Some health systems are evaluating technologies to address one of the trickiest aspects of treating chronic diseases: ensuring patients keep up with their treatments at home, Laura Landro writes for the Wall Street Journal.
Roughly half of all adults suffer from at least one chronic disease, and those conditions account for 70 percent of all U.S. deaths and 86 percent of all U.S. health care costs. New studies have shown that the technologies of digital medicine—particularly smartphone apps—can reduce costs and improve outcomes in patients with chronic conditions by assisting them in day-to-day disease management.
But as Amir Lerman, an interventional cardiologist and professor of medicine at the Mayo Clinic in Rochester, Minnesota, said, "You can't just build an app in your garage and think it is going to change medical care. You need to have a treatment plan behind it, and a health system to care for the patient."
How health systems are searching for digital solutions
That's where health care organizations are stepping in. Twenty-four organizations, including Rush University Medical Center and the University of Virginia Health System, have joined a network intended to test and vet digital health tools.
Partners HealthCare, a health system that includes Brigham and Women's Hospital and Massachusetts General Hospital, has tested approaches such as remote blood-pressure monitoring for hypertension patients, text messaging to help get their diabetes patients to exercise, and electronic pillboxes that are monitored remotely and can alert patients when they need to take their medications.
Intermountain Healthcare is working with AMA and Omada Health to test a year-long, online program for patients at risk for diabetes, including a 16-week introductory course that teaches better lifestyle habits. Participating patients are assigned a personal health coach and a support forum, and are provided a pedometer and cellular scale that uploads their weight readings so their health coach can view their progress. Patients also record their daily calorie intake and activity levels, either manually or automatically through a connected device, such as an Apple Watch.
Early data show that two years after beginning the program, participants have successfully lowered their average blood-sugar levels and lost weight. Omada predicts the program will produce a net savings of more than $2,000 per participant over five years.
Temple University's Temple Lung Center has created an app, called COPD Co-Pilot, that prompts patients with Chronic Obstructive Pulmonary Disease (COPD) to record their symptoms each day. An algorithm compares the reported symptoms with the baseline data on the patient, which is then reviewed by nurses who decide whether the patient needs immediate treatment.
A study in 2015 found that patients who used the app and received same-day treatment were better able to control their symptoms, resulting in improved lung function.
Mayo Clinic researchers have tested a program available both online and through a smartphone app that targets heart disease. Through the program, cardiac patients record their dietary and exercise habits and receive information about healthy lifestyles. Program participants had better lifestyle habits, lost more weight, and had fewer ED visits related to heart problems than those who had normal care.
Rush University Medical Center is working with Proteus Digital Health on the Proteus Discover system to improve medication adherence among patients with high blood pressure. Under the initiative, patients are prescribed medication that contains an ingestible sensor the size of a grain of sand that records and transmits the time medication is taken, as well as the patient's heart rate, steps, and rest to a patch worn on the patient's torso. The patch then wirelessly sends the information to an app on a mobile device for the patient to share with their health care provider.
A study published in the Journal of the American College of Cardiology showed that the Proteus Discover program led to greater improvements in blood pressure and cholesterol in patients with uncontrolled hypertension and diabetes than normal care.
New guidelines on the horizon
While researchers have begun testing some digital health tools, the industry currently lacks comprehensive guidelines for evaluating them.
So the American Medical Association (AMA) has teamed up with the American Heart Association, the Healthcare Information and Management Systems Society to create Xcertia, which is developing guidelines for mobile health apps. "Physicians recognize the tremendous potential in digital health tools," James Madara, AMA's chief executive, said, "but without a framework to evaluate them, there could actually be harmful effects" (Landro, Wall Street Journal, 6/25).
Why telehealth technology isn't always enough
There are dozens of telehealth technologies to choose from. But planners who ask, "What technology should I invest in?" are focusing on the wrong question.
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