Care outside the Hospital (aka Home Care)

Remote monitoring, testing, and treatment were trends in 2019, observes Lance Black of TMCx, TMC Innovation. “From diagnostics capable of being completed at home to transitioning care from hospital to another setting only feasible through wearable monitoring tools, this trend is becoming more refined, in that a number of these technologies and supportive companies are realizing specific cases that demonstrate a clear value proposition,” he says. “An example is a company called Patch’d, monitoring blood pressure and heart rate to predict sepsis in those high-risk patients being discharged. The capability of this company to demonstrate real financial return to the hospitals all the while allowing those institutions to extend their reach into the home of the patient is a great example of this trend.”

And this “wave of pushing healthcare out of the hospitals/clinics and to the home is just beginning,” he adds. In 2020, “we will definitely see more technology supporting telehealth, remote monitoring, and at-home care,” he says.

Stephen B. Wilcox, PhD, FIDSA, principal of Design Science, saw “two strong, intertwined trends” in 2019: “an acceleration of one that’s been going on for some time—the movement of devices from the hospital to the home—and the impact of the internet of things, which is transforming devices into interconnected and adaptive systems,” he says. Wilcox offers the examples of “home dialysis systems that send data to the cloud, where it can be used by physicians, researchers, and biomeds responsible for servicing the equipment,” as well as “all sorts of home drug-delivery devices that send data to physicians and the patients themselves, and, of course, increasing sophistication with interconnected diabetes-care systems and cardiac implants.”

Wilcox expects these trends to accelerate even more next year as the internet of things matures. “We’re thinking that 2020 is the year for two big things to happen—the final arrival on the market of closed-loop ‘artificial organs,’ probably starting with systems that connect continuous glucose monitors with insulin pumps, and the arrival of a whole new generation of interconnected large volume pumps that really take advantage of the internet of things, allowing remote programming and data transmission,” he says. “The latter were set back by the serious problems a few years back that led to recalls and a new FDA guidance on the subject. The delay means, I think, that we’re going to see a quantum leap in the nature of LVPs.”

Telehealth could be even bigger in 2020 than it was in 2019, predicts Scott Thielman of Product Creation Studio. “We are finally using telehealth! 22% of physicians report having used the technology in 2019 vs. just 5% in 2015. We know it wasn’t the tech gating this one, so why has it taken so long to get people in front of providers without getting on the road to the clinic?

“We have an aging population of tech-savvy patients (even Boomers own smartphones now) who want more instant information and want to spend less time traveling to and from clinics. On the flip side, burned-out clinicians are ready to embrace digital augmentation to speed their clinical workflows,” Thielman adds. “Remember, physicians are a segment that has been glued to their pagers and phones for decades already; the addition of video consultation doesn’t seem like a quantum leap here. We’ve also given the solution providers time to create some robust interfaces ready for adoption. Perhaps most critically, the reimbursement situation continues to improve with expanded coverage in 2020 for Medicare Advantage plans. So, by the end of 2020, I predict that most of us will have used telehealth services to ask our healthcare professional if we should be concerned about this mole, or this cough, or this fever.”

The aging population and the shifting points of care are leading to new medtech solutions, observes Stuart Karten of Karten Design. “Because of the greying of our population, and the resulting disruption in healthcare, we’re seeing a rapidly shifting ecosystem, in which a new type of medical device is emerging,” he says. “For example, with Axonics, we transformed an innovative technology into a complete ecosystem of physical and digital products that improve the experience of people suffering from incontinence. With Axonics, and many of our other clients, we’re seeing a shifting ecosystem in which the point of care has moved from traditional settings. Based on our medtech clients’ success in the marketplace, we're seeing evidence of a pent-up demand for new types of patient-centric innovation.”

Finally, “the hospital of the future will be reserved for those who are truly sick, requiring constant care, attention, and a host of expensive equipment,” believes Mark Wehde of Mayo Clinic Division of Engineering. “For the rest of our care? We can expect to see a return of the house call—that antiquated model of the traveling physician will be once again in vogue. But for this to happen, we need to create the virtual hospital of the future. Mercy Virtual Care Center is the world’s first hospital without beds, but it won’t be the last. The advances in home healthcare and telehealth are allowing physicians to visit their patients virtually in many cases, and when an in-person visit in needed, it’s the physician that goes to the patient. For many, many conditions we don’t need to stay in the hospital. In fact, often our mental health and recovery will be better in a familiar environment. Couple this with the incredible advances in connectivity, including the about to be released 5G network communication protocol, and we are likely to see more and more hospitals avoiding major and expensive growth and remodeling by simply sending many of their less-critical patients home. Organizations have been leveraging network connectivity and medical devices for telemedicine and home health monitoring for over a decade (decades really if you include some of the early ECG monitors that sent data from the patients home to the clinic over a phone line as early as the 1980s). But the intersection of cloud data storage, almost university connectivity, and the ubiquity of wearable consumer devices, and suddenly it seems that home monitoring is not only possible, but inevitable. This will lead not only to the home hospital, but also an associated concept of home healthcare. Patients will routinely be sent home with long-term monitoring devices to track their health and leveraging AI to report to their caregivers at some point in the future when the patient’s healthcare status changes.”

Tom Dudnyk of VIVO Agency sums it up this way: “2020 is the year of delivering patient care to the home.”