Medical Technology and Workers’ Compensation

At the 2019 Executives in Workers’ Compensation conference, a session talked about how advances in medical technology are impacting workers’ compensation. the speakers were:

• Constantine Gean, MD – Regional Medical Director, Liberty Mutual
• William Zachry – Senior Fellow, The Sedgwick Institute

New technology can be both good and bad. It can create efficiencies and solve problems. However it can also lead to unintended consequences. On the medical side, new technology also tends to be very costly.

The FDA recently approved a blood test to diagnose a mild brain injury. it detects certain proteins in the blood that are released following a mild brain injury. This test, called the Banyan Brain Trauma Indicator is very accurate and correlates with CT scans over 97% of the time. This test must be done within 24 hours of the injury and it should lead to faster diagnosis and treatment of mild traumatic brain injuries. This is being used in the military now and will be seen more in healthcare in the near future.

Post accident drug testing is also progressing so that a blood draw may not be needed in the future. Hair and saliva testing is showing to be increasingly effective in detecting the presence of drugs in the system. One challenge around drug testing is the lack of accepted standards for impairment associated with drugs. Compare this to alcohol which has widely accepted standards for measuring impairment.

CRISPR – Clustered Regularly Interspaced Short Palindromic Repeat: This genetic testing will revolutionize medicine as it will allow for for medical treatment, specifically medications, to be customized based on the genetic testing results. This technology could also allow the regeneration of tissue, which could be used to repair defective joints. The thought is someday we may be able to genetically engineer out certain diseases through this technology. There are a lot of ethical considerations around research on genetic engineering because the potential long-term impact of such things is unknown.

Artificial intelligence in the truest form does not exist yet. However this technology is evolving rapidly. On the claims side, AI technology can be used for thing such as automatic utilization review which would review the treatment guidelines, diagnosis and testing results automatically. AI technology (Watson) is also being used to assist physicians in diagnosis by reviewing medical records. This is in it’s very early stages of development. AI virtual assistants can follow up with injured workers to check their symptoms, remind people of follow up appointments and keep a diary of symptoms. AI is already being used with defibulators, both internal and external which automates the decision around whether or not a shock is needed.

Other issues:

• The FDA has previously approved an ingestible sensor for medication tracking. This device, called Proteus, alerts the physician if the medication is not taken as appropriate for the directions. These internal sensors could also help monitor heart rate, temperature, and other signs of physical exertion.
• Virtual reality and augmented reality has several potential implications for workers compensation including safety training, amputations, stoke rehab, and pain management.
• 3D printers are showing potential in the development of prosthetic limbs and orthotics. There is also potential for customized medical implants.
• Wearable devices could be used to track compliance with rehabilitation efforts. When a rehabilitation program includes self-care, the tracking can be used to monitor steps, physical activity, trips to the gym, etc. Apple Watch has new technology that can now monitor irregular heart rhythms and create an alert that can assist clinicians in making a diagnosis
• Tele rehabilitating using Skype of FaceTime is allowing physical therapists work work with patients to monitor their home exercise program to ensure they are performing the exercises correctly.

Telemedicine has huge potential implications for workers’ compensation. It can provide medical access in remote locations and underserved medical communities. One big potential area of focus is with mental health care as finding providers willing to accept workers’ comp in this is very challenging. Telemedicine can also speed access to care for certain conditions such as rashes, simple sprains and strains, minor burns, etc.