Technological Components In Pervasive Healthcare Technology

Published Date: 02 Nov 2017

Pervasive Healthcare Technology in Primary Care

One area that can be a compelling reason for technology is healthcare. Healthcare is one area where people do want to be more engaged, and not just more connected. A group of researchers at Partners Healthcare in Boston has done several studies looking at using technology to conduct "virtual visits" between patients and primary care providers. In two studies, they showed that both patients and primary care providers felt that a "virtual visit" was indeed a useful alternative to the traditional in-person visit for many different situations (Lankton & Wilson, 2007).

However, because patients are not interested in using technology with each other, pervasive healthcare will pose many unique challenges to healthcare that previous communication technologies did not. When one looks at the telephone and email, healthcare was very slow to adopt both of these technologies. By the time it finally happened (or in the case of email, is still happening), both technologies were already wide spread (Doukas & Maglogiannis, 2008; Lankton & Wilson, 2007). This may not be the case with technology. It is not enough for healthcare to simply adopt technology; healthcare must take "the first step" and offer this service to our patients, and hope that patients will indeed follow Anderson & Wittwer, 2011). This is a very daunting prospect for many people in the healthcare field.

Fortunately, many devices, including laptops and smart phones, have technology embedded in them. So the number of people with the needed hardware is at least growing over time. Indeed, of the five virtual visits that were in 2011, three of those patients were using a web cam that was built into a laptop computer (Pai & Huang, 2011). For these patients, the challenge is to get people to think about using hardware when interacting with their healthcare provider. However, the large majority of people in this country still do not have a web cam of some type in their house. For these patients, you also have the added task of getting them to buy the needed hardware in the first place (Ziefle & Rocker, 2010). While the hardware is not expensive, many patients are perfectly comfortable simply using the telephone and the traditional in person office visit to interact with their healthcare providers. Overcoming this inertia will be a new challenge for healthcare providers who want to introduce this modality to their patients (Pai & Huang, 2011).

There is growing evidence that the benefits of pervasive healthcare are worth the effort. One obvious benefit is that pervasive healthcare can often replace an office visit, which is a tremendous convenience for the patient (Pai & Huang, 2011). There are three main patient complaints where this can happen – skin, movement, and psychiatry. This last area has been a particularly active area at many academic medical centers. This is largely due to the fact that psychiatry does not rely on an in-person physical exam (De Moraes et al. 2010; Anderson & Wittwer, 2011). A virtual visit allows the psychiatrist to still see the patient’s non-verbal communication cues, which are critical in this field. In an article from 2010, a group of researchers from UC Davis used 5 case studies to suggest that tele-psychiatry may actually be superior to traditional in-person consultations for treating some pediatric patients (Nachman et al. 2010).

But on top of these benefits, pervasive healthcare can also be a great replacement to regular telephone visits. In these situations, they may not offer much in the way of clinical benefit to the provider, but it allows for a much higher level of engagement between the patient and provider, something that both sides often find beneficial. In a recent survey of 2000 doctors, 7% of physicians report that they are using online conferencing to communicate with patients (Munnelly & Clarke, 2007). In an article from InformationWeek about this survey, it was postulated that one reason for such a high number is that physicians may actually prefer this higher level engagement as opposed to using email to communicate with patients (De Moraes et al. 2010; Anderson & Wittwer, 2011).

Technological Components in Pervasive Healthcare Technology

A Pervasive Healthcare Technology system is comprised of healthcare service providers, healthcare application service providers, and communication service providers. Pervasive Healthcare Technology is a system that connects primary care physicians, providers, specialists and patients (Garson, 2008; Munnelly & Clarke, 2007). The fundamental platform of Pervasive Healthcare Technology consists of a user interface, some clinical devices, a transmission medium, and supporting software and hardware. The Pervasive Healthcare Technology user interface is achieved through a Pervasive Healthcare Technology workstation (Coronato & Pietro, 2010). The Pervasive Healthcare Technology workstation may be a simple personal computer (PC) or personal digital assistant (PDA). The user can interface through a telephone pad, mouse, touch screen, remote control, joystick, voice recognition system, and so on (Pai & Huang, 2011). Clinical devices are connected to the Pervasive Healthcare Technology workstation for local healthcare providers to capture patient vital signs or other clinical data, such as images and sounds.

