Future of Digital Health by Mediaplanet_USA

SEPTEMBER 2018 | FUTUREOFBUSINESSANDTECH.COM

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Future of Digital Health Not only one of the biggest names in business anymore, Mark Cuban is investing — and trusting — in the future of health care technology.

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why more people are putting their trust in telemedicine. DISCOVER

what artificial intelligence means for the health care industry.

Partners in excellence. Digital medicines are helping Rush doctors deliver improved health outcomes for patients. Find out more at www.proteus.com/excellenceatrush ©2018 Proteus Digital Health, Inc. All Rights Reserved. LBL-0505, Rev 1, 05SEP2018

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5 Trends to Track in Digital Health

Health Care Technology Conferences Edge 2018 Austin, September 26-28, 2018 WHINN 2018 Denmark, October 9-11, 2018 WEDI National Conference 2018 Arlington, October 15-17, 2018 Rock Health Summit San Francisco, October 16-17, 2018 MedTech Impact Las Vegas, December 13-15, 2018 JP Morgan Healthcare Conference San Francisco, January 7-10, 2019 Digital Health CEO Summit San Francisco, March 19, 2019

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These days, people are used to having just about everything at their fingertips. Health care is no exception. Technological advances are reshaping health care, putting access to information in our hands and creating a more seamless, interactive experience. This matters for open-enrollment season this fall, when millions of Americans will select or switch their health benefits. With that in mind, here are five digital health trends that consumers and business leaders should watch.

Mobile payments The health care system is modernizing how people save and pay for care. More consumers are using mobile wallets to pay for qualified medical services from a health savings account (HSA); artificial intelligence and virtual assistants are helping consumers understand HSAs; and apps offer a range of conveniences, including mobile check deposit and investing

options that help people keep track of qualified expenses.

Wearable sensors The wearable-technology market is booming, with revenues expected to reach nearly $52 billion by 2022, according to a 2017 report from MarketsandMarkets. These wearable devices can track daily steps, monitor heart rates and analyze sleep patterns. Employers and health plans are including fitness trackers as part of corporate wellness programs to help improve health outcomes and reduce health care costs. For example, smartwatches and activity trackers are integrated into UnitedHealthcare Motion®, a national digital wellness initiative that may enable people to earn over $1,000 per year by meeting daily walking goals. Employees may earn up to $4 per day for achieving FIT goals, which stands for frequency (500 steps within seven minutes, six times per day, at least an hour apart), intensity (3,000 steps within 30 minutes) and tenacity (10,000 total steps

daily). When goals are reached, earnings are deposited into HSAs or health reimbursement accounts to help cover out-ofpocket medical expenses.

Virtual care and remote medical monitoring Telemedicine services are a convenient, cost-effective way for people to consult with medical professionals online or via apps for preventative care and certain treatments. Other remote services include wireless scales, which can notify health care professionals about a patient’s sudden weight fluctuations that could signal the need for medical attention.

Artificial intelligence Artificial intelligence and machine learning leverage troves of health data to help improve effectiveness and efficiency. Potential applications include closing gaps in care, eliminating unnecessary treatments and improving customer

service. In the future, artificial intelligence will be increasingly deployed to proactively predict and prevent disease; understand what facilities or physicians produce the best outcomes; and engage patients so they receive care faster.

Blockchain Blockchain, which record and share database transactions securely and cooperatively across multiple computers, have significant potential for health care; some of those possible uses are already being tested. They provide a synchronized “source of truth” that can help automate processes and may improve the integrity of health care information, reducing data reconciliation costs and easing administrative burdens. Blockchain may be used to store and share health data, making it easier for people to navigate the health system. n Richard Migliori, M.D., Executive Vice President, Medical Affairs, Chief Medical Officer, UnitedHealth Group

