N°255 - June (Special)
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The connected patient. Are we about to enter a new era?
By S. Lustig in category TRIBUNE
Centre Albert Trillat – Orthopaedic Surgery Department Croix Rousse Hospital - Lyon
Modern medicine in general and orthopaedic surgery in particular is becoming increasingly specialised, which is without a doubt a good thing. The inevitable disadvantage is that we only focus on our field of expertise and learn less on developments outside our speciality, thus sometimes missing out on significant innovations. A recent example is the emergence of fresh interest for the concept of the "connected" or "supported" patient in the field of orthopaedic surgery, and especially prosthetic surgery, whereas this practice is already well-established in other medical specialities such as cardiology, without us, orthopaedic surgeons, being aware of it.
What is it about?
The idea is that to be able to better manage a patient, it is necessary to empower them in terms of their care and follow-up so they feel more involved. Even if we can of course envisage this during hospitalisation, the current move to shorter stays, especially in the aim for rapid (or "improved") recovery after surgery, does not make it possible to extend stays. In fact, it is exactly the opposite. It was therefore necessary to turn to more innovative tools such as web and mobile platforms like the BePATIENT e-health platform, specially developed for each type of surgery, and for informing and monitoring patients. The patient, once their surgery has been scheduled, has personalised (and secure) access to the web platform, via which they can take action (and even interact) from their home, before and after their surgery, thus receiving support throughout the care process.
We can schematically divide the concept into two phases.
The first phase takes place before surgery. With their secure code, the patient can connect from home when they want to obtain all the necessary information about their operation (which will be traced at the same time thus proving they have effectively received the information), and to answer a certain number of questions (from the PROMS (Patient Related Outcome Measurement Scores) questionnaires in fact) which will be used to collect accurate information and to trace the patient’s pre-op physical condition. It is useful for surgeons in that they do not have to intervene, but also that they receive, through the platform (i.e. on a page summarizing their patients’ data) feedback on the information, which is saved as it arrives and serves to compile their patient database.
The second phase takes place when the patient returns home. Via the same secure platform, they can provide precise information on the change in their condition over several weeks, and this information will also be available to the surgeon who can see the change in the pain, function, well-being scores etc. of the patients they have operated on, and will thus have access to highly accurate information, almost on a daily basis, at a glance whenever they connect. The patient can also ask questions via the platform if necessary, thus the notion of the "supported" patient. Once again this information is saved and used to compile the surgeon’s database gradually. The technology has also been used to develop patches which are Bluetooth sensors that the patient can wear for the first few days after surgery, and which forward parameters such as the distance covered daily, temperature, respiratory rate and heart rate etc. The patient thus becomes genuinely "connected", and in the event of out-of-range values, a report is sent which enables active remote monitoring. Patient safety, even with shorter hospital stays, would be further reinforced, with an obvious potential reassuring effect.
Why is it likely to come into widespread use?
If we want to get a sense of the whole potential interest of this concept, we can look at our cardiologist friends who have long-standing experience with invasive cardiac vascular procedures with shorter stays that have been made possible through home supervision via the support platforms. Our orthopaedic surgery stays will also become increasingly shorter, and supporting our patients in this way will make it easier to monitor, manage and watch them, while compiling databases which could in the long-term be used as a register of all our patients. Changes in legislation are likely to make the databases compulsory. We can bet on these "supported" patient platforms developing rapidly in our orthopaedic world, as it has already been the case in other specialities. We might well be leaving the hospitalised patient era behind for the connected patient era.