By Matt Phillion
During the COVID-19 pandemic, the healthcare industry has seen an explosion in telehealth. Initially crafted from necessity, telehealth advancements now seem like they are here to stay. But beyond virtual visits and check-ins, what other diagnostic tools and patient monitoring options are in the near future?
For Essen Health, the past year and a half has seen the company innovating in home healthcare by making a massive leap forward in using technology to monitor patient vitals from their homes.
“Our vision is to change the way healthcare is delivered,” says Sumir Sahgal, MD, lead physician and founder at Essen Health. “And to change that, we need technology.”
For one, he says, the industry simply doesn’t have enough people. Attrition continues to be commonplace as the pandemic stretches on, and beyond COVID-19, we must also have an eye to the future as more and more baby boomers reach an age when chronic illnesses become commonplace.
“The cost of healthcare is going up, and soon we won’t be able to afford it—the only way is by using technology to do the mundane things, to help us be more proactive, to intervene earlier,” says Sahgal.
Earlier intervention and remote monitoring can help keep patients out of the emergency department or hospital, he says. “Technology in many ways is an enabler,” says Sahgal. “We have to change the whole delivery system.”
Back in 2005, Sahgal’s organization started the EssenMED house call program, which essentially provided house calls for homebound patients. The area he covered, in the Bronx, had a large number of elderly patients, and some of these patients died at home, leading Sahgal and his colleagues to ask why. To find the answer, he says, “I hired a physician assistant and started doing house calls.”
The interpersonal interactions were rewarding for both provider and patient, but “after six months we looked back and realized that it was a difficult way to practice medicine,” he says. Insurance didn’t want to cover the costs, and house calls were three to four times less efficient in terms of patient volume than in-office visits. Driving around the Bronx, parking, and navigating apartments all burned valuable time, and the financial side of the process was terrible, he says.
“But the professional satisfaction we got, the happiness on the patients’ faces,” Sahgal says. “We learned why patients were sick. Maybe they weren’t taking their medications or were confused about how to take them. Or there were environmental factors not conducive to them being healthy, or other social determinants of health getting in the way.”
And so they innovated. “Over the years we kept tinkering with technology,” he says, looking for ways to improve access and provide better care. It was when the pandemic struck, however, that Essen was able to make new leaps forward with the emergence of telehealth.
Remote healthcare has its day
“Necessity is the mother of invention. The traditional system kind of collapsed in the pandemic,” says Sahgal.
Where once it was hard to implement telehealth calls, COVID-19 saw the industry embracing remote visits. “During the pandemic, patients were afraid to even let us in the house. Also, those people who could not get access to care were calling us,” he says. “At the height of the pandemic, it was terrible as everyone was just trying to survive but chronic as well as acute medical issues still needed care. As the pandemic progressed, it brought an acceptance of technology, which is unusual in healthcare, and access to care for people in a more open way.”
Healthcare can be a fragmented and siloed industry, but the more it opened itself to remote technology, Sahgal says, the more caregivers could work collaboratively with pharmacies, hospitals, and other providers.
The financial shift made a huge impact as well. “Now every insurance company allows telemedicine, including Medicare,” he says. Previously, “if we were to do an intervention and weren’t on the right plan, the burden would come onto us before but not the benefit.”
With the advancement in acceptance comes new technology, Sahgal explains. “In the old days, if someone’s blood pressure was high and we wanted to have them monitored, we’d reach out to a traditional nursing program with visiting nurses to check these things at home,” he says. “You can imagine the burden to refer, schedule, see the patient, and then transfer the information to their physicians.”
Now, Essen uses remote monitoring devices issued to the patient that upload results automatically every time the patient performs a blood pressure check. “The patient checks their blood pressure, and it shows up in a smartphone we’ve given them, so now that result is shared to our care management system,” Sahgal says. “If the reading is too high or too low, care management will call the patient and ask them to check again. If it’s still too high or too low, they’ll connect with the clinical team and a doctor will call them back and find out what’s going on.”
