Pathophysiologic Basis of Connected Health Systems

Abstract

Since the start of the COVID-19 pandemic, there has been a rapid transition to telehealth across the United States, primarily involving virtual clinic visits. Additionally, the proliferation of consumer technologies related to health reveals that for many people health and care in the contemporary world extends beyond the boundaries of a clinical interaction and includes sensors and devices that facilitate health in personal environments. The ideal connected environment is networked and intelligent, personalized to promote health and prevent disease. The combination of sensors, devices, and intelligence constitutes a connected health system around an individual that is optimized to improve and maintain health, deliver care, and predict and reduce risk of illness. Just as modern medicine uses the pathophysiology of disease as a framework for the basis of pharmacologic therapy, a similar clinically reasoned approach can be taken to organize and architect technological elements into therapeutic systems. In this work, we introduce a systematic methodology for the design of connected health systems grounded in the pathophysiologic basis of disease. As the digital landscape expands with the ubiquity of health devices, it is pivotal to enable technology-agnostic clinical reasoning to guide the integration of technological innovations into systems of health and care delivery that extend beyond the boundaries of a clinical interaction. Applying clinical reasoning in a repeatable and systematic way to organizing technology into therapeutic systems can yield potential benefits including expanding the study of digital therapeutics from individual devices to networked technologies as therapeutic interventions; empowering physicians who are not technological experts to still play a significant role in using clinical reasoning for architecting therapeutic networks of sensors and devices; and developing platforms to catalog and share combinations of technologies that can form therapeutic networks and connected health systems.

Keywords: architecting connected health systems; clinic; community; connected health; design; digital therapeutic; environment; pathophysiology; smart health; system; systematic methodology; technology; therapeutic systems.

Figure 1

Pathophysiologic map.

Figure 2

Expanded pathophysiologic map.

Figure 3

Targets for sensing and intervening. A: Work stress data sets; B: environmental noise sensors; C: food environment data sets (eg, food desert status and fast-food scores); D: real-time traffic data sets, real-time crime reports, and walkability scores; E: sleep quality sensors; F: food intake trackers and electronic food diaries; G: fitness trackers; H: connected scales and body fat percentage trackers; I: connected insoles, posture detectors, mechanical stress sensors, and sleep apnea detectors; J: apnea monitoring; K: connected protein sensors that sample material in the toilet; L: activity monitoring devices that can help detect and monitor progression of loss of sensation or perform surveys to measure the level of neuropathic pain; M: connected medicine bottle or smart cap; N: connected syringe and connected insulin bottle; O: continuous glucose monitoring.

Figure 4

Initial connected system deployed around patient.