Connected medical devices are coming. The FDA has developed protocols for regulating them, and so far the benefits seem to outweigh the costs. But as with all connected devices, the data they collect and how that data can be used against consumers needs to be addressed.
There are already connected pill bottles, inhalers, glucose monitors, and more on the market. In most cases, the devices are paid for and used by consumers to track how much medicine they are getting (or need), and to remind them to take that medicine. The data stays on the consumer’s phone or, in some cases, that of a caregiver.
But the increasing availability of connected medical devices — along with a recent decision to reimburse health care providers for monitoring patients remotely — means that the number of players that become involved in the relationship between the consumer and medical device provider will increase as well.
Last month, The Centers for Medicare & Medicaid Services (CMS) finalized plans to reimburse health care providers for remote patient monitoring and telehealth services. Physicians will be reimbursed for remote telehealth “visits” with patients, during which they will be able to measure a variety of vital signs and other factors such as weight, blood pressure, pulse, respiratory flow rate, etc.
CMS will reimburse physicians both for setting up remote monitoring equipment and for teaching consumers how to use it. It will also reimburse them for the time they spend monitoring the data. And insurers may be next in line.
But that’s where things gets dicey. ProPublica recently published an in-depth look at CPAP machines, which are prescribed to patients who have sleep apnea. Using them requires a person to wear a face mask that pushes air into their mouths at night to force open their airways. Unsurprisingly, many people who have sleep apnea and are prescribed these machines find them uncomfortable. And so they don’t always use them. However, there is a solution. Many people suffering from light sleep apnea may use mouth guards to help their condition.
This frustrates the insurance companies that are paying for the machines. So, as ProPublica notes, insurers are now looking at the data from newly connected CPAP machines to make sure their customers who need them are actually using them. If not, they refuse to cover the machines. The report also details how insurance firms are renting these machines to people at a higher cost than they’d pay if they bought them, in the hopes of pricing out consumers. Basically, insurers really don’t want to cover these machines.
But what caught my attention was the data sharing that’s going on between the insurance firms and the device makers.
As the story makes clear, in some cases patients are unaware that their connected CPAPs are sharing data with their insurer. Some patients don’t know the device shares data with anyone, while others think they are only sharing information with their doctor, and don’t realize that the doctor shares it with the insurer. It’s yet another reminder that our privacy and data-sharing policies are woefully inadequate for the connected era.
Moreover, tying adherence data to insurance coverage is punitive in a way that will not help drive adoption of technology that could be hugely beneficial — even save lives. Adherence to medical prescriptions is a significant factor in helping a person cure or manage an illness. The ability to track how someone is adhering or not to a treatment protocol is an invaluable tool for doctors, who can then use that information to understand what’s behind that patient’s non-compliance.
Ideally the doctor can use that information to get the patient back on track, which adds to their overall health and helps them avoid costly medical interventions. Vik Panda, VP of marketing at Adherium, which makes a connected jacket to track usage of asthma inhalers, says that such data is useful to both patients and their caregivers, but could also be used at a larger scale.
For example, Adherium sells its connected asthma jackets directly to consumers, but is also working with the City of Los Angeles to track aggregated patient data to see where others might need asthma services, as well as to understand the relationship between air quality and respiratory disease.
But Panda is clear on how his company deals with data. Because Adherium’s jackets are used by the consumer, it’s the consumer who gets his or her individual data. Any data that’s shared with third parties is aggregated among a population and presented anonymously. When I described an example of an insurance company getting access to personal patient data, Panda questioned if HIPPA rules that govern medical privacy even allow such a thing.
My hunch is the consumer signed away those HIPPA protections in the doctor’s office at some point. I know I’ve received forms that ask if I want to share the medical information I get from my doctor with my insurer, and at least part of the reason I was given was that it makes the repayment of claims easier.
Basically, we’re entering a time when connected devices could help doctors gather richer-than-ever information to help with patient care and to ensure patients follow their instructions. That should help improve overall health and presumably cut costs, as fewer people will face emergencies associated with a chronic illness.
However, none of this will happen if insurers use that information to punish patients instead of seeking ways to help them. It will also erode trust in the medical establishment when that trust is most needed. We will have to find ways to handle persistent non-compliance and incentivize patients, but taking away their medicine is not going to help.