Wireless and other digital forms of virtual healthcare, if designed and used well, can save a large amount of money, create better health outcomes, and help seniors remain in their homes. The extent and timing of this trend remains unclear, but seniors and their families should expect to see various forms of remote medical care headed their way. With aging populations soaring in virtually all of the world's most affluent countries, using technology to save money and improve medical care is set to become a major global industry.
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Last April, General Electric and Intel said that they would partner to develop and commercialize home healthcare technologies. Thousands of start-up companies may have promising technologies and share similar dreams. But perhaps none have the commercialization experience, government-relations savvy, and global reach of GE and Intel. Today, the companies' home healthcare offerings include GE's QuietCare product and the Intel Health Guide. GE will market the Health Guide through its sales network, and the companies say they will invest $250 million in building the partnership over the next five years. Given their size and the scale of the opportunity, that number most likely is only an opening ante in what will be a much bigger game.
Laura Tarantino, a registered nurse in central Connecticut, treats dementia patients at Mulberry Gardens of Southington, which has 93 beds in several assisted-living units in Plantsville, Conn. She's been working with an early installation of GE's QuietCare for about three years. A typical QuietCare installation includes six sensors—two in the bathroom and one each in the bedroom, medicine cabinet, refrigerator, and front door. They record movement and time. The real power of the product is in the increasingly sophisticated software that analyzes sensor readings and translates movement and time patterns into predictive health assessments.
Say, for example, a person is monitored as leaving their bedroom at 3 a.m. and entering the bathroom. If there is no indication after a certain time—say, 30 minutes—that the person has left the bathroom, an alert would be generated to caregivers that the person might have had a fall. Someone would call the home. If there was no answer, someone would be sent to check on the person. The system at Mulberry Gardens has evolved to include 11 indicated events that would trigger alerts to medical personnel. Alerts can be delivered to pagers, cellphones, and walkie-talkies, as well as to an online site where daily and cumulative reports can be accessed.
Tarantino says the events include bathroom visits, night bathroom visits, falls, medication access, and other motion patterns. If a person leaves their living unit between 10 p.m. and 6 a.m., the system triggers a wander alert, and a staffer will locate the individual and guide them back. Alternatively, if a resident hasn't left his or her home by 9 a.m., an alert is generated so that a caregiver can check on the person. Not all alerts generate a staff visit, but they do become part of a daily record that Tarantino sees each morning. "I can see where the high-priority alerts were," she says. "I can see how long it took the staff to get into those apartments and see if people are getting cared for in a reasonable period of time."
Behavioral trends that are documented by the sensors can become extremely useful to caregivers. If someone's trips to the bathroom increase noticeably, for example, it might indicate any number of sleeping or health issues that merit follow-up. Patterns can be observed with eating, taking medications, and even how often the person leaves their home. These patterns of normal daily activity are simply not known to doctors and other caregivers outside the home. Agnes Berzenyi, general manager of the home health division of GE Healthcare, says the accumulation of such gradual data "can tell you a lot."
People are very sensitive to privacy issues, and the QuietCare name is hardly an accident. "There is a delicate line between the right quality of care to the senior and the right privacy," Berzenyi says. The goal of QuietCare, she says, is to create the feeling that "nobody is watching but everyone is taking care of you." The product has an installation fee and a per-user charge of $70 to $100 a month. Currently, it's limited to institutions.
The value of what's called "trended data" is equally pronounced with the Intel Health Guide, which is a screen-based communications and remote diagnostic tool placed in the senior's home. Eric Dishman is the director of health innovation and policy for Intel's Digital Health Group. While QuietCare is designed to monitor activities of daily living, the FDA-cleared Health Guide is focused on managing and even avoiding chronic diseases, such as diabetes and congestive heart failure. Nine out of 10 seniors ultimately die of chronic diseases, and treating them is enormously expensive. Dishman says the system could cost between $1,000 to $3,000 a year, but even that upper limit can be dwarfed by the expense of a short hospital stay.
"A lot of healthcare today is based on data that is really suspicious," he says. If a patient goes to a doctor's office once a year, the readings taken there may not be reflective of the normal condition and behavior of the person. "Now, if you are suddenly able to get actual trending date," he says, "this is a window into the lives of the patients that [caregivers] literally don't have today."
The Health Guide has had a major pilot installation in 500 homes around Portland, Ore. Intel has gathered four years of real-life patient data and, Dishman says, "we are seeing patterns of behavior around the house" that may be predictive of a later Alzheimer's diagnosis.
"Virtual care is possible and preferred" in many settings, he says. "I think of the Health Guide as kind of an ATM [automated teller machine] for healthcare." It can provide video conferencing with a doctor or nurse, and patients can plug in various peripherals to measure and monitor health issues. If a new problem crops up, he says, an additional peripheral (such as a blood pressure cuff) can be shipped to the patient. And while filling out forms may never disappear from medicine, Dishman says that the record-keeping capabilities of the system allow nurses, in particular, to complete a lot more healthcare with a lot less paperwork.
Corrected on : Corrected on 09/22/09 and 10/01/09: An earlier version of this article stated that the Intel Health Guide is "FDA approved." It is actually "FDA-cleared." It also erroneously said the device was used to manage chronic diseases that included cancer and failing organs.