Smart Choices

It isn’t just home medical equipment providers who are getting smarter; products are smarter these days, too. At Medtrade 2008, in fact, HomeCare‘s staff pegged a range of products expressly designed to help providers troubleshoot problems and improve business efficiencies.

According to some manufacturers at the Atlanta expo, both patient demand and provider need have driven the smart product evolution.

“It’s a balance between economics and patient satisfaction,” said Ron Richard, RRT, CEO of SeQual Technologies. “Patients are getting more demanding. They are looking for lifestyle products that match up to their clinical needs, and if they want to travel, they don’t want a lot of hassles with their equipment.”

On the flip side, providers who want to stay competitive in an environment where reimbursement is continually crunched and costly legislative and regulatory mandates are the norm must find ways to do business better and smarter. Those are the ones who are investing in the more sophisticated products, manufacturers noted.

Everyone won’t buy in right away, said Don Spence, who heads Philips Home Healthcare Solutions. “We understand the vision and the opportunity in those products, but before they catch on, there has to be a reimbursement program.” For products involving monitoring, for example, “that’s a big part of the longer-term view in caring for patients at home, and it seems reasonable,” he said. “But at the same time, we’ve got to get Medicare and other payers to acknowledge how important that is and to realize that’s part of the solution of cost avoidance.”

Meanwhile, the smart trend is likely to continue. “I think all chronic diseases are going to have to have better outcomes,” Richard pointed out. And that means compliance will become increasingly important for reimbursement. “We are going to have to track the data and build better databases to make the protocols more efficient. We’re going to have to figure out what’s working and what’s not working so we can be more efficient and reduce health care costs.

“As the market changes with reimbursement and as it evolves,” he added, “you have to make products change with them.”

With all that in mind, we asked industry editor Greg Thompson to give providers a peek at the types of smart solutions available now, and those they can expect to see at trade shows ahead.

Ask someone what a “smart” product is, and you will quickly find out that the definition is a swiftly moving target. For some, a smart piece of equipment uses its electronic intelligence to detect and adjust to human use. Conversely, an old-fashioned “dumb” product does not interact with patients. Some experts have attempted to expand the definition of “smart” to mean economically smart, or even just more efficient. Who’s right? There is no dictionary definition, so meaning is evolving as fast as the technology.

For those looking to become involved in monitoring, for example, smart opportunities exist to network once-disparate elements and keep a closer eye on patients.

The Philips Respironics entry into this market is called Encore Anywhere, a product that Gretchen Jezerc, marketing director for the Murrysville, Pa., company’s sleep-disordered breathing sector, defines as smart due to its ability to collect patient data in new and different ways. The Web-based system manages patient records, develops patient reports and tracks treatment progress. Compliance data can be automatically uploaded on a daily basis via a wired modem, with prescription changes automatically communicated back to the patient’s device. The care team — RTs, physicians, clinicians and home care providers — can all access the same information and communicate via notification messages.

While higher acquisition costs can cause providers to shy away from smart products, Maura Weis, the company’s marketing manager for sleep therapy products, says that is a narrow way to view the new technology. “If you compare short-term setup costs to long-term total costs, smart products make economic sense,” she says. “If you can get one or two more patients compliant out of a sample of 10, and you keep them compliant, the value of those patients in terms of supplies and replacements greatly outweighs the initial setup costs.”

“You get what you pay for, and there are costs associated with these products that have a higher technical capability versus a basic CPAP device,” adds Jezerc. “But these tools can enable clinicians to treat patients better and more efficiently.”

Rolling Smarter

If you’ve ever ridden in a wheelchair, you may have noticed that a straight line becomes more and more difficult to maintain on tilted terrain. The ability of some manufacturers to correct this long-time problem is a prime example of technology that responds to changing conditions. Exeter, Pa.-based Pride Mobility‘s Q-Logic Accu-Trac drive system, for example, helps users to steer the company’s Quantum power chairs.

“Typical power chairs can drift off course when driven over uneven terrain, requiring steer corrections by the user,” says Walt Clark, Pride’s vice president, design quality and advanced technologies. “Accu-Trac’s smart technology knows to keep the wheelchair on course. Specifically, when the joystick or specialty control dictates a straight-forward direction, Accu-Trac knows that if the power wheelchair begins drifting off course due to a slope or obstacle, it must redistribute appropriate power to the motors, keeping the power wheelchair driving in the direction that the user intended.”

