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Focus on infrastructure to support the most disruptive changes to health care; home hospital care

By Andrew Rosenberg MD, Chief Information Officer, Michigan Medicine

As we witness the remarkable and unprecedented acceleration of telehealth, our industry must harness emerging technologies to support new models of care. There is no better place to do this than from patients’ homes. How we provide acute and chronic care management, digital diagnoses, and aging in place services to patients from outside locations is now our key challenge.

Consider a 65-year-old patient with heart failure and pneumonia. Typically, we would admit this patient for vital sign monitoring and active treatments; all of which are now possible to do at home. Measuring the patient’s vitals as well as more sophisticated parameters, such as oxygen levels, work of breathing, weight, and fluid balance, can all be accomplished through digital devices from the more patient-centric approach at their home. Even treatments such as administration of oxygen and IV infusions are increasingly available to home health professionals. Yet, we face numerous technology infrastructure hurdles to conduct these in patient homes — WiFi, bandwidth limits, reliable data transmission, and the power required to run the devices.

To advance hospital-level care at home, we will rely on distributed sensing and computing devices, as well as the use of new telecommunication spectra. Wearables, biometric monitoring, and virtual health assistants can compute, analyze, and even act autonomously. New 5G networks, operating as much as 100x faster with more reliable data flow, will also play a significant role.

Fundamental advancements to enable sensors to operate collaboratively and cohesively with data collection and transmission innovations will evolve. In the meantime, health system leaders can prepare the groundwork through connected command and capacity centers, pilot deployments of IoT solutions in more traditional care settings (hospitals, clinics, etc.) as well as home. These efforts will also improve IT units’ knowledge and develop their expertise in emerging standards, electronics, and other device technologies.

As devices become more adaptive, integrated, autonomous, proactive, and patient-centric, organizations must prepare to receive and act upon enormous increases in volume and types of data.

Andrew Rosenberg MD, CIO, Michigan Medicine

Health systems tend to purchase patient monitoring and management devices in isolation. To manage a more complex integration of IoT and data transmission, they will need a more comprehensive plan. Where available, most health systems use devices with high information latency. Decisions tend to be made retroactively relative to when the information was first collected and knowable. The relatively few devices that could continuously monitor patients’ vital signs from home are often stand-alone, isolated by narrowly defined clinical intent, and often managed in a distributed fashion by non-enterprise IT. Often, these devices are based on an individual clinician’s specialty and rely on the limited 4G/LTE cellular transmission due to the inherent inconsistencies and lack of home WiFi networks.

As devices become more adaptive, integrated, autonomous, proactive, and patient-centric, organizations must prepare to receive and act upon enormous increases in volume and types of data. Both real-time data and analytics will evolve to predictive and prescriptive smart systems requiring dynamic capturing of patient event data, automating event-driven responses, coordinating critical workflows, orchestrating entirely new workflows, and engaging with the patient across care venues.

Gartner estimates 22B IoT devices will be connected by 2025. Healthcare IT leaders will need to blend new, best-in-breed devices with those that are more cohesively designed to work together even if they lack some features.

Driving innovation with machine-to-machine and other connected devices relies on the development of new telecommunication standards, electronics and infrastructure, and a wide range of network technologies. Real-time information sharing, location-aware, and edge-computing methods will allow a vast range of commercial and personal devices to change paradigms of care.

Speed coupled with much higher data capacity means 5G can support the additional capabilities required for home hospital care. Among these, the ability for IoT devices to process or pre-process data, perform advanced analytics faster and more accurately sense and respond with fewer errors; in a phrase to make ‘edge’ computing pragmatic and affordable.

The development and implementation of full-featured and more ubiquitous 5G is complex and will take years to be sufficiently mature across communities. The first standards for 5G released in 2018 by the international standards organization (3GPP and ITU) were the basis for the limited use of 5G by the largest commercial cellular providers. The second set of standards is anticipated for final release in Q4 of this year. Expect significantly more advanced features based on multimedia priority services, satellite access, LAN support, and network automations. Subsequent releases (Release 17) are planned for early 2022. It is estimated that 5G will still take 5-8 years for complete deployment.

Additional hurdles for healthcare leaders to consider are increases in the security of using these networks, issues related to electromagnetic interference, intellectual property rights as well as unsubstantiated conspiracy concerns with 5G radiation.

The recent pandemic has no doubt accelerated virtual care models. These new models, and many others, require a solution that engages consumers, integrates with consumer health devices, and influences consumer-directed activities while being a seamless part of a provider’s existing care delivery systems.

There are numerous opportunities for novel care delivery through care at home capabilities. Patients want to be cared for at home, and the ability to extend the expertise and abilities of a real-time health system through some of these new technologies should be more commonly encountered. The fabric of IoT, edge computing, and 5G will undoubtedly be at the forefront of many of these efforts over the next years. IT leaders and their operational counterparts must create opportunities now for small pilots and experiments to do this with existing and emerging technologies in partnership with patients, payers, and policymakers.

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