Depending on the type and use of Pervasive Healthcare Technology, different clinical devices have been incorporated with Pervasive Healthcare Technology applications: digital electrocardiogram (ECG), tele-otoscope, electronic stethoscope, tele-pathology microscope, x-ray digitizer, high resolution digital camera, and pulmonary function test device (PFT) (Washburn & Hornberger, 2008). Acquired clinical data is then transmitted to distant remote site for examination and analysis. Pervasive Healthcare Technology data is presented in the form of text, voice, still images, and full motion video (Appari & Johnson, 2010; Ziefle & Rocker, 2010). Pervasive Healthcare Technology software systems facilitate data entry, data storage, data transmission, and data processing. A typical Pervasive Healthcare Technology software system has the following components:

1. User interface software for the user to interact with the Pervasive Healthcare Technology system

2. Data acquisition system and sensors for acquiring images and vital signs from the medical devices

3. Software to store and retrieve patient record and medical database

4. Software to ensure secure and successful data transmission

5. Network protocols for data transmission

6. Processing software to manipulate the acquired data

The selection of electronic links depends on the required bandwidth, the available telecommunication infrastructure, cost, and expansion potential. Transmitted data can be analog or digital as text, sound, and images (Bardram, 2008; Coronato & Pietro, 2010). The data can be formatted according to the digital Imaging and Communications in Medicine standard (DICOM) or in non-DICOM formats (Bardram, 2008; Coronato & Pietro, 2010). Transmission can be made through point-to-point connections or multiple point connections that link multiple sites over terrestrial or cellular mobile links. Tele-medical data transfer can be achieved via terrestrial media, cellular mobile media, and satellite (Coronato & Pietro, 2010). A variety of terrestrial services are currently used: (a) voice telephone networks including the Public Switched Telephone Network (PSTN) and the plain old telephone systems (POTS), (b) switched digital dial-up telephone services such as Integrated Services Digital Network (ISDN), (c) Frame Relay Services (FRS), (d) Local Area Networks (LAN) and WAN Area Networks (WAN), and (e) Virtual Private Networks (VPN).

Cellular mobile services currently used in Pervasive Healthcare Technology are Global System for Mobile (GSM) Communications (digital cellular phone technology), Code Division Multiple Access (CDMA), high-speed digital wireless General Packet Radio Service (GPRS), or 3G mobile technologies (De Moraes et al. 2010; Anderson & Wittwer, 2011). Satellite services generally utilize geosynchronous and low earth orbit (LEO) satellite, and very Small Aperture Satellite Terminal (VSAT). Although more costly, satellite services enable large amounts of data to be transmitted regardless of geographic boundaries (Pai & Huang, 2011). Transmissions of Pervasive Healthcare Technology are conducted in either real-time interactive synchronous mode or store and forward asynchronous mode.

Real-time synchronous operation requires that the patient and the care providers meet at the virtual space at the same time. It is used when immediate feedback is critical in situations such as emergent interactive treatments (Doukas & Maglogiannis, 2008; Lankton & Wilson, 2007). Real-time telemedicine allows remote healthcare providers to examine and consult the patients with little time delay. Conversely, if immediate feedback is not required, store and forward mode is used. Store and forward telemedicine acquires and stores medical data and then transmit the data to healthcare providers at a scheduled or convenient time for offline assessment (Lankton & Wilson, 2007). Rapid breakthroughs in computing and telecommunication technologies have brought about advances in telemedicine; however, fast evolution of technology means existing telemedicine systems may quickly become obsolete Anderson & Wittwer, 2011).

Although performance and cost-effectiveness are important factors, programmability, upgradability, and flexibility are even more crucial in designing or selecting a telemedicine system (Pai & Huang, 2011). A successful telemedicine system builds on reliable hardware, software and network architectures. The criteria for a telemedicine system design should follow the same rigorous guidelines as those for information systems (Doukas & Maglogiannis, 2008; Lankton & Wilson, 2007). Moreover, with the fast pace of technology, telemedicine system design must take a futuristic approach, emphasizing scalable and plug-and-play architectural frameworks and conforming to widely accepted industry standards.

