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Putting another ‘e’ in ‘Health’

Putting another ‘e’ in ‘Health’
April 3, 2013in Technology2013-04-032013-04-04technologyen
ICT is transforming healthcare worldwide. Our North America correspondent takes a look at a range of ehealth applications that are attracting attention across the continent.
e-health, patient and doctor


ICT is transforming healthcare worldwide. Our North America correspondent takes a look at a range of ehealth applications that are attracting attention across the continent.
Paul Turek doesn’t bother with the phone much anymore. The doctor, who runs a male fertility clinic, uses a web service called Healthloop to monitor his young patients after surgery, ensuring that they are recovering properly and using the right dose of medication.
“It’s both old school and new school, performing a function that healthcare has missed for years, which is closing the dialogue loop between doctor and patient,” says Dr Turek, who is a strong advocate for home-based care. Healthloop helps patients to stay at home and avoid visits to the doctor’s office. His young male patients find time to fill out web-based responses to basic prompts, which keeps him abreast of their progress.
Healthloop is a good example of an ehealth system in action. Ehealth  drives new efficiencies into healthcare both in patient-facing situations, and in back-end health service provision, through the use of analytics, and better health systems management. Together, they comprise a market that the GSMA predicts is already worth up to $160 billion, with a five-year growth rate of 12% – 16% between 2010 and 2015.
mobile health applications
On the patient-facing side, mobile ehealth (mhealth) systems use software, telecommunication, and in some cases, hardware to close the loop between doctor and patient, improving feedback on patient treatment and sometimes alerting healthcare professionals before a problem becomes serious.
In some cases, ehealth projects can be surprisingly simple. Physician Jennifer Dyer developed EndoGoal, a smartphone app designed to gamify diabetes monitoring and encourage patient adherence. Users (often teens) earn more points for recording their glucose, dietary carbs and insulin, which can eventually be translated into real dollars to use for Amazon purchases. They can set reminders to record their data, and then share it with their doctors.
Another solution, Glooko, connects an iPhone to a glucose meter, compiling glucose readings with the user’s own manually-entered dietary information into a journal that can then be emailed to a doctor. 
plugged in patients
Dr Turek’s patients are young, and plugged in. iPhone users may feel comfortable using apps like Glooko, or others such as Tinké, that measures heart rate, respiratory rate, and blood oxygen using a small sensor that plugs into an iPhone. But not everyone is as au fait with technology. 
Older patients who may not be comfortable tinkering with a phone or entering information on a website can still take advantage of ehealth. Sensor-based monitoring systems can keep track of everything from glucose levels through to basic motion, alerting healthcare providers, for example, if an elderly person wanders repetitively, or doesn’t move at all for an extended period. SensorMind provides sensors that can be placed around the home to monitor the movement of the elderly, and alert caregivers if they stop moving. 
Other, more sophisticated devices are also in play.  VitelNet provides wearable sensors that monitor ECG, heart rate, and skin temperature. It transmits this data to a smartphone or tablet, and combines it with information about a patient’s physical activity and posture.  The data can be used for remote real-time monitoring, the company says. It also offers a ‘virtual visit’ solution including videoconferencing, for follow-up with physicians.
implanted devices
This remote monitoring is also extending into implanted devices. Florida-based Orthosensor is creating embeddable orthopedic sensors, designed to monitor numerous parameters relating to implanted orthopedics. Physicians will be able to tell how well an artificial knee is performing, for example. 
Orthosensor has what many ehealth vendors are moving towards: an analytics platform that will provide extensive data on performance. Analytics will contribute to one of the most important aspects of healthcare provider-facing ehealth: big data. 
“As we collect this data, it can be used to develop a treatment plan,” explains Yeona Jang, professor of practice at McGill University’s Desautels Faculty of Management. “The data is then available to do competitive evidence-based treatment, and to compare the results of different kinds of medication.”
transforming North American healthcare industry
Analytics are important not just for better patient care, but also for economic transformation in the healthcare industry, say experts.
“Outcomes-based research asks ‘did the medicine change the patient’s condition?’,” explains Dane Stout, executive director of the Connected Healthcare Practice at regulatory consulting firm the Anson Group
“Payers are trying to shift the model and offer payments to primary care physicians based on these outcomes.” This is known as ‘pay for performance’, or PFP. The idea of paying practitioners based on the outcome of their healthcare only works in the presence of enough evidence, and this is what ehealth solutions provide.
The cloud-based ‘glue’ in the middle will be a crucial component in such transformations, and companies are already targeting this promising market. US-based Amdocs has launched a cloud-based service that can take input from multiple third-party devices, providing real-time reporting and analytics on home patients. Health care providers can be notified when incoming patient data hits key parameters.
There are many regulatory barriers for ehealth companies to cross. Healthcare is one of the most regulated industries, and the glacial regulatory process is constantly trailing the breakneck pace of technology development. Regulators on both sides of the Atlantic have been mulling how to handle the regulation of mobile medical devices designed for mHealth. The FDA recently testified on how and when to apply complex and cumbersome medical device regulations to mobile software apps and the hardware that they run on. While lawmakers ponder these questions, innovators are champing at the bit.

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