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a m e r i c a ’ s P l a n c H a P t e r 1 0 the clinician who can adjust medications, thereby averting a Mobile medicine takes remote monitoring to a new level. hospital readmission. Estimates indicate that remote monitor- For example, today’s mobile cardiovascular solutions allow a ing could generate net savings of $197 billion over 25 years patient’s heart rhythm to be monitored continuously regardless from just four chronic conditions.26 of the patient’s whereabouts.32 Diabetics can receive continuous, flexible insulin delivery through real-time glucose monitoring Mobile Broadband and the Future of Health sensors that transmit data to wearable insulin pumps.33 Mobile health is a new frontier in health innovation. This field Advances in networked implantable devices enable capabili- encompasses applications, devices and communications net- ties that did not seem possible a few years ago. For example, works that allow clinicians and patients to give and receive care micropower medical network services support wideband anywhere at any time. Physicians download diagnostic data, lab medical implant devices designed to restore sensation, mobil- results, images and drug information to handheld devices like ity and other functions to paralyzed limbs and organs.34 These PDAs and Smartphones; emergency medical responders use solutions offer great promise in improving the quality of life for field laptops to keep track of patient information and records; numerous populations including injured soldiers, stroke vic- and patients use health monitoring devices and sensors that tims and those with spinal cord injuries. Human clinical trials accompany them everywhere.28 Through capabilities like these, of networked implantable devices targeting an array of condi- mobile health offers convenience critical to improving con- tions are expected to begin at the end of 2010.35 sumer engagement and clinician responsiveness. Mobile and networked health solutions are in their infancy. Innovations in mobile medicine include new modalities The applications and capabilities available even two years from of non-invasive sensors and body sensor networks.29 Mobile now are expected to vary markedly from those available today. sensors in the form of disposable bandages and ingestible pills Some will be in specialized devices; others will be applications relay real-time health data (e.g., vital signs, glucose levels and using capabilities already built into widely available mobile medication compliance) over wireless connections.30 Sensors phones, such as global positioning systems and accelerometers. that help older adults live independently at home detect mo- Networked implantable devices stand to grow in sophistication tion, sense mood changes and help prevent falls.31 Wireless and broaden the realm of conditions they can address. These body sensor networks reduce infection risk and increase solutions represent a glimpse into the future of personal and patient mobility by eliminating cables; they also improve care- public health—an expanded toolkit to achieve better health, giver effectiveness. Each of these solutions is available today, quality of life and care delivery. albeit with varying degrees of adoption. Box 10-3: 10.2 the need For “How Health IT Saves digital cameras and remote actIon: MaXIMIZInG Veterans Affairs Billions monitoring devices. Each Year”27 CCHT led to a 25% reduc- heaLth It UtILIZatIontion in the number of bed daysThe Veterans Health Administration (VHA) coor- of care and a 19% drop in hos- dinates the care of 32,000 pital admissions. At $1,600 per Limited Health IT Utilization veteran patients with chronic patient per year, it costs far less The United States is not taking full advantage of the opportuni- conditions through a national than the VHA’s home-based ties that health IT provides. It lags other developed countries program called Care Coor- primary care services ($13,121 in health IT adoption among primary health care providers dination/Home Telehealth per year) and nursing home (see Exhibit 10-A). (CCHT). CCHT involves the care rates ($77,745 on average The United States ranks in the bottom half (out of 11 coun- systematic use of health in- per patient per year). tries) on every metric used to measure adoption, including formatics, e-care and disease Based on the VHA’s experi- use of electronic medical records (10th), electronic prescribing management technologies ence, e-care is an appropriate (10th), electronic clinical note entry (10th), electronic ordering to avoid unnecessary admis- and cost-effective way to man- of laboratory tests (8th), electronic alerts/prompts about poten- sion to long-term institutional age chronic care patients in tial drug dose/interaction problems (8th) and electronic access care. Technologies include urban and rural settings. Most to patient test results (7th). videophones, messaging importantly, it enables patients Adoption rates for e-care are similarly low. A Joint Advisory devices, biometric devices, to live independently at home. Committee to Congress found that less than 1% of total U.S. 2 0 2 F e d e r a l c o m m u n i c a t i o n s c o m m i s s i o n | w w w . b r o a d b a n d . g o v