National Healthcare Policy Drives Flex Innovation

Estimated reading time: 9 minutes

Editor's Note: This article orginally appeared in the September 2012 issue of The PCB Magazine.

The Patient Protection and Affordable Care Act and presidential election-year rhetoric on Medicare and Medicaid reform has just about everyone thinking about the cost of healthcare.

While breakthroughs such as an HIV vaccination or early detection of the onset of dementia would have a huge cost impact, healthcare policy makers and the electronics industry—flexible PCB makers included—are looking elsewhere. Technology that will keep people out of the hospital by improving home-based monitoring and treatment looks most promising.

Ezekiel J. Emanuel, M.D., who chairs the Department of Medical Ethics and Health Policy at the University of Pennsylvania and is an advisor for health policy to the White House Office of Management and Budget, is an advocate for encouraging healthcare innovations that may be less gee-whiz but actually lower cost and improve patient outcomes. In a New York Times opinion piece titled On Falling for Fake Innovation, Emanuel writes, “By the end of the decade, we will see many … true innovations—small and large, high-tech and non-tech. Diabetics’ smartphone applications could transmit their glucose levels to doctors’ offices; wireless home monitoring systems could be installed for patients with congestive heart failure… There will also be many innovations in electronic health records. These aren’t flashy robots, gleaming scanners or new pills, but there is already evidence that they will save money and improve care.” Emanuel is a champion of electronically managed prescription medicine adherence systems as yet another innovation to be encouraged under the Affordable Healthcare Act now being implemented.

The drive toward home healthcare technology solutions foretells opportunity for flex and rigid-flex designers and manufacturers who are equipped to meet reliability standards in an environment where sophisticated electronics are being placed in the hands of older and infirm individuals. James Mahoney, applications engineer at Mass Design in Nashua, New Hampshire, points out, “Home healthcare electronic devices increasingly depend on flex circuitry to cram more functionality into smaller spaces while delivering nearly 100% reliability. And they have to withstand the rigors of ‘round-the-clock operation and be easy to use, too. These applications are so demanding that instead of the term high reliability, the PCB industry should adopt the term high-stress circuits to reflect the unprecedented user and environmental demands of home healthcare applications.

Systemic Electronic Solutions

In addition to medical management and monitoring equipment placed in the home, another big opportunity for the electronics industry is to create a foolproof integrated approach to prescription medicine administration and adherence that seamlessly links the doctors, hospital pharmacy, nurses, independent pharmacy, caregivers, family and patients together with accurate, up-to-date information.

A coordinated and properly linked communication system will improve the capability of home-based treatment markedly over the coming years. Home dialysis, unheard of a decade ago, is being improved at the patient end, with insulin pumps that keep glucose levels stable for diabetics. Those suffering from Parkinson’s disease could use monitoring systems that might be incorporated into smartphone applications.

In short, patients will be going home from the hospital with electronic devices in much the same way they used to go home with a sheaf of prescriptions.

David Bear, M.D., founder and chairman of MedSentry, Inc., in Westborough, Massachusetts, and an observer of home healthcare technology trends, explains, “With Parkinson’s disease, for example, medication has to be precisely administered based on patient activity.  Too high of a serum level of medication and patients can develop tremors; too low of a level and the patients become frighteningly immobile. In the past, doctors had to ask their patients about their daily activities, resorting to memories, to determine the correct dosage. Today, these patients can carry an accelerometer to create a detailed, statistically reliable record of their movements. Similarly, diabetes patients can check their glucose level with a light beam focused on their blood vessels. These are not the big medical breakthroughs that make the evening news, but modest electronic applications that have an impact on better medical outcomes and lower cost.”

In addition to doctors relying on patients’ faulty memory, technology eliminates another human failing—lying. Studies show that patients lie to their doctor about half the time regarding drinking, medication, unprotected sex and so forth.

“Whenever pati"ents say they have a couple of cocktails after work, doctors routinely double that number,” Bear quips.

MedSentry Prescription Adherence System, about to be evaluated at Mass General Hospital, stores prescription medicines and monitors adherence through digital visualization. The device sits on a table, can be moved to a different home or apartment, and checks in via the Internet, communicating with a central monitoring facility using Wi-Fi or 4G wireless cards.

Says Bear, “Homecare has nowhere to go but up. People are living longer. Aging at home, with an independence program, is growing in popularity. In addition to prescription medicine adherence, technology is emerging that allows us to collect electrocardiography information, blood pressure data and weight. The MD can readjust medications accordingly, with devices like MedSentry confirming the new regimen. This creates a closed data loop coming from the home and returning as a medication adjustment that is verified by home monitoring. The system cuts down on follow-up doctor visits, trips to the emergency room and, most importantly, return hospital stays where older people are subjected to stress and resistant bacteria.”

Prescription medicine adherence technology is typical of the design challenges flex and rigid-flex designers and manufacturers will be facing as the type and complexity of home healthcare systems grow. MedSentry, for example, is built around a panel computer with a user-friendly, touchscreen. It has 28 individual cups with LED illumination containing enough medication for up to four doses a day for seven days. Eight video cameras peer into the cups and send high-resolution images of the pills to those responsible for patient care. When the cups are filled, the central monitoring station also checks for accuracy. Medication reminders can be transmitted by vibration, light, sound or any combination of the three.

