Monday, April 26, 2010

Aging in Place: The National Broadband Plan and Bringing Healthcare Technology Home

The Senate Committee on Aging held a hearing "Aging in Place: The National Broadband Plan and Bringing Health Care Technology Home" focused on the spread of broadband and how health IT could improve the relationships and communication between patients and their doctors. The panel offered a preview of the government’s future role in healthcare, showing how Americans may interact with doctors and other healthcare providers using the latest technology. The panel statements and video of the hearing are below. There was a broad bipartisan consensus the information technology can help improve clinical outcomes and lower costs.

“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).

“Five percent of Medicare beneficiaries, who in most cases have one or more chronic conditions, constitute 43 percent of Medicare spending,” said Dr. Mohit Kaushal, Digital Healthcare Director, at the Federal Communications Commission. He was testifying before the committee via video conference due travel disruptions caused by the Icelandic volcano. Speaking about recent economic studies (see citations in testimony below) he said "Although economic studies like these are open to criticism due to the difficulty in quantifying savings," Kaushal said, "the Veterans Hospital System has implemented its Care Coordination / Home Telehealth Program for 32,000 veteran patients with chronic conditions. The program has resulted in a 19 percent reduction in hospital admissions and a 25 percent reduction in bed days for those veterans who are admitted."

There were some interesting demonstrations of technology that may help move us in this direction. One interesting device shown 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 visits with patients in their office. “What we’re talking about, folks, is using a device like this one,” Sen. Ron Wyden (D-Ore.) said, as he showed the 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. The patient doesn’t have to go in to the doctor and then the pharmacy to change his or her prescription,” he said. “This device here connects to other devices that measure a patient’s blood pressure and glucose 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.”

Another interesting discussion was around 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. Professor of pathology and associate director of clinical chemistry at The University of Virginia School of Medicine Robin Felder told the committee, "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."

"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,” claimed Felder. “Broadband connectivity of these devices would allow the electronic medical record to be updated with regard to medication compliance and efficacy."

Eric Dishman, global director of health innovation and policy at Intel Corporation, compared the new paradigm of health 2.0 to the e-mail revolution of the late 1990’s, saying that new health technology is not meant to replace the doctor-patient relationship but to enhance it using new tools. “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.

The recent health reform legislation included the new Center for Medicare and Medicaid Innovation. The center is charged with testing innovative payment and service-delivery models designed to reduce Medicare and Medicaid expenditures while preserving or enhancing the quality of care. The center will be running pilot projects and the legislation gave the HHS Secretary authority to expand pilots that she determines would reduce spending or improve the quality of care.

“The new Center for Medicare and Medicaid Innovation is given authority to test innovative payment and service model,” said Dr. Farzad Mostashari, senior advisor at the Office of the National Coordinator for Health IT at the Department of Health and Human Services while testifying before the committee. "Delivery of critical healthcare services in patients' communities and homes can reduce costs borne by patients, providers and health insurers and increase patient satisfaction," he 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.

There is little doubt that new technology solutions offer great promise to improve quality of care while reducing health care costs. There are many efforts working towards achieving this shared vision. Hopefully we can continue to put partisan differences aside as these different projects work in concert to move healthcare into the future.

Panel Statements:

  • Mohit Kaushal, Digital Healthcare Director, Federal Communications Commission, Washington, DC
  • Farzad Mostashari, Senior Advisor to the National Coordinator for Health Information Technology, US Department of Health and Human Services, Washington, DC
  • Eric Dishman, Intel Fellow, Intel Corporation, Global Director of Health Innnovation and Policy, Intel Digital Health Group, Senior Policy Adavisor, Continua Health Alliance, Senior Fellow, Center for Aging Services Technologies, Washington, DC
  • Robin Felder, Professor of Pathology, Associate Director Clinical Chemistry, The University of Virginia School of Medicine, Charlottesville, VA
  • Richard Kuebler, Telehealth Department Head, University of Tennessee Health Science Center, Memphis, TN

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