The Untold Stories of our Health
The vast majority of clinical decisions are made based on a “snapshot in time” of our health, measured and recorded during a medical encounter. But our health “happens” all the time. Not just when we are in the clinic or the hospital.
As a common example- a patient’s blood pressure typically varies considerably throughout the day and over time. But decisions on whether or not to put a person on blood pressure medication, or what dose to prescribe are often based on one or two measurements, which might have been uncharacteristically high or low at the time they were taken because of the specific circumstances of the moment. Moreover – a moderately hypertensive person’s blood pressure can trend upwards for months between annual checkups, even to dangerous levels, without the patient feeling any change and without their doctor knowing.
And the same holds true not only for measurable vital signs like blood pressure. How we feel; what bothers us, what medication side effects we might be experiencing and so much more, ebb and flow all the time. Even between encounters. Mostly between encounters!
Most of us will seek care between appointments when we feel really sick, or if we are in acute pain or other discomfort. But the more subtle variances in our health indicators, along with the crucial stories they might tell, remain largely concealed from our healthcare providers. And it is often these very indicators – which patients may not notice or may not feel warrant medical attention – that can be early signs of a pending adverse event, or a potentially concerning trend in our health. And often, an earlier intervention – be it a home remedy, an over-the-counter medication or a more elaborate medical intervention could halt or reverse the trend and potentially avert a serious adverse event, and at the very least – make the patient feel better.
Finally – while most providers will ask during an encounter how we have been feeling and what has transpired since they last saw us, between our limited ability to recount (alas – even to recall) and the ever-present time constraints of today’s medical care, the full story is rarely told and thus rarely recorded, and rarely figures into the clinical decision making.
But we are entering an exciting age in which these stories are starting to be told.
The Next Frontier: Automated, Asynchronous Remote Care
A couple of important trends are breaking key molds of traditional medicine, setting the stage for a pending revolution in medical care – the Automated Remote Care Revolution. We are in the dawn of a new age where significant portions of the engagement and clinical interaction with patients are remote, virtual and automated.
The first trend is telemedicine. It wasn’t but a few short years ago that at least half the customers (mostly doctors) I connected with over Zoom had never turned on their laptop’s camera and would struggle to get video going for the call. Today, in part because the Covid-19 pandemic made virtual meetings a part of everyday life, seemingly overnight the notion of having a routine patient-physician encounter over video doesn’t seem unusual to either the patient or the physician.
The second trend is the rapid proliferation of remote digital sensors. From exercise watches to smartphones, blood pressure cuffs to Glucometers, consumer-grade fun devices to FDA approved medical devices, home-based connected devices that measure and can communicate some aspect of our health and well-being are everywhere.
So what molds are being broken and what new modalities of care does this enable? Think about the three pillars of a typical (traditional) physician-patient encounter: (i) vitals measurement, (ii) dialogue about the patient’s health and symptoms, and (iii) visual and/or physical examination.
These technological advances are enabling a paradigm shift. Telemedicine brought on a reality in which an in-person encounter is not needed for the dialogue about health and symptoms, nor, in many cases, for a visual exam. And connected devices have done away with the once-necessary norm that measuring and recording a patient’s vital signs requires the patient to be physically in the presence of a clinician.
These technological advances are the fertile soil out of which have sprung many RPM applications in the last couple of years. First generation RPM solutions manage the collection and transmission of remote sensor data. Some can also solicit patients to complete surveys about their health, and most will alert care teams when vitals and/or reported symptoms are outside of some predetermined threshold. It’s an important start.
But two real frontiers lie beyond virtual visits, remote monitoring and alerting. First- in the promised land, chronic disease patients are on personalized, automated remote care plans. Patients’ vitals and symptoms are frequently captured and recorded, and automatic triage determines if any intervention is needed (most often not). In appropriate cases, automated intervention is provided and suffices (for example – suggesting an OTC medication to alleviate a mild symptom). For the rest – cases where an interaction with a healthcare professional is warranted – the connection can be made right away by phone or virtual visit. In more acute cases the system could direct the patient to go to the ER, and for less urgent matters would set up an appointment. And beyond alerting care teams when a patient needs urgent attention, built in workflows would facilitate care teams’ response while logging all relevant data in the EMR.
Second – the transition from occasionally collecting and logging vitals and symptoms to daily, or even several times per day creates data trails of frequently sampled clinical data that unleash the potential for a new generation of diagnostics and prediction. From the simplest level – where our doctor can spend the first 1-2 minutes of our periodic encounters quickly scanning our records and getting a robust, accurate, detailed view of “how we have been” since our last encounter, thereby enabling a more focused interaction, to rules-based (and once the world has accumulated enough data for it – AI based) predictive analytics.
Quality of care will improve, clinicians will practice closer to the top of their license, and we – the patients – will have the comfort of knowing that we are regularly connected to our care teams and that our health is constantly looked after.
Example: A Datos Automated Remote Care Program for Cancer Patients
Chemotherapy, immunotherapy and other cancer treatments invariably cause side effects. While most side effects are not life threatening, and may be generally tolerable, studies have shown that side effects that go unreported or are not promptly acted upon can delay treatment adjustment, impact the patient’s quality of life and in some cases – cause patients to stop taking their cancer medications.
The Datos Automated Remote Care program serves as a day-to-day, hour-to-hour at-home and on-the-go companion for oncology patients. It can be configured to remind patients to take their medications per their medication schedule, ask about the known side effects expected for the specific medications they are taking and their severity and if desired by their care teams, prompt patients to measure relevant vitals like oxygen saturation level, weight or blood-pressure with a connected device. Pre-configured logic ascertains if any reported vitals or side effects warrant intervention, and if so – if they may be severe enough to require human intervention (such as a phone or video call with a nurse, who would be alerted by the system), or perhaps could be handled by recommending a home remedy like temporary change of diet, an OTC medication (e.g. an anti-nausea pill), or a video on managing mouth sores.
The system accomplishes several important goals:
The Sky’s the Limit
The oncology example is not unique. Thanks to more frequent “sampling” of vitals and symptoms, similar Automated Remote Care programs could help balance CHF patients’ medication dosing post discharge and longer term – raise earlier warning flags about a pending deterioration. Gastroenterologists could be alerted to worrisome trends that could provide early signals of developing flare ups in their IBD patients, while context specific diet and medication recommendations could be automatically sent to these IBD patients in response to their self-reported symptoms. Automated remote care workflows for pre- and post-surgery can help keep patients stable at home while reducing communication load on nurses. The examples are nearly limitless. We are entering the age of Automated Remote Care – an age where the untold stories of our health at home are being replaced by ongoing dialogues with our healthcare providers, and the lines between automated dialogue and human-to-human dialogue become increasingly blurred.
The Bottom Line
For Cancer, IBD, CHF, Diabetes and numerous other long-term conditions, Automated Remote Care will be a game changer. By adopting flexible remote care platforms for chronic conditions (like Datos Health’s) that adapt to both the unique management parameters of each disease, along with the workflow considerations of each organization, caregivers can lower overall cost of care and rehospitalization rates, streamline patient-doctor facetime, enhance patient well-being, and positively affect clinical outcomes.