Bringing it Together & Getting it Right.
The Open Digital Health Platform
Digital health solutions today are developed as closed platforms – with a major lack of standards for interoperability. Over the past 10 years, organizations such as Continua, (now part of the Personal Connected Health Alliance) have been working hard to implement interoperability standards. Unfortunately, a major barrier to that effort is the reality that solution companies have their own interests and may have to deal with additional regulatory scrutiny and costs to deliver new or updated products to market. It really comes down to a short-term vs. long-term play. Short-term agendas have won out in the past due to an emphasis on short-term targets and short-term financial gains.
The greatest benefit of Digital Health as a Service (DHaaS), is that it provides a highly scalable, agnostic healthcare platform that can overcome the pains of integration and scalability. In order to scale, this healthcare platform must provide the highest levels of security / privacy and interoperability standards – including HIPAA compliance and FHIR (pronounced “fire”: Fast Healthcare Interoperability Resources). The difference between Continua and the DHaaS platform is that the platform doesn’t require the digital health solution to adapt to a specific format. The platform absorbs the different digital health solution’s characteristics and transposes them into a standard format, thus the platform becomes a buffer, taking on the necessary changes and the interoperability hit instead of the individual digital health solution, which saves a vast amount of time, money and regulatory concerns.
Moving from Product to Service Offerings
Many companies are now trying to move from a stand-alone product to an integrated product + service offering. If the product offerings are not quantified, aligned and integrated into a platform, it’s much more costly, and less efficient to wrap services around those offerings. The DHaaS platform allows companies to take these disparate offerings and integrate them into a single, more comprehensive and stratified solution. No more “one-off” solutions – instead we have a “one-stop” digital health catalog that provides the best solution fit for a cohort of patients.
For example, medical technology giant, Medtronic has acquired many companies over the years and they currently have an objective to increase services built off of their current product offerings. Beyond their existing cardiac implantable device offerings, they’ve recently aligned with Canary Health (digital health self-management programs), acquired CardioCom (remote patient monitoring / management), acquired Covidien (medical product maker), and they maintain an enormous diabetes division with MiniMed and over 1.5M CareLink connected hubs in 100 countries throughout the world. In addition, they have multiple Connected Health initiatives ongoing. For Medtronic to move from a product company to an integrated product + service provider, they need to quantify the solutions they have, align them with patient and customer needs and provide a comprehensive service offering based on the integrated platform. Digital Health as a Service (DHaaS) in a single integrated platform that can help major enterprise customers quantify their offerings and streamline the move into services.
Health Automation Engine
Healthcare systems are now financially responsible for discharged patients at 30, 60, 90 days and beyond – they have a critical need to provide these patients with affordable solutions to stay connected to the patient to keep them from returning to the hospital.
A number of hospital systems have set up “Health Cafés”, so that upon discharge the patient can be prescribed a solution to stay connected to their care team from home. The challenge isn’t just knowing which offering to prescribe to specific patients – the care providers need to know if the solutions work across a broad population, if the Digital Health vendors are integrated with the system, as well as how the solutions are billed, paid and reimbursed.
The Digital Health as a Service platform provides a “Health Automation Engine” that sits between the Health Café and the DHaaS platform to help align and distribute the right solutions to right patients. If structured correctly, the Health System would send an automated ADT (admission discharge transfer) record to the Digital Health platform and an integrated vendor solution is distributed with a properly aligned patient, and billed to the customer with minimal or no additional effort from the hospital system.
Procurement for Digital Health
One of the key attractions of the Digital Health as a Service platform is the ability to act in a streamlined procurement function for the Healthcare Systems. Because integrating hundreds of vendors is expensive and time-consuming, the Healthcare System will choose only a few solutions for each disease state. If that vendor should go out of business or is acquired, the Healthcare System is at risk of losing their only vendor for a particular solution.
The DHaaS platform allows for multiple vendors addressing the same disease state and population to be on-boarded easily and cost effectively. The platform will also further quantify their services and pricing to help identify and provide alternate solutions, as well as curtail costs.
