Many teens with Type 1 diabetes have trouble keeping to a schedule for testing their blood sugar and giving themselves an insulin shot four or five times a day, Piehl says.
The phone is designed to help make sure they don't forget. It displays text reminders and various icons that appear every time the phone is opened. These signal the user to collect test data and transmit it to WakeMed.
"We have found kids using the phone are much more likely to remember to check their blood sugar," he notes. "The phone is with them all the time and reminds them that it's time to check their blood sugar."
Surveying The Landscape
Still early in the testing phase, the use of cell phones as part of a diabetes management program is part of an increasing reliance on telehealth, which is the use of information technology to manage health in the home environment.
WakeMed is using cell phones supplied by Research Triangle Park, N.C.-based Confidant International LLC and loaded with the vendor's diabetes management software. Another company, Toronto-based LifeWire, is testing the text messaging function of cell phones as the communication platform for a remote diabetes management program.
Home health agencies and hospitals are deploying home-based patient monitoring devices that patients use to collect vital signs and other health status data and transmit the data to secure Web sites via telephone lines or the Internet for clinicians to access and review.
Such devices have been around for several years, but manufacturers and software vendors continue to refine their functions and add new ones.
One new telehealth device is designed to give physicians the practice management and electronic health records functions they need when making house calls (see story, page 40).
Vendors are working on other new telehealth functionality, much of it exhibited during the American Telemedicine Association's Annual Meeting in May in Nashville, Tenn.
San Antonio-based AT&T Inc. and partner AMD Telehealth Inc. of Lowell, Mass., exhibited a three-lead electrocardiogram device that can be used with AMD's home monitoring system, which AT&T resells. The device is awaiting approval from the U.S. Food and Drug Administration.
The two vendors also are working on sending urgent clinical alerts to home health clinicians via smart phones that can access a secure Web site for more information. They also are developing software to enable patients to capture and submit health status data via smart phones.
Health Care Anywhere
Telehealth enables clinicians to monitor patients at home, where they are comfortable, and get the patients help quickly if necessary, says Bill Paschall, director of telemedicine at AT&T. "Not only has care moved beyond the four walls of the hospital, it's outside any four walls," he adds. "It's health care anywhere."
New uses also are being found for traditional telemedicine applications to enable consultation between physicians, patients and others.
For example, St. Mary's Residential Training School in Alexandria, La., is using technology from Los Angeles-based Digital Union LLC to consult in real-time with autism experts in different cities. The school, home to 186 children with autism or other developmental disabilities, has installed videoconferencing software at its site and at three specialist offices.
Using their own peripherals, such as cameras, microphones, monitoring devices, ultrasounds, stethoscopes and other devices, a trainer or clinician working with a child at the school can be coached by a remote specialist.
Walking the floor at the ATA show in May, Neal Neuberger, a consultant and secretary of the association, saw more mobile applications than ever before.
The turnout of 2,000 attendees and 160 vendors were hopeful signs for the telemedicine/telehealth industries, says Neuberger, president of Health Tech Strategies LLC of McLean, Va. "There's no shortage of entrepreneurial interest."
But he worries about the future. A range of nationally accepted standards covering data collection and exchange, and standards for use in cases that demonstrate the value of telehealth, are urgently needed, he notes.
His chief worry, however, is that the technology's biggest barriers-financing and state licensure policies-may be insurmountable.
Private insurance reimbursement for any type of telemedicine remains in the early adoption stage, Neuberger muses. Further, Congress has not been willing to adequately fund telemedicine for 15 years. Suing the Centers for Medicare and Medicaid Services to have Medicare reimburse for telemedicine services may be necessary, he contends.
ROI Is Avoiding Cost
For now, telehealth primarily is paid through grant funds or out of the pockets of provider organizations that view the technology as a cost-avoidance tool.
For the past year, Dr. Piehl at WakeMed has been testing cell phone-based diabetes management with about 10 teens. By giving them tools to better manage diabetes, he hopes to keep the teens healthy and out of the hospital.
The teens have a glucose meter that tests the blood and displays and stores results, which generally are downloaded by clinicians during an office visit.
But these kids also have a Bluetooth wireless device from Confidant International that plugs into the glucose meter and wirelessly transmits readings to the cell phone. The phone, loaded with the vendor's diabetes management software, then transmits readings via a cellular network to a secure Web server that clinicians-and parents-can access. The data can be presented in various ways, including graphs that show trends.
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