Written for JEMS in partnership with the National Association of Mobile Integrated Healthcare Providers (NAMIHP).
“Good news, we don’t need to take you to the emergency department (ED). You can stay home.”
Recent trends show that mobile integrated health (MIH) programs will reach even greater heights this coming year with the growing adoption of disruptive technologies and communication for delivering cost-effective, high-quality patient care. Telemedicine has expanded quickly since the COVID-19 pandemic with the re-allocation of limited resources towards alternative care models particularly when doing so can yield a positive return on investment. In fact, one poll showed that “more than one in five healthcare leaders said that their practice offers [remote technologies]” in April 2021.1
Momentum exists for identifying more ways of using technology to avoid unnecessary health costs. Strong evidence already highlights the importance of preventing avoidable visits to EDs. Studies have shown that almost 15% of Medicare beneficiaries transported to the ED by EMS can save upwards of $1 billion per year due to the nonemergent nature of their visits.2
In 2009, the Institute of Medicine estimated that the United States wasted $750 billion on unnecessary health spending, often driven by ED visits and inpatient services utilization.3 With the help of medics arriving on-scene to the patient’s home, telehealthproviders can reliably evaluate patients using the most up-to-date technology, a combined key strategy to capture all critical pieces of clinical information.
Remote technology has certainly revolutionized the way care is being delivered. Paramedics – after performing on-site physical examinations, checking fingerstick glucose levels, performing electrocardiogram (EKG) tracing – immediately connect with board-certified physicians for rendering a safe, shared-medical decision making with the patient and others on-scene.
Artificial intelligence (AI) companies are finding ways of transcribing spoken word into reliable clinical documentation, wearable tech devices are now able to reliably monitor vital signs between visits, and Electronic Health Record systems (EHRs) are supporting task-oriented and efficient communication between health team members.4,5,6
Beyond AI and EHR-based technologies, the digital health industry is rapidly growing. Projections have shown industry growth rates upwards of 18.3% compounded annually from 2024 to 2030 – a trend that should further innovate patient-centered, innovative delivery models for MIH-based programs. The trend is surprising given how healthcare compares to other economic sectors.7
Unlike the areas of media, finance, and even government, healthcare recently ranked near the bottom of a recent McKinsey Industry Digitization Index due to the lack of digital assets, usage, and workers in healthcare.8
There are few studies, however, investigating the impact of new technology on the home healthcare setting and more data is needed to evaluate the impact of new devices on patient care. Despite the upside of using new technology, there are challenges associated with further digitalization including the “digital divide,” health equity, and communication-related barriers especially with MIH.
No patient can be legally turned away from being physically evaluated in the ED but some can face serious hurdles receiving remote care without access to broadband connectivity. Even across the United States, rural (69%) versus urban (75%) communities have different rates of internet usage.9
A growing percentage of the U.S. population is growing older and with advanced age come new challenges with accessing digital technology such as smart phones, tablets, laptops and the internet – all critical tools used by paramedics to perform MIH services.
Communities and underserved zip codes also risk losing out on accessing novel technology due to lack of infrastructure and capital investment. The Center for Medicare and Medicaid Services (CMS) has created screening tools and frameworks for providing better health equity in the out-of-hospital setting but going “beyond the zip code” and addressing the true needs of communities can be more challenging than expected.10,11
Despite the challenges and risks of growing technologies in healthcare, investment into the MIH workforce can help in facilitating tech’s success in high risk communities. MIH teams and the medics core to these programs can ensure rural areas, those with significant social needs, and populations struggling with technology adoption can leverage the growing tech resources.
The rapid growth of MIH and novel technology could yield significant dividends for the coming years provided that (1.) more study data becomes available, (2.) patient safety and data privacy are preserved, and (3.) communities and complex patients receive equal care and access. Can we fail? Yes, but certainly patients, communities, health systems, and the country are rooting for success.
References
1. Medical Group Management Association. (2021, April 22). Is there room to grow with remote patient monitoring as COVID-19 continues? MGMA Stat. Retrieved from https://www.mgma.com/mgma-stats/is-there-room-to-grow-with-remote-patient-monitoring-as-covid-19-continues-
2. Shah, M. N., Gillespie, S. M., Wood, N. E., Wasserman, E. B., Nelson, D. L., Bogucki, B., … & Lerner, E. B. (2018). Mobile integrated healthcare intervention and impact analysis with a Medicare Advantage population. Prehospital Emergency Care, 22(2), 228-236. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29240530/
3. Frost, J. H., & Massagli, M. P. (2008). Social uses of personal health information within PatientsLikeMe, an online patient community: what can happen when patients have access to one another’s data. Journal of Medical Internet Research, 10(3), e15. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161318/
4. Lomas, N. (2023, March 14). Nabla, a French digital health startup, launches Copilot using GPT-3 to turn patient conversations into actionable items. TechCrunch. Retrieved from https://techcrunch.com/2023/03/14/nabla-a-french-digital-health-startup-launches-copilot-using-gpt-3-to-turn-patient-conversations-into-actionable-items/
5. Technology insights. Omnia Health Insights. Retrieved from https://insights.omnia-health.com/technology
6. JAMA Network Open. (2023). “Trends in Alcohol Use Among US Adults by Age, Gender, and Educational Attainment, 2002-2018.” Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804851
7. Grand View Research. (2023). “Digital Health Market Size, Share & Trends Analysis Report By Component (Software, Hardware, Services), By Deployment (On-premise, Cloud-based), By End-use (B2B, B2C), By Region, And Segment Forecasts, 2023 – 2030.” Retrieved from https://www.grandviewresearch.com/industry-analysis/digital-health-market
8. McKinsey & Company. (2023). “Digital Is Reshaping US Health Insurance: Winners Are Moving Fast.” Retrieved from https://www.mckinsey.com/industries/healthcare/our-insights/digital-is-reshaping-us-health-insurance-winners-are-moving-fast
9. Spiros Xanthos. (2020). “An Introduction to the Digital Divide.” Medium. Retrieved from https://medium.com/@spirosx/an-introduction-to-the-digital-divide-33dc670f8c16
10. Centers for Medicare & Medicaid Services. (2023). “Accountable Health Communities Health-Related Social Needs Screening Tool.” Retrieved from https://www.cms.gov/priorities/innovation/files/worksheets/ahcm-screeningtool.pdf
11. Wiley Online Library. (2017). “Social Disparities in Transport Behavior: Findings from the 2017 National Household Travel Survey.” Academic Emergency Medicine. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13412
