December 14-15, 2017

MedTech Impact 2017

Venetian/Palazzo Resort

Las Vegas, NV

(561) 893-8633

info@medtechimpact.com

Author: Sarenka Smith

The Cost of Chronic Disease

The primary issue that consumes the majority of the burden of healthcare costs in the United States is preventable chronic disease: while the most prevalent health conditions are simultaneously the most avoidable, they continue to cost the country’s budget billions of dollars. While overall numbers have decreased since 2010, when chronic disease cost the U.S. a total of $315 billion, morbid obesity rates have continued to rapidly spike—a condition that leads to a range of critical health issues including heart disease, diabetes, and stroke.

Primary care providers have long faced the struggle of determining how to implement best practice care for patients diagnosed with chronic diseases. Recent studies indicate that almost half of the entire U.S. population has at least one chronic health condition—including heart disease, cancer, diabetes, obesity, or arthritis. Statistics designate these health care treatments costs to account for 86% of cumulative national healthcare spending, and the CDC reports that chronic conditions are the leading causes of death and disability in the country.

Yet the past decade has seen the advent and proliferation of digital health technology, spurring the generation of new techniques and strategies for healthcare professionals to utilize in chronic disease management. These types of technology vary in terms of accessibility and usability, but include remote monitoring, mobile health apps installable on phones, and wireless wearables—which serve as activity trackers.

A series of interviews conducted by Medical News Today demonstrate a bright future for the potential of new technology, and its ability to spur and provide high-quality care. Suzanne Falck, MD, an associate professor of internal medicine at the University of Illinois College of Medicine, noted that a highly successful digital tool is currently in use for the management of heart failure: an implanted sensor immediately transmits data to a healthcare practitioner, who then analyzes the data in order to make medical recommendations. Further clinical trials and studies indicate that remote monitoring is more cost-effective than traditional, conventional management.

Moreover, the burgeoning popularity of medical apps signifies that mobile technology can make a hugely positive impact on chronic disease management. There are currently approximately 259,000 medical health apps available to purchase; over half are aimed at targeting consumers with chronic conditions. Clinical trials have repeatedly shown that patients with type 2 diabetes who utilized an app to monitor their blood glucose levels showed greater benefits than those who did not. A recent article in Diabetes Technology& Therapeutics states that the prognosis in patients with diabetes is ‘strongly influenced by the degree of control of their disease,’ which reinforces the effectiveness of self-management support through mobile apps.

Another innovative and exciting development is wearable technology and devices, which are currently being studied in a variety of clinical research settings. Many healthcare providers believe that the ‘potential of this technology is endless,’ as they can improve access to care while simultaneously enhancing convenience—and likely patient compliance.

Most importantly, being conscious of medicinal needs and treatments requires a consistently high level of responsibility and awareness. Healthcare experts urge patients to take active, informed roles in managing their health: online workshops have been developed to offer chronic disease self-management programs, which have been proven to significantly improve health statuses. Moreover, healthcare practitioners and professionals must collectively work together and utilize the new landscape of digital medical technology to their patients’ benefits.

Healthcare in the Home: Technology & Patient Care

The increase in human lifespan—currently at an average of 80 years in developed countries—is often attributed to improved medical treatments and technologies, including innovations like the discovery of antibiotics and enhanced care for once-fatal occurrences like heart attacks. Yet advancements in medical technology also impact quality of life, particularly as people age. Many recent breakthroughs have improved seniors’ ability to remain healthy throughout the aging process, while simultaneously improving home care and challenges like overcrowded hospitals and remote populations.

The ways in which technology facilitates aging in place and patient care at home include wearable health devices, the concept of telehealth, and mobile apps. Wireless and wearable devices like Fitbits, smartwatches, and other technologies can provide useful data surrounding heart rate, calories, steps walked, sleep hygiene, and stress experienced. While these devices provide information to patients, they also can be configured to automatically deliver data to physicians—who can more accurately monitor patient health and continually screen for potential risk factors or new health issues. Moreover, in addition to devices that specifically monitor health, there are now wearable devices that can remind patients to take pills or perform other necessary medical tasks. Some predict that by 2018 over 81 million Americans will use some form of wearable technology.

