October 15, 2006 (Vol. 26, No. 18)

Making Healthcare More Convenient, Efficient, and Tailored to Individual Needs

The concept of connected health, or telemedicine, extends healthcare beyond the traditional confines of hospitals and doctors’ offices to our everyday surroundings. The availability of technology in the home, our aging population, and the dramatic increase of patients with chronic diseases, such as hypertension, diabetes, and obesity, are some of the factors fueling increased interest and growth in connected health.

Combined with the relative shortage of healthcare specialists, sharply increasing healthcare costs, and patient demand for quality and convenience, we are seeing an increased interest and growth in connected health and the potential for a range of exciting new applications to address these challenges.

In today’s complex healthcare environment, connected health programs are valuable and necessary. Typically, such programs use new or available consumer technologies, such as the Internet, cell phones, and digital cameras, to facilitate patient-provider communication. Some of the most common applications in connected health today include online patient-provider consultations, home monitoring of patients, remote lifestyle feedback, and other home-based remote healthcare.

The new connected health models of care extend and enhance the patient-physician relationship. Further, connected health programs are demonstrating the kinds of measurable improvements in access, quality, and efficiency of care that get the attention of key players in the system. Employers are increasingly relying on connected health to administer wellness programs and other technology-driven care plans, while payers are realizing that connected health technologies make efficient use of dwindling resources to reduce healthcare costs and deliver quality patient care. Concurrently, healthcare providers have become more comfortable integrating technologies into their practices, and consumers are showing more interest in actively managing their health.

At Partners Telemedicine, we are taking a proactive role in developing initiatives and establishing an infrastructure for connected health. These programs are designed to deliver quality patient care wherever and whenever it is needed.

Improving Adherence

According to the World Health Organization, 50% of patients with chronic disease do not take their medication as prescribed. While the reasons for poor adherence vary, the impact on cost and treatment outcomes to patients, society, and our healthcare system is indisputable. Given the provider shortage, the challenge of adherence speaks directly to the need for better patient self-management.

For example, there are over 65 million Americans with hypertension, yet only 30% of those patients have control over their condition. The remaining 70% contribute over $40 billion in direct healthcare costs and generate over 17 million physician office visits annually—not to mention indirect costs, such as lost work days and decreased quality of life.

We believe that an essential part of patient self-management is the creative implementation of incentives and the development of content and interfaces that keep patients engaged—particularly in chronic disease populations.

Partners Telemedicine is currently analyzing data from a technology-readiness survey of several thousand diabetic patients to assess the level of technology use, current behavior, and barriers to adherence, as well as the opportunities and obstacles to connected health for the consumer. Initial data suggests that even if consumers have not yet used these technologies in the home, they are willing to adopt technology to share health information remotely with their doctors.

Connected health technologies can keep clinicians connected to patients long after they leave the office with their prescription. This is a critical opportunity to provide the incentives, feedback, and information that motivate patients, improves adherence behavior, and reduces medical risk.

Smart Pill Bottles

To further develop this concept, Partners Telemedicine is conducting a study of 70 patients using a smart pill bottle that sends electronic messages to a central server housing individual patient data. The server then signals back to a home device. Using data from the pill bottle and server, the device glows red when medication is overdue and green when the patient is on schedule with their medication.

This is the first step toward the development of effective behavioral strategies to improve adherence in chronic disease populations. The study is examining the effect of unobtrusive, no interface, personalized reminders on adherence rates.

The technology is readily available to improve adherence. Pharmaceutical and biotech manufacturers have a real opportunity, working with technology companies and healthcare providers, to create solutions that will be effective in large-scale settings or in specific patient populations.

Remote Monitoring and Care Delivery

Connected health strategies are also improving patient monitoring and home care beyond remote monitoring to include remote diagnostics and remote care delivery.

Several trends in employer benefits, payer programs, and consumer expectations suggest that connected health technologies and thoughtfully implemented disease-management programs, together, can play a role in enhancing care and outcomes for patients with chronic diseases, such as chronic heart failure (CHF).

Technology and device manufacturers are developing small, user-friendly devices that monitor heart rate, blood pressure, pulse oxymetry, and weight. The importance of these products will grow in the home care setting, as patients continue to become more technology savvy.

Some people have voiced concern that the elderly, who could benefit greatly from connected health advances in home care, are unlikely to adopt these new applications. There’s evidence, however, that they are changing with the times: The fastest growing segment of Internet users are over age 65.

In a collaborative study between Partners Telemedicine and Partners Home Care, we followed 85 CHF patients for two months following hospital discharge. Each day, patients transmitted their weight, blood pressure, and oxygen saturation to a telemonitoring nurse. The nurse evaluated the data and placed a phone call to each patient to share the data and ask scripted disease-management questions.

The use of telemonitoring devices combined with enhanced communications demonstrated a significant impact on efficiency of care while showing decreased hospitalization rates. Study participants required 40% fewer nursing visits to the home and experienced a 25% reduction in re-hospitalization rates.

Additionally, patients reported an improved quality of life and appreciation for increased involvement in their care. As a result of this study, Partners Home Care implemented telemonitoring for all of its eligible CHF patients, and has expanded the program to include patients with chronic obstructive pulmonary disease, renal failure, and more.

Personalized Medicine and the Future of Connected Health

Genetics and genomics have the ability to change the way our healthcare system approaches therapeutic and diagnostic procedures and could revolutionize the delivery of care in the near future. However, that is only a part of what we believe to be the promise of personalized medicine.

We have the opportunity to proactively re-engineer the entire healthcare delivery system to make healthcare more convenient, efficient, and tailored to individual needs. In any case, as healthcare consumers become more aware of the way their genetic makeup, history, environment, and lifestyle choices interact, while our healthcare system strains under the increasing demand for services, the availability of a healthcare infrastructure that provides patients with support, education, and self-care opportunities will become imperative.

Now is the time for pharmaceutical and biotechnology companies to get involved, to proactively develop connected health programs that will afford patients, caretakers, and providers a system for better coordination and delivery of care.

The technology exists today to help patients care for themselves, for caretakers to have access to pertinent information about their loved ones, for providers to monitor patients when they are away from the doctor’s office or hospital.

What is needed is better coordination and a connected health eco-system where incentives are shared by patients, providers, and payors.

Joseph C. Kvedar, M.D., ([email protected]) is director of Partners Telemedicine and vice chair of the department of dermatology at Harvard Medical School. Khinlei Myint-U is a corporate manager at Partners Telemedicine ([email protected]). Partners Telemedicine (www.telemedicine.partners.org), a division of Partners Healthcare, is connected to over 4,000 physicians at Harvard Medical School-affiliated teaching hospitals.

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