A mother tucks her young son into bed before heading downstairs to watch television. Unbeknownst to her, the boy, who has asthma, begins to wheeze in the middle of the night. In an instant, as the child remains sleeping, technology in the home causes the humidity in his bedroom to rise significantly and triggers two puffs of Albuterol to pump from an air vent. The next morning, an alert on the woman’s smart phone reports that her son had an asthma attack, and it was treated effectively — all before the boy woke up or the mom knew anything about it.
Such a scenario of a family living in a so-called “smart home” is closer than one might think.
That was the message Chris Gibbons, MD, MPH, chief health innovation advisor to the Federal Communications Commission’s Connect2Health Task Force shared with more than 300 attendees of the 2017 Summer Institute in Nursing Informatics held July 12-14 at the University of Maryland School of Nursing (UMSON). He shared his insights into how technology will transform health care during his plenary address, “Digital Health, The Underserved, and Health Innovation.” The three-day conference examined the field of informatics, which enhances the quality of patient care and outcomes through the development, implementation, and evaluation of information technology.
“That’s the future. That’s what can happen,” said Gibbons, who is also the founder and CEO of The Greystone Group, a technology research, innovation, and incubation company, and an adjunct professor at Johns Hopkins University. “Was that health care? Was health care delivered? Was it effective? Of course it was. That is not in place today but there are people working on it. I know that to be a fact.”
While the market for wearable devices such as Fitbits and Apple Watches continues to grow, Gibbons said, the future of health care will feature technology built into the walls of smart homes, connected to artificial intelligences and computers developed by doctors and nurses who are monitoring these systems from an off-site hospital that doesn’t house a single bed but operates more like an air-traffic control center. Smart home technology will not only be able to determine when an aberration such as high blood pressure or an asthma attack takes place, but also why it happened and what should be done to address it, then fix the problem, all within a fraction of a second and without waiting for someone to act.
In another example, Gibbons shared the fictional story of an overworked, tired diabetic mother restricted to a 2,000-calorie a day diet. After a long day at work, she dreads thinking about what to cook that will be healthy and meets the guidelines of her diet.
“That’s why KFC survives,” Gibbons joked. In his portrayal of the future, every item purchased in a grocery store has radio-frequency identification (RFID) on the label, which transmits nutritional information to an application on the woman’s phone. She enters her dietary preferences and in less than a second, three recipes pop up that she can make in 20 minutes using the specific foods she has in her refrigerator or pantry.
“I’m trying to illustrate ways that you can see how health care is going to be so substantially different than it was before, that if we don’t push ourselves to get into the mindset, how we can figure out to make it work for our industry, for our patients, for ourselves, we will be left behind,” Gibbons said.
Among Gibbons’ other predictions for the future:
- Traditional health care will go the way of big-box retailers such as Circuit City and five and dime stores such as Woolworth’s & Woolco.
- Within the next decade, and probably closer to five years from now, at least one major academic medical center will fold entirely or undergo substantial restructuring and “become almost unrecognizable from what it was before.”
- Many of the larger hospitals in America will fold because they are dependent on inpatient care, which is going to precipitously decline due to decreasing lengths of hospital stays for various procedures. Already today, patients who once had to remain hospitalized in the intensive care unit are now being sent home with monitoring equipment, including ventricular assist devices “that are about this big,” Gibbons said, holding his hands to represent a small object. “We could never have imagined that 20 years ago. Never. So it’s not even just that floor care is going to start happening at home. Intensive care unit care is going to be delivered outside of the hospital. It already is. I’m not sure hospitals can survive. They certainly won’t survive in the way that we know them today, in silos.”
- “Smart home care” will allow people to manage and overcome their health challenges in the comfort of their own eco-friendly homes using technology without the resident having to play an active role. Passive interventions – Gibbons cited the fluoridation of water as an example – are much more successful, he said. There’s a limit to how many devices such as a Fitbit a person can wear at one time. In the future, technology to track one’s health will be built into the architecture of the home.
- Retail health clinics such as those in CVS, Walmart, and Target, will thrive. Walmart has said they want to be the primary care provider of choice in the United States, Gibbons said, adding Walmart has a store within 10-15 minutes of 95 percent of the population. Faced with the option of either waiting three to four months to see a doctor versus being able to be seen right away at Walmart — and pick up groceries while you’re a it — the retail health care model will win every time, Gibbons said. “Academic medicine should be shaking in their boots because they can’t compete with that,” he explained.
- At least some of the hospitals of the future will operate as command centers, similar to air-traffic control towers, in which doctors and nurses will monitor data on patients receiving care at home. One such hospital already exists: Mercy Virtual Care Center, located just outside St. Louis.
The implications for nurses in the future of health care are vast, according to Gibbons. “We already do a lot of inpatient care. I’m suggesting there’s a huge amount of innovation, of new types of nursing models, of new types of care delivery. There’s tremendous opportunities for nurses."
In its 27 year, SINI is chaired by UMSON’s Charlotte Seckman, PhD, RN-BC, CNE, associate professor of nursing informatics, who heads a 17-member committee of nursing leaders from throughout the country. Other committee members from UMSON included: Patricia D. Franklin, PhD, RN; Arpad Keleman, PhD; Mary Etta Mills, ScD, RN, NEA-BC, FAAN; Eun-Shim Nahm, PhD, RN, FAAN; Ernest Opoku-Agyemang, MS, MA, RN; Ronald Piscotty Jr., PhD, RN-BC; and Sonia Smith, BS.
The conference offered lectures on topics ranging from self-management health applications to leveraging the power of digital health data for chronic diseases to engaging geriatric patients and caregivers with technology. Peer-reviewed presentations highlighting advances in informatics are also part of the annual event.
For first-time attendee Rosella Ganoudis, MSN, MBA, RN, CCRN, a senior clinical analyst at Union Hospital of Cecil County, the institute was eye opening.
“I’ve learned a great deal,” she said. “Seeing what other people have done with technology makes me think of what else we can be doing with similar technology.”
For Vickie Elliott, RN, CCRN-CSC, a clinical informatics nurse at Peninsula Regional Medical Center in Salisbury, attending her third SINI, there is always something new to learn.
“We all have similar problems. It’s great to get ideas on how others handle them,” she said. “The speakers have been fabulous.”
SINI 2018 will be held July 17-20 at UMSON.