Publisher Nikki Robinson Business Developer Jourdan Snyder Managing Director Luciana Olson Director of Sales Shannon Ruggiero Director of Business Development Jourdan Snyder Director of Product Faye Godfrey Content Strategist Mina Fanous Designers Chris Espino, Marie Coons Copy Editor Benny Regalbuto Production Coordinator Josh Rosman Photo Courtesy of Mark Cuban All photos are credited to Getty Images unless otherwise credited. This section was created by Mediaplanet and did not involve USA Today. KEEP YOUR FEED FRESH. FOLLOW US @MEDIAPLANETUSA

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Find out how one app helped a user improve her sleeping habits, and how technology can be good for our health. Can you give some background on who you are? Laurel: I’m a full-time mom. When I have time to myself — not a lot when you have four kids — I like shopping, cooking or just enjoying a quiet cup of coffee! How did you become a user of the SleepScore app? I discovered SleepScore through a friend. I was interested in finding out more because I was looking for a way to get more sleep. What have you learned about improving your overall health through this process? My days are better when my sleep is better. Without enough rest, I’m not as good at being a mom and getting things done. With SleepScore’s gentle reminders to prepare for bed and tips for sleeping better, it absolutely improves my next day. What is your take on technology being introduced as a solution for everyday issues? Technology is definitely improving the way people live. I’m always looking for an app that can help with different aspects of my life. Apps in general make things less complicated and put the power of self-improvement into my hands. How has technology revolutionized the way you track and better your sleep schedule? It’s given me insight into what kind of sleep I actually get. I know what kind of day I’m going to have based on my SleepScore! What is your favorite feature with this technology? I love the Sleep Guide filled with advice, as well as seeing the breakdown of my sleep quality. I know exactly when I was in deep sleep, and how often I woke up. Being able to go through and understand what I experienced while asleep is really helpful. Any tips and tricks for other potential users? Spend time going through the app’s tabs. Watch the videos on show. And take the time to set up your profile, because once you’ve provided all your information, the app does a great job of delivering an accurate read of your sleep and presenting ways to improve it.

The Future of Fitness Health and fitness guru Jillian Michaels is excited about how technology is changing fitness, and thinks you should be, too. From a workout regimen prescribed through your smartwatch to gadgets that count everything from steps to calories, technology has become an integral part of personal fitness. Health and fitness expert Jillian Michaels says that’s a good thing. “Technology provides access to expert instruction affordably; gives people access to detailed health and fitness info so they can make educated choices that yield powerful results; and functions as a source of motivation that allows people to set goals and track progress.” For Michaels, technology is just another tool she can utilize to help people get healthier. “I’ll take advantage of any tool I can use to help people get healthy in an easily accessible and affordable way, and technology allows me to literally train millions of people around the world.” Everyday people are taking advantage, too. According to mobile analytics firm Flurry, health and fitness app usage in the United States grew by 330 percent between 2014 and 2017. However, not all fitness technology is created equal, and Michaels says it’s important to put quality and safety first, whether you use Nike Training Club, Lose It!, Michaels’ own My Fitness or some other product.

“Technology allows me to literally train millions of people around the world.”

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How Technology Can Lead to a Better Night’s Sleep

“Like everything in life, there are true experts and then there are snake oil salesmen. Consumers should look at the source of the information behind the technology, because credibility is key.” She says a good way to gauge whether or not your chosen technology is working as it should is to simply compare real-life results with your device’s output. “If it doesn’t add up, consider getting a different device or app.” From shirt sensors that track your heart rate to cameras that

can predict injuries before they occur, there’s no shortage of fitness-related innovation on the horizon. Michaels says possibilities — like virtual training with your favorite fitness personality, linking up with friends online to work out at home and live streaming your favorite workouts — are truly limitless. “In truth, I am sure there are amazing things in the pipeline we can’t imagine yet, but I can’t wait to find out.” n Jill Coody Smits

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Health Care Technology Integration and the Future of Digital Health Todd M. Pope President and CEO, TransEnterix, Inc.

