Bedside Manners

Small data from patients at home will mean big cost savings

IN 2008 Jordan Shlain treated an elderly patient with pneumonia. He was worried about her, so he gave her his mobile number—but she didn’t use it, and ended up in intensive care. This set Dr Shlain thinking about how to follow up with patients; his simple solution was a daily phone call and a spreadsheet to record the data. One day another patient in his San Francisco surgery remarked, “Dude, you need to turn this into software.” He did, and earlier this year Cedars-Sinai Health System, a hospital operator in Los Angeles, adopted a patient-feedback system developed by the firm he set up, Healthloop.

Doctors can use Healthloop to send their patients questions about their condition, by e-mail, text or smartphone app. Its software then works out when intervention by a doctor or nurse is needed. It is efficient and patients like it. These days the idea of finding value in health data is very much in vogue but most attention is being showered on the promise of “big data”, in which giant databases on genomics, population health and treatment are crunched in the hope of discovering medical insights. But there is also a great deal going on to improve treatments and outcomes through this sort of “small data”—the collecting and processing of modest amounts of information from an individual patient.

Small data has been used for years, to great effect, in home monitoring. Philips, a Dutch technology company, has long sold versions of its Lifeline medical-alert pendant (pictured). Besides letting its users—generally the frail elderly—call for help, its devices can now detect automatically if they have fallen, and can also monitor their drug compliance. One million patients are using it.

As it gets ever easier to squeeze sensors and processors into small devices, their makers are thinking up all sorts of new ideas for patient monitoring. Liat Ben-Zur of Philips says the company is working with some European hospitals on a home device that will track the heart rate, blood pressure, heart variability and sleep patterns for patients with chronic obstructive pulmonary disease. Similarly, a startup in Chicago, PhysIQ, is developing a chest strap that measures respiration rate and heart rate to monitor patients who have cardiac disease, to alert their doctors to any problems before they get serious.

Such ideas offer the prospect of respectable profits for their inventors. But the financial benefits of being able to monitor and receive data from patients in something like real time will be much greater for hospitals and health insurers, who stand to save substantial amounts by intervening earlier. This is especially so given that relatively small groups of patients with chronic conditions account for a disproportionate share of health costs. In America, for example, only 1% of patients account for 22.7% of spending.

America’s Affordable Care Act, better known as Obamacare, introduces penalties for hospitals when patients have to be readmitted; and limits the sums hospitals can charge for certain conditions. These measures are forcing hospital operators to make serious efforts, for the first time, to improve the quality of care and keep patients out of the emergency unit where possible. As patient-monitoring systems become more sophisticated and widespread, they could reduce the load on doctors’ surgeries by reducing the need for routine check-ups; and help curb the rising cost of medical-malpractice claims.

Many personal monitoring devices now transmit data via the patient’s smartphone: Apple’s HealthKit app makes it easy for patients to connect them up, and to input data directly. At the other end, hospitals using HealthKit find it a lot simpler to integrate the incoming data with their IT systems. The Ochsner Health System in New Orleans recently announced it will use HealthKit to collect data on the weight of patients with heart failure. If their weight increases significantly, which is often a sign of fluid accumulation, they may get a call from a pharmacist about changing their drugs.

Medopad, a British medical-technology firm, has launched an app of its own for cancer patients undergoing chemotherapy, that runs on Apple’s smart watch: the patients can confirm they have taken their medication, and report any symptoms, by simply tapping buttons on the app. Their doctors will be able to use the accelerometers on the watch to monitor their activity levels.

Some patients will, inevitably, still want to talk to a real, live doctor. There is an app for this too. Doctor on Demand lets people in America request a rapid video consultation with a physician. Prescriptions can be sent electronically to the patient’s nearest pharmacy. The cost for this can be as little as $40. MDlive, a competitor, also offers quick video-consultations, for $49. It is not just the patients who gain: their health insurers and employers are also keen. UnitedHealthcare, one of America’s biggest insurers, now covers patients for their use of Doctor on Demand. Comcast, America’s largest cable-television provider, offers it to its workers.

Attempts to make hospitals and clinics more efficient by building huge, centralised IT systems have a sorry history—just look at the failed patient-record system for Britain’s National Health Service, scrapped at a cost of around £10 billion ($15 billion). But computing power is now being applied successfully in countless small ways, using smartphones and other diminutive devices, to make a big difference to the effectiveness of treatments.