The convergence of entertainment and technology signals the advent of information on demand — any type of information that customers want, when they want it, and where they want it.
Customers are voting with their pocketbooks and buying handheld devices as an indispensable part of their lifestyle. Can healthcare be far behind? Is disease management immune to such rampant consumerism?
The popular press — Wall Street Journal, The New York Times, Newsweek, Time — all acknowledge what healthcare industry experts have been touting for years, namely that information technology is the most promising vehicle, perhaps the only vehicle, powerful enough to harness the industry’s insatiable appetite for more and more data and patients’ demands for personal health information on a 24x7 basis.
Disease management and, more specifically, chronic care conditions present a formidable IT challenge: how to generate information on demand for anxious consumers and medically relevant data for patients and clinicians alike?
Since chronic conditions require day-to-day monitoring and management for years on end, patients need daily feedback and social support to stay on top of their condition and avoid costly life-threatening situations that can flare up. Likewise, care management teams need to efficiently monitor a range of patient symptoms — as they are occurring — in order to adjust medical regimens, actions plans, medications and office visits as needed.
Medically relevant information, such as patient-generated data on symptoms and provider feedback on changes in medical regimen, is very time sensitive and must be exchanged quickly and securely. This strongly suggests that cell phones will be the primary vehicles for patient-provider communication in the future, just as cell phones — rather than computers — are becoming the primary sources of on-demand information and media content for consumers.
There are many more cell phones being sold each year than computers. And many households have abandoned stationary phones altogether in favor of mobile handsets which are far more secure, personal and accessible. Cell phones go with the user.
Let’s get engaged
The biggest reason for adopting cell phone technology is its capacity to engage patients, the Holy Grail in monitoring and managing chronic conditions. Patients need providers to help translate medical regimens into daily behaviors and motivate appropriate follow through with positive reinforcement. Right now there is only so much that physicians, nurses and disease management vendors can do to encourage patients with old technology and business-as-usual outreach campaigns.
Office visits are too infrequent and expensive. Many standard telephone calls go unanswered and call center operations are very labor intensive. Print mail reminders usually go unread and have low impact on patient behavior. In essence, traditional forms of communication have been minimally effective in increasing patient adherence to medical and lifestyle change regimens. Patients are not responding, as intended, and DM vendors are having a difficult time penetrating more than 10 to 15 percent of chronic care patients.
The missing ingredient is increased communication with providers. Cell phone technology bridges the gap between the patient’s need to be more engaged and the provider’s expertise, but without further burdening already overworked physicians, nurses and case managers.
Enter the common cell phone and its computer-based applications.
It is ubiquitous (over 200 million users in the United States), low cost, and there are minimal barriers to entry. Most patients already use cell phones 24x7. Thus, voice, Web access and text messaging have the capacity to engage patients in their day-to-day care through reminders (appointments, medications), monitoring (patient-recorded symptoms and vital signs, diaries, medical information), medical management (personalized action plans, prescriptions and refills) and patient education and communication (text, charts, graphs).
These features enable clinicians to use cell phone applications such as an “asthma assistant” or “diabetes assistant” to better track patient behavior and to intervene when more intense care is needed.
Cells have the juice
Most cell phones have the processing power necessary to accommodate fairly sophisticated chronic disease applications that can be downloaded onto the handset, applications that help patients with their self-management. A cell phone’s main features — voice, Web access and text messaging — enhance communication between the patient, clinical team and support team members.
As healthcare executives earmark more and more dollars to enhancing IT systems and pursuing electronic medical records, it is critical to accommodate the use of cell phones as a strategic resource and patient management tool. At a minimum, each patient profile should include a separate field for the patient’s cell phone number.
Patients using cell phones to manage their condition (e.g., pilot projects in California) see the handset as an extension of their hand and a practical tool for maintaining their quality of life in the face of a possibly debilitating and freighting illness. It is ironic that the biggest advance in managing chronic diseases may already have been invented and is in the hands of millions of people with diabetes, asthma and cardiac conditions.
Peter Boland, Ph.D., heads business development at BeWell Mobile Technology, Inc., a San Francisco-based application service provider of disease management tools for mobile handsets.