Proliferation of Consumer Platforms and Devices Into the Medical Ecosystem, Part One

Proliferation of Consumer Platforms and Devices Into the Medical Ecosystem, Part One

This column is the first in a three-part series that will discuss the challenges as well as the possible successes of using consumer devices and platforms within the highly regulated medical device industry. Donna Fedor, director of Strategy at Jabil Circuit Inc., St. Petersburg, Fla., has assembled threeinformation technology professionals from diverse backgrounds to discuss the convergence of two dissimilar industries into a new ecosystem:

• Simon Karger, vice president of Innovation & Technology Management at Sagentia, a technology management and product development company based in the United Kingdom;

• Michael Huneycutt, chief technology advisor for the Federal, Commercial, and Healthcare business units of information technology company Dell Inc.; and,

• Alan Portela, CEO of AirStrip Technologies Inc., a San Antonio, Texas, software company that is developing tools to send patient information directly from hospital monitoring systems, bedside devices and electronic health records to a clinician’s mobile device such as an iPhone or BlackBerry.

The following are excerpts from the group’s conversation:

Donna Fedor:Consumer mobile devices already are being used within the healthcare setting. To clarify, these are mobile devices such as smart phones and tablets that have been designed and manufactured for consumer applications, not for medical specific functions or to meet any medically regulated standards. Remote access and monitoring, which has taken years to implement, recently has experienced critical mass and momentum. What are these recent drivers?

Simon Karger: I agree there has been a real step up in activity for remote access and monitoring in the healthcare industry.There are the obvious underlying drivers.The demand and need to reduce the cost of healthcare and the fact that 80 percent of the overall cost of U.S. healthcare is driven by five chronic conditions: congestive heart failure, diabetes, chronic obstructivepulmonary disease, hypertension and stroke. But, there are new drivers that have accelerated things.

The first is the possibility of consumer and medical technology supported by infrastructure technology. We, as an industry, are much more confident in the ability for products in the ecosystem to work together.

Then, there is the social driver—what we see and experience in our personal lives. Consumer mobile devices are becoming easier to interact with and are ingrained in all that we do throughout our daily lives. Our customers may be institutes, hospitals, physicians, nurses and patients but, mostly, they are people that are now accustomed to using mobile devices with instant access to information and instant control over everything from bank accounts to communication. We cannot separate the technology and devices we use in our daily lives from the devices we use in our clinical lives. So, it is a combination of the fundamental economic and industry drivers that have been accelerated by social, mobile interactive technology across the world that drives this trend.

Fedor: It is not just patients who desire to use mobile devices in the healthcare arena. Physicians and healthcare providers have become accustomed to easily navigating and accessing the Internet through intuitive and beautiful interfaces. They don’t wanttheir work environments to be 15-20 years behind the times with medical devices and interfaces that are unconnected and cumbersome.

Alan Portela: Remote monitoring is becoming a requirement in healthcare. I have been in the mobile technology industry for some time, and when I was on the board at AirStrip last year, I could see that everyone was talking about mobile access. We were in Apple’s commercial, so many big healthcare organizations were inviting us to give talks. They would say that we had such nice technology, and it would be the first thing implemented right after they finish their big EHR/EMR (electronic health record/electronic medical record) deployments. But we knew that EHR/EMR deployments were being talked about for the last 15 years with fewer than 10 percent actually deployed. So, AirStrip needed to take a shift and help the hospitals figure out how to get quick wins with a big impact on patient outcomes. Mobility is right there at the center of it. So, we started with chronic diseases like Simon mentioned. Out of the top five chronic illnesses, three are related to the heart. We used our cardiology product to follow the patients throughout the mobile continuum of care from the ambulance to the emergency room to the patient bedside to the step-down clinic to the home and beyond. We showed the impact in terms of meaningful use and Accountable Care Organizations. We saw an immediate change in uptake and grew over 300 percent last year.

