For many, electronic connectivity with patients makes good sense. Many potential patients avoid care because they are uncomfortable speaking with providers in person, particularly when the subject is psychiatric or sexual in nature, says Jason Hwang, M.D., executive director of the Innosight Institute, a Mountain View, Calif.-based think tank. I.T. can lower such barriers, Hwang argues. Providers, he advises, should look for opportunities to introduce electronic visits or remote access for patients into their care mix. "We're never going to knock out the hospital and replace it with a bunch of Web cams," he allows. "But we would like to clear out the emergency department of people who could be better treated at home, more conveniently and affordably. It starts with some sort of niche."
Meridian defined its niche during its three-month pilot program. It included 42 patients, whose average age was 69, Elliott recalls. During the trial, participants would receive pre-recorded phone calls timed to mesh with their prescription schedules. Patients did not want to be called constantly, Elliott says, so calls typically came in just once a day. The system was driven by an interactive voice response mechanism, from Proximity. Using the system, patients could report reasons for any non-compliance with their medication program, such as wanting to avoid side effects, not having the medications, or not feeling like they needed the pill. Overall, the patients in the program had a 26 percent improvement in their compliance, Elliott says. Meridian plans to continue the program, which it will market locally through a joint venture with BestBuy.
During the pilot, Proximity provided the health system with reports summarizing patient participation, listing the number of calls that went out and the compliance results. Meridian did not trap the data for individual patients, but moving forward, plans to capture the data in a personal health record it offers patient through a Web-based service, NoMoreClipBoard.com. It will also expand the service to loop in family members to the call chain, alerting relatives if an aging family member, for example, has neglected to take their medications. In addition, the expanded service will enable seniors to leave a message directly with their child associated with the reminder. "A parent might want to reassure their child they took the medication," Elliott explains. "Or maybe they just want to leave a message, like 'pick up the milk.' We added some consumer-oriented features to the service."
Other cell-phone driven consumer applications put the user front and center, with only marginal involvement by providers. Gary Miner, an independent technology consultant based in San Diego, has been using the MyGlucoHealth service since April 2009. Diagnosed with Type I diabetes as a teenager, Miner has seen self-care technology improve dramatically over the years. "When I was 17, I used to take an ugly chemistry test that involved urinating in a bottle. It was mad scientist and highly inaccurate and embarrassing. So I did not take the test. I was flying blind, the way most diabetics are."
Years later, Miner he woke up at 3 a.m. to find himself surrounded by paramedics. "My wife was claiming I was near death," he recalls. "It's not an unusual occurrence, but I really began paying attention after that."
With the MyGlucoHealth technology, Miner deposits a drop of blood on a glucometer, which displays the reading on a meter. It's a common process for diabetics, but for most, that's where the self-monitoring stops. In Miner's case however, the device transmits the result to his Web-enabled Nokia smart phone, which in turns dispatches the data to Miner's private page on the MyGlucoHealth site. About once a week, that data is ported to Miner's personal health record, from Google Inc., Mountain View, Calif. His lab scores from local provider Scripps Health also feed directly to the PHR.
The set-up has alert features, which trigger a call to Miner's network of family and friends if warranted. If his reading exceeds certain boundaries, Miner gets an immediate text message to his phone, asking him if he will take care of the condition. If Miner doesn't respond within five minutes, another alert goes out to his network. "It has prevented me from going to the ER twice," he says, adding that he jumps on any alerts. "I don't want my wife to get a call. It means I'm not in control."
Miner grants access to his MyGlucoHealth Web page to his physician. "He doesn't look at it very often," Miner acknowledges. "He doesn't get reimbursed for it." But that's how it should be, the technology consultant adds. If diabetics need anything, it is more self-monitoring and self-control, he contends. "I like the idea of being the center of my health care and taking responsibility for it. It's ridiculous to think that doctors will keep us healthy and we have no responsibility."