You’ve probably been inundated by new technology electronic health records, patient portals, and computerized provider order entry systems, to name a few. You may have had your fill for the time being, but more new technologies are on the way. These new technologies will, ideally, automate tasks and help you recapture time with patients.
As we are increasingly living “in the cloud”, the lines between hardware and software are blurring. But the term technologies encompasses more than hardware and software. It is broadly used to indicate computer code, devices, monitors, servers, databases, algorithms, and the structure of their interactions on different platforms.
Which of these new technologies in the pipeline will have an impact on your practice, and which are likely to fade away? Let’s take a look.
Technologies That Are Here or Almost Here
Want to publish your own articles on DistilINFO Publications?
Send us an email, we will get in touch with you.
You will see these technologies shortly, if you haven’t already. They might be called something different but will almost certainly make up part of your day.
Telemedicine. The American Telemedicine Association defines telemedicine as, “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” A broad term, telemedicine concerns the remote diagnosis and treatment of patients. A common example is a doctor using a smartphone’s video and voice features to speak with a patient who is located across town or across the world. The technology exists, but a basic organizational structure and insurance reimbursement need to be in place before adoption becomes widespread.
Remote patient monitoring. RPM is sometimes included with telemedicine under the umbrella term, “virtual health.” RPM uses sensors placed on the patient to remotely monitor the patient’s vital signs and more. Examples that are gaining traction include chest-worn devices that sense fluid accumulation in heart failure patients; intelligent beds that detect pressure and suggest turning the patient to avoid bed sores; smart bandages that anticipate impending wound infections; and pill packs that record regimen compliance. Integrated delivery systems are the first adopters of RPM, but its use is expected to filter down to hospital-owned practices as the technology demonstrates improved outcomes and cost savings to hospitals and insurers.
“Internet of things.” This term refers to the networking of smart devices. These devices collect, manipulate, and transmit data in an evolving ecosystem that includes more than just medically oriented hardware. Examples include digital blood pressure cuffs and blood sugar monitors that transmit information over the Internet for use with electronic health platforms, such as EHRs, to the clinician.
The barrier between healthcare monitors used in RPM and consumer fitness bands like Fitbit™ will likely dissolve in next few years, with patient information being transmitted to clinicians from both types of devices.
Luckily, clinicians won’t have to analyze all of these incoming data. As the infrastructure evolves, data analysis may be performed by third-party technicians or software, whose job it is to alert physicians if there are worrisome signs.
Patient-generated health data. The flip side of the Internet of things is the patient data that result from these devices, such as readings from wearables, activity trackers, monitors, and apps. Currently, clinicians use little of this information because it is voluminous and unvetted. That may soon change.
One reason: the American Hospital Association, the American Medical Association, and the Healthcare Information and Management Systems Society have teamed up to evaluate apps for safety and effectiveness.
Another reason is that the Office of the National Coordinator for Health Information Technology has mandated that these data be uploadable to EHRs.
In addition, innovations like Apple’s CareKit™ and HealthKit™ are making it easier for patients to collect their own sleep, health, and activity metrics. Software vendors will need to develop apps to bring digestible, accurate, timely, and relevant vital-signs readings to the clinician’s attention.
Technologies That Are at Least 2 Years Off
Researchers and companies are working hard on a number of new technologies, but frontline doctors are unlikely to see them because they will work behind the scenes of digital systems. Expect more uses in medicine over the next 2 years.
Artificial intelligence. AI includes natural language processing, machine vision, and machine learning. This type of software is increasingly able to perform actions formerly ascribed only to humans, such as understanding voice and text and independently learning new tasks and solving problems.
For example, a patient taking anticoagulation medication who is monitored by a wireless ECG monitor for atrial fibrillation may develop cerebral T waves in response to an intracranial hemorrhage. It would be a liability to have the ECG data without the manpower to identify the new change. But with wireless ECGs expected to become ubiquitous, not even an army of clinicians could comb through the deluge of data that will result.
