Wireless Medicine's Promise: Less Cost, Better Care

by David Gorn, California Healthline Sacramento Bureau

PHILADELPHIA -- The future of health care is here. It just left a text message on your phone.

According to Mohit Kaushal of the West Wireless Health Institute in San Diego, the promise of wireless technology is multifaceted, encompassing a range of devices, including the ubiquitous cell phone.

"Everyone has them, across most income levels, so you can leverage them to take better care of people," Kaushal said. Take the issue of non-compliance, he said, where patients forget to take medication that could help keep them out of expensive crisis care. Physicians currently have little control over such a situation.

"Poor compliance affects outcomes and drives up cost," Kaushal said. He recommended a simple system of non-invasive self-monitoring devices that can register an alert back to care providers if a patient's medication levels crash due to non-compliance. That alert could prompt a reminder to the patient, relative or caregiver.

"If they're not complying, we can know that, and we can send a relative a text that says, 'Hey, your mother isn't taking her medication.'"

That's a low-cost, low-maintenance alternative with many applications in health care, Kaushal said.

"We're looking at a whole series of changes in how medicine is practiced," Kaushal said. "A multifaceted approach that makes it easier for consumers, for providers, for everyone."

Kaushal -- one of dozens of health care experts who spoke at the Association of Health Care Journalists annual conference last week -- said the current medical model of fix-when-broken is expensive and inefficient.

"How do you switch that system, so that you catch the cascade of disease earlier?" Kaushal asked, referring in particular to "lifestyle" conditions, from diabetes to congestive heart problems.

"Chronic disease does not need to be handled by expensive doctors in expensive hospitals," Kaushal said. "There's no reason why people shouldn't be able to get the right care, at the right time, no matter where they are."

That's where wireless devices can come in, he said, and not just to reach individual patients. Hospital systems could operate more smoothly by joining the wireless world. "For instance, ICU monitoring can be put on the iPad," Kaushal said. "I mean, you can't afford to have a crisis physician in the hospital all the time, 24-7. So you can stream monitoring data live from the ICU. Using this, you can change the paradigm. Let's displace the notion that the hospital needs to be the epicenter of care."

Wireless technology also saves time, which can save lives, he said.

"Very often the speed of intervention can be really important in the ER," Kaushal said. "So there is a device, basically a handheld ultrasound, that can help you diagnose conditions without sending someone down to imaging. That amount of time, in a crisis situation, can make a big difference."

The Cost Factor

Joseph Kim, vice president of medical affairs and technology at Medical Communications Media in Pennsylvania, said wireless technology can be used across all income strata.

"One of the criticisms of wireless technology is the big cost of these devices," Kim said. "But I can't tell you how many times in my practice, some of my patients [with limited incomes], you think they don't have much, and you watch them pull the iPhone out of their pocket," he said with a smile. "So really, a lot of people are more connected than we realize, so we are looking to get this technology into the Medicaid population."

Kim said the use of new technology in familiar, already-owned formats doesn't incur much additional cost, as many people already have an Xbox or a cell phone.

"Even in Third World nations, pretty much everyone might have a mobile phone with a camera," Kim said. "A local person there could use it to take pictures of people with a rash or some other problem. That could be sent to a physician here, and then that local could convey the medical information to the patient."

It's a simple process, Kim said, if the consulting structure was in place, and developing nations could have a higher level of medicine with the click of a cell phone. "Technology is becoming so ubiquitous, even in Third World nations, so that kind of scenario is really feasible," Kim said. "It's really telemedicine if you think about it."

"There's a whole wide range of sensors out there now," Kaushal said. "There is a noninvasive patch that measures different pressures in the heart, and can transmit that information to the health care provider, so you can understand when things are going wrong and prevent them from occurring."

That may not sound like a big cost-saver all by itself, but Kaushal said that small savings per person add up when you take it nationwide.

"We spend $7 billion a year in the U.S. on congestive heart failure (hospital) admissions," Kaushal said. "And this [patch] can change the status around that condition. That's pretty powerful."

Risks of Mobile Technology

Just as people get health misinformation on the Web, they could download cell phone health applications that might be misleading, misunderstood or just plain wrong, Kim said.

"There is a lot of confusion around mobile health," Kim said. "How does a consumer or a health care professional know which one is reliable? It's an industry that is not regulated. And even if it was," Kim said, "technology is just moving faster than any regulatory body can keep up."

Anyone can develop and release a phone app, he said -- including app designers in other countries, where health information may be different than it is in the United States, with different drugs on the market, different attitudes and different health alternatives.

"The risk we run is, people are putting up apps that are inappropriate to the U.S., or have erroneous or outdated information on them," Kim said. "Medications approved elsewhere haven't necessarily been approved in the U.S. And there is always the risk of that information just not being accurate."

Privacy also can be an issue with health apps on cell phones, Kim said, because many apps have an embedded global positioning chip inside them.

The prime app risk, Kim said, is that patients might misconstrue the information they find on their phone. If an app designed for physicians lists the maximum dose of acetaminophen, for instance, that may not be the same dose for a patient with liver disease.

"So people could actually die from improper self-medication," Kim said.

Symptom checker applications have become popular, he said. "You could be having a myocardial infarction, and you look it up and it could be diagnosed as indigestion. That could be a serious problem," Kim said.

The potential advantages of phone apps are clear, but care is needed to make sure they do more good than harm, Kim said.

"The opportunities are tremendous for communicating more effectively, both within the team and with the patient," Kim said. "The future is bright, but we have to be cautious. And considering that it's all moving so fast, we have to be even more cautious."

'Not Whiz-Bang Science'

Kaushal, though, has a different caution: Don't be scared to embrace a technology that could improve patient outcomes, save time and dramatically reduce cost.

"Really, we're looking at new processes of care here. It's like online purchasing," Kaushal said. "I know the risk to my financial information but, to me, the value of online transactions outweighs the risk."

The thing to remember, he said, is that he's talking about transformative changes, using existing technology.

"It's not science fiction," Kaushal said. "It's not whiz-bang science. We're taking existing technology and running it on mobile devices."

In the end, he said, mobile health will succeed because of the money to be saved.

"By 2065," he said, "we'll be spending 100% of our GDP on health care."

The key to avoiding that, he said, is to bring down the cost of handling chronic, preventable conditions.

"Chronic disease drives cost," Kaushal said. "That will be especially important because there also is and will be a real shortage of doctors. So you'll have more people, needing more health care, with fewer doctors and less money."

The real promise of mobile health, he said, is to prevent disease before it develops and to prevent the advancement of diseases such as congestive heart failure or diabetes, after they've been diagnosed.

"Wireless health has real potential," Kaushal said, "to change both primary and secondary prevention."


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