Case managers increasingly will benefit from the use of wearable technology that helps them monitor patients across the care continuum.
“For case management, this is an opportunity to use technology to maximize patient care,” says Zack Craft, ATS, ATP, CRTS, vice president, national product leader for CarePath and durable medical equipment, and rehab engineer at One Call Care Management in Jacksonville, FL.
Here are examples of how this technology can contribute to better case management in healthcare and workers’ compensation cases:
• Shoe/sock/boot sensor. Patients with foot or leg injuries sometimes work with physical therapists to improve their gait and help them return to work and daily activities. However, if a patient does not perform the physical therapy exercises properly, there could be repercussions that lead to back pain or other problems. A small sensor placed in the patient’s boot on the injured leg can monitor the patient’s stepping and gait, Craft says. The sensor can send information to case management about the patient’s pattern of walking, and also give a vibration whenever the step is performed improperly, he says.
“It can use a small sensor analysis, and notify the patient if he doesn’t take a full step,” Craft explains. “Then, it gives us data that 90% of steps were within an appropriate range, but for 10%, he was not walking fully.”
The focus is on the quality, length, and height of a patient’s steps. The sensor is sensitive enough to know when the patient performs a half step, limps, or drags a foot. Because the vibrational feedback is self-reinforcing, it can prevent the person from developing poor gait habits.
“Our goal is to get patients back to 100%, and we’re using simple tools to remind them to take full steps,” Craft says. “This is where technology gets exciting — we have sensors that can go on a boot, ankle bracelets, and shoes.”
From a workers’ compensation perspective, improper gait during a patient’s recovery can end up costing more time and money, he notes. “It can cause secondary complications, like lower back pain,” Craft says. “Then, they need therapy for the lower back. This is extending the cost of the claim.”
• Smartwatch and wheelchairs. “For case management, we have a lot of different technology we’re looking to use,” Craft says. “I’m a big fan of the Apple Watch for individuals with wheelchair injuries.”
The issue is that most people are unable to propel their wheelchairs correctly. They can develop carpal tunnel syndrome or shoulder problems when they do not use the proper stroke in turning the wheels. “They’re trying to get around, and can hurt themselves, and create secondary injuries,” Craft says.
The solution is for wheelchair-bound patients to use a smartwatch with an app that measures their daily wheelchair propulsions. A paraplegic can perform as many as 18,000 propulsions a day, which could wear out their shoulders by age 30 or 40, Craft says. “If you do that many propulsions in a day and can’t lift yourself out of bed, then you are now dependent on home healthcare because you can’t transfer appropriately,” he explains.
The case management solution is to educate patients on the proper way to propel the wheelchair, or to use a smart wheel drive that helps propel it.
“We want to extend the shoulder life for those individuals,” Craft says. “The Apple Watch tracks their actual strokes — how many times they grab the wheelchair and pull it,” he adds. “It tells the difference between proper wheelchair stroke and when a person shortchanges it or goes too far, creating secondary issues.”
• Range-of-motion wearables. There are several devices that can track a patient’s range of motion, including how much he or she is bending over or lifting, Craft says.
“Are they doing full extension like they should post-surgery, or what is their body temperature or pressure on their feet?” he adds.
Some wearables can help track pain management. Others are voice recognition devices that help patients with limited functionality. Other devices can monitor a person’s posture, slouching, and positioning, helping to prevent repetitive stress injuries. They emit a gentle vibration when someone slouches, Craft says.
• Respiratory assessment. Patients recovering from surgery, a brain injury, or another injury that could affect their breathing might benefit from a wearable device that fits on their belt, around their waistband, or in their shirt, Craft says.
“Because those patients are sitting in a wheelchair or on the couch a lot, they are not taking a full breath, and this delays the healing process,” he explains. “We use those devices to remind them to take a deep breath.”
• Concussion monitoring. “Another trending area right now for wearables is around concussions,” Craft says. In the consumer products area, there are sensors developed for use in helmets, mouth guards, neck patches, or eyeglasses.
“If you fall, it tracks when you fell, and how long you were down,” he says. “With all the youth football players, soccer, and contact sports, it might be mandatory, someday, to have concussion monitoring systems for each child.”
Patients working at high-risk jobs could wear these devices to track their daily work and risk for falls or injuries, he adds.
• Wearable jewelry. “There is smart jewelry that gives you a vibration, like a text message, or it sends positive feedback information,” Craft says. “It can tell by your heart rate, posture, and respiratory rate when you are falling asleep. It uses an algorithm based on what’s normal for you.”
It is an easy way to monitor a person’s bedtime habits. If a patient is supposed to sleep eight hours a night, the wearable jewelry monitor will let the case manager know if that goal is met. It can tell when a person’s sleep is restless, which could affect recovery.
It also can spot a trend that suggests an impending infection, or other problem. The device can tell if someone’s body temperature spikes at night. Case managers can see that something has changed, and set up a doctor’s appointment for the patient, Craft says.
“The patient could be getting a kidney infection or the flu, and the device can give us a quicker notification of that and get the patient in to see the doctor earlier,” he adds. “It can reduce the cost on a claim, and enhance the case manager’s role.”