Connected Health

According to the Merriam-Webster dictionary1, the definition of the word “connected” (adjective) is (i) joined or linked together; (ii) having the parts or elements logically linked together. Similarly, according to the same source, the definition of the word health (noun) is (i) the condition of being sound in body, mind, or spirit; (ii) the general condition of the body, (iia) a condition in which someone or something is thriving or doing well, (iib) general condition or state. Thus, if we join the two corresponding definitions, it can be inferred that connected health is (i) joining or linking together the condition of being sound in body, mind, or spirit; (ii) having the parts or elements logically linked together for the general condition of the body (or state). These two definitions enrich our knowledge and help us to have a better understanding of the term connected health. Although there is no standard or accepted definition of connected health, several attempts have beenmade to define it as briefly presented herein. According to references (1, 2), connected health is an umbrella term arrived at to lessen the confusion over the definitions of telemedicine, telehealth, and mHealth. A very similar description is also given for the Connected Health—Mobile Health and Telehealth program of the National Institute of Biomedical Imaging and Bioengineering.2 According to the website of the program, it supports the development of enabling technologies that emphasize the integration of wireless technologies with human and biological interfaces. The program includes the development of software and hardware for telehealth and mobile health studies. The most complete and extensive definition of connected health was given by Caulfield and Donnelly (3). They stated that “Connected Health encompasses terms such as wireless, digital, electronic, mobile, and tele-health and refers to a conceptual model for health management where devices, services or interventions are designed around the patient’s needs, and health related data is shared, in such a way that the patient can receive care in the most proactive and efficient manner possible. All stakeholders in the process are ‘connected’ by means of timely sharing and presentation of accurate and pertinent information regarding patient status through smarter use of data, devices, communication platforms and people.” This definition will be adopted for the needs of the connected health specialty section.


Introduction
Understand the status of connected health and remote patient monitoring, physician and patient attitudes toward these e orts, and new technologies on the horizon.

1
Those who have tried virtual health services reported doing so because it was more convenient, because they were comfortable using technology in other aspects of their life and wanted to do the same with health care, and because they were curious about the prospect of receiving care virtually.
Among those who were less interested in virtual health, the survey found that encouragement by physicians would act as an important driver for virtual health utilization.
Source: Voting for Virtual Health. Accenture.

Best Uses
What are the primary bene ts and strategies of patient engagement technology tools?
Members of the New England Journal of Medicine (NEJM) Insights Council identi ed supporting patient e orts to be healthy (67%), providing information to providers on how patients are doing when not in clinic (60%), and creating an ecosystem that allows for better predictive analytics around patient health and timely intervention (51%) as the primary bene ts of using technology for patient engagement.
Among the tools themselves, Council members identi ed biometric measurement devices (85%), apps (75%), texting (70%) and wearables (68%) as the most e ective patient engagement technologies. These devices support monitoring and care 24 hours a day, in nearly any location, and can be especially useful to monitor patients with chronic conditions. Source: Download Healthcare: A Better Way -Free eBook. Health Catalyst.

Payment Rules and Codes
Beginning in 2018, the Centers for Medicare and Medicaid Services (CMS) will pay providers who leverage RPM tools and make use of the data they generate for care management and coordination.
Additionally, the AMA published three new CPT codes that will be available beginning in January 2019 and that cover aspects of RPM including equipment set-up and patient education on use, device supply with daily recordings or the transmission of programmed alerts, and remote physiologic monitoring treatment management services.

