The IoT of the Healthy Home

Imagine a world where your home nurtures your health and wellness. If you develop a chronic illness, where you live will be your care-giving hub. Home appliances and your bathroom and bed will know you, and your kitchen will anticipate your preferences and feed your health based on medical needs and taste profile.

That world is fast-evolving. This is not a surreal Stanley Kubrickean future.

In February, I attended a four-day marathon meeting known as HIMSS, which is the acronym for the Health Information and Management Systems Society. That’s an arcane name that goes back decades, but in shorthand, HIMSS is the membership organization for people keen on healthcare and technology – traditionally, information and communications technologies that are adopted and used by hospitals and clinicians.

Today, information and communications tech segments are blurring into new-new things, like smart home assistants, mobile apps, and cloud-based stuff-as-a-service (analytics-, software-, telehealth-, and other permutations of ‘as-a-Service’ offerings). And increasingly, these services and things are used by patients, consumers and caregivers in their homes, outside of the bricks-and-mortal healthcare system.

I had a brainstorm during HIMSS Dr. Kaveh Safavi, who leads Accenture’s global healthcare practice, on the state of the health-tech landscape. We deduced that we’re entering a new era we’ll call Health-As-A-Service (HaaS). Services that fall under this umbrella term will enable a broad and deep range of products and services for health and health care to be delivered to people wherever we are. The mantra among my public health tribe members is that health is made where we live, work, play, pray and learn, as the Robert Wood Johnson Foundation coined back in 2011.

With HaaS, people – consumers, patients, caregivers – can all make health with other people, who might be doctors and nurses, clinical coaches, wellness and athletic coaches, nutritionists, friends and family, other patients, and virtual assistants (more on those, below).

My HaaS concept was informed by my learnings at #HIMSS17, along with my recent experience at CES 2017 in Las Vegas which featured several hundred digital health products and a growing array of smart home and Internet of Things innovations, from connected cars to smart refrigerators. [I covered #CES2017 for health here in the Huffington Post].

The HaaS vision begins, first, with networks and platforms. This is an always-on world that must be redundant and resilient. It’s not just enabling video-gaming and entertainment (as fun and stress-relieving as these activities might be): the networks are supporting health and life. The Qualcomm 2net platform is one of the emerging enabling technologies that has developed to support HaaS. Qualcomm 2net is built to be HIPAA-compliant and already supports an ecosystem of dozens of healthcare devices, applications and tools.

Over the network, an array of health and medical devices, apps and digital tools can link, send and share data that can liquidly move into analytics services. Philips participated at both the CES and at HIMSS, with products that bridge both consumer home and daily living to professional/clinical medical worlds. Jeroen Tas, newly-appointed to Philips’ Executive Board in charge of strategy, wrote an essay just as HIMSS 2017 opened called “The Hospital of the Future Is a Network;” Tas describes a vision of a community embedded with sensors that accumulate data points about health citizens and continuously learn about us. The objective: to anticipate a person’s physical decline and to intervene before the onset of acute illness, such as a heart attack or a fall.

Both CES and HIMSS featured hundreds of consumer- and clinician-facing medical “things” in the Internet of Things landscape: for consumers, digital weight scales, activity trackers, blood pressure monitors, smart beds, sleep tech, digital tools for dealing with mental health and pain, and those connected cars which are integrating sensors for observing stress and medical metrics. On the clinical side of tech, featured at HIMSS, there were ubiquitous electronic health records, clinical imaging modalities, and telehealth providers, among other devices and services that generate data about peoples’ health and illness.

Two categories of consumer-facing suppliers exhibited at HIMSS are newer entrants to traditional healthcare technology: telehealth and digital home assistants. Telehealth has been part of healthcare for two decades, but until the past few years has been stuck in a pilot-itis phase with challenging reimbursement and payment models. Over the past three years, we’ve seen more payors reimbursing for these services, along with more employers insuring virtual healthcare services as a covered benefit. Together, following this money has led to greater adoption of telehealth services by health insurance plans, healthcare providers, and a growing number of un- and under-insured consumers (the latter in high-deductible health plans or paying for health services at full retail, out-of-pocket).

Several major telehealth providers participated in HIMSS this year: American Well, MDLIVE, and Zipnosis among them. I spoke with leadership from these three companies, and each has a differently nuanced approach to the market. The key takeaway here is that consumers, now payors, are seeking more convenient ways to access healthcare services: say, to solicit a doctor’s opinion on Sunday afternoon, or a behavioral health consult with a therapist for someone who lives in a mental health desert.

