“The “biggest value [of connected health]* is in unlocking [the] individual’s ability to care for themselves!” So says Joseph Kvedar, MD, Founder and Director The Center for Connected Health, a Division of Partners Health in Boston, Massachusetts.
#HCHLITSS, Health Communication, Health Literacy and Social Sciences twitter chat started 2012 with a bang. With our guest, Dr. Joseph Kvedar, participants entered into a thought-provoking and engaging conversation.
Dr. Kvedar is an innovator in the use of new technologies to connect health care providers-physicians, nurses, pharmacists and others-with patients. Using remote health monitoring tools, the Center is involved in helping patients manage their chronic disease and engaging people in their own health and wellness.
To get the chat started and get everyone on the same footing, Dr. Kvedar (@jkvedar) answered the question, What is connected-health?
Connected health is “creating a new model of healthcare delivery by leveraging IT to move care from the doctor’s office into the lives of patients.” The way to achieve this change in healthcare delivery is [to provide]“objective information about you, presented to you in context, surrounded by the factors that motivate you to improve your health.”
Motivation or engagement comes from the “objective info about you. [It] holds everyone in the conversation to the same objective standard and aids in reality and accountability.”
Feedback seems to be a powerful motivator.
“Feedback loops offer active reflection, sentinel effect and ability to take action. [With] info[rmation] about health, indiv[iduals] can ch[an]ge behavior.”
One program the Center is known for involves home monitoring of patients with Coronary Heart Failure (CHF).
“Home monitoring for CHF is a terrific example of integrating patient, nurse and physician to achieve health at home and [at a] low cost. …We’re expanding our CHF program to include acute MI (myocardial infarction) and other cardiac conditions. [We] already do HTN (hypertension or condition of chronic high blood pressure)… CHF – p[atien]ts [are] responsible for daily weight, bp[blood pressure]/hr[heart rate]. [This information] goes automatically over phone line. Nurses view dashboards,[and] do exceptional m[ana]g[emen]t.”
Another innovation developed by the Center involves improving medication adherence.
“The RX [Prescription] vitality glow cap first glows, then chimes. [It] r[e]m[in]ds U to take med[ication]s. Improved adherence by 68% in our trial!
Dr. Kvedar notes in previous presentations that there are certain people who are more likely to want to be involved in connected health. They are truly engaged in knowing their numbers, for example, how many steps they take in one day or how many calories they use in one hour. He calls them the “Quantified Self” population. During the chat, he was asked
“How can connected-health get beyond the Quantified Self population to a more generalized population?”
He believes that this can happen by “1) understand[ing] patients and their motivations; 2) giv[ing] them simple tools to track and understand the data 3) empower[ing them] to take ownership.”
Who will drive connected-health (or m-health) physicians or patients? Or pharmacists or nurses?
“All of the above, but mostly patients,”
Will the volume of baby boomers help “force” a move towards telemedicine if hospitals cannot meet demand?
“I don’t know if boomers will be the sole catalyst, but something outside the system will be the tipping point.”
Another mover in the connected-health arena may be large businesses.
“Several global fortune 500 firms are getting into CH [connected-health] as we speak.”
One participant noted, “one day, soon, connectivity is gonna prove its[e]lf to be cost-effective and improving outcomes. (or: are we there yet?)”
Dr. Kvedar agrees that we are “very close to proving the value of connectivity… Especially in the context of ACO (Accountable Care Organizations).”
Following up on this comment, Dr. Kvedar was asked if our present health care cost crisis will be solved by innovation occurring outside of traditional healthcare delivery system, Dr. Kvedar replied,
“My hypothesis: the cost crisis cannot be solved from within. each dollar saved is a dollar of someone’s income lost… MDs are the last to come on board, but with new payment models, they are coming on board. 80% ready in our IDN (Integrated Delivery Network).”
Dr. Kvedar’s passion or vision for connected-health (which he admitted was tough to do in 130 characters) is
“Empower consumers to be their own doctor. It can be done.” Then he clarified by saying that “of course there will always be a need for providers. We just overuse them now.”
Although there was some enthusiasm about connected-health, participants voiced real concerns.
Concerns about connected-health that were raised by participants included:
The digital divide:
“Health literacy and literacy as part of the digital divide”
“Low tech communities need most help”
“Those who are rural are the ones who may need this kind of distance support the most”
Cost of technology for the poor: “When I see personalized medicine- I think medicine for those with “resources” only”
Use of hands, eyes for text messaging
“The age ceiling to connected health”
“Risk of increased disparities”
Where is the desire “for telemedicine in #diabetes?”
Participants also proposed solutions and or disagreed with these concerns:
“Digital divide can be addressed several ways: provide access in clinics, libraries, community centers, or provide print “
“Use existing communication resources in the community to engage/ distribute info[rmation] this is when the value of partnerships with community health leaders and advocates becomes more vital”
“Projects provided to many people have cell phones-programs such as text4baby.org by the National Healthy Mothers. Healthy Babies Coalition can help”
“Actually at least in much of the #US, even the poor have dumb cell phones, and most have basic texting, least from what I’ve seen”
“In developing countries mobile phone technology developed where there were no landlines everything now moves on new platform.”
Although this statement was challenged “For many in developing countries-local comm.[unity] leaders (word-of-mouth) [is] still [the] most effective source of med[ical] info
Others suggested more ways to use connected-health:
“Encouraging mentorship in online communities is a very powerful tool to give more power to the patient and their loved ones
Participants also provided useful information on the use of technology for those who have a disability.
The chat provided a forum for information exchange and opportunities for further discussion. Finally, there was generous sharing of information among the participants. Many thanks to Joseph Kvedar, MD and all the participants in #hchlitss chat.
Wonderful links were provided by participants:
The Center for Connected Health http://t.co/quTwGzdg
Dr. Kvedar’s blog http://t.co/gnni5SC6
UC Davis eHealth Broadband Adoption: http://t.co/62wbn5Fl bridging the divide
California Model E-Health Community Awards http://t.co/Dywo8Q9s
In Canada, the Telemedine Network http://t.co/CauUkO6v has made great inroads connecting /helping esp with mental health
Also need a connected healthcare workforce where needed, when needed & tech to get them there http://t.co/Bjg0dIiX
Recent blog post ?: Can connected work in a fee for service model, or more movement in integrated system?http://t.co/wlGfzSc5
Telcare review from Walt Mossberg. WSJ tech writer with type 2 diabetes. http://t.co/vhQsSSHj
Scottish Centre for Telehealth and Telecare http://t.co/Ncfd0ICv
Project Echo- promoting care for complex diseases in rural and underserved areashttp://t.co/v3OZSDEM
Non traditional entrants into connected-health http://t.co/alxEdh5r
MyVoice is for aphasia and stroke http://t.co/byXDK5W5
Ipad apps for kids with autism @thinkingautism @shannonrosa
*Due to the twitter’s 140 character requirements, comments are shortened by eliminating articles or using shorthand. [Braces] are used throughout this summary to enhance readability.