Editor's note: This is the second part of a two-part series on new care models and delivery methods. The first part described industry trends and emerging technologies that are moving health care toward lower cost, improved access and increased productivity. The second part takes a closer look at changes in patient behavior.
The care team approach, as described in Part 1 of this series, is designed to let patients take on a more active role in managing and monitoring their health. They are in charge of measuring and reporting vital signs, taking medications and following their care plan on a daily basis, thereby sharing the care with providers. The intent is not to diminish the role of the physician, but to expand the role of the patient: Patients become empowered by changes in behavior and new knowledge of health information. These "e-powered" patients are bolstered by new technologies.
New Technologies that Enable Patient "e-Power"
The technologies described in Part 1 support data sharing and communication among care team members. But patients can use many other technologies, depending on their health issues and level of mobility. These technologies can collect data, provide a ready resource for medical information, and remind patients to log vital signs and other care information pertinent to their condition and goals. Following are three examples of these technologies.
Chronic care monitoring. The smart phone is the technology of choice for active patients with such chronic conditions as diabetes, hypertension and heart disease. There are many smart phone apps available that provide alerts, reminders, education and suggestions based on the patient-provider care plan, and algorithms built using evidence-based medicine protocols. The application can be connected (wired or wirelessly) to medical devices to collect information like blood sugar, weight and blood pressure, or the patient may enter the information directly. Proteus Biomedical's wireless, adhesive-sensor technology, called Raisin, can track and record a patient's heart rate, physical activity and other biometrics. Worn like a Band-Aid, Raisin then transmits data via Bluetooth to a PC or mobile device.
These data are recorded and stored, and myriad graphs and charts show the patient's health metrics over time. As mentioned in Part 1, including the physician in the process remains one of the biggest challenges. The physician's involvement is essential, because when new information indicates there is a problem, he or she can address it quickly, before the patient's health deteriorates.
Post-acute care monitoring. After hospitalization, patients need intensive monitoring of vital signs or other measures to speed recovery and avoid readmission. In the past, health-delivery organizations have piloted the use of nurse-transition coaches, who call patients and make house visits to help them understand medication changes, arrange follow-up appointments, and ensure that patients are keeping up with therapy or dietary requirements. While the results of these studies show positive outcomes, few health systems can afford to use this labor-intensive and costly approach.
But technology can give patients the tools they need to help themselves. For post-acute care, the technology of choice is typically an Internet-connected home PC, with medical devices attached to help the patient collect vital signs and health-status data. The data are analyzed and sent to the care team. Technology does not eliminate the need for nursing or physician interaction, but it can ensure that data are entered regularly and that the data indicate a positive recovery. When issues arise, the appropriate care provider is alerted so interventions can start before the patient requires hospitalization.
Detecting health problems. When a health problem arises, empowered consumers are more likely to detect it themselves, and sooner rather than later. Mobile medical-content technologies such as ADAM, WebMD and iTriage now arm patients with a library of medical information written especially for nonclinicians. Using these apps to learn about their symptoms and medications, consumers have information about basic first aid and when they should seek medical attention. In addition, iTriage can help patients find primary care physicians, specialists and emergency care locations.
e-Power to the Patient. When we look at time spent on care management, it is clear that patients take active roles in their overall care to begin with. According to data from The Innovator's Prescription: A Disruptive Solution for Healthcare by Clayton Christensen et al., doctors spend about two hours a year with a patient, while the patient spends 8,758 hours annually on diet, exercise and medication treatment-plan decisions.
Pilot studies have shown that active patient involvement works, but results are short-lived unless the individual changes his or her behavior to build health and fitness into the daily routine and to know what to do when health problems arise. Fortunately, new technologies in development and in commercial use help patients make these difficult behavioral changes. For example, one key element of behavior change is the ability to connect with others who have similar health issues for support and advice. Disease-specific websites such as PatientsLikeMe.com and Dlife.com provide information about symptoms and treatments, and they offer diets, advice and chat rooms.
Care providers also are using social networks such as Twitter and Facebook to direct patients to articles and blog posts of interest. As one physician cited in our research has said, "If you allow your patients to become engaged in their own health care, they ironically make good decisions."
Another key success factor for e-power technologies is that they are mobile—enabling a patient to connect from virtually any location. The everyday, always-with-you smart phone offers continuous access and support, with varying levels of sophistication and patient-specific customization depending on the application and device.
When people are involved actively in getting healthy and staying that way, the onset of costly health issues such as heart disease, hypertension and diabetes can be delayed or prevented. E-power to the patient, to spur personal involvement in managing one's health and wellness, just makes sense.
Fran Turisco is a research principal in Healthcare Emerging Practices at CSC, headquartered at Falls Church, Va. Much of the information for this article was taken from her latest research report "The Future of Healthcare: It's Health, then Care," available at www.csc.com/lefreports.
