Philips' Interactive Healthcare Services: Putting the Patient in Charge
The year 2001 was one of transformation for Philips generally and, in particular, for Philips in the United States. During the year Philips completed a $5 billion, three-year acquisition program for Philips Medical Systems with the purchase of Agilent's Healthcare Solutions Group, ADAC Laboratories, ATL Ultrasound and Marconi Medical Systems. The result was a new Philips Medical Systems, the global number two player in medical diagnostic imaging equipment.
Prior to its acquisition by Philips, Agilent's Healthcare Solutions Group was a worldwide leader in clinical measurement and diagnostic solutions for the healthcare industry. The group had 4,500 employees and had revenues of more than $1.5 billion in its 1999 fiscal year. Key products included: diagnostic cardiology, patient monitoring, ultrasound imaging, automatic external defibrillators, point of care diagnostic systems, related supplies, professional services and support. Agilent held leading market share worldwide in patient monitoring, cardiovascular ultrasound imaging and for critical-care information-management systems. Agilent's Healthcare Solutions Group was acquired by Royal Philips Electronics of Amsterdam, Netherlands, on August 1, 2001.
In the United States, Philips Medical is the second largest medical equipment imaging company (behind General Electric) and the single largest Philips business, with 10,500 employees. Royal Philips Electronics of the Netherlands is one of the world's biggest electronics companies and Europe's largest, with sales of EUR 37.9 billion in 2000. It is a global leader in color television sets, lighting, electric shavers, medical diagnostic imaging and patient monitoring, and one-chip TV products.
Managing Health Care At Home"Congestive heart failure is the leading cause of hospital admissions for Americans over 65. Home-based technologies for self-management of this disease have become an effective approach to reducing unnecessary admissions and for enabling patients to take an active part in their own medical care". (Rich, 1999)
"Having this system in my house has changed my life because it's given me more independence. It gives me more satisfaction in knowing that I'm doing alright and I don't have to wait for somebody else to tell me that."
Thomas Danna, patient
Growing Use of Telemedicine
Increasing costs of institutional care, restrictions on inpatient care by managed-care organizations, and the desire to "age in place" by individuals with medical conditions requiring regular medical monitoring, are driving the development of telemedicine products and services. Building on the success of home diagnostic tests such as those for pregnancy and glucose levels, technologies for managing chronic disabilities are developing rapidly. Home kidney dialysis and cardiac pacemaker monitoring are two of the procedures which previously required in-patient professional care but are increasingly done in the home, with minimal professional supervision.
Telemedicine began in the 1960's with the use of ordinary telephone and wire communications by physicians who were physically remote from their patients. Since then high-speed data lines, advanced data compression technologies, and computerization of patient records have made telemedicine a much more powerful clinical tool.
As home health care and telecommunication technologies have continued to improve, patients have become increasingly involved in managing their own health care. At the same time, chronic conditions requiring regular monitoring are increasingly common among the growing elderly population. Congestive heart failure is among the most common of these conditions, requiring regular monitoring of blood pressure, weight, and heart rhythm.
Development of Interactive Healthcare Services
Philips' Interactive Healthcare Services is among the first to employ telecommunications technology for remote monitoring of patients' vital signs. Using portable, battery-operated measurement units which operate automatically or with a single push of a button, patients take their vital signs daily. The portable units transmit the data and the time by radio frequency automatically to the home telecommunications "hub". The hub then transmits the data, using ordinary phone lines, to a comprehensive patient database accessible to the health care provider.
Industrial designer Gil Lemke joined Agilent's Healthcare Solutions Group in 1999 specifically to develop the home technology for patients to monitor their blood pressure, weight, and heart rhythm. Lemke's responsibilities included the ergonomics, industrial design, and mechanical engineering of the product.