The technological breakthroughs in communication and connectedness have also made it possible to provide healthcare services to remote places and populations. In 2016, approximately 74% of employers offered a ‘telehealth’ option as part of their medical service benefits. Through these services, a simple video chat with a clinician serves as a bridge for patient recommendations for treatment or further care. Because those who live in remote areas cannot easily access doctors’ offices—reports indicate that the physician-to-patient ratio in rural areas is 39 per 100,000, whereas in urban areas it is 53 per 100,000—telehealth technologies allow patients to easily access quality healthcare.

Finally, the ability to easily and rapidly connect customers with workers through mobile apps helps the healthcare industry by providing on-demand services to patients in need. These services include visiting patients’ homes, helping to set up smart devices, delivering medical products and equipment, and assisting with routine tasks. Not only does the need for on-demand professional services foster and create an entirely new industry, but it also dramatically improves home patient care.

Because the constant breakthroughs in technology are consistently increasing the human lifespan, the quality of our lives gains even more importance. Wearable medical devices, telehealth, and app-enabled, on-demand services can collectively help enhance the quality of healthcare in the home.

Linking Life Expectancy & Innovation

Recent data and statistics demonstrate that overall American life expectancy has dropped for the first time in a decade, spurring an urgent and pressing need for the advent and proliferation of medical technology—coupled with scientific progress and laws to encourage innovation.

While the research points to specific factors that have lowered rates of mortality, including increased obesity, long-term unemployment, and a resurgence of chronic diseases, the studies incontrovertibly suggest the critical need to provide enhanced ‘life-saving and life-prolonging’ therapies and treatments.

There is no specific way to address the divergence of issues regarding lowered life expectancy, but there are particular measures that must be undertaken. These include enacting evidence-based policies that spur innovation, and further eliminating any roadblocks to America’s inventors.

By spearheading research that targets the most grave and life-threatening challenges in our medical and healthcare system, new resources will grow and develop, ultimately allowing for patients to access breakthrough therapies. The need for medical-technology innovation is steadily increasing, while removing obstacles to improving patient outcomes and creating high-tech manufacturing jobs remains a challenge.

We must collectively and cooperatively tackle the persistent healthcare problems that our country faces, while boosting innovation in the technological sector in order to further address medical challenges.

The World’s First Digital Medicine

U.S. regulators recently approved what is being termed the ‘world’s first digital medicine’: a pill with an inbuilt sensor that can be tracked inside the stomach, and communicates data surrounding whether—and when—patients have taken critical medication. The Food and Drug Administration are permitting the device to be used in an antipsychotic medication, with the overall goal of increased medication adherence, and the hope that the data can be used to help both doctors and patients better manage treatment.

The issue of medication non-compliance has been an ongoing challenge for pharmaceutical companies, healthcare systems, providers, and patients alike. This technology, which was developed over the past decade by Silicon Valley-based Proteus Digital Health, will be incorporated into the antipsychotic medication Abilify—which has been taken by approximately 7 million people in the United States since its inception 15 years ago.

Chief executive of Proteus Andrew Thompson asserts that the technology would allow people “to engage with their care team about their treatment plan in a new way,” supplemented by the ability to use a mobile phone to track and manage medication regimens. When patients swallow the tablet, which contains the sensor, a signal is sent to a patch worn on the body, which subsequently connects to an app on the patient’s phone: showing that he/she has taken the necessary dose. The prescribing physician will automatically receive the data; patients can also choose for family members and other providers to get the notifications. Moreover, the wearable patch has the capacity to track levels of physical activity—considered a key indicator of overall health and wellness—and allow patients to self-report mood and sleep quality.