Pervasive Healthcare Approach for Aged Patients

Among Healthcare Technology developments, tele-monitoring is the fastest growing category that highly suits aged patients for home based treatment. In 2004, research studies reported that the total healthcare technology market was about $380 million (OTP, 2004). In 2007, it was predicted that the tele-home care market alone would grow to be in the billions by 2010 ("Home ehealth", 2007). Uptill now, the prediction has come true (Pai & Huang, 2011). In-home tele-monitoring for aged patients currently focuses on two chronic, high mortality diseases: diabetes and congestive heart failure. However, tele-pulmonary monitoring has also been prevalent in elderly patients. Healthcare Technology in these cases provides remote consultation and helps manage the episodic needs of high-risk illness for elder patients, provide education, schedule care, reduce hospital stay, and improve overall patient and clinician satisfaction.

Research studies suggest that even though not all aged patients are willing to be monitored 24/7/365, most homebound aged patients who have difficulties accessing to medical care are comfortable with the arrangement (Sneha & Varshney, 2007). According to research, demographic trends would likely require increasing future home healthcare ("Home e-health", 2007). Research studies assert that an aging population and increasing rates of obesity and cancer indicate a significantly larger population of chronically ill elders that require rehabilitation and long-term care management (Ziefle & Rocker, 2010). This scenario translates into significantly increasing demands upon the relatively small group of healthcare providers and inevitable cost inflation. Compounded with the increasing shortage of healthcare professionals and facilities, healthcare provision is becoming an acute problem; Healthcare Technology will most likely be the only solution (Sneha & Varshney, 2007; Varshney, 2009).

The use of Healthcare Technology allows patients to access to the best clinical providers, despite differences of time and distance, and frees up the small group of highly specialized experts for the most critical cases (De Moraes et al. 2010; Anderson & Wittwer, 2011). From the aspect of a hospital, healthcare technology technologies enable the efficient use of resources, improved quality, decreased medical errors, and enhanced medical care experiences. From a patient’s perspective, healthcare technology allows aged patient to stay at their residence, to cut the cost of long-term healthcare, and to decrease the frequency of hospital visits (Thuemmler et al. 2009). Timely data entry and immediate access to patient electronic records help reduce the latency issues of patient care. Moreover, recent wireless technology further promotes the mobility of both healthcare professionals and patients. Researchers predict that the future of inpatient care is digital, wireless, and interactive (Washburn & Hornberger, 2008). With the help of Healthcare Technology, patient care can be achieved in the patient’s room at hospital or at home with the CAD-CAM assurance of safety and quality.

Relative Advantages for Home Based Aged Patients

Healthcare Technology enables specialists to attend to aged community that otherwise could not be served (Doukas & Maglogiannis, 2008; Lankton & Wilson, 2007). It eliminates possible travelling time and cost for aged patients and healthcare providers. Healthcare Technology allows quick access to specialized care in rural communities. It reduces economic strain as well as alleviates a patient’s emotional strain of travelling far from home (Aziz et al. 2006; Washburn & Hornberger, 2008). In rural areas, treating local aged patients with Healthcare Technology means more than to provide access to otherwise impossible treatments. It also increases the financial viability of rural medical facilities and strengthens the rural economy.

Networked healthcare also brings balance to the distribution of aged patients and care providers among urban and rural facilities (Thuemmler et al. 2009). Tele-monitoring aged patients inside hospitals may potentially reduce the cost of intensive care and post intervention observation and increase the administration’s effectiveness. Tele-monitoring aged patients at their homes can lead to improved, continuous, and highly effective disease management (Lankton & Wilson, 2007). Healthcare Technology makes personalized pre- and post-treatment integration possible through continuous consulting and monitoring. To conclude, general agreements on fundamental benefits of Healthcare Technology are as follows:

1. Increase aged patients’ accessibility to medical care in their own community.

2. Effective use of healthcare resources.

3. Enhanced continuum of patient care.

4. Access to specialty care when either geographically or physically impossible.

5. Timely institution of healthcare at emergencies or otherwise.

6. Increase productivity of practitioners and improve healthcare service quality.

7. Cost-effectiveness for the entire healthcare system.

8. Support of healthcare maintenance needs such as education, training, and informatics.

Traditionally, Healthcare Technology is supported for its benefits to the otherwise inaccessible rural populations (Thuemmler et al. 2009). Today’s Healthcare Technology also reaches out to the medically underserved urban populations in inner cities, senior facilities, prisons, and so forth. Global availability of the Internet and highly sophisticated computing technologies has propelled the growth of Healthcare Technology (Pai & Huang, 2011). Healthcare Technology is becoming an integral part of healthcare throughout the world.

