By Eugene SCHNELLER
During a workout in the gym this past winter, I fell. No good deed goes unpunished! I fractured my femur, and now I have a rod from my hip to my knee. One interesting part of the journey was being able to look at biosensor technology and how the health system functioned as it affected me personally, rather than just academically as a healthcare efficiency scholar.
After my surgery, I was in a rehabilitation hospital. My heel began to ache significantly; I knew I was getting a bedsore. I called the nurse in and said, "My heel feels terrible, what's your bedsore protocol?" She replied that there wasn’t one. I told her she really ought to look at my heel. She looked at it and told me, "You're beginning to get a bedsore." But she didn't look at my rear-end or my shoulder (common spots for bedsores to form). "You really need a protocol for this," I said again.
In addition to protocols, how do we prevent bedsores in patients who can’t alert nurses to their signs? Well, we know there are sensors you can put in the bed that measure the heat in different parts of the body. Sensors can continuously monitor patients and send signals to nurses when temperatures shift. This doesn’t have to be restricted to the hospital setting; such devices can also be great fits for bed-bound patients in their homes.
Every year, health systems spend between nine to eleven billion dollars on treating bedsores and associated morbidities. They are big deals. Why? They can prolong a patient's hospital stay and be complicated by pain and infection; sometimes they are fatal. They’re always difficult to heal. According to a 2010 article in The American Journal of Surgery, an estimated 15% of acute care patients have pressure ulcers (another name for bedsores), and pressure ulcer incidence has increased by 63% in recent years.
Fortunately, I caught my potential bedsore early, and was able to prevent long-term or debilitating damage. I'm walking around, now—no more cane. I can do a mile. But by and large, mortality for what I experienced can be very high, particularly in people who are a little older.
My health outcome was positive. But my journey through what this experience cost the health system had just begun. The response from the system was interesting.
When I got home from the hospital, my phone started to ring. Who was calling? My insurance company; I had just cost them over $100,000, and therefore had become a problem. And now my insurance company follows me in a way that consumes even more human and financial resources.
First, they want to make sure I'm hydrated. A nurse calls up frequently and asks, "Are you drinking a lot?" Fortunately she doesn’t ask what I’m drinking – but I’m sure she hopes it is water. She also wants to know if I'm taking my medication, and I tell her I'm doing all those things. Unfortunately she doesn’t explain how these things interconnect, or give me an update on my status, based on the information I have provided. And I wonder how she confirms the information I provide?
I appreciate what my insurance company is trying to do, but all this information could potentially be tracked and translated in a much more affordable way (requiring much less staff time) by biosensors. The sensors could confirm whether I'm regulating my medication or if I've got a blood pressure medication that's making me dizzy and I'm likely to fall with the outcome being another potential fracture. This would save money and time, but also be great for me and my caregivers—in addition to my insurance company.
People, patients, consumers—whatever you want to call us—need to understand what behaviors hurt and hinder us, as well as the kinds of markers and data that indicate we are doing something in a healthy or destructive way.
I got another call recently – from a doctor at another institution than where I was hospitalized. Apparently, an electronic health record I had in that system sent some kind of trigger; an endocrinologist called me and said, “I'd like to check your bone density, because if you fall at home we don't want your bones to be susceptible to fractures. We want to make sure you're taking medications that will prevent the experience you just had from happening again in the future.”
How about that? All these things are possible. That call gave me faith that health care provider systems can and even are starting to integrate inpatient care, outpatient care, and predictive care.
Written by Eugene Schneller, Professor of Supply Chain Management, ASU W.P. Carey School of Business
Prof. Schneller first told this story at the April 2014 Forum for Sustainable Health, which focused on Project HoneyBee. He will be one of the professors for ASU’s new interdisciplinary “Opportunities in Healthcare Course”, which is part of Project HoneyBee.
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