One goal of mobile healthcare technology is to move care outside the walls of traditional settings such as hospitals and physician offices. The shift certainly has begun, but it is far from complete.
"Point of care is not everywhere right now," said Dr. Joseph Kvedar, director of the Center for Connected Health at Partners HealthCare in Boston. He moderated a session called "Point-of-Care, Everywhere," Wednesday at the Digital Health Summit at CES in Las Vegas.
But he and panelists from digital health vendors and a major payer agreed that the trend is generally positive.
"We are coming into a complete medical experience in the privacy of your own home," said Walter De Brouwer, founder and CEO of Scanadu, a Moffet Field, Calif.-based startup that is working on a "medical tricorder" device that helps diagnose illness with the help of a smartphone. In March, Scanadu will ship its first devices to 8,800 Indiegogo supporters, and their data will be part of the Scripps Wired for Health clinical trial.
If the point of care is moving to the home, medical technology will be "displaced, replaced or substituted," De Brouwer said, so devices will need to work outside the controlled environment of a clinic or laboratory. Developers will have to demonstrate to physicians, hospitals and, yes, the Food and Drug Administration, that the data from mobile and home-based devices is the same in the home as in the clinic.
It's an uphill battle for sure to sell certain healthcare organizations on new technology. Laura Mitchell, VP of business development at GrandCare Systems, maker of communication and monitoring systems for independent living, said that some long-term-care providers see the West Bend, Wis.-based company as a competitor rather than a useful service.
"We're sort of the baby monitor but we're not the mom," said Mitchell. It is GrandCare's job to deliver useful, actionable information—with as little "noise" as possible—to caregivers. The caregiver needs to be able to act on the information GrandCare delivers, but the vendor needs to eliminate "noise" in data.
Information should be in the form of "constant reminders," integrated into the lives of patients and their caregivers, Mitchell said.
On the consumer side, Kvedar noted the ubiquity of a certain piece of technology. "Everybody's addicted to their mobile phones. We're checking them constantly," perhaps 150 times a day, he said. However, it is difficult to get many people to care about their health even once a day.
Smartphones in particular are addictive. Digital health tools generally are not.
Kvedar offered three strategies for creating addiction in this sense: Make it about life rather than illness or even health; make it personal; and reinforce social connections. Tactics he recommended included "subliminal messaging," meeting people where they are in their daily lives so the technology does not seem intrusive; offer unpredictable rewards, as people check their phones so often because they never know what they might find; and create a sentinel effect so people feel like someone is watching when they make unhealthy choices.
This sounds simple, but it so far has not been. Kvedar said that Wellocracy, a social community for health that the Center for Connected Health spun out and launched at CES last year, still searching for its audience.
However, he is optimistic, given the changes going on in healthcare and the merging of institutional and consumer technologies. Despite the rocky rollout of HealthCare.gov, Kvedar said that health insurance exchanges are a "powerful force for engaging consumers." Kvedar acknowledged that these exchanges are about connecting people to insurance coverage, not managing health conditions, but he said that they at least start people thinking, perhaps for the first time, about being consumers in the healthcare segment.
New payment models that reward outcomes rather than value also are driving growth in nontraditional care settings, plus, as Kvedar illustrated with the smartphone "addiction" example, consumers – all of whom are potential patients – are already so familiar with so many technologies on display at the massive CES show this week.
Again, though, the shift is in its early stages. Yasmine Winkler, chief marketing, product and innovation officer for insurance giant UnitedHealthcare, said that risk-sharing is a clear trend in healthcare, but providers still need to learn to earn reimbursements, not simply take the money for granted as they do in a fee-for-service environment. Some are starting to change their views on virtual visits and other forms of telehealth, Winkler noted.
"We know that healthcare is really complicated," Winkler said, and navigating it is difficult for everybody. United wants to make it simple, personal and about accessing the right care in the right place at the right time, she said.
"We're doing a lot of experimentation," looking to meet consumers "where they want to be met," according to Winkler.
"There's a lot of power here, but it's raw and new," Kvedar added.