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September 10, 2018 01:00 AM

Telemedicine meets artificial intelligence at bedside

Jay Greene
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    SimpleC
    SimpleC Companion computer application displays how a daily schedule of a patient can be programmed.

    One of the most serious problems in taking care of the elderly, disabled or those with a chronic disease is getting them to take their medicine or participate in their care because of feelings of isolation, confusion, sadness or depression.

    Those failures cause unnecessary hospital admissions and emergency visits that drive up healthcare costs and lead to poorer outcomes or untimely deaths.

    But new technologies and devices that meld telemedicine with artificial intelligence and predictive analytics are giving hope for greater care coordination to thousands and potentially millions of people in the healthcare system.

    Dan Pompilio, CEO of SimpleC, an Atlanta-based healthcare technology company that earlier this year signed a joint venture contract with Jems Technology of Orion Township, tells this story about an elderly patient who used SimpleC's "Companion," a smart software program that encourages patients to stick to their medical care plan.

    John, an aging 6-foot-5-inch former offensive lineman on Michigan State University's football team who suffered from dementia, was living in an assisted living facility in Atlanta. Day after day, John sat alone in a community room, hardly talking. Providers were intimidated by him, and family members were worried. Caregivers know patients in this condition go downhill fast.

    Jason Zamer, a SimpleC clinician, met with John once a week in a therapy session. He introduced him to the Companion software and slowly taught him how to use it on a computer. Zamer added pictures from John's past, including his old MSU football team and the fight song "Victory for MSU."

    After a few sessions, John began to respond, first using a few words, then speaking in complete sentences.

    "Then, one day, Jason walked in," Pompilio said. "He saw Jason, looked in his eyes, stood up, and sang the Michigan State fight song. Everybody in the place knew that it was more than a good day. For us, it was a turning point.

    The SimpleC Companion — one of a new generation of artificial intelligence-enhanced software programs — can be installed on handheld devices like smartphones or tablets, desktops or laptop computers, said Kevin Lasser, CEO of Jems, who does business development, sales and marketing for SimpleC. Jems also manufactures telehealth devices securely transmits video images and data on patients from ambulances, emergency rooms, skilled nursing facilities and prisons.

    A growing number of companies in Southeast Michigan and Canada are either signing agreements to purchase Companion or entering into pilot projects to test the technology. The licensing cost is $119 per patient with volume discounting, Lasser said. Companion is sold in 15 states with more than 2,000 users.

    What is the Companion?

    The SimpleC Companion can be installed on an intuitive touch-screen computer and activated on its own several times a day as a reminder for medications, activities and mealtimes. It also can offer mental stimulation to guard against anxiety and depression and improve brain health.

    Each application is custom installed so users can see their own family photographs, hear such familiar audio as favorite music and personalized messages recorded by family members or caregivers.

    Using an artificial intelligence platform powered by IBM's Watson, the Companion manages chronic conditions or hospital discharge instructions. If a patient goes off track from their care plan, the device triggers notifications to family or caregivers to prevent unnecessary trips to the hospital.

    Lasser said the SimpleC companion has been through multiple studies at Emory University and Johns Hopkins University. It has been used by more than 2,000 patients in 10 states.

    "The patient puts (the program) on a smart device and it gives you 360-degree continuum of healthcare," he said. "The caregiver has the application, the family and patient have the application. It is like having a million doctors and the smartest journals at your fingertips."

    Henry Ford Village, the largest senior living facility in Michigan with more than 900 residents in Dearborn, has signed a contract with SimpleC to conduct a pilot program using Companion with 20 independent living residents who have chronic diseases, said Bruce Blalock, the Village's executive director.

    Integrity Home Health in Troy will participate as the Village's preferred home health provider, said company founder John Byrne.

    McLaren Health Management Group and about 20 of its 100 palliative care patients also will participate in a three- to six-month pilot project starting in October, CEO Bart Buxton said.

