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In-home medical devices such as
heart rate monitors and blood pressure cuffs for cardiac patients,
glucose meters for diabetics, spirometers for asthmatics, scales to
measure weight, and infusion pumps for medicine intake, are commonly
used to gather data and transmit it to the patient, their families,
caregiver, and/or medical provider. With an estimated 7.6 million
people receiving home health care in the U.S. (National Association for
Home Care & Hospice, 2008) and one-third of the U.S. households
having at least one unpaid family medical caregiver present (National
Alliance for Caregiving, 2009), the use of in-home medical devices is
on the rise.
New to the world of medical devices are implants placed inside the body
for a variety of conditions. The implants are still being tested and
are at different levels of approval by the FDA. Each one is smaller
than a dime and can transmit data to a remote device for a physician to
interpret. One such implant measures cardiac pressure to indicate heart
problems, another is a sensor that measures blood sugar continuously
for patients with diabetes, and yet another one monitors tumor progress
for up to many months following a biopsy.
In-home medical devices have become more portable and easier to use,
enabling patients recently discharged from the hospital or who are
managing a chronic disease, to receive continued care from the comfort
of their own homes and sustain normal activity levels.
Regular monitoring and instant response to a significant change in the
person’s health is likely to prevent trips to the emergency room or
admissions to the hospital, keeping medical costs down.
As costs for health care and long-term care rise, the support that
in-home medical and safety sensing devices and wellness monitors
provide is a less expensive option than hospital stays or repeated
doctor visits. The needed care is delivered in a more desirable
setting, better health results are achieved faster, and families and
doctors are able to keep closer watch over the status of a patient. The
individual and his or her family are put in the center of their own
health care setting by taking on more responsibility for consistently
maintaining their care requirements.
Cost of Inpatient Care Compared
to Home Care (Per Patient, Per Month)
| Condition |
Hospital
Costs |
Home Care
Costs |
Dollar
Savings |
Ventilator-dependent
adults |
$21,570
|
$7,050 |
$14,520
|
Congestive
heart failure
in the elderly |
$1,758
|
$1,605
|
$153
|
Intravenous
(IV)
antibiotic therapy |
$12,510
|
$4,650
|
$7,860
|
Source: National Association for Home Care &
Hospice, 2008
Connecting patients to their doctors and families is easier than ever
with health monitoring mobile phone applications, sometimes referred to
as “connected health,” “telehealth,” or even “mhealth.”
Generally, the monitoring system of choice is placed in the home or
in/on the individual’s body. The patient or caregiver is trained to use
the device. The data captured by the machine itself is transferred to a
home computer through a USB, wireless connection, or cell phone and
then transmitted to a health record management system at the doctor’s
office, Google Health, or an independent service provider. The results
are monitored for consistency. In the event there is an abrupt changed
in the readings, the individual, doctor, family, and/or caregiver is
notified.
The
impact on real-life
People use connected health devices for three main reasons – chronic
disease management, independent aging, and health and wellness.
Chronic disease management
Over 133 million Americans have chronic diseases with that number
expected to rise to 157 million by 2020 (Centers for Disease Control
and Prevention, 2005). With in-home medical devices, patients regularly
track their health status, and physicians and family members can
intervene when necessary.
Devices in this category:
Glucose meter, blood pressure cuff, heart rate monitor, weight scale,
spirometer, medicine tracker, infusion pump, implant
Real-life
application:
Bob
has diabetes. He uses a glucose meter and cell phone to monitor his
blood sugar levels. The cell phone reminds Bob to check his blood sugar
regularly during the day. Using his glucose meter, he tests his blood.
The reading from the glucose meter immediately transmits the data to
his cell phone. The data is delivered to a diabetic monitoring service
that maintains his long-term history and looks for abnormal events. If
the reading is unusual or if Bob skips a test, the system automatically
alerts Bob’s family, doctor and/or caregiver.
Independent
aging
As the population ages, more people are living longer and ‘aging in
place’ is typically the preferred senior housing arrangement.
In 2030, when all of the baby boomers have 65, nearly one in five U.S.
residents will be over 65. By 2050, this age group is projected to be
88.5 million, more than doubling the number in 2008 (38.7 million). The
85 and older population is expected to more than triple, from 5.4
million to 19 million by 2050 (U.S. Census Bureau, 2008).
In-home safety monitoring devices allow seniors to stay in their homes
and family members to keep an eye on seniors remotely, saving on costs
of long-term care or the need to move to a senior residence.
Devices in this category:
In-home and mobile medical alert system, wireless monitored automatic
medication dispenser, individual GPS, scale
Real-life
application:
Carolyn
lives alone in the home she has lived in for 30 years. Her children
live out of state. Carolyn has some cardiovascular issues and her
cognitive abilities are not as sharp as they used to be. Each day,
Carolyn gets up at 7:00 a.m., uses the bathroom, weighs herself, and
goes to the kitchen to eat breakfast and take her pills. She then sits
in the family room to watch the morning news. At 9:00 a.m., a message
appears across her television screen reminding Carolyn to take her
blood pressure, which she does, using a wireless-enabled blood pressure
cuff that is on the table next to her chair. At 10:00 a.m., her
daughter, who is 500 miles away, receives a text message on her cell
phone that says “Mom is okay,” giving her peace of mind.
The
safety monitoring systems, scale, wireless automatic medication
dispenser, and blood pressure cuff setup around Carolyn’s house have
determined that she got out of bed, used the bathroom, her weight did
not dramatically change, she took her pills correctly, the gas stove is
off, and her blood pressure is stable.
If
something out of the ordinary would happen in Carolyn’s routine, the
automated service, which is monitoring Carolyn’s activity, would alert
her daughter by cell phone, and she could take appropriate action to
care for her mother.
Health
and wellness
Every year, more than 2 million deaths worldwide are attributable to
physical inactivity (World Health Organization, 2003). Medical devices
in this category revolve around either prescribed or personal fitness
goals for better long-term health and quality of life.
Devices in this category:
Heart rate monitor, scale, mobile phone applications
Real-life
application:
Brian
has been put on an exercise regimen by his doctor because he is 75
pounds overweight. He uses a mobile wrist device to record his heart
rate while he is exercising and a scale to record his body mass index
and percent body fat. After exercising, he uses his personal computer
(PC) to upload the data from his wrist device and the reading from his
scale to a software program. He is able to record and view his personal
training statistics and progress. In addition, he can send data to his
doctor and fitness coach to get training and guidance.
Important to the success of the overall system is how the devices
connect to each other, the services that support them, and the medical
providers and families who need the information that is gathered. This
is the focus of Continua Health Alliance, an international alliance of
over 130 companies in the medical device and related industries.
Continua is developing “guidelines for the emerging personal telehealth
ecosystem for new and innovative products to radically improve health
and quality of life as well as eliminate unnecessary costs from the
healthcare system” (www.continuaalliance.org). Their efforts will show
the advantages and cost savings of in-home medical devices to
the health care system as a whole, resulting in impactful
evidence to share with insurance providers and doctors.
The FDA is also helping integrate in-home medical devices into the
larger health care system. They recognize the potential safety concerns
related to the products and are attempting to educate consumers. The
FDA has launched a new and comprehensive Home Use Device website that
includes downloadable brochures, lists of recently approved devices,
alerts for recalled devices, and much more. www.fda.gov/homeusedevices
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