Lemke's design drew from the experiences of his mother in law who had congestive heart failure, diabetes, arthritis, and high blood pressure. Originally, he had considered modification of a bathroom scale, but decided this would not be adequate. For one thing, his mother needed something to hold onto for balance, making accurate readings difficult. He wondered how many other potential users shared this need, as well as limitations of hearing or vision. At the same time, he was sensitive to seniors' preference for uncomplicated set-up, control, and maintenance. "The last thing they need is to have to go to a manual the size of a phone book", Lemke says.
After some initial research into mobility devices used by persons with disabilities, Lemke developed some concept sketches and crude aluminum-pipe mockups. One of the design challenges was to develop a design that could accommodate a wide variety of user sizes and abilities, yet be small enough for use in small apartments or mobile homes.Lemke, along with a team of engineers and marketing staff, field-tested the first prototype among residents of small nursing homes and heart clinic patients. This first prototype was dubbed "Easy Rider" because it looked like the handlebars from a motorcycle, with controls as simple as possible. Lemke relates that users were unanimous in their approval of the design. The team continued with durability testing, including suspending 100-lb weights from the column handles, without any twisting or breaks in the structure.
Philips' in-home measurement and communication device
A large digital display makes reading easier with limited vision or under poor lighting. Battery power and RF data transmission was used to reduce the risk of tripping over power and data cables. The "Easy Rider" model was submitted to the 2000 American Society on Aging's Universal Design Competition, where it won an award for its innovative technology and simple design. It also won an IDSA Medical Design Excellence Award in 2000.
Market and technical testing has not been rigorously scientific to date, but rather designed to yield practical direction toward further development of the concept. The design has purposely remained simple, to make the product easy to use and non-imposing to patients. Patients have responded favorably to the product, which have proven to be durable and reliable. Some have even refused to return the units, after their conditions have become better controlled.
Heart Patient Users
"It's like an electronic house call. The patient gets attention. The provider gets information. And we maintain control of that information -- that's essential."
Dr. Allen Hinkle, Senior vice president
and chief medical officer
Anthem Blue Cross and Blue Shield
of New Hampshire
imilarly, training in the use of these technologies is critical to effective monitoring. Usability of home health care technologies is paramount. If patients are not both willing and able to use it effectively, the results can be worse than no monitoring at all, since clinician, patient, or both may be misled into believing that signs are normal when they are not.
he benefits of effective monitoring go beyond the blood pressure, pulse, and heart rhythm data transmitted. The time stamp on recorded data also provides the clinician insight into other potential health issues. For example, if the data shows the patient took his blood pressure at 3:00 AM, the clinician can follow up on potential sleep problems.
Interactive Healthcare Services at Philips
Because of the growing need, the compelling business case, and the company's history of contributions to health care development, Philips Medical Systems decided to take a leading role in the development of telemedicine products and services, says Dan Barton, Director of Marketing for E-Care Services for Philips Medical Systems. Philips acquired Agilent's Healthcare Solutions Group on August 1, 2001. Barton estimated that over 5000 patients would be enrolled in Philips' Interactive Healthcare Services across the U.S. by the end of 2002.
In addition to reducing unnecessary hospital admissions, the system facilitates prompt and appropriate response by the clinician. Philips' Interactive Healthcare Service system includes thorough clinician training and tracking software to monitor daily patient measurements, store and retrieve historical data, and generate reports. Patient measurements which fall outside preset limits can be flagged for immediate follow-up by the health care provider.
According to a Philips press release, "By engaging patients as active participants in their own care and providing physicians and nurse case managers with daily access to timely, accurate, and relevant patient data, the Interactive Healthcare Services strives to improve the management of heart failure disease. Patients receive a set of portable, easy-to-use devices that measure and transmit vital signs from their home to their healthcare provider's computer. The devices include a scale, a blood pressure unit, heart rhythm strip recorder, and a unit to transmit the data using the patient's phone line. In a user study, patients using the system had a hospital readmission rate of 0.13 visits a year, compared with an average of 1.5 for patients not using the service."
