Managed Care - February 2009 - (Page 27) such as wireless local-area networks, broadband wireless, and Bluetooth. What technology will be the next big thing is up for grabs, but it will doubtless follow the same pattern of quicker, cheaper, better, and easier that will allow the movement of ever larger volumes and types of data between devices, places, and platforms without the need for human intervention. Doubtless, too, it will still include things like telephony, in whatever form that takes in the future, but it will also increasingly focus on the use of devices — which are evolving into “smart” devices. Some of the future in those devices is already here, but just is not yet well known, widespread, or heavily adopted. The devices that are common tools in today’s DM programs are already starting to become yesterday’s devices. New tools are being introduced daily, and there is starting to be some blurring of who is interested in and involved in these technologies, as is often seen as an industry matures. For example: § Smart pillboxes already on the market not only audibly and/or visually remind people to take their medications but also track that usage and report it electronically to a data center through a telephone line or via wireless upload technology. § Today’s implanted cardiac defibrillators contain electronics and communications technologies that allow data to be captured and uploaded indicating when and how the unit triggered a shock to the heart. The information also is tied to algorithms that can predict when a patient is getting worse and whether the implant is functioning correctly. The implant can have its parameters changed remotely, based on an assessment of the data generated by the unit. Medtronic, one of the leaders in the implantable medical device industry, already has links to a call center and is able to monitor over 100,000 patients who have implanted devices2. § The reader is probably familiar with insulin pumps that have been around for a long time now, but may not be as aware that implantable tiny catheters, available since 2005, can monitor blood sugar levels by being placed under the skin. § There is also a leather wallet available which not only does everything your standard wallet does but also has a single lead electrocardiogram (EKG) that can be triggered by simply holding the wallet against your chest. It can transmit a rhythm strip via telephone or cell phone almost instantaneously. § Another device can actually analyze a tiny blood sample looking for blood changes indicative of a cardiac event (myocardial infarction or heart attack) as well as provide an EKG and symptom checklist that can be uploaded to a medical facility for rapid assessment, hopefully preventing a serious cardiac event. That same patient could also be instructed to self-inject with lidocaine (a local anesthetic also used to prevent certain serious heart arrhythmias) to prevent an arrhythmia on the way to the hospital, using an available device that is almost identical to an EpiPen (containing epinephrine and used for people prone to serious allergic reactions). § A company in the United Kingdom has developed a small patch worn on the chest that can monitor a patient’s vital signs including respirations, oximetry (the amount of oxygen in the blood), patient movement, temperature and electrocardiogram. All of this is available today and I do not doubt that there are more out there that we just have not heard about yet. At the time that this chapter was being written, the giant computer chip maker Intel had just received clearCardioPocket wallet ance from the Food and with built-in EKG Drug Administration to market its in-home personal health system. What is being called the Intel Health Guide was devised to allow medical professionals to monitor people with chronic conditions. It combines an in-home device with Web connectivity and a communications interface to allow for home monitoring of various conditions. Intel has already completed a number of pilot studies and is in the process of doing others. It is expected that the tool will be on the market in 2009. ADT Security Services Inc., the home security company, offers a monitoring service for elderly adults that allows them to use the existing connectivity, including voice communications, of their home burglar alarm system and ADT’s existing call-center structure to call for medical help should they need it while in the home. FEBRUARY 2009 / MANAGED CARE 27
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