As part of the quality and procurement function, the vendors are on-boarded using specific criteria. They’re gauged against a checklist, rated, integrated and contractually bound. This takes the burden away from the Healthcare Systems so they can focus on patient care and not the technical logistics and procurement functions.
Life in Context
It’s reported that 56% of hospital and ER admissions are related to social issues. In the previous 10+ years of remote patient monitoring efficacy, most of the data being presented to the analytic systems was biometric (ex: FEV1 = Severe COPD) and some behavioral (ex: Meds = Not taken). In the past, this information would prompt a phone call to patients with reminder to take their medication.
But, what if we could bring in other information that is now starting to become more readily available such as social engagement, home automation data (climate and security), indoor / outdoor air quality and other factors? This additional information would provide valuable new context to biometric data. The DHaaS Platform can integrate connected health devices as well as other IoT devices in the cloud to help provide more insightful and comprehensive care to the patient. Life365 is partnering with Citrix/Octoblu specifically for this type of data, which will provide deeper understanding into changes in patient conditions. Was a change purely physiological? Has there been a difference in engagement patterns because of a change in social factors? Have cold temperatures or decreased air quality acerbated a condition? Perhaps a simple phone call or home visit from a professional or family caregiver could prevent a medication adjustment or hospitalization, or maybe their electric bill needs to be paid.
Connecting to a patient at this level gives the ability to look at a broad range of biometric, behavioral, environmental, social, regional, economic, cultural, consumer data and more. The Digital Health platform allows individuals to present their lives in deeper, richer context that enables better interventions and outcomes.
The Binary Option / Exception Based Processing
Very simply put, because of the nature of new financial models, those financially responsible for the patient need to do more with less. Scaling solutions that work, to a broader population within the mid to moderate risk populations in a “lite” way is becoming a more widely accepted mindset. “Lite” solutions will provide the largest impact and benefit to the healthcare system.
One way to get lighter is through the use of smaller, smarter and more cost effective sensors. These solutions can be utilized in more creative ways – for example in an “off label” and “binary” approach. I’ve heard stories about family caregivers placing activity trackers on their older parent’s wrists – not to monitor their specific number of steps, calorie burn or heart rate, but simply to see if they have a heart beat, did they get up this morning, are they’re moving more or less than usual, and are they active and engaged. Deploying this type of first-step “binary” / exception based processing approach to engagement and adherence provides the “lite” touch with simpler types of data – but still very useful information. This data can be enhanced by the Digital Health Platform, driven by an Engagement Analytic / AI engine to help care providers more efficiently gauge trends and adherence. For example: Patient A has a heart beat, is moving the same as last week, is taking medication regularly, and is socially engaged = No interaction is needed – leave them alone. Patient B is not within their normal data parameters or expected patterns, the System’s Exception Based Processing is used to help determine an intervention – additional equipment, solutions or services may be needed to gather more data or different information to provide better analysis or a change in therapy.
Imagine the extreme cost savings if an enterprise could monitor 70% of a patient population using “lite” solutions and only having to address 30% with a heavier touch, more robust solutions. Imagine if we could start leveraging a wider range of existing solutions, from consumer wearables to apps and gamification, all on the integrated Digital Health as a Service (DHaaS) Platform to provide the healthcare arena with a new first line of defense in monitoring and engaging their moderate risk populations and keeping the numbers of people who require more expensive and complex care at a manageable level.
The Time is Now
The time is now to bring the available Digital Health solutions together onto a common platform in order for the industry to scale and meet the demands placed upon it by the Healthcare Systems to achieve interoperability, access to cost effective data and to make the financial models work.
The Digital Health market is estimated to be $233B globally by 2022 (21% CAGR). The Mobile Health market is estimated to be $49B globally by 2022 (47.6% CAGR). The market and potential is obviously there and growing, but in order to scale, quantification, integration and alignment is required.
The time is now to build upon the successes of the past 10+ years, allowing the healthcare industry to scale outside of the hospital walls and move point of care to the home. The Digital Health as a Service (DHaaS) platform is a necessary and integral component to achieving scalability in both patient outcomes and financial success.
Until next time.
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