The SCOTUS decision regarding the ACA will bring millions of more covered lives into the healthcare system. There is no debate that this will significantly increase the cost of healthcare. This creates a more pressing need for cost-saving technologies. In a previous post I discussed ways in which the SCOTUS decision on healthcare reform would affect mHealth in general terms. I think it is worthwhile examining areas of healthcare technology which will potentially provide the biggest cost-saving impact and thereby derive the most benefit from the new reality. 
1. Informatics. The collection and processing of data into project-driven objectives will be critical to drive revenue at an institutional level. This will involve supply chain requirements, outcomes-based reimbursement management programs, formulation of discharge planning and institution of home health solutions. This type of IT will provide the biggest bang for the buck, but it will likely not be a priority to most hospitals in the near future. Meeting other IT mandates and obtaining trained personnel are presently their biggest concerns.
2. Mobile apps. The demand for mobile apps in both the consumer and healthcare arenas has been rising independently of the outcome of the SCOTUS decision. However, the decision will markedly increase the demand for this technology because of the relative increase in the provider shortage to come. People will be looking for alternatives to long appointment intervals and a paradoxical decreased access to care arising from limited healthcare resources. Initiatives to certify and facilitate prescribing of apps to patients are underway.
3. Telemedicine. Telemedicine is experiencing significant gains over barriers to adoption. It has a longer history than other technologies, is closest to what patients remember as an interpersonal experience, and has made strides in the regulatory arena regarding physician licensing and reimbursement. Large scale adoption by pharmacy chains, state Medicaid agencies, and hospitals are contributing to this growth already. The shortage of providers as a result of the ACA will further fuel use of telemedicine.
4. Peer to peer healthcare social networking. The Internet is the primary source of searching for health related information today. Social networking sites focusing on health, wellness, and medicine are becoming extremely popular. The importance of these social networks cannot be overestimated. Crowdsourcing of information about specific diseases, medications, problems of patients and caregivers in navigating the system, and clinical studies will become invaluable. Peer to peer interactions themselves decrease stress and frustration, possibly resulting in improvement of provider-patient relationships.
5. Remote patient monitoring. More patients seeking care because they will be insured means more patients with chronic diseases seeking care. Remote patient monitoring, whether it encompasses text messaging or sensors delivering actionable alerts of vital signs, glucose levels or other information has promise to lead to more care at home. This can decrease incidences of hospital-acquired infection and death from institutional medication and other mishaps. It may also increase medication adherence.
While the SCOTUS decision will not directly affect technology, the ramifications of it will provide a more pressing impetus to develop, approve, and adopt it.
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By Dr. David Scher
David Lee Scher, MD is director at DLS HEALTHCARE CONSULTING, LLC, which concentrates in mobile health technology clinical research design and implementation. A former cardiac electrophysiologist, clinical trial primary investigator, human subject research committee chairman, Medicare advisory committee member, Dr. Scher was also a medical device industry key opinion leader for 20 years.Visit website | More posts by Author
I'll add that the AMA's Council on Ethical and Judicial Affairs came down rather hard on the ethical issues around telemedicine--lack of confidentiality in transaction medium (e.g. online, Skype), misdiagnosis and doctor-shopping for controlled substances. Since CEJA often recommends policy to AMA delegates and state medical boards, the barriers to #3 may be more significant than we think--even though consumer demand for online consults is strong.
@Bill, I totally agree that technology is not a lone solution to any problem, healthcare or otherwise. It provides us with tools to aid us in solving complex problems by more easily collating data and formulating ideas towards solutions which may require (and patient management certainly does) overseen human reasoning. I also agree that this is a critical opportunity to insert these technologies to change the landscape of healthcare. We do not need thousands of apps. Just a few proven ones.
@Donna, I appreciate your comments as well. I don't believe that ACA threw technology into mass confusion as much as it propelled it into a prominent place to solve the chaos, but perhaps at a more rapid pace than we would have liked. Yes, your four big questions remain. I would hope that since the blueprint for healthcare has been settled, that we can move on to address these critical questions. There are certainly smart enough people to do it if conflicted interests and lobbyists stay out of the mix (tall order, i know). The integration of this data is paramount to improving care. Connectivity will remain the holy grail of both participatory medicine and Meaningful Use. It is up to patient advocacy groups and others to pressure the healthcare IT industry and HIE administrators to make this happen. It is up to the informatics and app developers and the Chief Knowledge Officers of the future to develop ways in which data is delivered in an actionable and filtered manner.