This doesn’t necessarily lead to emergency care, either—it gives the physician the chance to talk with the patient and get an overview of what they’re going through remotely. “It’s a proactive approach without sending someone out to check on them,” says Sahgal.
One example Sahgal mentions is an elderly patient who is legally blind. She has high blood pressure, but it’s difficult to have her come in weekly for checks. She now has one of the patient monitoring devices, enabling physicians to monitor her from the office and see if she’s under extra stress. She’s even found a workaround for when a family member isn’t there to help her: She activates the device and then can call the care management team to ask them about her results.
“It’s patient engagement,” says Sahgal. “As people get older, the burden of chronic illnesses grows, and in this country it’s not just a matter of if you’ll have high blood pressure but when. This allows us to engage with elderly patients and young patients alike.”
Patients have a spectrum of comfort levels with technology, but for many, once they’re onboarded, building the device into their daily lives is simple. After a few weeks, Sahgal says, about 60% of patients are fully engaged.
The smartphone used for the monitoring also has benefits for overall care. “Because it’s a phone, we’re able to send them a copy as a reminder about medications, for example, as a way to interact with the patient, going above and beyond passive communication,” says Sahgal.
Practitioners, too, have varying comfort with using technology, but Sahgal notes that most come around once they see how the devices and digital platform make their lives easier. “Our practitioners are very happy because it’s all about ease of use,” he says.
If the tech simplifies working with patients, it’s a welcome shift. “We want to keep people practicing at the top of their training and enable them to use the professional knowledge they have,” says Sahgal.
Artificial intelligence and home care
Essen works with an artificial intelligence (AI) voice bot as a patient engagement tool. It places a phone call to the patient—who knows in advance that the call is coming from a machine and not a doctor or nurse—and collects data before the patient ever talks to a provider.
“Initially when they came to me I thought, ‘Nobody wants to talk to a voice bot,’ ” says Sahgal. “But I was surprised. People were more willing to talk to the bot than to a person. Patients are talking and telling them what their problems are, and the AI takes this information and stores it, so when it calls the next week it can ask questions based on the previous call.”
The AI will highlight certain items, like fever, headaches, or medication issues. One out of five calls end up requiring clinical intervention, but this pre-screening allows providers to go in prepared to deal with specific topics. This avoids the frequent problem where a patient, facing a long wait to see a provider, forgets about the reason they wanted to see the doctor in the first place and moves on without addressing the issue at hand.
The pre-screenings also assist with accuracy, Sahgal says. “When you go into a doctor’s office, people forget half the things they want to talk about because they’re worried or stressed,” he says. But the voice bot has already discussed their worries or concerns with them and fed it into the record for the physician.
“We find our energy and time is better served,” says Sahgal. “Particularly during COVID we’ve seen shortages of staff; the Bronx was hit very hard and at times didn’t have enough people.” An AI assistant can help take the grunt work off the provider’s plate so they can focus on what clinical interventions the patient needs to stay healthy.
Sahgal says that patients’ willingness to interact with the AI continues to be a pleasant surprise. “The amazing part is that it has better outcomes in reaching patients. When a human calls, they don’t pick up, but the AI calls smartly, knowing what time of day the patient is easiest to reach,” he says.
The AI can’t take the place of human interaction completely. “It’s an enabler,” says Sahgal, not a one-stop shop. Yet the more tech interacts with patients, the more it empowers both patients and practitioners to increase the quality of care the patient receives.
“The technology we use will only increase. At the same time, which technology works and will really make a difference needs to be judged by the outcomes,” says Sahgal. “It is best measured when you look at the quality of care, the cost, and contribution towards value-based care. Technology can’t just be an app—it has to do more than one thing. And that’s where I see the future. Will it happen overnight? No. But technology will be necessary to reinvent healthcare delivery.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at firstname.lastname@example.org.