This landmark regulatory clearance highlights the burgeoning high-tech evolution in the ways drugs are delivered, which can ultimately assist in curbing the estimated $300 billion in wasted medical spending caused by patient non-adherence. One of the bedrock pillars of the digital health revolution is making it easier for patients to comply with drug regimens, while simultaneously tracking their habits. Yet digital tracking is one of several outlined approaches to increase patient compliance; companies like Intarcia and Braeburn Pharmaceuticlas are pursuing other tactics, including the creation of implantable devices that contain up to one year’s worth of treatments for people with chronic medical needs.

Fitbit Addresses Diabetes Management

A recent article in Harvard Business Review details the ways in which digital health care can help prevent chronic diseases like diabetes. One of the most expensive and rampant chronic diseases, treatment for diabetes exacts a staggering cost of $245 billion each year, with an estimated 30.3 million people affected.

A number of digital health interventions can be used to address chronic conditions like diabetes, with the ultimate goals of reducing costs, improving patients’ involvement in their own care, and mitigating the overwhelming burden of chronic diseases in the U.S. Most recently, Fitbit has demonstrated its interest in addressing diabetes management, forming partnerships with medical device giant Medtronic and DexCom.

Fitbit CEO and Chairman James Park states that these collaborations have involved the integration of data streams from connected glucose monitors into Fitbit’s data streams, and then displaying that data on Fitbit’s app. “For a lot of people managing their diabetes, access to that data has traditionally been very difficult so just being able to have that data be able to merge into other data streams and be available in real time is an advancement for people with diabetes.”

Bryan Boda, Head of Business Development at Fitbit Health Solutions, is a featured speaker at the upcoming MedTech Impact conference. Our lineup of speakers will collectively explore the latest technologies, products, and services that can track patient progress, assist with diagnoses, prevent and manage disease, and improve overall patient care.

The Financial Potential of Digital Health

New research indicates that digital health has the potential to save up to $46 billion in annual healthcare spending, according to a new report from IQVIA (Quintiles/IMS Health). Murray Aitken, Executive Director of the IQVIA Institute for Human Data Science, describes a new landscape of healthcare, in which a model that looks across five different patient population groups has seen a proven reduction in acute care utilization–typically hospitalization–when consumer mobile apps are used.

“Diabetes prevention, diabetes care, asthma, cardiac rehabilitation, and pulmonary rehabilitation: in each of those five areas we took the results from published research and modeled that to estimate that if these available apps today were used by all patients who could benefit from them, the US healthcare system could save $7 billion per year. So that’s just for five areas. If that level of savings was achievable across all disease areas, we’re looking at annual savings of something like $46 billion.”

While there is an incontrovertible increase in terms of innovation, and increased evidence surrounding the impact that digital health can have on outcomes in addition to cost, there is also an uptick in adoption of mobile health apps. Aitken and his team report that there are now more than 318,500 health-related consumer apps available for download: nearly twice the amount from two years ago. Around 200 new apps are added to the marketplace each day.

The majority of health apps are comprised of general wellness apps, yet recent advancements in chronic condition management apps have made them increasingly popular and relevant. In addition to the apps themselves, there is a growing amount of efficacy data available surrounding the apps, based on searches on ClinicalTrials.gov. As of February, there were 869 active trials utilizing digital health technology worldwide; 540 were in the United States.

Moreover, several of the barriers to adoption that were previously restrictive are changing; as there are more publications regarding privacy and security guidelines, app formularies are being officially established, and there is a continued shift to value-based care. “We still have a long way to go,” says Aitken. “We don’t want to overstate the extent to which mobile health apps have become mainstream, but relative to four years ago, there is a lot of progress that has been made.”

Applying Artificial Intelligence to Suicide Prevention

This week, a group of researchers published a new study that demonstrates how a novel brain imaging technique can identify people who have suicidal thoughts, simply by presenting them with certain key words, asking them to reflect on their meanings, and using machine learning to analyze that brain activity.