Jodi Euerle Eddy Chief Information Officer, Boston Scientific

What challenges do health care professionals face in terms of technology? Todd M. Pope: Millions of surgical procedures are performed laparoscopically each year in the United States with manual tools that limit surgeons’ capability, comfort and control. The challenge is to leverage technology that can enhance surgeon skills and clinical outcomes while working within today’s value-based health care. At TransEnterix, we have commercialized a new digital interface between surgeon and patient to bring the benefits of robotics to more procedures. Jodi Euerle Eddy: While the promise of digitally-enabled health care is exciting, IT solutions have historically been cumbersome and can even distract from delivering optimal care. We understand this and strive to simplify care and delight patients, caregivers, clinicians and health care administrators. Our digital solutions focus on avoiding harm, resolving health care’s inherent complexities, delivering insight and enabling action that improves care. And while technology is a powerful enabler, I don’t believe it will ever replace human insight. Lee Waskevich: The adoption of technology into the current workflow is a big one. There’s a lot to learn and adapt to when your primary mission is around the ability to save lives and health. Along with workflow challenges, there are numerous security and resiliency issues. Will the technology be available 100 percent of the time? And will the software, hardware and data sets used maintain patient privacy and confidentiality? What do you think the future of digital health looks like? TMP: The future of digital health will enable more predictable and positive clinical outcomes by giving

Lee Waskevich Vice President of Security Solutions, ePlus Technology

surgeons more clinical intelligence, comfort and confidence. By digitizing the interface between surgeon and patient, technology like the Senhance Surgical System can improve minimally invasive surgery in meaningful ways. For instance, there can be fewer patients on opioids post-surgery by using tiny 3mm computer-assisted instruments. We offer specialized sensors to alert the surgeon if excess force is being used while operating to decrease patient trauma. The Senhance is an open surgical platform, allowing surgeons to harness the power of advanced technology to deliver both value and best-in-class quality. I believe the future of digital health will create open-source platforms to incorporate technologies from many different companies versus today’s vertically-integrated platforms. JEE: Digital health will enable us to personalize care and extend our reach to individual patients and physicians, providing opportunities to improve health for many. We’re especially excited about opportunities to close the loop between diagnosis and treatment — for example, digital technologies that help patients and physicians achieve optimal care, avoid mistakes and reduce costs. The direction in which health care is moving will keep the patient out of the hospital both pre- and post-procedure. The opportunities are endless and inspiring. LW: The progress made in digital health will allow for more intuitive and comprehensive patient experiences. With the ability to gather, analyze, predict and cure based on data, technology will empower the industry to enhance care standards. With this data comes responsibility, and as organizations embrace and adopt technology in a clear, prioritized progression, it will ensure that privacy, protection and resiliency are a native part of the process. n

How Artificial Intelligence Is Changing Health Care The algorithms may be hidden, but artificial intelligence is improving health care for both patients and doctors in a multitude of ways. Artificial intelligence (AI) is an inevitable force of change. Advancements assert that AI and machine learning (AI/ML) will help us better diagnose and predict disease, uncover new drug therapies and deliver precise patient information. Yet thorny challenges stand in the way of a truly AI-enabled health care system. We hope to shed light on some of these challenges, where AI is already having an impact and what patients can expect moving forward. What AI can do AI doesn’t mean robots replacing your doctor — it’s just math. Terms like “machine learning” and “deep learning” are simply ways of explaining complex algorithms, which use data to identify patterns and become powerful prediction tools. Although more health data than ever are available, the data still tend to be siloed, messy and proprietary. Patients ultimately benefit if researchers can draw from data worldwide — and AI can help encourage collaboration for scalable impact. As Google Ventures partner and physician-scientist Dr. Vineeta Agarwala noted, “AI is uniquely capable of forcing data silos to break down and forcing large institutions to finally see a source of self-interest in it.” As an early stage health care technology investor, we see many startups leveraging AI/ML. From 2011 to 2017, investors poured $2.7 billion into AI/ML digital health startups. While media attention has largely centered on AI/ML’s ability to revolutionize the delivery of clinical care, the technologies are even more quickly transforming the business of health care. Companies are creating more efficient processes, from the drug development pipeline in pharmaceuticals to clinical operations in hospitals. Some of the more clinically-focused use cases — like diagnosis and robotic treatment — will likely take longer to build and scale due to the risk of integrating new technology into direct patient care. Why you should care Though the algorithms may be hidden, AI has likely already touched some part of your care. Many consumer-facing products integrate AI to offer tailored recommendations. For instance, symptom-checker apps like Ada are powered by machine learning algorithms, while Woebot offers people emotional support via an AI-powered chatbot. Other solutions help providers manage their patients. For example, Omada Health uses machine learning algorithms to help health coaches predict which of their pre-diabetic patients could use additional support. And many hospitals use predictive algorithms — like those offered by AgileMD — to monitor patients and flag emerging clinical issues. We live in a world with an unprecedented and growing mass of health data. To capitalize on this treasure trove of information, we’ll need AI/ML to comb through, find patterns and derive insights that can be used to improve health. As investors and digital health enthusiasts, we’re eager to support companies applying AI/ML to create a more efficient, accessible and intelligent health care system. Megan Zweig, Director of Research, Rock Health

