Connected health and the doctor patient relationship

By Joseph C. Kvedar
06:56 PM
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One of the pillars of connected health is the collection of a patient’s physiologic data using biometric sensors. These data are trended, subjected to rules and presented to the patient in an educational context, as well as to their provider.

At the Center for Connected Health, we are using sensor technologies as tools to encourage health and wellness. We use weight to track fluid gain in our congestive heart failure patients, glucometer readings to track diabetic control, blood pressure readings to correlate lifestyle changes with changes in blood pressure and smart pedometers to give folks feedback on their caloric output.

This approach clearly provides more rich and accurate patient information. But, our research also demonstrates that when patients gather these data, and know that their healthcare provider is regularly reviewing their individual results, they feel empowered to better manage their own care – and this dramatically improves adherence. For motivated patients, access to their own data in context is powerful, but providing these patient data to healthcare professionals ups the stakes significantly.

Imagine a discussion with your doctor or nurse at your regular office visit. Instead of asking you about your weight, or your recent exercise level, the health professional looks at a screen and begins a dialogue with you about how adherent you have or haven’t been to the care plan you agreed on. Scary thought? Nowhere to hide?  Perhaps, but once you have embraced the need for certain health behavior changes, these tools promote an honest dialogue with your provider.

Our patients tell us how motivating it is for them to know that their healthcare provider is reviewing their personal health data. It is one of the most compelling ways for a provider to demonstrate they care. In some recent focus groups we ran, diabetic patients were quite willing to annotate their personal data with information about diet and exercise to put their glucose readings in context if they were assured that their healthcare provider would look at the data and use it as part of their decision-making.  Our heart failure patients consistently tell us how knowing that a nurse will be calling if their weight goes up 2-3 pounds is a strong motivator for them to watch their salt intake and stick to their fluid restriction. They tell us how the technology empowers them to be better self-caretakers.

My favorite example is the congestive heart failure patient who, in commenting on his required daily weigh-in said, “I can’t cheat on my diet anymore. If I have too much salt today, it will affect my weight tomorrow. When my weight goes up, they have a nurse out here within half an hour.” We actually don’t dispatch a nurse for every elevated weight, but the psychology around objective information and the resulting accountability is striking.

Patients live with their illness all day long, 365 days a year, and if they are careful observers, they can provide infinitely more detail about their illness than can be recorded in an annual visit to the doctor.

Hypertension management is a perfect case in point. Most physicians who manage blood pressure do so on a few – and often as few as two – readings per year taken in the doctor’s office. Our Blood Pressure Connect program allows patients to take blood pressure readings daily or more often and provides a trended report to their physician on how blood pressure is varying and what aspects of the patient’s life impact the readings. The immediacy of information in this type of model allows patients to self-manage through diet, exercise or lifestyle decisions as never before, preventing exacerbations of their condition or the onset of complications that would necessitate intensified use of healthcare resources.

Providers are realizing the power of staying connected to their patients once they leave the medical setting, being able to monitor their vital signs in real time.  Patients are more motivated than ever before to get involved in their care, and are empowered by the personalized information they can receive and comforted to know that their healthcare providers are watching. Even employers are jumping on the connected health bandwagon, seeing how employee wellness and disease management efforts can create a healthier, happier workforce while reducing healthcare costs.

Better, more accurate collaboration between patients and providers – supported by technologies such as smartphones and wireless devices – is at work to improve care, improve outcomes and improve the doctor patient relationship.