Remote Monitoring and Telehealth on Patients with Heart Failure
The study reviewed RPM interventions including telemonitoring, home telehealth, videoconferencing and mobile phone-based monitoring.
The results concluded that telemonitoring, including blood pressure, heart rate, weight, and electrocardiogram (ECG) must form an integral part of the routine care of patients with heart failure, and contribute to reduced mortality and hospitalization, as well as improved quality of life.
The study also suggested that home telehealth interventions, classi ed as remote health care monitoring or delivery between a health care provider and patient outside of a clinical setting, contribute to reduced health care utilization and improved quality of life. However, the study noted that number and quality of studies related to home telehealth interventions on heart A review of 19 studies of the effects of RPM on the health outcomes of patients with heart failure found that telehealth and home telemedicine appeared to be largely effective in reducing heart failure rehospitalization and mortality. failure were limited, and that these interventions were not shown to improve knowledge and/or self-care.
Additionally, the study did not nd conclusive evidence to support the e ectiveness of video monitoring and mobile phone-based monitoring, possibly due to a limited number of studies examining the e ects of these interventions on patients with heart failure.

Wearable Devices for Monitoring Respiratory Function
These wearable biomedical sensors o er the promise of monitoring a patient's physiological or biochemical status continuously, rather than the snapshot o ered by traditional diagnostic tools.
While roadblocks exist, including regulation, data ownership and security, and accuracy and reliability, wearable devices have shown the ability to aid the assessment and monitoring of respiratory function and provide information about the environment that may a ect the respiratory system.

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Wearable devices refer to those that can be worn on the body without restricting mobility or daily activities; wearable biomedical sensors are a subset of those devices that have the ability to measure physiological parameters.
Pulse oximetry refers to the measurement of oxygen saturation through the illumination of a small portion of human skin and measuring light absorption, which depends on the levels of oxygenated and deoxygenated blood. Recent advances in wearable pulse oximeters have led to signi cant improvements in accuracy and reliability of such devices, which can be worn in various places on the body including the wrist, head, earlobe or legs.
Pulmonary ventilation is the product of respiratory rate and the volume of air inhaled and exhaled with each breath.
Ventilation assessment often still requires use of a owmeter embedded in a mouthpiece, mask or tube, which while e ective in clinical settings, are not useful for respiratory monitoring after discharge, during daily activities or sleep.
Recently, start-up companies have begun to develop wearables aimed at measuring ventilation by other means. Such methods include body surface sensors that measure rib cage or abdominal motion; calibration methods that estimate volume changes via physical measurement; and accelerometers worn on the torso and derive breathing rate by measurement of the chest wall. Each of these methods have limitations, but are capable of providing valuable information under certain circumstance.

Introduction to Telehealth
While no universally agreed-upon de nition of telehealth, (or telemedicine) exists, the literal meaning of the term is "healing at a distance." Generally, the terms refer to the use of telecommunication technologies and electronic information to allow for the remote delivery of health care.

Lesson 4 of 6
Telehealth Some sources di erentiate between telehealth and telemedicine, but in this module, the terms will be used interchangeably.

Spending and Growth
In February 2018, Congress passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, which allowed for broader use of telehealth services: CMS payment of telehealth claims grew 28% from 2015 to 2016, reaching $28,748,210. Over the same period, the number of claims rose by 33%, showing a continued trend of growth.
Sources: Kacik A. Telehealth market poised for growth, but use remains low. Modern Healthcare. www.modernhealthcare.com/article/20170620/NEWS/170629995. Accessed April Medicare Advantage plans may now include additional telehealth services in bids Some ACOs were granted added exibility to provide telehealth services Bene ciaries receiving home dialysis treatments can now perform monthly check-ins with their doctor via telehealth rather than in-o ce Availability of telehealth was expanded for individuals who may be having a stroke to ensure that they receive the correct diagnosis and treatment

Impacts on Health Care Costs
A study by the RAND Corporation in March 2017 found that telehealth may increase cost of care. While telehealth appointments ($79) on average are cheaper than o ce ($146) and emergency room (ER) visits ($1,734), the convenience and low cost of telehealth services may encourage patients to consult physicians for conditions they otherwise may not have, such as the common cold.
The report suggested that increasing patient cost-sharing could discourage overutilization.
Conversely, the report suggested that health plans encourage patients who frequently use the ER for chronic, low-acuity conditions to use telehealth services instead, as it would lead to a decrease in spending.