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Mark Cuban Invests in the Future of Health Care Technology From artificial intelligence to remote patient management, billionaire venture capitalist Mark Cuban is betting big on the health care sector.

Improving Safety and Security in Health Care

Mark Cuban is one of the most successful businessmen in history, and one of the first to take the lead on investing in the technology currently transforming health care. When he talks about the future of medicine, people listen. The health care tech revolution “Tech has impacted every aspect of health care,” says Cuban. “While that technology can’t replace conscience and empathy, what’s exciting is that it can bring precision, reach and scale in ways that can improve care.” When asked what technologies excite him the most, Cuban doesn’t hesitate. “What really accelerated my interest and commitment was the advancement of artificial intelligence. At its heart, digital health is all about capturing, processing, interpreting and utilizing data. Artificial intelligence, via machine learning and neural networks, enabled companies to do all of the above in a far more comprehensive and accelerated manner. “I think the value of remote patient management will skyrocket with the implementation of 5G,” he adds. “Patients will be able to not only use telemedicine and remote monitoring via broadband into the home, but will be able to take those resources with them.” Cuban sees this as empowering. “When people own their own data, they can leverage that data and new tools to have a better understanding of their health and care.” Fewer buzzwords, more benefits “Technology is core to everything I do,” Cuban says. “That said, the more tech that a company introduces, the greater the need for amazing people to implement it.” When it comes to choosing investments, Cuban is done with overheated hype. “The fewer the buzzwords the better,” he insists. “The questions I always ask are ‘What makes the company unique?’, ‘How can they prove it’s unique?’ and ‘How will they implement this feature in a manner that truly benefits patients?’ Because the technology is changing so quickly,” he adds bluntly, “there are a lot of people whose sales pitch is better than their company’s technology.” Jeffrey Somers

In ensuring the safety and security of everyone who’s a part of the health care system, research, teamwork and integration are the keys to success.

he safety and security of physicians and patients are pressing concerns that are broadened significantly when considering the same issues as they relate to all caregivers, support staff and the visitors that enter health facilities every day. Cyberthreats related to digital health, including the theft of protected health information, the denial of services and other violations of privacy, will require continuous assessments of risk as the technology changes rapidly. The value of private health information is high and the routes to access that information could be through any of a number of networked systems. The International Association for Healthcare Security & Safety (IAHSS), in developing guidance related to security systems, risk assessments and investigations,

believes that addressing these issues requires collaboration in the selection, management and maintenance of systems that are intended to protect the physical environment while potentially creating a weakness in the network. Security systems including cameras, access control and alert systems — and the infrastructure that supports them — should be incorporated into mitigation strategies that are identified in the design of new systems, new space, renovations of existing space and corrective action plans from incidents that have occurred, or from vulnerabilities identified during risk assessments. IAHSS has done significant research related to the amount of violence in health care. The effort has looked broadly at patients and visitors, clinical and support staff, and internal and external

responders, as well as issues generated from within and outside the health care facility. IAHSS has focused on the collaboration and training that should be in place to address these issues. This body of work has reinforced the need to assess risk and vulnerability regularly and to do so when incidents occur to take advantage of lessons learned. This approach will allow us to improve and strengthen each facility’s ability to provide a safe and secure environment for all patients, visitors and staff. Doing so, and including the risks associated with digital health, requires the input and output of those that manage physical and digital security so that comprehensive and coordinated solutions are implemented. ■ Kevin Tuohey, Board President, International Association for Healthcare Security & Safety