Figure 1: MedSentry—a prescription adherence system, stores prescription medicines and monitors adherence through digital visualization.

Figure 2: Home healthcare delivery and monitoring systems will become more prevalent, pushing the demand for increasingly smaller devices, benefiting from flex and rigid-flex PCBs.

Mahoney points out, “These devices benefit markedly from flex. They are crammed with communication electronics, LEDs and video cameras. They pack a lot of capability into a small space. They have to be tough, easy-to-use and virtually drop proof as well as compact and attractively designed.”

Reverse Technology Transfer

Mahoney observes that the trend toward more home-based medical electronics is bringing about an unexpected benefit, reverse technology transfer. “We think of home medical electronics as less-costly consumer versions of highly sophisticated, expensive equipment found in hospitals and physicians offices. Technology is going the other way too. Medical devices designed for home use are contributing to lowering the cost and improving technology for professional equipment as well.”

Palomar Medical Technologies of Burlington, Massachusetts, designs, produces and sells cosmetic lasers and intense pulsed light (IPL) systems to improve skin appearance for men and women, and has now developed a low-price, non-ablative fractional laser for home use. This product is now being marketed to professionals. Explains Joseph P. Caruso, Palomar, CEO, “We have leveraged many of our consumer product technologies and manufacturing processes to substantially reduce cost and enable us to offer entry level professional systems at a very attractive price.”

With many devices, especially those that are hand held, Mahoney notes, “Compressing more circuitry into a smaller space by using flex not only offers the advantage of decreasing space, it also reduces the risk of uneven performance and increases circuit speeds.

“In addition to speed, the need to be thin is also a challenge. Where we used to have surface mounted components encased in ceramic material, we are now seeing components placed in recessed pockets to save space and mounted directly in contact with metal to dissipate heat,” states Mahoney.

Flexibility is also inching toward stretchability. Last year, The Economist predicted that coming generations of circuits will stretch to mimic, say, human skin in a prosthetic hand. Even the hard components that sit on tiny islands in these circuits may one day be flexible.1

Says Mahoney, “True stretchability in flex circuitry is still in its infancy. Stretching a circuit board, like an elastic band, changes the electrical characteristics of the vias by making them thinner and longer. We’ve turned to mechanical means to add stretchability more simply. Imagine a hairpin or spring, with the ends being pulled apart. It’s a mechanical approach to adding stretchability without actually stretching the material. In principle we do the same thing with flex.”

Of course, cost is a factor. Mahoney points out, “I run into cost every day when I meet with OEM manufacturers. The manufacturing cost has to be weighed in several ways with reliability being the byword. Consider the cost of downtime. In a hospital, where there may be multiple devices performing the same function, downtime is not as costly or as critical as when home health equipment fails in the middle of the night.”

On the outcome end of the equation, the cost savings derived from reliable home-based technology—let alone reduction in human suffering—are enormous. Says Bear, “Congestive heart failure is the most expensive illness we treat. Physicians prescribe as many as eight different medications, some of which require critically precise, constantly adjusted dosages. Patients get confused over changes, shifts to generic drugs and so forth. They typically get the dosages right only about 50% of the time. Largely because of adherence errors, about 27% of these individuals wind up back in the hospital in the first month following discharge.”

Monitoring weight and blood pressure at home and having a nurse call to check up on the patient has been shown to cut hospitalization by around 40%. “With broader implementation of technology we can do much better. Our goal is to maintain adherence at greater than 95% and reduce hospitalizations stemming from poor prescription medicine adherence by more than 45% at a lower cost than intensive home health monitoring,” Bear explains.

Adds Mahoney, “Increasingly, the most reliable solutions in these high stress home healthcare environments are flex and rigid-flex PCBs that can meet the high-stress demands placed on them by their users.”

When it comes to the future of flex circuit technology in home healthcare monitoring and treatment, these are the six factors to watch, says Mahoney:

1. Recessed components that will squeeze more capability into thinner boards, while flex enhances heat dissipation in smaller devices to increase reliability.
2. Smaller and faster circuits in healthcare devices relying on RF communication with electronics operating at faster speeds.
3. Stretchable PCBs with wearable circuitry—including prosthetic devices with circuitry that acts as a subcutaneous layer around an extremity, possibly adding sensitivity to the fingertips of a prosthetic hand, for example.
4. Flex will play a bigger role in a vastly improved systemic approach to prescription medicine adherence—electronically linking the hospital and patient using smaller, more widely deployed, handheld devices.
5. Expect reverse technology transfer. Home healthcare devices will pave the way for making their professional counterparts less costly and more universally available, helping to improve healthcare delivery.
6. Smartphone sales will increase and lower healthcare costs. Home medical devices will increasingly be incorporated into flex-dependent smartphones that can take your pulse, read glucose levels and measure activity. This will increase sales of smartphones among an older population, as it may be cheaper to equip patients with a smartphone loaded with the medical monitoring applications than to manufacture specialized devices in lower volume.

References

1. The Economist

Dick Pirozzolo is a freelance journalist who writes about trends in technology. He lives in Wellesley, Massachusetts, and is a member of the Society of Professional Journalists and Foreign Press Association of New York. For more information, e-mail dick@pirozzolo.com.