Today’s contributor, Charlotte Kellogg, has contributed a post about the ability for mhealth apps and telemedicine to monitor chronic illnesses. This blog has previously discussed potential drawbacks in telemedicine and Kellogg has built upon that by layering in a comparison of potential benefits and known drawbacks.  Kellogg is a writer and researcher for an public health education resource that offers information about public health certification, classes and programs.  

The Potential for Telemedicine to Monitor and Improve Public Health

The need for quality, consistent healthcare is growing in nearly every corner of the world. Modern scientists are finding new ways to treat conditions every day, but finding ways of bringing that care to the people who need it most is often logistically challenging—not to mention tremendously expensive. New developments in telemedicine, including mhealth, seek to bridge these divides.

Integrating technology into existing healthcare frameworks has the potential to help doctors and other medical providers work faster, more effectively, and with greater accuracy. More patients than ever before can be reached, and information that is centralized on a cloud-based server has much less of a chance of getting lost or overlooked, and can ensure more efficient coordination of care.

The cost savings alone are often substantial. For example, telemedicine has the potential to lower costs from preventing unneeded trips to the emergency room through reliable, real-time video communication between doctors and patients. Telemedicine also reduces the number of routine visits as doctors can effectively monitor a discharge patient from the comfort of their own home. This is especially pertinent for patients who live far from medical centers, as they will not need to travel to an office unless it is absolutely necessary.

Still, providers should be wary of jumping in too deep, too fast. The mobile health landscape is still very much under in the nascent stages of development, and improvements are needed before new technology will be able to fully manage chronic conditions and other public health concerns.

Benefits to Public Health

Health care providers across the board are finding tremendous success using telemedicine in the treatment of chronic conditions like congestive heart failure, diabetes, and HIV/AIDS. Doctors can equip patients with remote tracking devices, which allow for monitoring of blood pressure, glucose levels, and other vital statistics without requiring an in-person visit. Medical providers can also use technology to track pharmaceutical prescriptions and send patients personalized reminders of when and how each drug should be taken.

Telemedicine promises improved care to those living in rural or otherwise remote locations, as well. Patients are increasingly able to check their symptoms through mobile phone apps or online database systems, and also speak to physicians and other members of the care team through web-based video conferencing. This saves time and, increasingly, lives as patients become more empowered and are able to more readily determine when an injury or illness is something that should be waited out or needs immediate attention.

Potential Threats to Public Health

As advanced as many aspects of telemedicine are, the field is nevertheless still quite young. Providers and developers remain in the throes of figuring out how to tighten up on the platform’s accuracy and usability. In many cases the technology is very new and prone to have bugs in the code, and because these technologies are protected intellectual property, many of these bugs are not caught before the programs hit the market.

One of the biggest problem areas is the degree to which patients may elect to rely on apps or electronic information in place of, rather than in addition to, in-person primary care. “The problem with this kind of gold rush is that it attracts not only the best and brightest but also the fast and furious—IT developers looking for quick profits with minimal investment of resources,” Information Week said in a 2012 article evaluating some of the potential downsides of the telemedicine “revolution.”

There is also a concern when it comes to expectations. Medicine is an immensely nuanced field that often defies easy answers. A simple statement of symptoms can indicate a range of wildly different causes, which can lead patients and providers to overlook some of the most obvious possibilities. Researchers from Good Morning America exposed just how difficult online diagnoses can be when they visited three different telemedicine sites armed with the symptoms of Hodgkin’s Lymphoma—and did not get a correct diagnosis anywhere. “It’s totally, totally upsetting. It reduces medicine to piecemeal work,” Dr. Marie Savard, a medical contributor to the show, said in an article for ABC News.

While the diagnoses on these sites were incorrect, it is important to remember that the root cause of most misdiagnoses is poor communication. While these sites and tools may not be able to necessarily match symptoms with diseases, they can make it much easier for a patient to relay symptoms to a doctor who can then interpret the data.

In most cases, the benefits of telemedicine outweigh the potential risks, but there is still work to be done. The cost and time savings allowed through telemedicine, for example avoiding unnecessary appointments and being able to adjust dosage on prescriptions without needing to travel to a doctor’s office, are tremendous, and are likely to continue to grow in the years ahead. It is already the case that diabetes patients are more conveniently and effectively monitoring their health, something that has saved many lives and millions of dollars – something sure to continue as technology improves and people become more comfortable with telemedicine.

