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Connected Health, Chronic Illness and Internet Use

March 28, 2010

The latest from my friend (and font of wisdom) Susannah Fox, is a piece about Internet use amongst the chronically ill.  It  compliments data from e-patients.net showing that the phenomenon of patients using the Internet as a tool to become proactive with their care skews to younger and healthier individuals.  Fox’s recent report notes that of patients with two chronic illnesses, only 52% are Internet users.   Likewise, the other study notes that only 27% of patients over 65 define themselves as e-patients.

This is consistent with our observations in rolling out connected health programs in a large integrated delivery network.  For instance, in one of our primary care practices, only 60% of diabetics we enrolled in our home glucose monitoring program were Internet users. In our CHF population, it’s even less.

I always note this when talking about technology choices and program design.  There are so many really exciting iPhone apps out there for example, but we haven’t tried to deploy one in our setting because the population of patients who would find it useful, let alone familiar, is tiny.  This is because we care for a disproportionate number of Medicare recipients (essentially all > 65) and Medicaid recipients (low percentage of Internet access there too).  If one is an employer or health plan that insures an employee population, the technological opportunities are vastly more intersting.

So we use lowest common denominator technologies in most of our programs.  The best news is that we’ve learned that Internet access is not a must for improved care.  For instance with our diabetic population, if the patient uploads their glucose readings (via analog phone line) and if the nurse in the practice (after seeing their data on the website) stays in contact with the patient, even by periodic phone call, their health improves.  Its those two variables (patient uploads and provider views of the data) that correlate most strongly with better outcomes.

This is not to knock the Internet or e-patients.  We’ll all get there eventually.  When my youngest daughter gets old enough to have two chronic illnesses she will surely demand that all health care is delivered via text message!  In the meantime, we can use more primitive technologies to achieve the vision of connected health – care where the patient is/when the patient needs it.

10 Comments leave one →
  1. Kevin Jones permalink
    March 29, 2010 10:12 am

    More of a question – If the key factor for improved outcomes is the patient uploading readings and the HCP providing feedback, do you think the focus should be to 1) make it as easy as possible – i.e., automatic – to upload readings and 2) provide the feedback through a channel tailored to individual needs. The technology exists today to do this at relatively low cost. Once readings are uploaded, automated analytics can identify abnormal conditions and the feedback can be provided the way the patient wants it. Those who prefer a text message can get that. Those who need a phone call can get that. The lowest common denominator in that scenario is the automated uploading of readings which help improve frequency. What are your thoughts about that?

    • March 29, 2010 10:44 am

      It is ideal to involve the patient if possible. Those that have access to the data (usually via web browser) tend to do better. So I agree that automatic upload is ideal, but some sort of feedback to the patient is important – it allows the patient to provide self care and takes some burden off of the provider.

      • Kevin Jones permalink
        March 29, 2010 11:19 am

        Thanks for your reply. I hear you that the feedback is important. To that point, I was trying to say it is not technically difficult to provide feedback the way the patient wants it: A) self-service in a web browser, B) pushed to them in a text message or email, or C) a phone call from a nurse.

  2. March 29, 2010 11:24 am

    Yes, I agree with you. It should be highly customized. That is our long term goal

  3. March 29, 2010 1:20 pm

    Great observations – and mirrors what I’m seeing more broadly/globally. In some ways, this really is a generational issue. When I asked my 8 year-old at dinner what he did in school – he said he used Google Docs to write about his favorite Hot Wheel car. Online services (including health care) will not only be expected by generations behind us – they will be demanded. They will make decisions (including health care ones) based on connected access. Similarly – providers will reap additional benefits by interacting with patients online – and while I can’t prove it – it stands to reason that graduating medical professionals will gravitate to those opportunities that are more “connected” as health care delivery systems.

    Look forward to meeting at some point in our travels – maybe H2.0 this fall in SFO … ?

  4. April 9, 2010 1:39 pm

    Joe –

    The lowest common denominator approach is a great way to think about technology, kind if like the rate limiting step in organic chem so many years ago.

    What are you seeing as far as regional medicaid/medicare reimbursement for using this type of technology ? How is your group providing the education to patients to use the technology especially since there is a strong inverse correlation between medicaid enrollment and literacy level?

    Thinking about how to implement a similar program in Appalachia.

    thanks –

    Steve

  5. Sandra Peters permalink
    April 26, 2010 3:10 pm

    Hi Dr. Kvedar,

    I read your entire blog and am impressed at the success rates that you are getting using connected prgs to treat expensive chronic disease pts. Wondering, is there a way to expand these progs to pts in rural areas through telederm? Perhaps through health care reform funding coming down the pike to community health centers?

    Sandra

    • April 26, 2010 9:23 pm

      I’m sure there are rural opportunities. We’ve been focused on our own delivery system, so haven’t looked thoroughly at these opportunities

Trackbacks

  1. Apps useful, familiar to tiny number of patients | mobihealthnews
  2. ICMCC News Page » Connected Health, Chronic Illness and Internet Use

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