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Connected Health and the Doctor Patient Relationship

July 28, 2011

One of the pillars of connected health is the collection of a patient’s physiologic data using biometric sensors. These data are trended, subjected to rules and presented to the patient in an educational context, as well as to their provider.

At the Center for Connected Health, we are using sensor technologies as tools to encourage health and wellness. We use weight to track fluid gain in our congestive heart failure patients, glucometer readings to track diabetic control, blood pressure readings to correlate lifestyle changes with changes in blood pressure and smart pedometers to give folks feedback on their caloric output.

This approach clearly provides more rich and accurate patient information. But, our research also demonstrates that when patients gather these data, and know that their health care provider is regularly reviewing their individual results, they feel empowered to better manage their own care – and this dramatically improves adherence. For motivated patients, access to their own data in context is powerful, but  providing these patient data to health care professionals ups the stakes significantly.

Imagine a discussion with your doctor or nurse at your regular office visit. Instead of asking you about your weight, or your recent exercise level, the health professional looks at a screen and begins a dialogue with you about how adherent you have or haven’t been to the care plan you agreed on. Scary thought? Nowhere to hide?  Perhaps, but once you have embraced the need for certain health behavior changes, these tools promote an honest dialogue with your provider.

Our patients tell us how motivating it is for them to know that their healthcare provider is reviewing their personal health data.  It is one of the most compelling ways for a provider to demonstrate they care. In some recent focus groups we ran, diabetic patients were quite willing to annotate their personal data with information about diet and exercise to put their glucose readings in context if they were assured that their health care provider would look at the data and use it as part of their decision making.  Our heart failure patients consistently tell us how knowing that a nurse will be calling if their weight goes up 2-3 lbs is a strong motivator for them to watch their salt intake and stick to their fluid restriction. They tell us how the technology empowers them to be better self-caretakers.

My favorite example is the congestive heart failure patient who, in commenting on his required daily weigh-in said, “I can’t cheat on my diet anymore. If I have too much salt today, it will affect my weight tomorrow. When my weight goes up, they have a nurse out here within half an hour.”   We actually don’t dispatch a nurse for every elevated weight, but the psychology around objective information and the resulting accountability is striking.

Patients live with their illness all day long, 365 days a year, and if they are careful observers, they can provide infinitely more detail about their illness than can be recorded in an annual visit to the doctor.

Hypertension management is a perfect case in point. Most physicians who manage blood pressure do so on a few – and often as few as two – readings per year taken in the doctor’s office. Our Blood Pressure Connect program allows patients to take blood pressure readings daily or more often and provides a trended report to their physician on how blood pressure is varying and what aspects of the patient’s life impact the readings. The immediacy of information in this type of model allows patients to self-manage through diet, exercise or lifestyle decisions as never before, preventing exacerbations of their condition or the onset of complications that would necessitate intensified use of healthcare resources.

Providers are realizing the power of staying connected to their patients once they leave the medical setting, being able to monitor their vital signs in real time.  Patients are more motivated than ever before to get involved in their care, and are empowered by the personalized information they can receive and comforted to know that their healthcare providers are watching. Even employers are jumping on the connected health bandwagon, seeing how employee wellness and disease management efforts can create a healthier, happier workforce while reducing healthcare costs.

Better, more accurate collaboration between patients and providers – supported by technologies such as smartphones and wireless devices – is at work to improve care, improve outcomes and improve the doctor patient relationship.

8 Comments leave one →
  1. July 29, 2011 8:53 am

    I am so encouraged to read your comments. I have been conducting reasearch for 5 years using technology to remotely monitor people with chronic diseases. Our findings have been consistent with what you describe. I am now trying to provide this as a service in my home care company. Although all participants found that this monitoring, follow-up and teaching support was so helpful, we are in the new phase of trying to sell the service. We can hardly give it away. We are back to the question… “Who pays?” I am curious aout your company and what you are doing. Do your clients have buy-in? Does your Government see the potential for cost savings and a better health care delivery system. It’s not happening here. Donna
    http://www.telehealthaccess.com

    • July 29, 2011 11:49 am

      As provider groups are faced with risk-bearing contracts, they will adopt this model of care delivery because it is efficient and effective. Stated another way, we as providers will pay through adoption of connected health as a business expense, once we are compensated on the basis of quality and outcomes rather than units of service (value-based, rather than volume-based reimbursement).

  2. July 29, 2011 12:33 pm

    Interesting article in July/August Issue of Ambulatory and Family Medicine entitled: What Keeps Patients from Adhering to a Home Blood Pressure Program? The study involved giving study participants a complimentary automated blood pressure cuff and access to a centralized system for report BP results to their physician.

    While 58% did report their BP to their physician via the “automated reporting system” 42% percent did not. Reasons for not communicating readings to providers were largely physician factors (no doctor visit, doctor didn’t ask, thinking doctor wouldn’t care).

    It seems one of the biggest challenges to “connected” health care is getting the patient’s physician to actually use the data collected from the patients.

    Steve Wilkins
    http://www.healthecommunications.wordpress.com

  3. July 31, 2011 9:44 pm

    thanks for this reference. We have data that shows how important patients perceive physician (or provider) interaction as a motivator for continuing to collect these data, so I agree. Still, i’m not surprised that a group of identified hypertensives engaged at the rate quoted since they represent a wide variety of ‘readiness to change’ psychology. My point is that there are patient factors too.

  4. September 1, 2011 3:29 pm

    Some frustrating information you provide here. Patients should always come first.

  5. November 2, 2011 10:17 pm

    I am not empowered by my health care provider “WATCHING” me. I am empowered because my physician is engaged in my care and actively listens to me. Please consider having patient participation in your next symposium. Patient voices are an under-utilized resource. Please give patients the opportunity to educate physicians what it is like living with a disease, and learn how many of us are accountable for our care. I welcome your participation in our patient community’s upcoming chat. We are doing something a little different in our patient community, FMDChat is holding a facebook chat, but instead of doctors telling patients about Fibromuscular Dysplasia (FMD), we are giving patients the opportunity to educate physicians what it is like living with FMD, what our challenges are in health care.
    http://on.fb.me/v0QIw4

  6. November 3, 2011 8:58 pm

    We agree more than disagree. the point is that some folks are willing in spirit but weak in execution and need a bit of helping hand/coaching to improve their health behaviors. Universally they tell us that knowing that a provider is looking at their data makes a difference in adherence. Thanks also for your comment on having patients attend our symposium. we have indeed had patients on panels in the past and it has not always worked out well. Still I have several ideas for patient advocates to involve in next year’s event. We very much want to get the voice of the patient involved. Interestingly enough, the headline of my talk was ‘patients are our biggest underutilized resource’. it will be up online soon if you missed it and care to watch. i can join the chat next Thu because i have another commitment but appreciate very much being invited.

    thanks

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