This is where AI tools such as machine vision and machine learning can help. These tools learn to act in concert to detect the T waves, check them against a compendium of pathophysiologic waveforms, and alert the clinician to the possible bleed.
Such a system is a quantum leap beyond basic threshold alerts of telemetry systems. These tools, which mimic human cognition and have the potential to open the data bottleneck, are necessary to offload some of the manual chart review of exponentially increasing patient data and can literally help save lives.
Predictive analytics. Overlapping AI, predictive analytics refers to the software businesses use to analyze trends and to make predictions about the future. Think of them as clinical prediction rules, such as the thrombolysis in myocardial infarction score for non-ST-segment myocardial infarction but much more powerful.
As software dashboards become more commonplace, expect to see them show predictions about the probability that a patient with chronic obstructive pulmonary disease will be readmitted or how a patient’s blood pressure may respond to an angiotensin-converting enzyme inhibitor. Similarly, you might receive an alert about a patient who is anticipated to require intensive care unit admission in the next 36 hours.
While great clinicians often have uncanny insight into which patient is sickest or what the best treatment is, not every patient is lucky enough to have an experienced doctor at the bedside at all times. Predictive analytics provide physician-level insights during nights and weekends.
As these technologies mature, they will help guide the clinician’s medical decision-making, similar to how more recently adopted technologies, such as CT scans and EHRs, do today. While these technologies will never replace clinicians, they will help deliver a high level of patient care.
Technologies That Are 5-10 Years Away
Several interesting and potentially paradigm-shifting technologies will take at least 5-10 years before their adoption in healthcare is widespread.
Blockchain. Some experts expect blockchain to be as revolutionary as the Internet itself. This technology’s secure data structure enables all kinds of transactions to take place without a trusted authority—such as a bank or insurance company—serving as middleman, allowing two people to trust one another without ever meeting.
The most successful use of blockchain technology is Bitcoin, a digital currency. Possible uses in medicine include drug discovery, patient identification, insurance claim simplification, and collection of data on patient-reported outcomes. Some experts believe that blockchain technology will eventually make global interoperability among different healthcare data systems possible, making modern EHRs seem antiquated. Currently lacking a robust infrastructure, however, this technology is years from common use in medical practice.
Augmented reality (AR). AR layers digital images or sounds, and usually additional information, onto the real world. For many years, AR has been used in medical education by layering text over anatomic structures. Recently, the game Pokémon GO grew extraordinarily popular by placing virtual figures around the country for “capture” by game players. The figures could only be seen through an app.
Future uses of AR may include vital signs pushed to a head-worn display during a cardiac arrest, facial recognition for patient identification in a crowded waiting room, and environment-scanning to locate the last pair of size-nine gloves in a stock room.
Virtual reality (VR). VR immerses the user in a simulated world. In one iteration, named “diversional therapy,” pain researchers have found that burn victims feel less discomfort during dressing changes, confirmed by functional MRI imaging, when they are virtually placed in a world of ice and snow. Some psychologists use simulated cliffs or cockroaches to treat patients with phobias. Rehabilitation specialists prescribe exercises for recovering patients modeled by virtual trainers.
Limits of Technology
To be sure, every one of the technologies listed has drawbacks. Telemedicine may increase access to clinicians. But what happens when the suicidal patient is not physically in your office for a proper referral to psychiatry? A remote monitoring device may experience battery failure, and changes in patient status may be missed. Older versions of insulin pumps or cardiac pacemakers can be hacked and their settings changed, with possibly lethal results. Software flaws may allow personal data to leak to criminals. Poor algorithms or rushed products may fail to perform.
Creating a new technology is the easy part compared with the Byzantine process by which it is discovered, discussed, chosen, bought, presented, taught, piloted, troubleshot, rolled out, stocked, replaced, and scaled up. Much like human development, each emerging technology has a natural history of genesis, growth, and maturity. Each is subject to influences from a complex ecosystem of stakeholders that includes patients, doctors, government regulations, and laws. As shifts occur, the trajectory of each technology will shift. But the technologies discussed will likely endure and become more refined and useful to practicing clinicians.
Date: February 06, 2017