Suddenly hot: chronic condition management in telehealth initiatives at University of Virginia and Doctor on Demand

Chronic condition monitoring is suddenly hot. UVA has been a telehealth pioneer going back to the early oughts, with smart homes, sensor based monitoring, and remote patient monitoring. Their latest initiatives through the UVA Health System focus on preventing or managing chronic conditions. It will include remote monitoring for patients with diabetes, screenings for patients with diabetic retinopathy, home-based cardiac rehabilitation programs for heart failure patients and streamlined access by primary care physicians to specialists through electronic based consults. The program will also include specialized trainings for health care providers.

The programs are being funded by a $750,000 grant from the federal Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health. UVA press release, Mobihealthnews

Mobihealthnews earlier noted that Doctor on Demand, a smaller commercial telehealth company, is also expanding in the management of chronic conditions through a new service, Synapse, that creates a digital medical home for personal data. This data can include everything from what is generated by fitness trackers to blood pressure monitors. The data can be directly shared with a provider or across health information exchanges and EMRs. Doctor on Demand plans to use this longitudinal data to identify gaps in care and increase access to healthcare services–and also integrate it into existing payer and employer networks.

This Editor recalls that this was a starting point for telehealth and remote patient monitoring as far back as 2003, but somehow got lost in the whiz-bang gadget, Quantified Self, and tablets for everything fog. Back to where we started, but with many more tools and a larger framework.

Docs tickling the computer keys a turnoff to patients: JAMA

Health tech as perceptual barrier. A study published Monday in JAMA Internal Medicine-Online First (limited content) found that patients were noticeably less satisfied their care when the physician used the computer (e.g. EHR) during the appointment. According to Reuters, only half of the 25 visits with high computer use were rated as “excellent care” by the patients, compared to more than 80 percent of the 19 encounters with low computer use. iHealthBeat cited that physicians who spent more time on the screen:

  • Spent less time making eye contact with patients
  • Tended to do more “negative rapport building,” such as correcting patients about their medical history or drugs taken in the past based on information in their EHR.

The researchers (primarily from the University of California–San Francisco) used data from two years of visits by 47 patients to 39 doctors at a public hospital. The patients had Type 2 diabetes, rheumatoid arthritis or congestive heart failure, with some having multiple chronic conditions. What is downplayed is that the patients were considered ‘safety net’ patients with communication barriers–limited health literacy and often limited English (primary Spanish speakers). But even this special population may be pointing to an overall problem (more…)

165,000 apps, 3 bn downloads and counting: global mHealth apps study

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/11/mHealth-Developer-Economics-2015.jpg” thumb_width=”200″ /]The results of the fifth annual mHealth App Economics survey are out. Our Readers were invited to participate back in March when it was sponsored by German research firm research2guidance in collaboration with mHealth Summit Europe and HIMSS and kicked off at the Riga meeting in May.

Major apps stores reported more than 165,000 mHealth apps published by 45,000 companies, and projected 3 billion downloads by close of 2015.  Some other key findings from R2G do surprise:

  • The target for apps is DTC–chronically ill patients–with their hospitals as #2. Physicians are important, but less so than last year’s survey.
  • App publishers aims appear altruistic. 53 percent of mHealth publishers claim that their main motivation is to help people improve their medical conditions. However, 60 percent aren’t reaching their goals yet mainly due to low reach. The vast majority of apps (62 percent) mark up less than 5,000 annual downloads. (See the chart below for some possible reasons why)
  • Diagnostic apps lead in anticipated business potential until 2020. And app publishers have added medical professionals to their team.
  • What app publishers find works to change behavior is not gamification. What does: integration of provider feedback or dialogue.
  • Yet providers, such as doctors and nurses, are seen as the most threatened group by mHealth solutions.
  • A scant 3 percent of mHealth publishers generate more than $1 million–and they are far more focused on sales and brand awareness than their brethren which make little. (chart)

(more…)

Drive to ACOs and value-based care may make 2016 The Year of Telehealth (US)

An encouraging prediction? Two Foley & Lardner attorneys with evidently a great interest in healthcare predict that 2016 may very well be The Year of Telehealth. Why? They cite accountable care organizations (ACOs) and the coordinated care at the heart of their model as a protected activity under the Medicare fraud and abuse waivers. “Coordinating care, such as through the use of telehealth, remote patient monitoring, and other enabling technologies”is “an activity reasonably related to the purposes of the Medicare Shared Savings Program and therefore is eligible for protection under one or more of the fraud and abuse waivers”. National Law Review, mHealth News. While from the legal point of view this may be significant, there’s been a concatenation of other factors.

What are the drivers for telemedicine and telehealth in ACOs? In the Medicare Shared Savings Program (MSSP), which is one model, ACOs must leverage savings, and perhaps the largest is avoiding unnecessary hospitalization costs among ‘high-risk’ patients–those with chronic disease–and usually more than one. They are also over half of high ER/ED utilizers. The Federal agency behind Medicare, the Centers for Medicare and Medicaid Services (CMS) has since 2011 been signing up ACOs in risk and value-based payment models that offer incentives such as shared savings. In 2014, only 28 percent of ACOs in the MSSP program earned shared savings bonuses. (more…)

Patient groups most likely to use mobile phones for health: study

A new Manhattan Research study, which starts off rather pedestrian, contains a surprise. The trend of increased used of smartphones for health is not it, as it follows online use: 95 million Americans now use their mobile phones for health information or tools, up 27 percent from 75 million a year ago, and the Cybercitizen Health US 2013 study of over 8,600 Americans found that 38 percent of online smartphone users consider it “essential”. What sets the study apart from the usual enumeration and semi-puffery is the discovery of which patient groups find smartphones most useful and are most likely to use their phones for health reasons. It is closely linked to medical chronic conditions, but not the ones you think. (more…)

Medivizor patient info site goes public with additional information

Medivizor, which was one of the better discoveries of our CE Week (NYC) coverage and the H20NYC/Healthcare Pioneers evening back in July [TTA 3 July], has moved out of what was a largely private beta to what they interestingly term a ‘public beta’. The site provides individualized content, understandable by the layman, for subscribers on a larger group of diseases which were on track for this fall: lung, colorectal, breast, and prostate cancer, as well as melanoma, diabetes, coronary artery disease, hypertension and stroke. The goal is to improve doctor-patient communications by better patient education. Another important feature is a “personalized system for matching individuals with specific clinical trials available worldwide.” Company release, Xconomy article.

A related New York Times article is an appreciation of how physicians are overwhelmed by information and that “doctors also need a skilled docent to help walk them through all that curated data.”  Healing the Overwhelmed Physician