To help streamline that patient-consumer’s experience in a retail health landscape, Zipnosis announced a partnership with PokitDok to provide claims processing for patients in the MultiCare Health System. Zipnosis provides the virtual healthcare platform for the system’s employees, and PokitDok providers a seamless claims process back to the payor. This pleases patients on two levels: people receive just-in-time care, and do so with reduced hassle in payment processes. Patients, now health consumers, are looking for this kind of friction-free retail experience as they take on more of the cost of care.

The new-new thing at HIMSS this year was the emergence of digital home assistants with health care smarts. Note that Echo devices sold out on Amazon over the 2016 holiday season: this technology is going mainstream, fast. These devices were featured as generic home assistants at CES. But at HIMSS, Orbita showed off their healthcare connectivity with Amazon Echo, Google Home, and a new link-up with Lenovo Health. Orbita’s team comes out of the software world, not healthcare. They built their capabilities based on personal experiences: at least two people on the leadership team have family members dealing with aging, so their development ethos is built on personal passion with deep experience in technology and user experience. Orbita’s first applications are designed to support aging people at home, using voice-first: “Alexa, tell me what day it is,” someone with growing dementia might ask. Or, “Alexa, when should I take my next Coumadin pill?” for medication adherence support. This patient might need some cheering up due to loneliness, so she could command, “Alexa, play me some Willie Nelson,” as she needs a musical lift in the moment.

All of these devices and care encounters generate patient data, and data has been said to be the new oil. But “where are the refineries?” a recent Deloitte report asked. HIMSS hosted dozens of data analytics companies, from IBM Watson Health and SAP to smaller companies tightly focused on healthcare analytics and the growing field of population health. These are the data crunchers that take the sensor and digital data bits, mash them up into algorithms, and sort out any number of issues – say, how many people with Type 2 Diabetes live in a particular zip code, and whether there’s a food desert and primary care available there; or, what’s underlying a propensity of children to be sick and newly-developing learning issues, embodied in the Flint water crisis.

So the platform and network are in place, and devices, services and apps scattered throughout a person’s community, accessible at home, in the car, or via mobile platforms. Data is generating from these things 24x7 based on a person’s activities, movements, consumption, and clinical metrics. What’s the value of this network, and all the data that’s generated?

Here’s one general scenario: at home, at work, at a party, or otherwise on-the-go, our consumer receives a message (a text, a call, a voice from a home assistant, an alert of some sort – the communications form of which is based on her preference). That alert comes to her based on data that converged from various sources, combined in algorithms, and converted into a single piece of information that may recommend an action: say, to eat, to check blood pressure, to take a walk, or to head to the nearest emergency department. If the algorithm makes an acute assessment, an ambulance may be sent directly to our consumer, or her connected car may drive her to the closest ER based on an imminent, anticipated acute episode.

The biggest challenge, which is not trivial, is the assurance of privacy and security. Cybersecurity is a hot issue these days in healthcare: personal health information is much more valuable to hackers and “data kidnappers” (aka data ransomers) than our financial data. The Health-as-a-Service world requires trust. Trust is a key enabler to health engagement.

Lack of trust could be a limiting factor preventing mass adoption of digital health services (Haas), challenging both individual health citizen-consumers as well as institutional players like the insurance and re-insurance industries, clinicians and hospitals, and regulators. Data is indeed a valuable currency, and can easily travel globally, instantaneously, in a networked world. We must consider risks/rewards, and we must be mindful and artful in mitigating risks.

On the upside, a crucial use of health IT can be to boost the social determinants of health – and mitigate negative ones – to promote health and prevent illness. Doing so can scale health in communities. This opportunity was illustrated in a profile of Judy Faulkner, CEO of Epic, published in the HIMSS Daily Insider dated 22 February 2017. Faulkner talked about Dr. Mona Hanna-Attisha, a physician who worked at Hurley Medical Center in Flint, Michigan, who used the Epic EHR. The system played an all-important role in helping to identify the extent of the Flint water crisis. “If we did not have Epic, if we did not have EMRs, if we were still on paper, it would have taken forever to get these results, Dr. Mona Hanna-Attisha was quoted as saying.

So we come full circle, with technology underpinning health where we live, work, play, pray, and learn. The best medical home is home, and we are getting to that Holy Grail sooner rather than later.

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