The issue with mobility is simple. We have to narrow it down to ROI (return on investment)—not just financial ROI but clinical and organizational ROI. There is a shortfall of doctors and nurses across the globe. In the United States, this shortfall is estimated to be more than 100,000 climbing to 150,000 within 10 years, according to the American Association of Medical Colleges. Many of those doctors are becoming specialists. In 2009, almost 70 percent of doctors worked as a specialist vs. a generalist, resulting in “hyper-specialization.” With U.S. healthcare reform, we will add another 14 million patients to the system over the next three years.Healthcare is moving from the four walls of the hospital to the home. So, the few doctors that we have are not going to be able to take care of all the patients in all of the environments. Also, reimbursement is changing from volume, episodic-based care to outcomes-based care. All these indicators tell you that mobility is the only vehicle that physicians can use to get access to the data. Specialist physicians are highly mobile professionals. We need to take the data to the physician instead of making them come to the data.

Michael Huneycutt: Changes to reimbursement and the move to accountable care organizations will drive a lot of the use of mobile devices in healthcare. Patients want more access to information and want to take control over their own care and now they havemore skills and tools to be able to do just that. We come from a connected, information-rich world, which is definitely driving innovation in healthcare. We are finally over that hump.

I also have to note that my work at Dellalso is on the government side. The U.S. Department of Veterans Affairs (VA) is seeing a large influx of young soldiers returning from overseas. They will be in the healthcare system for a long time. Since many come from rural areas and cannot drive to hospital, there is a need to find new treatment methods and it’s not just in the United States. China Telecom and the Chinese government are trying to find ways to reduce the influx of people into hospitals. Hospitals now look like trading floors on a stock exchange, so they are using mobile technologies to enable care outside of the hospital to both reduce influx and improve care. Around the world, we are all looking at the fact that the four walls of the hospital cannot sustain the current population using our current model. We must find other approaches and mobile devices are definitely the way to do it.

Portela: In the United States, 10 percent of the population and 20 percent of soldiers live in rural areas where healthcare is not readily available. The army has a program called mCare where they use mobile technology to follow up on patients—messaging them to remind them when to take medications or perform treatments or even remind them when they need to eat. These kids are coming back home with very serious injuries and mobile communication technology is a very good way to reach them.

Fedor: We need to keep our eyes on the results of the VA and U.S. Department of Defense programs. A few years ago, the VA performed a telehealth study noting that better results were obtained when mobile technologies were combined with personal contact, either from the healthcare provider or from a local caregiver. It’s not just one or the other. You need both to be most effective.

Karger: Also, one of the new dynamics is around usability. One of the reasons behind the success of smart phones and tablets is that they provide a very easy interface and easy access. They are becoming extremely intuitive and usability is a key. There has been a big disconnect in what we are seeing with usability in the consumer space and how medical device companies have thought about usability in the past. Usability is a classic example of how the medical industry is unaccustomed to understanding how consumers want to interact with their medical device and their healthcare data.

Fedor: And when that product goes home with a patient, it’s not only about the usability it’s also is about how usability, human factors and mobility come together to build clinical oversight into the device.

Editor’s note: In the March 2012 issue of Medical Product Outsourcing, the second part of this series will address current solutions on the market, recent U.S. Food and DrugAdministration regulatory guidance, andmedical device companies’ concerns with usingconsumer platforms in mission-critical applications. Part three will focus on data security and data management within “the cloud” as well as the alterations needed to the hospital infrastructure, services and payment models to support physician and patient remote access and monitoring globally. In addition, the future of the medical device will be discussed—if and when consumer platforms become a mainstreamelement in the medical technology ecosystem.

Donna Fedor has been the director of strategy for Jabil’s Healthcare & Life Sciences sector since 2009. She is responsible for developing unique strategies to build deeper knowledge and expertise in the global healthcare industry, specific conditions and disease states, and medical products and technologies. Fedor holds a bachelor’s degree in electrical engineering from Boston University.