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How to Maintain Patient Safety by Securing Patient Data Patient data has never been more valuable — or more vulnerable. As health care technology becomes more pervasive, security must keep pace. SPONSORED

These concerns are underscored by a recent study from the University of California that found potentially hundreds of patients had experienced “adverse events” resulting from ransomware malware, or attacks compromising electronic health records (EHRs).

ccording to IBM’s Cost of a Data Breach study, the average cost of data security failures is nearly $4 million — and that doesn’t quantify the impact on consumer confidence. In the health care industry, that translates into two primary concerns for patients: that their private information is safe, and that their care won’t be negatively affected by cyber attacks or other events. “As health care institutions strive for new ways to drive patient experience, they want that experience to be as valuable as possible,” says Lee Waskevich, vice president of security solutions at ePlus Technology, a network, storage and security solutions company. “And that takes new applications and new ways of interacting with the client, which puts data in a lot of different places. Preventing unauthorized access is critical.” Inside and outside threats The range of events that can negatively impact patient data — and thus degrade the patient experience — is broad, including direct attacks via malware or ransomware as well as indirect factors like unpatched systems or insufficient backup and recovery

plans. And the data put at risk by these factors is quite valuable. “Patient data is the most valuable data asset available on the black market,” notes Sonia Arista, national health care practice director at Fortinet, a network security and threat management company. “Those patient records can be parceled out to sell in multiple ways.” Waskevich believes anyone charged with protecting patient data and the value of the patient experience must think seriously about the state of their organization’s security posture. “At ePlus, we recommend going down a path of assessing cyberattacks as a business risk and following a cybersecurity framework that can help you outline

where the data exposure risks are,” he says, “and also having preventative measures in place identifying different aspects of malware or insider threats where people are accessing data they shouldn’t be.” This should include robust training and education for staff, according to Arista. “Education and awareness campaigns within an organization should focus on fundamental good habits related to IT security: not sharing credentials, logging off terminals and devices when they’re done with their session and making sure any emails they receive that look out of place or odd go unopened.” Such policies also need an emphasis on workflow habits around document handling.

“As health care institutions strive for new ways to drive patient experience, they want that experience to be as valuable as possible." And according to Ken Puffer, the chief technology officer for health care solutions at ePlus, patients are paying attention. “It starts from the time patients walk onto the property. How visible are the security measures? They’re as concerned about physical security as much as information security.”

One guy Securing that patient experience has gotten more complicated, but the solution is straightforward. “Make sure that there’s a defined process complemented by a strong security architecture,” Waskevich stresses. “One that’s very interoperable and collaborative across itself, sending up a signal when something is amiss. Then having a proper reaction plan can help minimize any damage.” Waskevich also notes that organizations often don’t think about what happens after an attack or failure. “A lot of things boil down to one guy — and that same guy is fixing things as well as trying to keep people abreast of the situation that’s going on. Making sure that there’s a team of individuals involved, along with proper communication channels, and that this plan is tested just the same way that you would test a physical outage — like power or communications — is crucial.” Patients are paying more and more attention to how their private information is handled and their overall experience. Securing that experience means investing in preventative as well as reactive measures to protect that data — because in the health care industry, lives are literally on the line. n Jeffrey Somers

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Student Insights on the Health Care Industry What challenges do health care professionals face in terms of technology?

