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The Next Phase of Connected Health: Connected Personalized Health

July 12, 2010

Our Center just launched a company called Healthrageous.  It’s exciting to see them get going.  One of the things they are doing is refining their message. They’ve come up with the concept of ‘Connected Personalized  Health’ and their ambition is to be the market leader in that space.  The more I think about it, this represents the next phase of maturity for connected health as a concept.

A colleague from the U.K. wrote recently to ask my reaction to the idea of taking connected health in his geography from pilot stage to real scale by engaging in a roll out of remote monitoring to a population of >150,000. After I stopped to admire both the vision and the leadership, I thought about why I was cautious in my endorsement of the concept.  I came up with a three way matrix (management consultants inevitably have a two by two matrix to break down any problem; I tried but could not reduce it to two variables, so my matrix has a third dimension).  My reply was that to reach the kind of scale suggested AND to have a real impact on health outcomes would require attention to customization along three axes.

The first is the severity of chronic illness.  At our Center, we have become comfortable offering a pretty different program to the patient with class IV CHF (congestive heart failure)  vs. the patient with mild, uncomplicated hypertension.  The sicker CHF patients need more human intervention, almost constant oversight and inputs from multiple sensors.  The hypertension patients are much lighter touch.

The second dimension is the patient’s readiness to engage in a connected health intervention.  This turns out to be a critical component of program design.  The outreach to an individual who is motivated enough to do the data uploads and view his/her own information online is different than to a patient who will not even bother to set up the equipment.  Our goal is to predict these states (and those in between) before putting a person on a program. This will enable much more efficient use of program resources.

The third dimension is technology readiness.  If we encounter a patient who has a home WiFi network and knows how to add devices to it, our approach can be different than to a person who is Internet-phobic, has no PC and only an analog phone line for communication.

I suggested to my colleague in the U.K. that these are the three most important variables to work with in scaling a program and avoiding a ‘one-size-fits-all’ mistake. I’ve invited him to comment here and I am curious on your thoughts too.  What are the best variables to consider when taking connected health programs from pilot to scale?

Connected Personalized Health is our next big step forward. My friends at Healthrageous are creating an amazing software platform that will collect information about you from all manner of sources and create the absolute best program for you to achieve health behavior change, constantly customizing and refining according to your progress.  I am excited to be a part of their success as we build this next phase of connected health and take the concept to scale.

13 Comments leave one →
  1. July 12, 2010 2:19 pm

    Isn’t the provider (doctor, nurse etc) readiness another dimension? Without them most patients won’t try new health technologies.

    • July 12, 2010 8:45 pm

      This is a great point of discussion! I deliberately left providers out, because I am so passionate about empowering patients/consumers to take charge of their health. Your point, however is well taken; providers are a powerful influence. it takes forever to bring them along. would love to hear from others on this.

      • July 14, 2010 12:16 pm

        I think leaving out the providers out makes for a better model. Provider readiness should be subsumed by patient-readiness. In other words, part of patient readiness to engage in a connected health intervention has to be that she’s found a provider who will work with her or at least can find one. It might sound like I’m putting too much of a burden on the patient, but really, empowered patients pick their own providers. No one’s selected a provider for me since I left the Navy over twenty years ago.

        I’d leave the three dimensions alone. I think you nailed it.

      • Diane (consumer) permalink
        August 23, 2010 11:11 am

        I think provider readiness is a critical component of success. Speaking from personal experience, my husband’s physician was flat-out insulted when we saw a homeopathic doctor as well as the traditional physician. My husband was diagnosed with diabetes, high blood pressure and high cholesterol. He had suffered bouts of gout and fatigue for months. The physician’s prognosis was “these drugs for the rest of your life, and see my dietician (nearest appointment: 6 weeks out)”. The homeopathic DR gave my husband (in just 2 weeks): hope for getting off the medication and a diet that addressed ALL of his issues, including scientific reasons why the gout would likely subside. The traditional phsyician’s dietician only decreased the carbs, with no other dietary limits (thereby NOT addressing the high blood pressure, cholesterol, fats, sodium, etc). Since my husband chose to follow the stricter diet, he has lost 30 pounds, decreased his blood pressure and avoided gout. His traditional physician has not returned any of 3 calls.

        If Healthrageous, or any other patient-responsiblity solution is going to be successful where the rubber meets the road — between Provider and Patient — it is imperative that the provider community be prepared to support their patient’s efforts.

      • August 23, 2010 11:26 am

        You make an excellent point and your story, I’m afraid, is pretty common. The challenge is vexing, because physcians view themselves at the top of the health care chain and have been rewarded for thinking so for decades. This creates a culture that is not as open as one might like to alternative approaches to illness.

    • July 13, 2010 6:28 am

      More and more people are becoming motivated, engaged and proactive about their health. It’s clear that this trend will continue to gather pace. I think the adoption of new technologies by providers will increasingly be driven from the consumer side, not the other way around.

  2. BJ Cook permalink
    July 13, 2010 7:35 pm

    How does all this fit into Obama’s health care plan? This software won’t be free and I’m guessing a lot of people won’t pay for it themselves so will it be included in health plans?

    • July 13, 2010 7:57 pm

      I don’t have a crystal ball, but there are many instances in the health reform bill that direct the large government payer, Medicare, to pay for outcomes and quality, rather than units of service. When that becomes a reality, providers will adopt this sort of approach as a business expense as it results in improved quality and improved efficiency

  3. July 23, 2010 5:11 am

    I have waited a little time to join the thread of the conversation conscious that there are potentially significant cultural and systemic differences each side of the Atlantic because of how we organise and experience health care. I absolutely concur with Joe’s initial list as severity of disease, connectivity and patient readiness are key. I also think that because of the barriers to market entry existing “trusted” brands need to be prepared to innovate in developing service models that incorporate technology. The pay off for them going forward is that they can enjoy competitive market advantage as consumer expectations develop. What was radical today becomes tomorrows norm as the user/patient experiences a wholly different and postive relationship with the management of their disease. If I am currently significantly restricted in pursuing my preferences in activities of daily living because of morbidities associated with my condition and I achieve more controlled health status and more confidence in self management through a care management/technology combo I am going to value it highly in every sense. I am not going back to that previous state – why would I. A cardiac surgeon talked to me about the game changing experience in his discipline of realising that improved outcomes at lower risk with shorter recovery periods for patients could be achieved by less interventionist procedures to unblock furred arteries or remove obstructions. This became “the way things are done around here” and the specialty norm in an incredibly short time. We need a pull from consumers – who need to know/experience the benefits – and a push from professionals who are prepared to rethink their role as experts in 21st C, with the system incentives (and penalties) aligned, to get scale and pace. The technologists aren’t off the hook though, reliability is increasingly robust but interconnectivity is critical. Also high volume users have comorbidities and increasing cognitive impairment (dementia), single disease service models have had their day.

  4. September 2, 2010 3:21 pm

    It seems the second and third dimension are basically the same reflecting the patient’s knowledge and openness to technology. I suggest the second dimension should be regarding the patient’s level of self-management which might be assessed by a tool such as the Patient Activation Measure (PAM).

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