by George Mathew, MD
There's a lot of talk about digital connectivity and its role in healthcare. Patient engagement platforms, for example, are designed to encourage consumers to use devices to track their health and participate in their own care to improve outcomes. And smart homes could help patients with disabilities or illnesses manage more easily by using tools such as smart speakers that provide voice-activated assistance.
The question is, does digital connectivity create (or exacerbate) a two-tier healthcare system for those who are digitally enabled and those who are not? A recent New York Times Magazine article says that big data technology 'might seem like a social neutralizer or even a leveling force,' but notes 'it can have a way of increasing divisions.'
Before we consider the potential for more uneven user access to data leading to further inequality, we should examine how healthcare companies are seeking data to offer new products and services.
Both payers and providers have shown a growing interest in gathering more data to improve their risk-scoring capabilities. Payers, for example, want to gather data to make risk calculations. In fact, Optum filed a patent application in 2016 to gather data from social media platforms such as Facebook and Twitter so that it could connect to each person's clinical and payment data. (However, recent revelations that Facebook has been sharing information about millions of users without their knowledge could have ramifications for sharing data in the future.) On top of that, providers need more data to assess the health risk of patients.
The desired data
The general trend going forward is shifting care from the doctor's office and the hospital back into the home. As a result, providers and payers will need to know what patients require to provide the necessary support, which means accessing even more data.
In addition to broader access to electronic health records and data that patients record themselves on personal devices - such as heart rate, blood pressure, etc. - providers and payers want to be able to gain a better understanding of a patient's risk through social determinants of health (SDOH). These are factors that contribute to a person's current state of health, such as social and physical environment, job training, and employment opportunities.
That circles back to the need to better assess patients risk: More robust data leads to insights and actuarial analyses for healthcare businesses looking to better manage patients. Increasingly, this data will come from a wider range of sources, including the smart home. Indeed, the market for smart homes is growing with 27.3 percent of homes in the United States now making use of this technology, which is expected to rise to 53.9 percent by 2023.
The consumer market recognizes the value in investing in the smart home for healthcare-related support. For example, Best Buy recently acquired GreatCall, which manufactures healthcare alert devices aimed at the aging population. Large tech companies have also begun offering smart home devices - think Google Home Hub, and Amazon and Apple products - that can monitor and offer decision support for patients/healthcare consumers at home.
Before long, the data from smart home devices and patient engagement platforms will be shared with providers and payers in real time - and at a premium.
But we can't overlook the complexity of getting the data to the provider or payer as they need it. For this to happen, connectivity will be needed between the smart home and incumbent health companies. It will require interoperable solutions that can pull data from these sources and combine them with traditional claims and clinical data, as well as unstructured data from mobile devices.
All this takes us back to our earlier question: Will this lead to a two-tiered healthcare system that leaves many patients unsupported? Imagine those who can't afford connectivity or can't afford personal devices that provide data the patients can use to participate in their own healthcare. It's inevitable that a lack of data will be expressed as an uncertainty, or 'financial risk' - meaning the premiums to insure that person will be more expensive. And, ultimately this could lead to 'cherry-picking' those patients who allow their monitor-generated data to be used to assess their risks.
According to a Pew poll from 2016 (PDF), many people are extremely sensitive to the idea that their health information could be accessed and shared, and that they could be tracked in the privacy of their homes. There's a real risk that the coverage available to those people will become too expensive. Indeed, they may even forgo care completely, raising the risk of the healthcare equivalent of an urban 'food desert' with at-risk plans unwilling or unable to offer affordable healthcare products and services to particular areas - all because of the lack of data.
So, how should healthcare systems address this?
There are movements at the federal level, such as the Trusted Exchange Framework and Common Agreement (TEFCA), which establishes a national-level path toward interoperability and data sharing. At a state level, interoperability will rely on the continued presence of health information exchanges (HIEs) and waiver programs to continue to build out Qualified Health Information Networks (QHINs), connectivity brokers, participants and end users.
For connectivity to the home, though, local healthcare systems and corporate entities investing in home-based care will have to go beyond this, and even beyond upcoming legislation on telemedicine, to be able to ingest data from the home, parse it, clean it and funnel it into a larger, longitudinal health record for a patient.
Solutions to address this will have to be able to integrate and securely share disparate data from beyond typical hospital and medical office walls in order to deliver a true digital user experience and enable evidence-based insights. The solutions will have to be vendor-neutral, reduce time to value, simplify data access, allow for population health management, and give truly actionable insights - all while being scalable to health delivery models that allow for cost-effective deployment.
Learn more about DXC's digital health solutions to help improve outcomes for patients and populations at DXC booth 4559 at HIMSS19.
George Mathew, M.D. is the Chief Medical Officer for the North American Healthcare organization for DXC. In this role, he serves as the clinical expert and healthcare thought leader to our healthcare clients in transforming the healthcare marketplace. Dr. Mathew graduated from Boston University School of Medicine and completed his residency in Internal Medicine at Greenwich Hospital/Yale University in Connecticut.