The results of the study, published in the journal Nature Human Behaviour, challenge the common stereotype that suicidal people could change their perspective if they exerted more effort; the data suggests that suicidal feelings and thoughts are deeply intertwined with the way the brain processes information.

“Suicidality isn’t that you can’t cope with life; it’s that you’ve somehow gotten into a pattern of thinking that leads you to consider suicide,” states Marcel Just, a cognitive neuroscientist and the study’s lead author, and a professor of psychology at Carnegie Mellon University.

Just and his co-authors studied 34 young adults, half of whom had a history of suicidal thinking or past attempts, and half of whom did not. The participants were placed in a functional magnetic resonance imaging machine (fMRI), which measures brain activity by monitoring blood flow. The researchers then showed each person 30 words related to suicide and positive and negative feelings, including “death,” “desperate,” “carefree,” “kindness,” “trouble,” and “worried.”

To analyze the results, the researchers used machine learning to characterize people’s brain activity patterns: 91 percent of the time, it correctly determined which participant had a history of suicidal thoughts, and which did not. It also successfully identified which individuals had previously attempted suicide.

The analysis yielded critical information about which concepts led to the clearest distinctions between the groups. The brains of participants with suicidal thoughts and behavior had vastly different responses to the words “death,” “cruelty,” “trouble,” “carefree,” “good,” and “praise,” and most of those participants demonstrated high levels of self-reported depression that included a negative view of the self, world, and the future. “Our research shows that suicidal ideation is exactly the way you think about things,” Just says. “Something changed the way your brain and mind work.”

Though the study is small, it demonstrates the promise of fMRI used in tandem with machine learning, a novel approach that resolves some of the challenges of relying on imaging to make conclusions about brain activity. Machine learning makes it possible to observe statistically significant differences between patients and a control group, which has been difficult in the past.

Just asserts that if the technique remains successful in larger studies, it could become an important tool in helping doctors assess suicide risk and develop targeted treatments. If a psychologist, for example, had better information surrounding which concepts were altered in a suicidal patient, he/she could potentially tailor talk therapy or medication to positively change that person’s way of thinking.

The study’s results also raise complex questions about new technology that helps reveal what processes are occurring in our brains as we think. In a dystopian future, one could imagine the tool being used as a way to exclude people with suicidal thoughts or behavior from certain professional and private roles, including military service, political office, or even parenthood.

Just says the technology requires immense focus and participation from the subject, so it could not be forced on people — yet. How people decide to subject their thoughts to examination and whether that information is shared publicly will eventually become the “ultimate privacy question,” adds Just. In the meantime, he is hopeful that the technology, if proven successful, will give patients and their doctors meaningful ways to assess and prevent suicide risk. Just is optimistic in the human ability to influence and shape the brain with the right tools. “There’s no question that our brains are malleable,” he says. “They are the most powerful tool that mother nature gives us.”

NCQA Patient-Centered Medical Home: Updated & Upgraded

The National Committee for Quality Assurance (NCQA), an independent non-profit organization that works to improve health care quality, has given its patient-centered medical home ‘a makeover’ in order to “reduce documentation burdens, lower costs, and facilitate quality improvements.”

The NCQA’s move marks a growing effort spearheaded by the healthcare industry’s leadership organizations in response to new technologies, uncertainty surrounding reimbursements, and heightened reporting requirements. The organization’s recent announcement of a comprehensive overhaul will enact changes that aim to create “a much more user-friendly version of the popular practice transformation framework that avoids the pain points of previous iterations of the program,” said Michael S. Barr, MD, Executive Vice President of the Quality Measurement and Research Group at NCQA.

Due to a host of complaints from physicians and providers regarding the ‘unduly onerous’ recognition process, the NCQA wishes to reduce or eliminate costs, lower documentation burdens, and streamline some of the aspects of the recognition process that were devaluing patient care. A marked change is the abolition of distinctions between Level 1, 2, and 3; providers are now recognized or working towards recognition. The NCQA and healthcare industry realizes that ‘all-or-nothing measurements’ are not the optimal, most effective way to encourage innovation and improvement.