Patients titrating and administering their own medication? Sounds like some futuristic scene from a sci-fi movie where Doctors no longer exist and patients are in charge of their own healthcare.  But this is actually not so futuristic explains Dr. David Judge, medical director of the Ambulatory Practice of the Future (APF) at Mass General.  Diabetic patients are already successfully self medicating, and David plans to soon pilot similar care modalities for other patient populations such as those with chronic heart disease.

As a featured speaker at yesterday’s MassTLC Executive Summit, an event highlighting innovative technologies and applications and their impact on businesses and consumers today, David detailed how his team is deploying new tools to improve how care is delivered, and at the center of that care are the patients themselves. David’s vision of the patient of the future is a healthier, more informed and empowered patient in control of his/her own health destiny. To enable this vision, the APF is providing patients with tools that enable them to self manage, thereby allowing them to improve their health outcome and quality of life while at the same time allowing David and his care team to focus on spending more time with patients who need their care most.

At the summit, David also highlighted several pilots underway at the APF focused on innovating care delivery for primary care in partnership with the Center for Integration of Medicine & Innovative Technology. Fueled in part by the shortage of primary care providers, these projects focus on the exploration of new models of care delivery and are attempt to utilize all members of the care team to train and empower patients to be more proactive managers of their care. David calls this “patient apprenticeship” and the APFs initial findings are that this is a very successful and effective patient-centered care model. He went on to share his insight on the impact of ACOs, payment for value, culture change, informed patients and the increased demand for technologies to enable prevention and proactive disease management on care delivery.

The patient of the future will be here sooner than we expect explained David, as by 2020 he predicts expert patients will manage 95% of their preventive and chronic care. The patient of the future will be a healthier, more informed and empowered patient in control of his/her own health destiny.

To learn more about David Judge and his work at the Ambulatory Practice of the Future, visit http://ow.ly/dRj6m

‘Life changing. Diverse. Awe inspiring. Rejuvenating.’ 

SBR is at this year’s Mayo Center for Innovation Transform symposium to experience the revolution in care delivery. Joining today’s healthcare movers and shakers – innovators, leaders, designers, entrepreneurs, policymakers and business thinkers, SBR is excited to be at the forefront of innovation and design solutions that are reshaping how we think about care.

Follow SBR’s CEO Christopher Herot’s twitter feed for updates throughout the symposium, which runs Sept. 9-11.

–Robert Fabricant of United Healthcare showing data from America’s Health Rankings.

–David Ewing Duncan says most people don’t want to live past 80.

–Laura Adams on her first medical mistake – Rx had been transcribed 6 times before she got it. Wrong dosage. Death by decimal point.

–Dick Gephardt says there is no silver bullet for cutting health care costs. HRCA is probably too big but is a start on the hard work.

–John Hockenberry says healthcare must be prepared for unexpected outcomes.

–John Hockenberry describes the ‘unexpected outcome’ of his success after a car accident left him paraplegic.

Watch the Transform 2012 live stream here.

While Apple has long reigned supreme in the tablet space with the iPad, demand for the Google Nexus 7 has taken the tablet world by storm. Christopher Herot, CEO of SBR Health and a connoisseur of tablets, can speak knowledgeably on the design, quality and function of today’s tablets by big name brands like Apple, Microsoft and Google. At SBR Health, tablets are an essential tool for communication among patients, providers and members of the care team, and Christopher makes evaluating the quality of video interaction on mobile and tablet devices a top priority. In this interview, Christopher shares his thoughts on the Google Nexus and its advantages over Apple’s iPad.

Why the Google Nexus?

The open question with all these things is how will Google deal with the huge lead in the tablet space that Apple established with the iPad. The iPhone got an early start with mobile but there are now more Google phones than Apple phones, so what’s the problem with tablets?

Google did the Nexus tablet because they were impatient with how fundamentally horrible the other tablets were. Some of them really aren’t that bad. Take the Motorola Xoom. It’s not bad for techies but when I have to decide which one to throw in my bag, the iPad is the more pleasant one to deal with. It’s brighter, sharper and has more apps.

What’s the Google experience?

I like my Google phone better than the iPhone. Google engineers felt they could do better so they worked with Samsung to build the Nexus. The Nexus brand is the more pure Google experience, and it’s pretty good. The other reason why I think it’s really interesting is that it’s at a size between the iPad and iPhone.

What are the advantages?

While some might say the Google tablet is an awkward size, I was pleasantly surprised that the screen is large enough to read but can also be used for video calls.