Autumne E. Smith Productivity Analyst, Palmetto Health

Sambasiva Rao Gangineni Graduate Research Assistant, Boston University

Autumne E. Smith: The goal is to provide patients with safe, high-quality, low-cost health care. Technology should follow suit, but cost can be tricky. Health systems often try to save money by not purchasing all aspects of a solution, leading to workarounds that may affect safety and quality. We often discuss the right health care for the right patient at the right time. The same sentiment needs to pertain to health care technology. There is also very little global data standardization. Even with the data tsunami that has invaded health systems, so much time is spent “cleaning up” data to ensure accuracy that we lose efficacy. The government has pushed for robust health information exchanges to

help clinicians without laying the groundwork to include data standardization. It is sometimes nearly impossible to match patients without key identifiers. It’s important to look at technology solutions from a systems-thinking approach, but without foundational standardization, you are building a mansion on top of matchsticks. Considering regulation compliance, health systems have to provide excessive documentation. This can vary by agency so much that full-time staff are hired to meet requirements, raising health care costs. For example, we have to submit quality data to Centers for Medicare and Medicaid Services quarterly. However, we sometimes get the analytics back six months later. Hospital systems can be penalized based on what this data says for up to three years post-submission. If we could provide stan-

dardized data and reduce data latency, we could provide actionable information that counts. Sambasiva Rao Gangineni: It is challenging to collect, process, store, secure and analyze exponentially-growing health data. Health care professionals have less exposure to these stages; not knowing how the infrastructure works hinders them. Also, health care professionals have less exposure to programming — an important tool in managing data. What do you think about the future of health informatics/health information management? AES: We are on the cusp of revolutionary health informatics and technology solutions. The power of real-time analytics to identify

patients at risk and provide interventions is incredible; technologies such as virtual reality are making a significant impact in radiology and physical therapy. The key to continuous improvement is training for leaders in health information technology programs. Through them, we truly will be able to improve patient safety. SRG: Health informatics will reach a stage when individuals will be able to track the status of their health from apps or websites. This is possible by personalizing individuals’ health data and running automated analysis on the data with the help of machine learning and artificial intelligence. The individual — and health care professionals — will be alerted about an imminent precarious situation, and care will come on time. n

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Health Information Management on the Cutting Edge of Health Care Health care shifts with even the slightest breeze, and health information management professionals are tasked with tracking changes in the weather. Although much has changed since the American Health Information Management Association (AHIMA) formed 90 years ago, one constant remains: the importance of the relationship between patient and health care provider. A key component to this relationship is the reliability of the patientâ&#x20AC;&#x2122;s health information, helping the patient and provider make informed health care decisions.

Information management Health information management (HIM) professionals work to improve health record quality, leading the management of health data and medical records so information is secure, accurate and available. While these records were once hand-written notes, health information now comes from multiple sources and results in vast amounts of data, making it an important and exciting time to be in the profession. Today, with every health care experience, more and different types of data are produced, which must be converted into usable information that remains private

yet accessible. The special and unique skillset of the HIM professional has a major effect on the consumer and the health care system. HIM bridges the gap between providers, patients and payers, maintains confidentiality and revolutionizes how information is handled. As the need for them grows, the skills needed by HIM professionals must continue to meet the demands of the evolving health care community. The future-focused health care environment HIM Reimagined (HIMR) is an AHIMA Leadership initiative aimed at providing a framework

to transform HIM and position professionals for the future. It offers long-term strategies to ensure that HIM professionals are equipped to keep pace with industry changes. The HIMR program and its accompanying white paper is a future-focused analysis of the changing health care environment. For example, preventative, predictive, participatory and personalized approaches to medicine, increased automation and an aging population will have a significant impact on both consumers and HIM operations and what employers will require of HIM professionals in the future.

Assuring the reliability of health information in support of patients and providers is so vitally important that credentialed HIM practitioners are required to keep their knowledge and skills current through mandatory continuing education. A minimum of 20 continuing education units (CEUs) are required every two years for any HIM credential-holder. Qualified CEU activities include formal college-credit classes, webinars and authorship. Itâ&#x20AC;&#x2122;s also important that students and practitioners use the tools available to them to keep up with industry trends and needs. By staying abreast of trends and emerging roles in the industry through continuing education, HIM professionals are poised to meet the ever-evolving demands of health care. n

Wylecia Wiggs Harris, Ph.D., CAE, CEO, American Health Information Management Association

