Disconnected Health

Disconnected Health

Roadblock to connected health outcomes

Flying to the American Telemedicine Association (ATA) annual conference in Minneapolis, as the CEO and Founder of Tactio Health Group, a leader in remote patient systems empowering patients with mobile apps and connected health, you may wonder why I would write an article with such a title. And you are very right about that. While I am a profound believer in a lot of the revolution in healthcare that started a few years ago and is taking place worldwide today. That revolution has been fuelled by the ubiquity of smartphones and tablets, the advanced science of biosensors being productized by innovative tech startups and the sheer demand of baby boomers wanting to age younger and healthier,  thus taking responsibility to change their behaviour and ward off chronic diseases.

On the face of it, it sounds like every possible ingredient is right there today for the perfect storm--with all that connected health promises.

At Tactio we've spent countless hours designing, building and maintaining a complete system for patients to enjoy, take ownership of their health condition and start living in a new relationship and access paradigm with the healthcare world around them.  We have worked not only on the technology but also on the data security compliance, the regulatory aspects and other components, and we've connected the technology and policy requirements, with a lot of moving targets in turmoiled evolution over the recent years.

Herculean work, you could say, but we're far away from done. Despite the elephant in the room that I reveal in this article, the future of healthcare is too fascinating to give up on challenges, so we are carrying on the mission full steam ahead!

Smartphones and tablets 

For that revolution to happen we were counting on Apple and Google to make smartphones and tablets widely available. With more than a billion active devices worldwide, it was just a matter of time before the whole world has mobile Internet access, living 24/7 with a tiny yet powerful computer they can hardly think today of living without. Think about it. Apple introduced the AppStore in 2008, just 6 years ago.

Remember going to EggHead to purchase software on floppy disks with all the painful, geeky install process that was not always collaborative to stay polite. That was only 20 years back. My children barely have a clue what installing software means, yet they do it many times daily each time they download an app. Yes, after Microsoft making computing personal in the 80s and 90s, Apple and Google truly made the computing world smarter, easier and mobile. They've done their part for healthcare and are continuing to do so today providing us instant, always on access to the entire knowledge of mandkind in the palm our our hands.

Self-care patients 

For that "self-health" revolution to happen, we were counting on patients worldwide to get onboard the train and start engaging themselves in self-care by taking charge of their health, buying connected health devices, see the benefits, and start evangelizing the world around them. With more than 4 million  Tactio health app downloads, we've seen real patients getting an app, starting to track and embrace a new relationship with their data, lifestyle and habits. Not everyone got connected health, but lots of patients engaged with the new digital health logbook technology and feedback system. What's incredible is that with the sheer number of people trusting Tactio to safeguard their data and bring them further in this connected health journey, when we look at the Tactio community population stats, we get precisely the same numbers as the World Health Organization does for percentage of the population with diabetes, hypertension and obesity. Without any study or advertising.  And our numbers are not from a few years back, they are live! Every morning when someone using a Tactio platform weighs himself, our population health stats take this new data point into consideration.

The numbers are so valid that we are seriously thinking of publishing them, live, of course. So, we can say that patients worldwide have done their part and provided all the contribution we needed to move the mission forward, even sometimes suffering the inevitable tech issues along the way :-).

Productized biosensors

For that revolution to truly happen, we were counting on the biosensor technology to surface, get productized and be widely available. That development started 40 years ago, when patients who went to their doctor to have their blood pressure taken started requesting a BP cuff for themselves. Retail pharmacies saw the trend and started to offer personal BP cuffs. And would anyone today set up a doctor's appointment merely to get a BP reading—and risk having that reading distorted by white-coat syndrome?

Today, we're witnessing accelerated demand for the personal health measurement devices we collectively call biosensors. Patients want to self measure to track themselves or take control their health condition. And they want to do it in the comfort of their home, or at the convenience of their new mobile, on-the-go lifestyle. Among the emerging biosensor manufacturers, market leaders such as Fitbit and Withings have emerged, and consumers have been buying the companies' activity bracelets and scales and a a bunch of other smart connected objects they've produced.

 These products, which today appeal primarily to technophiles and fitness enthusiasts, have made it to the retail stores such as Target, Best Buy and Sports Authority. But can you get them at your local pharmacy? In a few, such as Walgreens, yes, but pharmacy chains haven’t yet moved into this market to any significant extent.

We also hear at least weekly about new biosensors, like the Google lens for diabetes. So what's clear is that the biosensor manufacturers have done their part to fuel this healthcare revolution. And now we're seeing those companies' effort convince the incumbent healthcare diagnostic manufacturers to enter the market and start converting their popular self-measurement devices to work with connected health technology. As a case in point, Roche, Abbott and J&J have all launched connected health glucometers. Even Welch Allyn established in healthcare since 1915, has gotten into connected health with its new line of remote patient monitoring scale and BP.