For our purposes, the Nexus is small enough to fit in the pocket of a doctor’s lab coat. Doctors laugh because their pockets are already jampacked. They could make room for a tablet the size of the Google Nexus. While an iPad is more convenient than a laptop, it still is big.

What are your predictions for adoption?

I expect the Nexus will become an unconscious carry device. These are things like a phone, wallet and watch that you carry everyday. You don’t think about these things. When I go on a trip, I bring a laptop. When I’m going to a conference or an event, I bring my tablet. The Google sized tablet is along the same line. There are places where the iPad is awkward.

In the clinical space, the Google tablet easily fits in the labcoat pocket.

There are a number of use cases where doctors may want to give devices to patients. When deciding between an iPad at $800 and the Nexus at $200, Google has an advantage. That price point makes it something they could give to people to accomplish a specific task. With the iPad, you have to justify the price.

What are the disadvantages?

The thing that’s missing from the Google tablet is a wide area network card. It doesn’t work on Verizon or Sprint. You have to tether through your phone or use the wireless LAN. That’s a bit of a limitation. I don’t think that will be a big deal at hospitals because most hospitals are putting up Wifi throughout.

The reason I still carry the iPad is that it has a lot of my favorite apps.

A question for the Google Nexus is will there be a killer app? It used to be that people bought a PC to use a spreadsheet and the Apple for desktop publishing. With the iPod, it was the iTunes store.

Wow Factor?

We can’t dictate to our customers what device to use and want to accommodate what they’re asking for. Right now, they’re all asking for the iPad. But everytime I pull the Google tablet out of my pocket, people go ‘Wow.’ I was at the Apple store buying my wife an iPhone for her birthday and impressed the guy at the Apple store when I pulled out my Google phone to get her account information. The Nexus wow factor is unbeatable.

News on the Nexus:

Fueled by Tablets, Telemedicine Market to Grow More Than 300% by 2018

Five reasons the Google Nexus beats the iPad

Nexus 7 Sales: Google Tablet Going Fast at Retail Chains

Google Nexus versus other tablets

Hospital networks take key role in healthcare as IT makes further clinical advances

Nexus 7 Sold Out: Google Halts 16GB Shipments, Surprised by Demand

Alexandra Drane goes by Alex, and she is graceful, elegant and full of passion.

In spite of today’s healthcare challenges, Alex is always the first to attack the elephant in the room. Problems big, small, personal, professional, Alex takes them all in stride and doesn’t stop working. In fact, she hasn’t stopped working, and her career is representative of her infinite tenacity. She got her start attending business meetings with her father at an early age and later went on to found several healthcare ventures and nonprofits, and is the current founder, Chief Visionary Officer and Chair of the Board of Eliza Corporation. A mother, daughter, wife, boss, mentor, friend, coach, leader, Alex is an exception to the male majority of healthcare executives. In this interview, Alex shares her motivations and passion for improving healthcare and changing the world.

When did you make the decision to focus on healthcare? 

Sometimes the universe serves something up for you. It just gives it to you and ultimately becomes the greatest gift.

I believe that you should do something everyday that you love, and I want to spend all my time helping people improve their lives. I realize that healthcare is at the core of what makes people healthy and happy.

What goals did you set, and how did you go about achieving them? 

I think there are so many different types of people in the world. There are those who plan and those who don’t. I’ve never been a planner. Wherever I am, I want to have made a very informed, heartfelt and conscious decision. Sometimes the greatest adventures happen in little steps that you build over time.

What are your shortcomings/challenges?

My biggest challenge in life and what keeps me from being successful that I’m incredibly inpatient and care enormously about what I’m doing and the outcomes. That obviously has wonderful benefits but can also be damaging because I bring everything to every moment. That can be overwhelming and dangerous. I work all the time to get myself to relax. Sometimes I do that successfully and sometimes I don’t.

I love getting older, and I’m about to turn 41 in one week and I can’t wait. I love being 40. Forty means I’m legit in that I’m carrying a lot of scars. You naturally become more tempered. If you bring your best foot forward everyday, this enables you to survive. Age doesn’t matter.

How do you define yourself?

I’d like to think that I’m defined by my genuine love for people. I find them fascinating. I want to know what makes them tick, what makes them happy and keeps them happy. What makes them feel good about their place in the world.

What’s on your roadmap of things to do/achieve?

I want to eat at a restaurant by myself. I think it would be bold and brave. All the things that I want to do, I’m doing now. I want the healthcare space to broaden the definition for the things it’s responsible for.

I consider a walk down the street an opportunity to interact. I think as humans we’re obligated to bring joy to others.

