by Audrey Kinsella
The annual Partners Health Care symposium, "Connected Health in Practice: Engaging Patients and Providers Outside of Traditional Care Settings," provided examples of cutting edge healthcare innovations to keep patients connected and engaged.
Wearable devices that track daily activity, such as FitBit, however, were pushed to the back burner in favor of those that provide health information to physicians and the wearer. "Self-monitoring" for personal use is for wellness, not healthcare. One reason to focus more on self-care apps than fitness apps is that use of these consumer technologies has proven to be faddish and short term.
Joseph Kvedar, MD, Director of Partners' Center for Connected Health, pointed out that more than 80% of health apps are abandoned by users within two weeks. People apparently become infatuated to the newfangled gadgets but are not interested in committing to them as part of a permanent health plan. Even when they are used for a longer period of time, it is apart from a clinician's guidance.
This quirk of human nature requires healthcare providers to reconsider indiscriminately providing or recommending health apps. Instead, clinicians must focus on working with people who need self-management tools in order to manage a chronic condition. As Kvedar suggested, this group is limited to older and sicker people who do need help, not the leagues of fit and wired consumers who do not.
Example: Diabetes Manager
For this group, one example of a technology Kvedar would recommend is a service, the online Diabetes Manager from WellDoc. He described a case undertaken through a Maryland chapter of the ADA where diabetic patients were coached by WellDoc physicians on use of glucometers and related devices, and given healthcare routines. Physicians are able to access data collected from patients' self-management devices as needed and clinical decision support is returned to the physician, who uses the data to optimize the treatment plan. (See a case study at described at devicespace.com)
This model was promoted throughout the conference, combining patient self-monitoring with real-time, telehealthcare-enabled collaboration between patients and physicians. Wholesale self-monitoring of entire populations, it was concluded, is not the most useful path to follow. Providing targeted care to patients with specific needs is.
Another example was provided by Michael Palmer, Chief Innovation Officer at Aetna Managed Care. In his address, "Leading Innovations in a Connected World," he described how innovative technology from Britain's Capita Health (capita.co.uk) provides clinicians details on patients' conditions. Capita Health's information system assesses whether specific patients are failing at or engaged in their self-monitoring programs.
Palmer insists this is not a policing program but a way to improve care. Knowing patient behavior allows health insurance companies to match quality caregivers with the most complex and difficult patients and use decision support software to help them become better engaged and more compliant.
Assuming that patients will keep up their end of a teamwork agreement is leaving too much to chance, according to Phillipe Schwartz, President of Withings, Inc., a smart health device development company. (withings.com/eu/about-us) Can more assistance be provided to patients to keep them using healthcare devices/apps? There are certain "must-haves," he noted during a panel discussion, titled "From Farming to Factories to Fitness Trackers: The Natural Evolution of the Patient." Mobile or wearable devices must be:
This last feature is a phrase that surfaced frequently during the conference. What is the best way to "forget" that you are wearing a device? One answer to this question was suggested by David Icke, founder and CEO of MC10, in "Seamless Sensing: Tomorrow's Smart Silent Solutions."
Calling Dr. James McCoy
In the new world of patient tracking, devices may be worn on or embedded in the body. In the past five years, Icke noted, wearables like FitBit were looked at as a niche market, with not one deemed essential to healthcare tracking. In fact, journalists often write about these products as "funky gadgets to track one's weight in order to one day fit once again into skinny jeans." Today, however, Icke asserted, wearable sensing devices have advanced significantly and follow strict design requirements. One of them, for instance, can track atrial fibrillation through an iPhone app to reduce the wearer's risk of stroke. (medicalapps.com/2013)
These clinical wearable health devices suggest a turning point described by Roy Schoenberg, MD, MPH, CEO of American Well, a long-time telemedicine innovator. On a panel discussing "Large-scale Connected Health Interventions - Lessons Learned," Schoenberg asserted that "the Wild, Wild West of telemedicine has fallen by the wayside," citing recent passage of telemedicine practice guidelines issued by various telemedicine practice boards and approved by the AMA. (www.americanwell.com)
Another device to help patients stay on track may be "smart eyeware" such as Google Glass, which can be used for healthcare purposes. One use described at the conference was to help the user get immediate access to healthcare information in general and on his or her specific care plan. In this case, more theoretical than practical at this stage, use will likely be limited to engaged patients who want to access the information in this way and are committed to following through on self-care directives. As Kvedar stressed in what became a mantra about patient compliance and the road to wellness: "Engagement is King."
Technology can encourage patient engagement. What is necessary, however, Kvedar noted in his closing keynote, is "frictionless technology" — intuitive, seamless, with no need for a user manual — that instantly gets information to and from the engaged patient.
We may not be that technology-savvy as a culture yet but we are getting closer every day. This is the sentiment conference attendees took away, from the opening addresses, when we learned that there are many hands on deck to move us toward a more technical healthcare world — Microsoft, Apple, Samsung, Google, etc. — to Dr. Kvedar’s optimistic closing keynote, where he commissioned us to answer "Will 2015 Be mHealth’s Coming Out Party?"
Audrey Kinsella, MA, MS, is HCTR's telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at audreyk3@charter.net or 828-348-5308.
©2014 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com