Does this new complexity mean more headaches for providers or patients? No, says Jerry White, Pride’s vice president of global power chair products. “A big misconception that some have regarding smart products is that they are complicated or unreliable.” Instead, he says, “smart products are specifically intended to reduce complexity while increasing reliability.

“A perfect example is the latest generation of battery chargers that are not only fully automatic but also contain ‘logic’ that monitors the batteries’ condition at all times, adjusting the charge rate for optimal battery maintenance. The result is a smart charging technology, where the user simply plugs in the charger cord, and the battery charger takes over from there.”

As an added plus, Pride officials say that smart integrated technology features go hand-in-hand with reducing overall costs. Whether these costs are for attendant care, elimination of non-integrated systems or reduced down time and troubleshooting time on products, they can reduce overall costs to users, providers and third-party payers.

While users are rolling smarter, The ROHO Group can help patients sit smarter, too. The Belleville, Ill.-based company’s Merlin Proximity Sensor aims to help users maintain the elusive cushion immersion depth that is so critical to avoiding pressure ulcers.

“There must be a half-inch to one-inch gap suspended above the base, and that’s difficult to judge,” explains David Barsons, senior vice president, research and development. With the Merlin pad positioned under the cushion, “you still adjust the cushion to get the gap you want,” he explains. “Once you have that gap, you then calibrate or lock in the system to measure that gap as desirable, so it continually monitors whether that gap has changed.”

ROHO says Merlin is the first in a series of smart technologies created to enhance the performance of existing products — and to make people’s lives better.

Home care providers have also seen a huge push from manufacturers to lighten portable oxygen concentrators, increase battery life and necessitate fewer maintenance calls. And Ron Richard, RRT, CEO of San Diego-based SeQual Technologies, believes that is just plain smart. In the case of SeQual’s Eclipse, for example, a feature called AutoSat actively monitors a patient’s breath rate.

As breath rate indicates input or uptake, the machine calculates motor speed, valve speed and interactions of other components, all of which help produce more consistent oxygen levels. Since AutoSat adjusts and adapts to the patient’s demand, it comfortably fits under the smart umbrella.

Is a product smart if it simply has a logical interface and is easy to use? By most accounts that counts as good design but not does fall into the smart category. But when it comes to ensuring that complex machines work properly from remote distances, SeQual’s Eclipse Diagnostic Acquisition Tool (EDAT) fits the bill.

The remote diagnostic system gives providers the ability to look at a portable oxygen device from virtually anywhere without having to send a technician out or bring the machine in to figure out what needs to be repaired. Special software and the correct elements on the provider’s computer allow techs to change the Eclipse settings to see how they impact performance. The system data also includes the most recent 300 events recorded on the machine and monitoring of metrics including compression, flow, pressure, temperature and battery power.

“It improves up time, reduces down time and increases the amount of time the device can be out generating revenue and being used on a patient rather than being in a shop,” explains Richard, who notes the EDAT can not only help providers keep devices in service but could also help them support traveling patients.

He adds another reason providers should consider the capabilities such smart technology offers: “I think that long-term oxygen therapy is going to evolve in a similar direction as what we’ve seen happen in obstructive sleep apnea, where we are looking at compliance data.”

Consumer gadgets such as cell phones tend to set the pace when it comes to high technology, and health care often scrambles to catch up. Smart homes received a lot of publicity in recent years with no edifice garnering more notoriety than Bill Gates’ house. Huge corporations are getting into the act, making it possible for home owners to program sprinklers that turn off when it rains, send video of pets to a cell phone and even warm up the pool on your way home.

Smart Revolution

If houses can be smart, medical equipment can’t be far behind. The idea of a home “thinking” for the owner is analogous to respiratory devices making adjustments for clinicians. HME providers, however, typically view new features with skepticism. If it doesn’t make business sense, the chances of adoption are slim.

“Even if we don’t have proof that putting intelligence in machines improves patient care, at the very least it cuts the cost because it reduces the amount of human labor that is necessary,” says Robert L. Chatburn, RRT-NPS, FAARC, clinical research manager for the respiratory therapy section at the Cleveland Clinic. “I think smart technology has a vast potential for increasing the level and quality of patient care for no other reason than machines are more consistent.”