@David, I agree with you about the importance of interoperability and coordination of healthcare. The sheer number of healthcare IT vendors with its spectrum of quality create barriers to connectivity and progress. Political barriers are the most detrimental to progress because though their basis might be one thing, it becomes one crafted by special interests. This is a reality of the legislative process. Hopefully the mobile health industry develops enough clout to become part of that legislative process, representing a better way to help providers manage patients. Let's seize this opportunity afforded by the SCOTUS and realize that we are hopefully at the beginning of the dawn of participatory medicine.
As they say, it is far easier to identify problems than develop solutions. Healthcare is a broken, inefficient mess and I don't believe that technology alone is able to repair it. It will take wholesale societal changes, methodology improvements and technology can be a big help with this. I do however believe there is a silver lining to be found. While healthcare was digging trenches to hold its ground other industries were plowing the fields and cultivating new technologies and business models. Helathcare now has the opportunity to reap the benefits froma decade of advances without most of the risk or investment.
I don't think Helathcare needs thousands of applications at this point and I think much of the failure to launch is because this was the focus of many looking to advance the healthcare industry. A proven, reliable and scalable technology platform is needed and they do already exist. You start to build a house with a solid foundation, not by picking out the drapes...
David's points are excellent--absolutely there are barriers from the state perspective. I would add that they regulate not only medical practice, but also payers, home health providers and LTC facilities which are users of all except #4. I would add the ACA adds another huge and 'puzzle palace' layer on top of this, called HHS. Thus rather than clarification, the ACA threw technology and big data, and how it's integrated into patient care, into mass confusion.
In writing for Telecare Aware, I've summarized them as the Four Big Questions or FBQs: who pays, how much, who's looking at the data, who's actioning it. These are fundamentals that haven't been solved and moreover, many of the players involved don't *want* to solve them. (David, you touch on all of these.)
The fifth Big Question implicit in the last two questions is effective integration of the data into patient records. Correct me if I'm wrong, but 'meaningful use' hasn't gotten us anywhere nearer this goal.
No one yet in mobile apps and telehealth has figured out what to do with the ton of data it generates. Overworked doctors, home health providers and DONs at LTC facilities barely know what to do with what they have now.
You can follow the investment. Granted, it's a horrendous market, but you'd think healthcare, RPM and apps would be The Next Big Thing. It has--since 2003. There are effective, adopted systems out there right now starving for next round funding, and new ones in the cradle which are getting kickstarted rather than going through normal investment, because no one in the strategic investment (much less VC) area wants to be involved with all this to date money-losing sturm und drang.
I do hope that in the future (say, 2013) both the states and the Feds will effectively meet on this to understand and remove the barriers so that the tech part can finally get to a workable business model. We are long past due.
The biggest barriers to why these 5 technologies aren't more pervasive are the balkanized state based medical legislation not participating in mandating interoperability and oreserving the mom-and-pop shop cottage industry that is our health care system. All of us are firmly wedded to autonomy yet cry for systems that when suggested threaten that autonomy. Telemedicine has been around for well over 30 years now and still hasn't made significant inroads because it still is tied to healthcare facilities rather than the telemedicine to the consumer that would help prevent office and facility visits. The reimbursement issues for individual telemedicine needs to be eliminated so physicians and other providers could actually start seeing patients where they work and at home. The expensive healthcare facility to facility telemedicine is not where your cost savings are going to occur. Telemedicine is still synchronous and many of us physicians are so busy seeing patients in real-time that we don't have the time to see virtual patients in addition. So right now it really pays when we can eliminate a specialist having to travel. The real benefit of telemedicine has yet to be unleashed when it begins to eliminate millions of office visits each year. The promise of telemedicine to the individual becomes even more distant and problematic when a patient lives in one state and the physician is licensed in another. Right now the physician needs to be licensed in the state where the patient resides. Creating a national medical license would make many of these policy barriers vanish but I seriously doubt any state would voluntarily give up their regulatory control. The same could be said for mobile applications. Too many systems, policies and procedures all but prevent individuals using mobile application to share that data in real time with their providers as HIT organizations and even many physicians don't want their records "polluted" with patient generated healthcare data and they certainly aren't going to purchase every app that all of their patients' use. Bottom line seems that no matter what innovation individuals would like to use to lower the cost curve there are mountains of legal, financial (re: reimbursement) barriers. These barriers are never technical, they are all political at some level. It'll come and the SCOTUS decision was the first step towards getting to a more logical and unified healthcare system but we're a long, long way from laws and regulations unleashing the potential these technologies promise.