It tortures me to think that people are facing real problems that we’re not addressing.

Why are there so few women today in the healthcare space?

I think the right answer is to look at the projector. I think there are increasing numbers of women in the healthcare space, and I think this number will only increase. I believe that the things that kept women from being active in the workplace have changed so fundamentally. We’re only going to see more women in this role. There’s a new generation of women coming through. Women who have the confidence, are role models and have the fundamental belief that they can be successful. These numbers are going to be drastically different five years from now.

What would be your tips to women starting out in healthcare?

My first and fundamental advice is to know the things that make you who are and keep going.

Women have the ability to see the challenges impacting people and really talk to what’s there with grace and make a difference. I think you have to own your scars and share your experiences.

You’re going to have bad days.

Things are imperfect. I think the thing for all women to remind themselves is to find joy in the things you love.

*Note: This post was written to support this week’s XX in Health, which recognizes today’s accomplished women in healthcare. Visit XX in Health to learn more.

The global expansion of the Internet and mobile communications technology has made a host of new connections possible, perhaps none so significant as those in the healthcare sector. Health science professionals have been hard at work over the past few years to harness technological avenues to bring less expensive, more efficient health care to patients all over the world. Telemedicine initiatives, digital information sharing between medical professionals, and the use of mobile phones to help diagnose and deliver care are only some of the ways technology is changing the face of modern medicine. Health scientists in all disciplines, from biology and chemistry to immunology and epidemiology, are actively contributing to advances in mobile health initiatives, known commonly as “mhealth.”

One of the most basic forms of mhealth involves digital exchanges between doctors and established patients. Video conferencing is one of the most common forms of communication. Rather than call the doctor for an appointment to check out a sore throat, a sprained foot, or other minor ailment, a patient can simply log on to a video chat with his or her primary care provider.

Christopher Herot, Chief Executive Officer of SBR Health, identified two primary benefits of video conferencing in a January 5, 2012 release  describing the company’s lessons learned over the past year. “The obvious role, as pioneered in dermatology and neurology, was using video as a diagnostic tool,” Herot said. This sort of remote care is generally viewed as quite efficient, as it reduces travel and wait times, and cuts down on interaction costs.

The other benefit was psychological. “Video, like an in-person visit, ensures a higher level of trust between the patient and doctor,” Herot said.  Other alternatives to an in-person visit, such as e-mailing or calling the office, can be a bit more impersonal, which can lead patients to withhold information or not disclose all symptoms.

Technology is also increasingly intersecting with health care in rural communities. More isolated patients can save long trips to see specialists in bigger towns or cities by logging on to internet-based medical portals or visiting local clinics with mhealth capabilities. With the right tools, a world of cutting-edge medicine is accessible almost anywhere. Local doctors can upload records, test results, and x-ray scans, and send them to specialists at larger tertiary hospitals instantaneously. Feedback and consultations happen just as fast.

The United States Department of Health and Human Services announced a nearly $12 million grant at the end of 2011 to help develop rural mhealth initiatives in the U.S. “We need health information technology to bring our health care system into the 21st century,” Department of Health and Human Services Secretary Kathleen Sebelius said in announcing the grant on September 2.  “These funds will help safety net providers acquire state-of-the-art health information technology systems to ensure the delivery of quality care to some of the most remote areas of our country.”

Innovations in bridging health science with technology are not limited to developed nations, however. Initiatives like the United Nations Foundations’ mHealth Alliance and the public/private Stop TB Partnership involve a range of health scientists in leveraging technology, particularly that associated with mobile phones, to bring medical care to countries in Africa and South Asia.

According to the mHealth Alliance, mobile phones are one of the best ways for health care providers to “reach the unreached,” particularly where treatment of specific illnesses and conditions is concerned. Phones “can empower the public with information, enable remote health workers, reduce inefficiencies, provide training, improve monitoring of activities and outcomes, support remote diagnostics, and support electronic payments,” the alliance said in a 2010 technology briefing.

Field workers studying disease outbreaks and mapping treatment zones in remote areas can easily connect with lab technicians, biologists, and researchers across the globe with a simple text message or phone recorded video. Bio-informatics specialists can easily analyze reported data, and public health experts can work with physicians to devise treatment and diagnosis regimens that can be immediately implemented. As more health scientists get involved in technology-driven health care, the more changes, advancements, and improvements the field is likely to see in the months and years ahead.

By Jocelyn Salada, Guest blogger, Contact: jocelynsalada11@gmail.com