The State of Connected Health. Explained Simply

What Is Connected Health?

   Definitions galore. In a previous article, we created a digital health definition cascade where the most popular jargon in the digital health space were listed in order of influence. Connected Health was sandwiched between Virtual Care and Telehealth, where it was under Virtual Care, and telehealth was under it. To briefly recap, Connected Health is the coordination of knowledge between various stakeholders as it pertains to patient care. It falls under Virtual Care because of its use of technology to provide care to patients, but it gets its own term as it focuses more on the connectivity aspect of care in bridging any informational or communicational gaps.

Particularly, some of its most popular applications includes telemedicine, remote patient monitoring and mHealth, known collectively as telehealth. It can be boiled down to the use of apps in phones and PCs, and any other devices that enable connectivity in the form of virtual communication and coordination of healthcare. It includes exchanging patient information such as medical history and physiological data. Now that we have untangled connected health from its web of jargon, we investigate its current state. Doing so allows healthcare organizations to best utilize its value.

State of Connected Health
The cell phone has facilitated many remote and virtual connections between patients and physicians.

Leading up to The Current State

   The current state of affairs have been brought about by two forces at play, lagging capital investments and a greater acceptance of Connected Health technologies by patients. Each of these observations is expanded on below.

Lagging Capital Investments.

   Despite technology getting more pervasive, the need for cost effective healthcare is rising all over the world. Even if there are more innovations and more tech savvy people walking around than ever before, healthcare systems always need bigger budgets due to inflation, aging population and the rise of chronic care. For 2020/2021, UK’s NHS has a forecasted funding gap of about pound £30 billion. You would think that the greater access to technology for the masses and new digital health solutions would increase the total budget ceiling or at least the capital costs portion, to manage the greater healthcare demand for the future. But it hasn’t happened thus far. Health systems are falling behind in capital investments.

In Canada, unlike total healthcare spending which has been increasing steadily, healthcare capital spending has fluctuated in recent years. The story is similar in USA where despite having the largest public healthcare funding in the world, the actual percentage of public funding of total healthcare expenditure has been declining over the last decade. In both govt controlled and privatized health care, there is a race to curb healthcare costs from spiraling out of control. So in response, a funding gap is more likely as fiscal control is exercised which results in less than adequate spending on capital infrastructure.

Greater Consumer Acceptance of a Connected Health Reality

   At the same time, people’s interest in technology has grown. Healthcare consumerism has meant that patients at all level of care are very open to the idea of using technology to access care, and have their care coordinated digitally. To demonstrate, there are more healthcare devices in the market than ever before. 52% of hospitals in USA use three or more connected health technologies such as using telehealth to videoconference and text message and access patient information over a portal. Around 85% of facilities in USA have some sort of telehealth service, a 31-percentage point increase from 5 years before.

Historically, Canada has been a slower adopter of healthcare tech compared to USA. 22% of Canadian physicians employ telehealth. But this number is only set to rise as 68% of a patients claim that technology is already playing a role in improving their care experience with their physicians. Over three quarters of this group believe that they will be able track appointments and manage their medical history digitally for easy sharing. Such fervor for Connected Health technology is felt across the Atlantic as well, where UK, 75%  of the population go online to research health information.

The Current State and What is To Come

   As we see, there aren’t enough investments in fixed assets in order to put a lid on the demand onslaught. All studies indicate that there is current shortage of healthcare professionals, and a further windfall is to be expected in the coming years. So technology has to pick up the slack when it comes to the efficient provision of healthcare. The large consumer demand for Connected Care is met by supply in the form of the innumerable digital health and mHealth platforms. But it is plausible that the health tech solutions have overplayed their cards, where there now exists an influx of supply. Hence health systems, private physicians and other buying agencies are overwhelmed with the number of options. But expect this to change as consolidation continues to happen in the market.

   Healthcare by nature cannot move too fast, as safety and regulations are always first priority. But as technology has become such a catalyst in enforcing change, expect Connected Health to become more popularized with the following trends.

Current State of Connected Health
The Current State of Connected Health

Increased Connected Health Device Capabilities:

   Besides monitoring the basic vital signs of the patient, devices can now do things such as monitor blood flow to the artery, use machine learning to identify heart murmurs before they occur, and interface with neurons to restore speech in the form of implantables. Instead of devices just giving a reading, they are also used to deliver drugs into the system such as wearable insulin pumps, or manage a condition such as respiratory devices that provide airflow based on breathing patterns. With increased device capabilities, the reality of a virtual hospital inside a patient’s residence is becoming more of a reality.

Continued Growth of mHealth

   mHealth is showing no signs of slowing down. Alongside the proliferation of measuring devices, there is also the rise of mHealth apps. Regardless of whether it’s just a fitness tracking app, or an app that is connected to a health system, mobile devices are proving to be the gateway to Connected Health. There is no end to what people can do with their cell phones, from controlling light switches to opening car doors. So using mobile devices for accessing healthcare and managing health has become a popular idea, similar to one calling in to schedule an appointment or walking into a hospital or outpatient clinic. mHealth apps that monitor patient’s condition and aid in medical adherence are projected to grow at a CAGR of 38.9%

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
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COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

Description
  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
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COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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