Outpatient rehabilitation from illness, injury, or surgical procedures is a $30B+ segment of healthcare. The process of rehabilitation can be quite complex, often varies from patient to patient, and is critically dependent upon patient engagement. Patient adherence to prescribed rehabilitation, together with careful clinician oversight and adjustment of prescribed activities during recovery, can have an enormous impact on the long-term outcomes of acute interventions.
Until now, as almost all post-acute rehabilitation and recovery occurs in the home, skilled office or hospital-based clinicians have been left with only brief, infrequent glimpses of patient progress. Patients striving to recover at home have often been left with unanswered questions or important misconceptions about their recovery program. And, delayed recognition of issues or lack of patient engagement can adversely affect overall outcome.
Complicating all of this is that relevant information is sparse, qualitative, and usually self-reported, so that when recovery is delayed or derailed, it is challenging to understand the root-cause.
We are now on the verge of a sea change in outpatient rehabilitation. Digital assistants, telemedicine, telehealth, computer vision, and augmented/virtual-reality systems are finally able to allow clinicians the ‘privileged insight’ into the full process of outpatient, at-home recovery. Patients can look forward to on-demand, expert guidance into their recovery. Clinicians can look forward to streamlined workflow that provides more objective and actionable information in a highly accessible format.
Early results using Reflexion Health’s VERA™, a virtual exercise rehabilitation assistant, highlight the opportunities of this new modality and demonstrate value accruing along the three axes of Patient, Provider and Process:
Patient – When built with a deep understanding of the patient journey through the entire care pathway, digital rehabilitation assistants can dramatically improve the patient experience. From early education and expectation setting, to helpful reminders, to detailed risk assessments, to animated and interactive patient-specific instructions, all the way through to detailed measurement and audio-visual feedback, these systems guide patients through their rehabilitation experience. Patients comment on the convenience of having an on-demand assistant, and describe an added sense of accountability as they ‘know their doctor or therapist is watching.’ This sense of accountability, combined with the comfort of knowing they are performing their regimen correctly and the coaching of an engaging avatar, has driven unprecedented levels of adherence to prescribed therapy.
Provider – Following an acute injury, illness or surgical intervention, clinicians typically provide a detailed set of instructions to guide rehabilitation and recovery. Exigencies of today’s healthcare environment only allow for brief and occasional check-ins, with the result being that well over 95% of the process of recovery process is currently unmonitored/invisible. With home-based digital rehabilitation assistants, the entire process of rehabilitation can be objectively quantified, distilled, and indexed to contemporaneous functional assessments and patient-reported outcomes. Quick review of a clinician dashboard of all treated patients can allow for ready identification of those patients needing additional attention, assuring that all patients are getting the care they need, and that clinicians are focusing their time and resources of those patients most in need.
Process – It has often been said that you cannot manage what you do not measure. Rehabilitation is a practice of rich diversity in methodologies and routines, with wide variability in post-acute care paths, at times tailored to patient specifics, but at others, more determined by local practice patterns. Using digital health tools like VERA® provide a first opportunity to systematically and objectively document previously unmeasured aspects of the rehabilitation process (i.e., exactly which therapies were performed, when, how often, how accurately, how quickly, etc.) and then link these objective data with objective assessment of long-term outcome. Only with a careful understanding of the interaction between performed rehabilitation routines and ultimate outcome can we begin to optimize each patient’s course and outcome.
Here in the early going, there are also some lessons learned:
In a general sense, patients are digital health consumers, with 64% of patients responding to a recent survey said they use a digital device to manage health. That being said, not every rehabilitation patient has wi-fi or a broad-band connection in their home. For digital rehabilitation assistants to reach the broadest population, it is important that they arrive complete with integrated internet access. Additionally, there is some perceived concern that seniors may be unaccepting of such digital assistants or find their use too complicated. In practice however, by paying careful attention to the user interface, the reality can be quite the opposite, with seniors reporting being delighted by the convenience of use.
The adoption of home-based digital rehabilitation assistants into the care pathway requires stakeholder alignment. Even as experience documents that: 1) patients prefer the associated convenience; 2) that adherence to prescribed regimens are dramatically improved; 3) that recovery times are shortened (likely as a result of greater adherence to prescribed therapy), and; 4) that there are associated cost savings in fewer office visits, co-pays and travel expense, adoption can be delayed by some stakeholders’ concerns of declining revenue for face-to-face encounters.
Digital rehabilitation assistants do more than provide patients with an on-demand digital companion for the rehabilitation journey. They also provide clinicians a smart window into what had been the black box of at-home rehabilitation. This privileged insight into the post-acute period opens the door to an enhanced understanding of what works, what doesn’t, what’s needed for optimal recovery, and forever crosses the Rubicon for optimized and patient-centered rehabilitation.
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