mHealth: Telemedicine delivers patient decision support

Mobile healthcare technology is delivering decision support right now, but it’s not all for clinicians, according to panelists at the World Congress second annual leadership summit on mHealth in Boston last week.

Given the opportunity, many patients will become more engaged in their care, proposed Katherine Clark, RN, manger of telemedicine at Englewood Hospital's Home Health and Hospice Services in Englewood, N.J.; Joseph C. Kveder, MD, founder and director of the Center for Connected Health, Partners Healthcare in Boston; and Alexander M. Nason, PhD, program director of Johns Hopkins Medicine Interactive and director of telehealth at Johns Hopkins Medicine in Baltimore.

Home care “self-empowers patients so they can understand their illness a little better,” Clark said. Englewood Hospital provides a secure encrypted, password-protected and firewall enabled monitoring program for congestive heart failure (CHF).

In addition to being cost effective, the program allows nurses to manage more patients, and to better target their visits. “Nurses log in to their telemedicine patients and see their vital signs and know whether they need to go see that patient or not,” noted Clark.

Appropriate screening of patients is key with placement of these monitors, she said, but the results have been dramatic: Of 72 CHF patients enrolled in the home care program, from January 2009 to May of this year, only three were readmitted with active heart failure, according to Clark. “Our goal is to make sure we don’t send any patients back to the hospital. Telemedicine is one of the way we can keep these patients home,” she said.

And patients understand this, said Kveder. “So much of what we’re learned from using connected health is that success is about drawing patients into their care and about allowing patients to care for themselves,” he said.

The advent of inexpensive, ever-smaller sensors and the arrival of the internet have provided healthcare with the opportunity to track and the opportunity to communicate—and have opened up “a wildly different way for us to provide care and to look at healthcare in a totally new model,” Kveder said.

“The fundamental components of that are measuring something about you [something objective], sharing it with you in a way that engages you in your health, and sharing it again with another resource that can hold you accountable to achieve a higher healthcare goal," he said.

“We were excited because we thought we would be providing clinicians with more information to make better decisions in a timely way,” Kveder said. “What we missed completely in the beginning was that patients start to take better care of themselves. Very quickly they learned how to manage their own heart health.”

The combination of patients learning to take care of themselves, and quick interaction with a clinician when necessary, has resulted in a drop of about 50 percent in rehospitalizations, Kveder said.

The Center also has a blood pressure application, which Kveder said is more of a self-help wellness app; and a diabetes telehealth program.

In the diabetes telehealth program active patients--"those who upload [information] even once"--did better than inactive patients--“who took this stuff home and threw it in a corner”--in A1-C readings, he said.

“It’s measuring something about you, allowing you to interact with that information in a way that’s meaningful to you to draw you into your care, and having the ability to deliver that information,” said Kveder.

Johns Hopkins’ Nason agreed. “We’re trying to raise the standard of care through this kind of ability,” he said.

Hopkins has several mHealth initiatives on campus, according to Nason: the newest is Mood 24/7, an SMS-based tool under development by a psychiatrist at Hopkins. After signing up, patients receive a text message every day asking them to rate how they feel. Responses are sent via SMS, he said.

eMocha, an open source based clinical decision-making tool out of the Hopkins Center for Clinical Global Health Education, on the Google/Android platform launched in Uganda in the past year. eMocha allows caregivers to go into villages with mobile devices and interview patients with a whole series of questions built into eMocha platform, and through these questions, that data can be used as decision support tool to help them ID what might be happening in that village.

This tool can also sync up with a GPS to identify if there are outbreaks or info like that.

Hopkins’ oldest mobile health project, called POC-IT (Point Of Care IT), is an evidenced-based reference tool for healthcare workers, according to Nason. Web, paper and PDA-based, all info is succinct, bulleted and easily readable on a handheld, he said. There are guides: the Antibiotic Guide, with more than 600,000 users now; Diabetes Guide, with 160 modules and the HIV Guide out for several years.

“These tools are made in a way to be very accessible and can be modified to make them work locally,” Nason said. “How we manage HIV in the U.S. is going to be very different than how we do it Uganda, Zambia and other countries around the world, whether because of access to medications or philosophy of taking care of patients.”