All of these capabilities point squarely at “integration,” a smart concept that experts agree is the next big buzzword. “Integration is essentially the ability to track, treat, and observe a variety of disease states even beyond OSA,” explains Jezerc. “There are so many comorbidities associated with sleep apnea, such as cardiovascular disease, diabetes, obesity and other interrelated conditions. While you have a unit in place that can be transmitting information about the patient’s apnea-hypopnea index or a possible leak, other disease parameters could be tracked and transported through that same data management system.”

Hospitals have been moving toward a high-tech model for a long time, and they may ultimately fashion a blueprint that home care providers can use. At the Cleveland Clinic, Chatburn points out there is still plenty of potential for connectivity via the Internet. “You might have a blood pressure device connected to an IV pump, which is connected to a cardiac monitor — and all these devices are talking to each other,” he says. “It’s going to be a network of distributed intelligence. The power from that is that you have multiple feedback points and the synergy that comes from that. It takes the huge burden of data collection that we have now and turns it over to a network.”

The ability to analyze information and turn it into action is one way to transform a smart product into a smart way of doing business. “A smart product is a product that is going to give you more information than you currently have,” says Bently Goodwin of RemitDATA, Memphis, Tenn. “It will give it to you in a concise way that’s easy to draw a conclusion from so you can start taking corrective action where needed. Smart products give you more units of work for less dollars per unit.”

In the best-case scenario, smart products allow providers to increase efficiencies, make staff members more productive and, in many cases, upgrade patient care levels. “You can try to buck the change,” warns Goodwin, “but the change is coming.”

Smart Future

It doesn’t take a psychic to predict that smart products will only get smarter in the years to come. Thomas J. Williams, RRT, believes part of that drive toward smarter equipment will be fueled by the changing face of the health care worker and the massive retirements that are sure to come. “The number of physicians, nurses, pharmacists and providers that are going to retire is alarming,” comments Williams, managing director of Strategic Dynamics Inc., Scottsdale, Ariz.

How will home care providers and clinicians adjust their staff ratios? Part of the answer, says Williams, will be better information driven to employees in the form of electronic records. And the use of remote diagnostics that has already started, he predicts, will only become more widespread.

“We will see a merging of technology where monitors and ventilators come together in one box to provide more information to clinicians so they don’t have to be working with multiple pieces of equipment,” says Williams. “We’re going to start to see more and more of this smart equipment so that we can use the technology to diagnose whether something is working effectively. In some cases, it may need a simple software download that can be done over the Internet. In other cases, it will require repair.”

Ultimately, Chatburn says it will be up to clinicians and providers to decide how best to use all the information that gets collected. “There is a difference between intelligence and wisdom,” he says. “Intelligence is just a set of facts, and wisdom is knowing when and how to act. Knowledge is no substitute for wisdom.”

Smart Sampling

• The Sandman Alliance from Covidien, Boulder, Colo, is a sleep management program that uses the Web to unite a sleep apnea team — of patients, clinicians, physicians and home care providers — to manage treatment via education, support and monitoring. “The program links a sleep counselor with each patient to document progress and track the patient’s therapy using a Web interface, which provides a common area for the patient’s sleep physician to log in and monitor the patient’s performance under the program,” the company says. The product is also designed to offer crucial proof of compliance.
• For those looking to boost cash sales, Jay Vreeland at Philips Home Healthcare Solutions, Murrysville, Pa., points to the Heart Start home defibrillator. The device requires no physician prescription, and it may fill a niche for patients with multiple comorbidities. “When you open the device, it audibly walks you through how to apply the product to the patient in distress,” says Vreeland. “When you put the electro-pads on a person, the device actually decides whether you need to shock the patient. It is truly smart in the sense that it guides you and quickly makes clinical decisions on the fly.”
• It’s not a medical product, but Memphis, Tenn.-based RemitDATA says Contract Manager can smarten up your business. An add-on module to its flagship product, Reimbursement Pro, which focuses on managing denied claims, Contract Manager helps providers monitor contract performance to identify and collect underpaid claims. “Providers need to make sure they are getting paid for everything they are doing, doing everything as efficiently as possible, automating where they can,” says company CEO Bently Goodwin. “But the big thing is, even if you automate, you have to make sure you are getting paid for everything you are providing.”