron is a household brand of blood pressure monitor devices. They spent many years to gain the trust of doctors. Chances are when an individual buys an Omron device it is because the doctor tells the patient to do so much like a prescription. The mission of Omron is to help eliminating heartdeceases such as heart attacks and strokes by offering technology solutions. One of the methods Omron uses is to provide useful data for free. “After a device such as the blood pressure monitor is purchased, if the users desires, data can be uploaded to the cloud and it can be used at no cost by caregivers and love ones”, commented Ranndy Kellogg, President and CEO of Omron Healthcare, Inc. By having timely access to vital data, caregivers can monitor the well-beings of users.”

    “After a device such as the blood pressure monitor is purchased, if the users desires, data can be uploaded to the cloud and it can be used at no cost by caregivers and love ones”, commented Ranndy Kellogg, President and CEO of Omron Healthcare, Inc. By having timely access to vital data, caregivers can monitor the well-beings of users.”

    ResMed, a leading provider of devices to treatsleep apnea, has more than 3 million patients remotely monitored via their CPAP machines and ventilators. With the cloud connection, users can track their own CPAP therapy and receive personalized coaching tips. Additionally, caregivers can monitor the condition of the patients and make necessary adjustments. “By having such a big database, ResMed can provide valuable insights to help clinicians improve patients’ therapy experience and health outcomes,” according to Kari Hall, VP, Software Services.

    Finally, I have been tracking Qualcomm Life for years. In the early days, the 2Net devices were alwayshighlighted at various events as the secured connected solution for connected health. This year, the emphasis shifted to the availability of enabling almost real-time data. The 2Net device was not even mentioned had I not asked about it. Overall I see the trend will continue to focus on the meaningful use of data via IoT and the cloud.

    Emerging technologies such as Artificial Intelligence (AI) and Internet-of-Things (IoT) start to impact the industry.
    At the event, new and improved wearable devices have shown that we have made significant improvement in the area of monitoring. Stylish smartwatches can monitor not only heart rates and steps but measure many vital signs as well. Reemo launched a brand new stylish smartwatch while FitBit announced a new model with added features.

    Perhaps, the most impressive device is from the BodiMetric. Many vital signs including ECG signals can be measured in 20 seconds and together with the AliveScience software, the Ruthman Index can be obtained. What is the significance of a Ruthman Index for health? It is like the FICO score used to measure one’s credit. Two Ruthman brothers experienced a tragedy of losing their mother after her heart valve replacement. The patient seemed to be recovering well. But it took a downturn without warning resulting in her death. While the doctors and nurses were competent individuals, there seemed to be undetected vital signs to cause the patient to “fall through the crack”. After many years of research and working closely with hospitals, the Ruthman Index was It is a combination of measuring vital signs and the review of those charts to come up with an index. The results of using those indexes have helped saved thousands of lives.

    Chart 1: After many years of research and working closely with hospitals, the Ruthman Index was born. It is a combination of measuring vital signs and the review of those charts to come up with an index. The results of using those indexes have helped saved thousands of lives.

    Connected Health (some prefer Digital Health) relies on digital transformation. Gone are the days of pager worn by doctors. (Some of you may ask what a pager is. Not to worry, it is not important if you don’t know what it is). Now we use the cloud and IoT to access real-time data to improve outcome. Smartphone and apps will play an increasingly important role. When I heard about the use of health apps, I always wonder how they would be regulated by the FDA. I got my answer. In 2016, the FDA cleared (approved) 36 health related apps. Here are a few examples. (http://www.mobihealthnews.com/content/thirty-six-connected-health-apps-and-devices-fda-cleared-2016)

  • Sensimed received the de novo FDA clearance for the Triggerfish, an innovative connected contact lens. This contact lens can record continuous ocular dimensional changes. By observing the recorded data, uploaded from the lens to the computer via Bluetooth, physicians can monitor the progression of glaucoma in patients.
  • By observing the recorded data, uploaded from the lens, made by Sensimed, to the computer via Bluetooth, physicians can monitor the progression of glaucoma in patients.

  • Scientists and physicians are always searching for a better pain control medicine or method. Neurometrix came to the rescue. Their wearable, smartphone-controlled version of Quell, received FDA clearance. By sending signals to the brain to release natural opioids, the device allows users to control therapy levels.
  • Medtronic’s AVIVO Mobile Patient Management System received FDA clearance. The device monitors the condition of the patient with cardiac illnesses by measuring and recording data before sending to the Medtronic server. In turn caregivers will have access to the information and take proactive actions if necessary.
  • What will the future hold?
    Technology will continue to play an important role in connected health while not every hospital or care facility is using connected health yet, some have. For example, the Geisinger Integrated Health Systemwhich manages 12 hospitals use connected health to manage data including patient electronic medical records (EMR). “We address patient care needs using connected health and can interact with them,” commented Chanin Wendling, AVP, Informatics, Geisinger Health System.

    “We address patient care needs using connected health and can interact with them,” commented Chanin Wendling, AVP, Informatics, Geisinger Health System which manages 12 hospitals.

    While progresses are made in the connected and digital health segments, there are also hurdles and challenges. Because multiple technologies are used, a device has to face multiple hurdles such as FCC and FDA compliance before it can go to market. For medical devices, the HIPPA privacy act adds another hurdle limiting what information can be shared. The biggest challenge and most urgent one is how to secure the connections used by IoT and connected medical devices to counter cyberattacks (note that I don’t use the word prevent because you can’t completely prevent cyberattack) that had taken multiple hospitals hostage. Developing innovative products is only the beginning. Having secure and safe products is critical. My advice is to work with organizations like the Medical Device Innovation, Safety and Security Consortium (MDISS) to ensure safe, secure and high quality medical devices are developed. Unsafe medical devices being hacked will have grave consequences.