Current State and Challenges for Pervasive Healthcare Technology

Research studies have long concluded that Healthcare Technology is useful for aged or adult aged patients. Nevertheless, Healthcare Technology adoption is still in its infancy (De Moraes et al. 2010; Anderson & Wittwer, 2011). Mainstream UK healthcare organizations have been hesitant about Healthcare Technology adoption until recently. There had been considerable amount of scepticism from practitioners, due to a lack of face-to-face, reach-and-touch intimacy (Coronato & Pietro, 2010). Hence, Healthcare Technology was often limited to rural settings and was applied to aged patients without critical needs. The return on investment (ROI) was difficult to justify due to often refused reimbursements, huge initial start-up costs, and high maintenance costs. In addition to these considerations, legal issues regarding physician licensing, legal liability, and patient confidentiality concerns also deterred Healthcare Technology adoption (Pai & Huang, 2011).

Patient care favours personal touch. Research studies agree that in certain cases, medicine can only be fully exercised through one-on-one interaction between the physician and the patient (Sneha & Varshney, 2007). With higher speed communications and more advanced computing technologies, recent Healthcare Technology has allowed healthcare providers and aged patients to meet in virtual spaces synchronously in ways that such personal attendance can be achieved (Olguin, Gloor & Pentland, 2009). Live communication, aided by audiovisual devices and high speed Internet, has been rendered accessible due to such devices as tele-presence robotics and pervasive tele-monitoring used in current healthcare technology practices. As computers and telecommunication become increasingly prevalent and familiarity to the technologies grows, pervasive healthcare technology has become acceptable from the perspectives of healthcare providers and healthcare recipients (Washburn & Hornberger, 2008).

Healthcare technology used in critical patient interventions has been proved successful in the past. In those cases, remote medical specialists were linked to the actual examination or operating room through real-time interactive communications (Ziefle & Rocker, 2010). Healthcare Technology for use in neonatal intensive care units (NICU) has been proven feasible as early as in the 1990s (Pai & Huang, 2011). Tele-ICU provides innovative remote care for centrally monitored ICU aged patients in an effort to improve ICU critical care as well as leverage scarce intensive care doctors. Tele-surgery requires more technical skills and costs, but tele-robotic surgical systems used with laparoscopic techniques have also demonstrated the capability and effectiveness of remote tele-surgery (Munnelly & Clarke, 2007).

Regarding fee structures, the ATA (2009) emphasizes that services provided on site are not different than services provided remotely through Healthcare Technology (Sneha & Varshney, 2007). Nonetheless, the Healthcare Technology reimbursement issue has persistently been identified as a critical obstacle to Healthcare Technology adoption and expansion. Healthcare insurers (Medicare, Medicaid, and private insurers) have argued that the access and cost of healthcare technology cannot be adequately addressed (Appari & Johnson, 2010; Ziefle & Rocker, 2010). This is possibly due to difficulty to build a chain of traceability for treatment and is vulnerable for fraud and abuse. Moreover, although the costs of high-speed networks and IT devices have decreased in recent years, tele-digital versions of medical devices are certainly more expensive than traditional versions (Sneha & Varshney, 2007; Varshney, 2009). Costs for Healthcare Technology provision are difficult to recoup since reimbursement policies are nonexistent or limited. The integration of Healthcare Technology is seriously challenged by the lack of consistent and comprehensive reimbursement policies and regulations (Doukas & Maglogiannis, 2008; Lankton & Wilson, 2007).

Legal and licensing issues are also big hurdles to healthcare technology adoption ((Munnelly & Clarke, 2007; OTP, 2004). The transmission of medical records across state lines, different state licensure and accreditation requirements, and dispersion of liability in cases of cross-state practices are all pending on Federal regulation. Moreover, by elevating the care provision, healthcare technology also affects the standard of healthcare (De Moraes et al. 2010; Anderson & Wittwer, 2011). With new standards, healthcare providers may have increased liability for failing to implement up-to-date technologies in addition to liability for inadequate maintenance or use of technologies, resulting in patient dissatisfaction (Lankton & Wilson, 2007).

