The Patient’s Office

We’ve discussed how IT can extend the borders of the patient experience. Hospitals and specialists can serve rural and remote communities; the walls between hospital and clinic and doctor’s office can be virtually removed. But technology can also extend the reach of health care to a new frontier—the patient’s home.

Of course, private and not-for-profit organizations have been bringing health care to homebound patients for many years now—the Victorian Order of Nurses was founded in 1897—but new technology can make patients part of their own virtual care team.

For example, the Ontario Telehealth Network (OTN) has been providing connected medical devices—blood pressure monitors, blood oxygen monitors, scales etc.—to people who suffer from chronic obstructive pulmonary disease (COPD) and heart failure since 2007. The devices connect to a tablet computer. Outputs are monitored by nurses in a primary care facility for spikes or anomalies in the readings. The program now serves 3,000 Ontarians. (You can read more about it in this issue of networking magazine Connections+.)

The program and others like it reduce the number of hospital visits patients make, streamlining care processes. They seem to work best with patients who already have to monitor their own health because of their conditions already—diabetes sufferers who have to monitor blood sugar, for example. So they’re already engaged in the home care routine. But it’s the proliferation and affordability of mobile devices that makes it a workable scenario. Even seniors who have had minimal exposure to high-tech can learn the intuitive workings of a tablet computer.

Wearable technologies are also expanding the possibilities for extending patient monitoring beyond the hospital, clinic and doctor’s office. Devices like the Fitbit, a wrist-watch-like accessory that monitors heart rate, activity level, sleep times and more 24 hours a day, are already designed to upload data to a web portal. They can offer clinicians a comprehensive barometer of at least some baseline vital signs.

(No, the Fitbit does not include an actual barometer. Yet.)

Pulling this information into health care systems requires some development. A complex interface or time-consuming process will discourage engagement. If a patient is already uploading FitBit information to a web portal, there’s going to be a lot of deep sighing if he or she has to upload it to a care provider’s as well. A better approach would be for the care provider to create an interface that uploads data to its own system and the FitBit portal in one fell swoop. It’s an also an opportunity to pick up a few relevant details the wearable doesn’t.

Then there’s the issue of infrastructure on the providers’ side of the house. People in the profession are the first to tell you that health care practitioners still love their faxes. Many physicians run their offices on nothing more sophisticated than a PC. And while many hospitals, clinics and health units have made innovative technological advances in their systems, a lot are still wrestling with legacy systems that require extensive development to bring new applications into the fold.

This requires a comprehensive strategy for migration to next-generation platforms. One complication for health care providers looking at fork-lift replacements of aging systems is that they can’t afford to be down. Patient health is on the line. Here’s where hosted, virtualized infrastructure comes into play. It’s possible to duplicate physical infrastructure for a temporary cutover, then seamlessly shift it to new virtual systems, possibly on the same machine.

Sounds easy, right? Of course it isn’t. It requires detailed strategic and tactical planning, a clear roadmap, and partner expertise to guide the shift.


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