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6 Myths That We Need to Address in Telemedicine With all the skepticism surrounding the value of telemedicine, an expert from the inside steps into the ring to support the present and future of the industry.

hen I told friends that I was joining the American Telemedicine Association (ATA), their response was either, “What is that?” or “Isn’t that how people get care in rural parts of the country?” Their view of telemedicine was limited. They assumed it was a medical subspecialty, operating on its own. However, I believe telemedicine is medicine, and the market is much bigger and broader than my friends’ perceptions would suggest. Telemedicine, or virtual care, represents a rapidly growing sector of the health industry. Its beauty is in the eye of the beholder. For the consumer who is trying to avoid a cross-town trip on public transportation to see their provider, it represents convenience. For the parent whose newborn is in a neonatal intensive care unit several hours from home, it is a chance to be “there” with their child while taking care of the rest

of their family. For the provider who needs to consult with a colleague — even though they’re in different time zones — it means a better chance of a correct diagnosis and treatment for the patient. And for the millions of Americans who live in communities that have inadequate mental health resources, telemedicine is quite literally the only viable option. That is the exhilarating part of why we’re here. We want to ensure people have access to care where and when they need it, and when they do, that they know it is safe, effective and appropriate. We also want to ensure that providers can do more good for more people. If you see “tele-everything” as a way of delivering care — taking advantage of technology to deliver on this great promise — then it is a social injustice that it isn’t more broadly available. Yet there are arcane laws, regulations and reimbursement barriers that are still in place that negatively impact the

opportunities in telehealth. Why is it that after 25 years, in which we’ve seen tremendous innovation with telemedicine — including the fact that most large employers now offer virtual health services to their employees — “tele-everything” is not more broadly available, the way it is for Kaiser Permanente health plan members? I’ve identified six myths that I believe cause confusion in the market and ultimately inhibit the expansion of telehealth in the United States — myths we should address and disprove in rapid order.

Telemedicine is only for rural areas While access to medical resources has improved in many communities thanks to virtual services, “medical deserts” exist in urban communities as well.

It’s impersonal If you think using FaceTime is impersonal, then

you might agree with this. But the experience of millions of consumers suggests otherwise.

It’s more expensive While it’s likely true that more people can now readily access health resources, telemedicine is also used to redirect people to more appropriate and typically less expensive venues for care (going to an urgent care center and not the emergency room, for example). And some visits may seem duplicative, but the use of technology, artificial intelligence and other tools will reduce those over time.

Providers overprescribe antibiotics and opioids To paraphrase Cuba Gooding Jr.’s “Jerry Maguire” character, “Show me the data.”

It’s a threat to clinicians I hear something different from clinicians. They talk

about having greater control over their hours and schedules, being able to communicate with patients and colleagues more easily and deploying a more consistent approach in their patients’ treatments.

It’s the same as synchronous video visits This has historically been true, but we must now realize that technologies that help providers scale their services go much further than video visits. Asynchronous technologies including remote monitoring, feedback and even automated processes must now fit within our broader definition. To ensure the benefits of telemedicine and virtual care are broadly available — to meet people where and when they need it — we need to remove remaining barriers. At the ATA, we intend to do just that. n

Ann Mond Johnson, CEO, American Telemedicine Association

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Combating Chronic Disease with Digital Medicines Dr. Scooter Plowman, medical director at Proteus Digital Health, discusses developments in digitial medicine as an industry leader.

Empowering Patients and Making Medicine Smarter Safe, edible digi-meds make it impossible to miss a dose while putting the patient’s own data at their fingertips.

he World Health Organization estimates that 50 percent of patients worldwide don’t take their medications as prescribed, costing more than $500 billion. The impacts on patient health can be devastating. But a new hightech way of delivering those medications offers a solution. Digital medicine “Medication adherence is a very old problem,” says Sara Browne, M.D., from the University of California, San Diego.“Digital medicines combine pharmaceuticals and edible sensors with a platform to capture medicine ingestion in near-real time.” Digital medicine users typically wear a sensor patch that pairs wirelessly with a smartphone app, which records when the medicine is taken as well as vital signs. “It’s really a patient empowerment and management system,” Browne says. Her trials involving digital medicines such as Proteus Discover® from Proteus Digital Health found the sensors to be extremely accurate.