Efforts have been put forth for interstate compact and licenses for healthcare technology practices. Various organizations such as Federation of State Licensing Boards and the Centre for Healthcare technology Law (CTL) have initiated policies and regulating models on aspects of licensing and litigation ((Varshney, 2009; OTP, 2004). However, state licensure and liability issues continue to be unresolved obstacles to healthcare technology marketing and user acceptance (OTP, 2004). For healthcare technology to be successful, patients require confidentiality, reliable and available connectivity, and consistent data transmission. Real-time data transmission can be especially problematic in remote areas, which is a critical concern when human lives are involved.

The issues of data security and patient confidentiality raise critical concerns that demand the development of secure, reliable, and capable connectivity and transmission infrastructure. Current infrastructure and patient data systems, such as electronic healthcare records (EHR), require financial and regulatory encouragement from policy setting organizations in order to meet the standards and compatibilities of healthcare technology. Healthcare technology is a marriage between technology and healthcare. It thus inherits the complexities of both disciplines. Healthcare is a context and culture specific industry. Unique healthcare needs and individualized approaches often demand special considerations. The decision making process and workflow patterns require adaptation to specific healthcare provisions and providers.

Conversely, to keep pace with the constant evolution of new technologies, IT must address usability, connectivity, scalability, maintainability, and so forth. IT practices follow standard development cycle with multiple iterations of prototyping, developing, and testing that are not usually applied in the healthcare. By merging the two disciplines, healthcare technology expansion must seriously focus on inter-disciplinary practices, blended expertise and partnership (De Moraes et al. 2010; Anderson & Wittwer, 2011). Challenges have persisted in healthcare technology adoption and expansion despite its evident effectiveness. However, with techno-centric development in almost every business area, the demand for healthcare technology applications will drive the market (Sneha & Varshney, 2007; Varshney, 2009). Using healthcare technology is not only critical to the healthcare systems, but also important to the healthcare delivery model and to the entire economy.

Conversely, regardless of the tele-part of healthcare technology, healthcare providers must abide by the rules of quality healthcare practices and patients need to accept the advance of medical technologies while understanding their limits (Nachman et al. 2010; Pai & Huang, 2011). Furthermore, research asserts that there is an existing wide "digital divide" between those who, including both healthcare providers and recipients, have access and those who do not have access to healthcare technology (Coronato & Pietro, 2010). If not properly addressed soon, this differentiation may continuously widen and result in serious problems in healthcare delivery in the future. To sum up, continuing patient education and practitioner training is absolutely critical to healthcare technology progress.

Present Research Intention

Present research concentrates on pervasive healthcare technology based on the following facts. First, pervasive healthcare technology has a potential for virtual face-to-face communication regardless of the distance. Distance can be created through geographic location, transportation imparity, and other social issues (Nachman et al. 2010; Pai & Huang, 2011). Pervasive healthcare technology can help bridge the distances. Second, pervasive healthcare technology has a potential for unrestricted data continuity when data collection and transmission can both be automated without time constraints (Pai & Huang, 2011). Third, broad band and cellular communications are more economically feasible currently. The advanced technology has translated technological intrusiveness into virtual closeness.

The demands for pervasive healthcare technology has consistently presented through market forecasts. In order to sustain market position and patient pool, it is necessary for healthcare organization to leverage this up-to-date Healthcare Technology application (Ziefle & Rocker, 2010). However, Healthcare Technology adoption requires organizational strategic effort and healthcare professional’s recognition and contribution.

Moreover, with the diffusion of information technology, the attitude and expectation to tele-medical innovation from patients will also be crucial to the adoption of healthcare innovation (Olguin, Gloor & Pentland, 2009). Healthcare Technology is a distributed cooperative care. The cooperation and communication among clinicians as well as patients, their relatives and peer patients are critical (Lankton & Wilson, 2007). Applied in chronic disease management, such as diabetes and heart failure, successful implementation of pervasive healthcare technology relies heavily on patients’ ability and willingness to use the technology. A tele-medical technology would not be useful unless patients use it (Tu, Zhou, & Piramuthu, 2009). In response to this understanding, present research focuses on the determinant factors for patients’ technology acceptance.