Healthcare services 

For that self-management revolution to really take off, we were counting on the healthcare services to get onboard. We wanted to connect the healthcare payers and providers with patients everywhere so that patients would not only have the ability to have a connected, live, mobile health logbook, but that the logbook would also be connected to their healthcare provider. And that provider would, in turn, give patients access to services, monitoring, and advice on their data, lifestyle and chronic conditions in a totally new, secure, personal and mobile way.

Well, that too has happened! Indeed we've found innovative, far-sighted organizations from hospital systems to health insurers and pharmacy chains embrace the model and link their professional services to a new connected-health patient population. And patients like it! We've even seen elderly patients in a senior residence in Quebec embrace this new paradigm. Results were so impressive the pharmacist even presented his results at Stanford MedX last September.

Telemedicine

Telemed projects have been clinically validated as providing better outcomes, but they've traditionally been hardware focused and deployable to the top 3% to 5% of patients costing the most to the healthcare system. Now, the newer programs are embracing mobile technology and connected health to deploy the telemed benefits to a much larger rising-risk population, yet at a disruptive fraction of that price since using the patient's devices. And what we have now is a staggering number of aging baby boomers just underneath the top tier of the Kaiser pyramid of care—and no healthcare payer wants to see this population get to the top and start generating huge chronic care bills. Slowing down the aging process, changing habits detrimental to health to in essence "revert the clock" and prevent onset of chronic conditions is the only way to save healthcare costs in the future, and the technology exists today to deploy telemed-type solutions to the mobile-connected mass!

A sign of hope that the policy side starting to do its job in fueling the revolution... CPT code 99091 allows providers to be reimbursed by Medicare for remote patient monitoring of chronic conditions through a monthly unadjusted non-facility fee of $56.92.

What's missing?

If almost everything that needed to happen to fuel the revolution has happened happen, why is the connected-health market still not where it should be, helping us all in our daily lives, and making it easy for our aging mom and dad to self-care? Why hasn't the healthcare system turned itself upside down into a massive prevention system, saving the growing, unsustainable healthcare costs that every payer, every government wants to avoid? Costs are skyrocketing and the trend is unsustainable unless we start mobile, connected and massive prevention programs immediately.

So what's that roadblock? Retail. Retail is the answer. Fitbit has mastered the retail problem and made its products available worldwide. But Fitbit until now is far more into digital fitness and wellness than chronic disease management and healthcare prevention. Think of yourself as a patient, a 50+, 60+, 70+ patient who needs a scale, a BP, a glucometer and an oximeter. Where would be the natural place to find these products with professional healthcare advice? The obvious answer is your local pharmacy. Pharmacists are available, and could very well help you select the right one or supervise a tech-savyy clerk to help. The considerations for that purchase are as much technology related as healthcare related. Does it work on iOS and Android? How long is the battery life? Are the measurements reliable? Is it approved by the health authorities? Is it covered or reimbursed by your insurance plan? How does it connect to your personal connected logbook? Which one does your pharmacist recommend?

Retailers are great at making products available to us but without a pharmacist they simply can't offer that type of service. Pharmacies do. They already sell scales and BP cuffs,so why not sell all the devices patients need, and why not make all the best connected ones available? Still, that is only one piece of the problem. Imagine Apple having launched the iPod without iTunes... Or the iPhone without the AppStore!

Yes, pharmacies need to see themselves as the biggest retail problem today in connected health. And as Einstein once said, "opportunity lies in chaos." Indeed, this problem is in fact a huge opportunity to unlock the self-care revolution and make it available to the masses. The 1789 French revolution was the one of the people. This 2010 healthcare revolution is the one of the patient. As Dr. Topol said to the healthcare world in his last book... "The patient will see you now." 

Walgreens and CVS are trying to move forward with connected health, but the effort still isn’t organized enough to enable patients to find what they need, to get connected and to use the technology. Pharmacies should create an ecosystem of services and train their pharmacists on the technology, so that it can spread to the masses. Target is soon launching a connected-health space in 500 stores. If Target pulls it off, that might spark the change that is required. But if they don't, the initiative could flounder--like the FNAC French retail chain that has a Connected Objects space in all its outlets but has neither the health focus nor the needed support services and ecosystem around it. So patients, particularly elderly ones, can't never find the connected-health devices they need even if those devices exist and are readily available.

Until the retail pharmacy starts fixing the issue, the connected-health market and its huge potential to serve as a massive prevention program to save our healthcare systems from financial collapse, will stay disconnected from the most important person in the entire healthcare system today: the patient.