Success in the trenches These digital medicines are impacting the real world as well. “We first conducted a pilot with 20 patients that used the tool,” says Amanda P. Tosto, R.N., M.S., a clinical transformation officer at Chicago’s Rush Ambulatory Transformation Center. “We focused on the hypertension use-case.” “Hypertension is an illness where we know that in the good majority of patients, the medications will work,” Anthony Perry, M.D., the vice president of Rush, points out. “But consistent usage of medications can be challenging. Proteus steps into that area as a kind of behavioral tool to help people consistently take these medications.” “After the pilot, we saw that the medication adherence rate among patients was 85.5 percent,” adds Tosto. Patients used the tool and wore the patch 90 percent of the time, and “we brought over 80 percent of patients into blood pressure control.” Patient empowerment While digital medicines can

improve adherence and lower costs, the real impact is felt by the patients. “I have high blood pressure, I’m diabetic and last year I had a heart attack,” says William, a Vietnam vet and patient at Rush who uses Proteus Discover® for his cholesterol and heart medications. “It’s kind of fascinating — when you take your medications you see right on your phone that you [did it] at the prescribed time. It also records things like my blood pressure, and all that information goes to my doctor, which I love.” William got used to wearing the patch very quickly. He cites the access to data as an important benefit. “Early this year I caught a bug, and my blood sugar was running extremely high. My diabetic team reached out to me and said, ‘We noticed that your blood sugar is running high.’ That was amazing. Psychologically,” he adds, “it gives you a feeling that you are actually more in control.” For patients like William, digital medicines represent more efficient and effective treatment, proving that the future of medicine is wireless. ■ Jeffrey Somers

One in 3 people in the United States have hypertension, and over 9 percent have diabetes. With all the medications people take for these chronic diseases, why aren’t they getting better? People with hypertension and diabetes are prescribed medications to help them get their conditions under control. The World Health Organization published statistics showing that over 50 percent of people do not take medications as prescribed — meaning their health doesn’t improve. If doctors don’t know if patients are taking their medications, they can only guess if a different dose or a different medication will work. What can people do if they really want to get their chronic diseases under control? In most cases? Lifestyle changes. Changing behaviors is one of the most difficult things to do. To start, people need to make sure they are regularly taking their prescribed medications. Something new being used in the United States today to help people develop such habits is digital medicine, which enables patients to know for sure that they took their medication and get a better picture of their health. Digital medicines have been shown to improve patients’ clinical outcomes significantly. What are digital medicines? Digital medicines are a new category of pharmaceuticals that include: widely-used drugs, formulated so they communicate when they have been ingested; wearable sensor patches that detect medicine and capture physiologic responses; apps to support patient self-care; a provider portal to support physician decision-making; and data analytics to serve community health needs. What are the benefits of digital medicines for patients and their health care providers? Digital medicines enhance trust and transparency between patients and their health care providers. Patients using digital medicines receive regular feedback digitally about their medication-taking behaviors. With permission, programs also share information with patients’ health care teams to ensure patients get full value out of their prescriptions. For the health care team, digital medicines improve patient outcomes by measuring ingestions and providing data that leads to improved clinical decision-making and patient engagement, while increasing care team productivity. Most importantly, patients stay healthier, don’t need to see their doctor as often, avoid hospitalizations and enjoy an improved quality of life. This sounds interesting, but is it safe for patients? The key components of digital medicines are an ingestible sensor the size of a grain of salt and a small, wearable sensor patch worn on the patient’s torso. This technology is safe and effective, having undergone 13 years of testing in over 120 clinical studies, the majority of which evaluated device system safety and performance. The ingestible sensor is made of minerals that would be found in a person’s everyday diet — copper, magnesium and silicon in tiny quantities — which make this extremely safe to ingest with medications.