    For McLaren's palliative care patients, who are homebound and on strict therapy regimens, Buxton said consistency in care is very important to extend their lives as long as possible and reduce trips to the hospital. Current care now includes phone reminders and visits from providers to encourage they stay on their therapy regimen.

    "We think this (system) will be more interactive. If a family says we can't manage the in-between time, (they ask) what are our options?" Buxton said. "The only option is (hiring) private duty (nurses). We think (Companion) will give them another option."

    Deb Sattler, director of Windsor-Essex Compassion Care Community, said the community also is in discussions with SimpleC Companion about testing the device in a pilot program. She said using the telehealth device could help the elderly and disabled people stay in their homes.

    "We hope it will help improve their quality of life as part of our program to reach the elderly, disabled or isolated," Sattler said.

    Of some 1,000 people in the community, Sattler said more than 300 have been matched with community volunteers to help them. Volunteers and family members make regular visits to people in their homes. But the Companion device can give a sense of 24-7 support and connections outside of the regular aspects of care, she said.

    "It brings that human touch. I love the use of music, person pictures, gentle reminders," she said. "People can support themselves, make decisions to help themselves. They just sometimes need a little help."

    Sattler, who also is team manager of the Canadian Ministry of Health and Long Term Care, said the community hopes to start testing 10 of the devices this fall. "Probably 5 to 10 percent of the 400,000 population" in Windsor could use a device like this, she said. If it works, Sattler said it is possible the model might be used in other communities in Canada.

    Blalock said he signed up to test Companion at the Village because of the potential to reduce unnecessary ambulance trips to the hospital for his residents. With 900 residents that range in age from 62 to 105, Blalock said the Village has 650 hospital admissions per year and two ambulance trips per day.

    "This gives us an opportunity to give a piece of technology to our residents to stay as independent as possible," Blalock said. "It will help foresee as many problems as possible; and allow communication with nurses and doctors to unnecessary trip to hospital as possible."

    Blalock said the Village hasn't yet decided how to price Companion, either as a fee directly to the residents or baked in as part of the rent. The pilot will be test on 20 residents with congestive heart failure, diabetes and some dementia for three months, he said.

    "A hospitalization for an 83-year-old can be traumatic. Everybody says once they go to the hospital they are usually less than they were. We are trying to do what we can to prevent that," Blalock said.

    Byrne, who also is a Village board member, said he is a big fan of telehealth because of how it extends caregivers into homes of his home health clients.

    "If we can drive more care in the home, we can keep people out of the hospital. The majority of issues are not clinical. They are social. The elder person is anxious, and just talking with the caregiver, doctor, nurses to get comfortable helps a lot," said Byrne, who founded Integrity in 2005 after his father had a near-death experience.

    "I ordered home care and within 48 hours we had doctors and nurses in the home, looking after Dad. It looked like an inpatient unit more than a home," said Byrne, adding that his mother told him: "You saved Dad's life."

    Lasser said the Companion has been shown to stimulate positive memories in patients that encourages compliance with healthcare orders without the use of medications.

    "The Companion application can improve health and reduce costs by using artificial intelligence for cognitive and behavioral health issues," Pompilio said.

    The use of artificial intelligence in medical software programs is just beginning. For example, Ann Arbor-based Fifth Eye Inc. is developing software to warn medical professionals that certain patients who seem to be doing well after an operation are actually, based on almost imperceptible changes in their vital signs, at risk for serious deterioration in their conditions.

    Researchers at the University of Michigan, led by Mark Salamango, are using artificial intelligence to analyze patient data to show it is possible to predict if a patient is crashing, known as hemodynamic instability, Crain's has reported. The technology combines the much better signal-to-noise ratio in current electrocardiography with machine learning and the ability of computers now to affordably process large volumes of data in real time.

    The NYU School of Medicine and Facebook Artificial Intelligence Research are conducting joint research to reduce the time for MRI scans. MRI scans provide a greater level of detail than other medical imaging, but it can take 15 minutes to more than an hour compared with a minute or less for X-rays and CT scans.

    "Telemedicine meets artificial intelligence at bedside" originally appeared in Crain's Detroit Business.

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