Moreover, the NCQA has replaced the three-year recertification cycle with annual check-ins, so that providers are not required to go through the entire recognition process again. Yearly meetings are designed to ensure that recognized practices are primarily focused on a high level of patient-centered care, and continuously improving. Each practice will also be assigned an NCQA representative, who can assist them in moving throughout the process, and also confirm and certify that the practice has met the necessary requirements.

Barr hopes that the revamped PCMH recognition process will help providers move towards a more efficient, effective way to deliver care, but admits that they will need more than yearly check-ins to succeed in an increasingly data-driven world. He urged stakeholders that it is time to “optimize electronic health records (EHRs), so that we can really align them with what we need to do to improve patient care.” Barr further clarifies that EHRs should be redesigned in order to effectively communicate the patients’ stories, and simultaneously equip providers with the necessary data to make informed, personalized, and effective choices with the patient and caregivers.

Physical Activity & Psychological Health

While research has long confirmed the strong correlation between exercise and psychological health, a recent study utilizing cellphone data to track activities and moods has confirmed that people who move are overall more content than people who sit.

While previous epidemiological studies have found that people who are active are less prone to depression and anxiety than sedentary people, the majority of these studies solely focused on negative moods. They generally relied on people recalling how they had felt, in addition to how much they had moved or sat in the previous weeks—with little concrete, tangible data to support their recollections.

The new study used a different approach, focusing on correlations between movement and the most positive emotion: happiness. The researchers also looked at what people reported about their respective activities, comparing it with objective measures of movement.

In doing this, the team first developed a special app for Android phones: advertised as helping people understand the ways in which lifestyles choices—like physical activity—might affect moods. As the app sent random requests throughout the day, during which people were asked to enter estimations of their current moods in addition to an assessment regarding their satisfaction with life in general, they also answered additional questions about whether they had been sitting, standing, walking, running, lying down, etc.

The app also asked about the users’ moods at that moment, simultaneously gathering data from the activity monitor built into almost every smartphone available today. Essentially, it checked whether someone’s recall of his/her movement tallied with the numbers from the activity monitor. Overall, the information provided by users and the activity monitors’ data was almost exactly the same.

People using the app also reported greater levels of happiness when they had been moving in the past quarter-hour, rather than when they had been sedentary—although often, they were not engaging in rigorous, strenuous activity. Researchers also found that people who moved more frequently tended to convey greater life satisfaction than those who spent most time in a chair.

The results suggest that people who are generally more active are generally happier, and in the moments during which they are active, they are also happier. While the study does not establish causation, the findings incontrovertibly indicate that if you get up and move often, you are more likely to feel cheerful than if you do not.

Virtual Reality & Pain Reduction

Virtual Reality (VR) has been increasingly used to manage pain, trauma, and distress–particularly during painful medical procedures–as investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting “an array of emotional affective, emotion-based cognitive and attentional processes on the body’s intricate pain modulation system.” While originally recognized for its entertainment value, the application has expanded to a number of clinical areas.

A study conducted by Cedars-Sinai using virtual reality therapy, during which participants wore virtual reality goggles to watch calming video content, indicated that VR may be an effective tool in addition to traditional pain management protocols. Moreover, VR gives doctors more options than solely medication or pharmaceuticals.

More recent research tested real world dental procedures, using circumstances that included a cold pressor lab setup and virtual reality headsets. The participants were immersed in two differing environments: a calm beachside walk, and a busy urban situation that was rife with distractions. The calming scene was significantly more effective in terms of improving the ways participants experience and remember pain, during tooth extractions and fillings.

While the data is not unpredictable, the study points to the fact that it is important to discern what types of virtual reality environments are effective in alleviating pain. Perhaps more importantly, future variations may include certain virtual situations that are better at reducing pain in other procedures.