Medical Device Daily Contributing Writer

SAN FRANCISCO — How disruptive is the coming revolution in home-based medical care?

Beyond the technology, the processes of traditional healthcare are likely to be re-engineered as patients become empowered to better manage their own health, and healthcare organizations will be seeking more than stand-alone devices and systems in making their purchasing decisions.

These themes and other unsettling challenges were prominent on the agenda of Healthcare Unbound, an annual conference held here earlier this week, focused on fostering a revolution poised to move medical services out of the hospital and into the patient’s home.

Among the unsettling ideas presented at the conference, Michael Robkin, the architect for Kaiser Permanente Information Technology at Kaiser Foundation Hospitals (Oakland, California), probably shook up those clinging to the idea that healthcare is more high-touch than hi-tech. “Banks,” he said, “used to advertise their friendly tellers to win business. Personally, I have not seen a teller in six years.”

And it is assuring, rather than disturbing, to Donald Jones, VP-business development at Qualcomm (San Diego) that people form a nearly personal relationship with their cell phones or music players. He said he believes that the cell phone will be a key player in the coming home care revolution.

“The key to effective home care is creating a presence with the patient, a peace of mind with an assurance, or simply the knowledge of what to do next,” he said, in a keynote address at the conference.

“Cell phones deliver that presence, and they can be used to create touchpoints to remind subscribers to a health service of why they subscribed and the services they can use.”

Qualcomm’s strategy for home care is to avoid clinical applications and instead focus on “connecting people and things,” Jones said.

Cell phones are connected to biosensors, including new “Band-Aid sensors with a very exciting potential that you peel and stick to monitor or diagnose a condition,” he said.

A connected sensor or other medical device can either use the computer processors onboard the cell phone, or can connect to a remote server to process information, he said. Processing the data, cell phones can create and display dashboards for a health condition, serve as a controller for a device, or simply as a communication gateway.

A significant gift to the medical industry is coming from Mastercard and Visa, Jones said, in the form of near-field communication radio, or radio frequency identification devices (RFID).

“As the personal finance industry moves your wallet into your cell phone, they will be creating an infrastructure that can be used by the healthcare industry for patient identification,” he said.

The expected addition of biometric sensors to cell phones will provide further patient authentification, and the same payment systems created by the personal finance industry will be used by payers for patient co-pay and reimbursement.

More sophisticated functions for the cell phone have recently been demonstrated, said Jones, citing implanted insulin pumps that transfer data when a NFC-enabled glucose meter unit is near the implant.

Perhaps a more unsettling example is the coming Star Trek-like ability of cell phones to acquire vital signs directly from a patient with a swipe.

Jones cited an Irish company, Bianca Med (Dublin), that is creating a baby monitor capable of not only continuously listening but also acquiring and tracking an infant’s breathing and heart rate.

Winning strategy: Hide the device behind a service

“We are successful in placing sophisticated medical technology in the home if the patient does not see the technology,” said Jeff Perry with Philips Medical Systems (Andover, Massachusetts) Consumer Healthcare Solutions. Instead, he said, the patient should see only an assurance of service.

Philips is taking what it calls a platform approach to the emerging market for in-home care. While the platform is loaded with medical technologies, Philips puts the emphasis on patient-facing interactive media to support behavior modification and to promote health literacy in adults with chronic conditions.

Philips divides patient care into three stages.

• Remote patient monitoring uses simplified, mainly one-button devices to pull data from the home.

• Motiva, a behavioral modification program, then pushes information to the home using multi-media.

• Finally, the patient is provided tools to self-manage a condition, such as medication management devices or scheduling tools.

The Motiva program, which aims to improve patients’ compliance with medications and physician guidelines, was first implemented by theErasmus Medical Center (Rotterdam, the Netherlands), using a television as the primary channel for a push-pull information exchange.

The Philips program is the one to watch, according to Marcia Reissig, CEO of Sutter VNA & Hospice (Emeryville, California), which serves 22,000 home care patients each year.

“As a payer I don’t need just technology,” she said. “I also will need billing for the service provided, need to create new policies and procedures, monitoring, and especially the financing for it.”

“The winner for me in the explosive growth that is coming will be the people who can bundle these services with their product and create a package,” said Reissig.

“I look at Philips’ Lifeline program and see they have a scalable program with a product that is easy, cheap and a business model that is simple,” she said. “I can use it as a subscription model, mark it up, sell it and make some money.”

“I need to find these services that people need and sell it to them before Walgreen’s does it for us,” she added.

Susan Van Dorsten from SeniorMed , a business of Walgreen (Deerfield, Illinois), said that while the major business line for her division is compliance packaging of medication delivered to group homes for assisted living, a negotiation nearing completion will create a more targeted product for individuals in their own homes.

“The average senior with one or more chronic conditions is taking from nine to 12 medications, and these people are seeing from three to five different doctors,” she said.

The new Walgreen’s service will create 14-day medication dispensing packs equiped with prompts and alarms to help the patient comply with the prescribed regime. She said the deal will include visual and audio aides as well.

“We’re trying to manage medications, avoid duplications, and of course, win the business,” she said, adding that patients with multiple doctors also have multiple pharmacies.

Among the systems introduced at Healthcare Unbound,LifeLink Monitoring (Norcross, Georgia) featured its MDILog, a metered-dose inhaler for asthma and chronic pulmonary disease patients that records date and time of medication use to increase caregiver awareness of therapy compliance.

The inhaler features a screen for patient’s to view feedback on the effectiveness of the dose delivery and an audible alarm to remind patient’s to use the medication. An infrared device transfers data from the handheld unit to a a docking station connected by a plain old telephone (POT) line to a server. The patient usage data is uploaded to a secured website that can be monitored by a caregiver or family member.

LifeLink has 1,000 patients currently using inhalers and has served 10,000 patients to date.