Managing Medical Costs Through Telemedicine
We've seen firsthand that we can reduce admissions <ETH> and it's a sound business decision to invest in services that help lower cost and improve care."
John W. Polanowicz, Vice President
University of Massachusetts Memorial Medical Center
(Agilent Technologies, 2002)
The cost-effectiveness of telemedicine technologies is just beginning to reshape the healthcare industry. Medicaid traditionally does not pay for less expensive alternatives to nursing homes, including in-home and community based care. That is starting to change with Medicaid waiver programs that help elders remain in their homes with assistance from visiting nurses and homemaker aides. For example, through South Florida's "Channeling" program, one of the state's first waiver programs in 1986, home health care costs about $26 per day, while institutional care would cost at least 5 times that much.
At the same time, home health care visits to monitor weight, pulse, blood pressure, and heart rhythm (ECG) are also expensive. For patients with congestive heart failure, clinicians must be aware of even slight weight gains, which don't often occur in sync with regular office visits. Regular trips to the doctor can be difficult and expensive for patients with mobility and transportation difficulties. Some visits cost as much as $500, including accessible van transportation services. For these reasons, insurance and managed care companies place limits on office and home healthcare visits. (Baker, 2001)
State and Federal Initiatives
Some 20 states have begun conducting projects to explore the effectiveness of telemedicine. The Veterans Administration is testing the concept through programs in Connecticut, Florida, Georgia, Maryland, and Texas (Baker, 2001).
The federal government is also taking an active part in studying the effectiveness of home healthcare technologies and services. Rehabilitation Engineering Research Centers (RERC's) on telemedicine at Catholic University in Washington, D.C., and The Shepherd Center in Atlanta, GA, are funded by the National Institute on Disability and Rehabilitation Research (NIDRR).
Many federal agencies, including the Department of Defense, Food and Drug Administration, National Library of Medicine, and the Public Health Service are taking an active role in development and regulation of telemedicine and other home health care technologies.
Today and TomorrowHome health care technologies such as blood pressure monitors, glucometers, and fetal monitors have given patients more information and more responsibility for their own care. The advent of telemedicine has added a new dimension of interaction between the health care provider and the patient. As a result, patients today have unprecedented access to medical information, and more and more (especially aging baby boomers) are taking advantage of it to become directly involved in their own health care.
hilips' Dan Barton sees Interactive Healthcare Services as part of this healthy movement toward healthcare that is both patient-centered and cost-effective. "This is a new approach, and payers are very risk-averse. But with the average hospitalization of a heart failure patient costing $5-10,000, technologies that can help avoid the need for re-admissions quickly pay for themselves", Barton observes.
n the future, Barton foresees changes not only in clinical service delivery and payment systems, but also in smarter and less-intrusive technology. Technological advances and sensitivity to patient ergonomics will help to make these technologies increasingly reliable and accurate. An example of this sensitivity to user needs is Philips' HomeLab, a house designed to enable people to test technologies of tomorrow in a realistic setting over extended periods of time. Opened in April, 2002, HomeLab features a range of prototype technologies that are sensitive, personalized, adaptive and responsive to people. Among these experimental technologies is a bathroom mirror with biofeedback sensors (Newstream, 2002).
Tomorrow's elders, patients who have grown up with technology, are sure to be more receptive and demanding of health care technology. As these and other telemedicine technologies increase patients' abilities to actively participate in their own care, clinicians will find themselves adjusting to far more proactive customers - perhaps even the word "patient" will have to be changed.
ReferencesAgilent Technologies (2000). "Interactive Healthcare Services for CHF". Andover, MA: Agilent Technologies.
Baker, B. (2001). "Home Care's Future is Now". AARP Bulletin, October 2001. Washington, D.C.: AARP.
Newstream (2002). "Philips Opens 'Home Lab'". New Product News.
Rich, Michael W. (1999) "Heart Failure Disease Management: A Critical Review". Journal of Cardiac Failure (5:1), pp. 64-75.