Senate Panel Previews Electronic Health Technology
The effort, loosely called e-Health or e-Care, combines health-care technology with 21st-century Internet connectivity. It will allow doctors to interact with their patients through innovations such as video chats, telephone health checkups, and home-health monitoring devices that relay data over wireless Internet connections.
“The development of the broadband network and health information technologies has the potential to truly transform health care and simultaneously enable better outcomes and lowering costs,” said Sen. Susan Collins (R-Maine).
One of the new health technologies on display last Thursday was an automatic drug dispenser that can monitor and adjust medication dosages wirelessly, allowing doctors to tailor dosages of drugs such as insulin without having to schedule in-person visits with patients.
“What we’re talking about, folks, is using a device like this one,” Sen. Ron Wyden (D-Ore.) said, as he displayed the small device. “It attaches to the patient’s skin and is loaded with drugs that are administered in the exact way that the doctor prescribes – wirelessly.
“That means that a doctor can vary the doses based on the information the doctor is receiving [from the monitor]. The patient doesn’t have to go in to the doctor and then the pharmacy to change his or her prescription,” he said.
The data recorded by such devices would be automatically uploaded to a patient’s electronic health record, which could then be reviewed by a doctor from a computer or smart phone, allowing the doctor to monitor a sick patient in almost real time.
“This device here connects to other devices that measure a patient’s blood pressure and glucose [sugar] levels – things that any doctor treating a diabetic patient wants to know about,” Wyden said. “It wirelessly uploads this data to an electronic medical health record that is monitored by a health care professional.”
The key to the new health care technology is broadband Internet connectivity, Wyden explained, because new technologies such as home monitors and new methods such as video conferencing require high-speed connections.
“What all these devices and technologies require is access to a high-speed Internet connection, or what is commonly called ‘broadband,’” he said.
In adopting these new technologies, the government aims is to reduce the cost of Medicare by changing the way it pays doctors, who would be allowed to bill for Internet-based "visits" with patients instead of in-person visits.
“Five percent of Medicare beneficiaries, who in most cases have one or more chronic conditions, constitute 43 percent of Medicare spending,” Dr. Mohit Kaushal, health care director at the Federal Communications Commission, told the committee.
“But there’s a set of broadband-enabled health information technology, both now and emerging from development, that can mitigate many of these issues and reduce the cost of care while improving clinical outcomes,” Kaushal said.
Kaushal, testifying before the committee via video conference due travel disruptions caused by the Icelandic volcano, said that Medicare needs to begin reimbursing for e-Care technologies so that doctors will have an incentive to purchase and install them.
“Given what it will take to implement an outcomes-based reimbursement model [for Medicare] reimbursement should be expanded for e-Care technologies that will improve system-wide expenditure reductions under CMS’ [Center for Medicare and Medicaid Services] fee-for-service model,” Kaushal said.
Other areas of interest include medicines that can tell a doctor if they have been taken on time, wireless monitoring of nutritional information, and sensors worn on the body or placed around the home that can detect if an elderly person has experienced a fall, alerting emergency personnel and the person’s doctor.
“Continuous monitoring of vibrations in the floor can detect falls and classify them according to the best choice of first responders – either a 911 call or a visit from a caregiver,” University of Virginia professor Robin Felder told the committee.
“Emerging technologies allow pills to be electronically outfitted with transmitters to communicate with the user’s wristwatch that shows that the pill has been consumed,” Felder continued. “Broadband connectivity of these devices would allow the electronic medical record to be updated with regard to medication compliance and efficacy.”
Government plans to use grant programs, as well as Medicare’s Center for Medicare and Medicaid Innovation – established by the health care reform package passed in March – to test which technologies actually work.
“The new Center for Medicare and Medicaid Innovation is given authority to test innovative payment and service model,” Dr. Farzad Mostashari, senior advisor at the Office of the National Coordinator for Health IT at the Department of Health and Human Services, said.
“These models may include care coordination for chronically ill individuals at risk of hospitalization through telehealth, remote patient monitoring, care management, and patient registries,” he explained.
While the government’s current focus is on saving money in Medicare, private sector companies see much broader uses for e-Care technology.
Eric Dishman, global director of health innovation and policy at Intel Corporation, compared e-Care to the e-mail revolution of the late 1990’s, saying that new health technology is not meant to replace the doctor-patient relationship.
“None of this effort is about replacing the traditional doctor-patient relationship, but it’s about enhancing and extending it to more people and regions of the country,” Dishman explained.
“Just as e-mail became a new way of interacting with other people that didn’t replace all other forms of communication such as phone calls and letters, e-Care uses new technologies to create a new way of providing care that complements – but doesn’t replace – all clinic visits,” he said.
Despite the high praise and high hopes expressed by everyone in attendance, e-Care technology is still very much in development requiring more market innovation and “thoughtful study” to see which methods work and which ones don’t.
“We don’t yet have all the answers,” Mostashari said. “They will come from continued market-based technology innovation paired with more results-oriented payment and thoughtful study to capturing the lessons and evidence from ongoing efforts.”