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Remote Monitoring, Wearables, and Telehealth Boost Care

By Vera Gruessner

- The mobile health industry is affecting how this country is managing the health and wellness of its population in a variety of ways. For instance, wearable devices and remote monitoring tools aggregate a large amount of patient data and offer a system for tracking patients’ health and vital signs from afar. Telehealth technology and mobile health apps including patient portals enable doctors and patients to communicate securely through messaging platforms and video consultations.

Wearable Medical Devices

To learn more about how the mobile health industry is benefiting patients and providers alike, mHealthIntelligence.com spoke with Dr. Joseph Kvedar, Vice President, Connected Health at Partners HealthCare System.

How do you see wearable devices and mobile health apps affecting patient care over the coming years?

Dr. Kvedar: “The framework that we use to look at this trend has to do with the objective data that the wearable device provides and the feedback loop. That’s one important component.”

“If I can measure something about you objectively and use it to make you more aware of that particular number or activity, that, in and of itself, can lead to some behavior changes. In fact, I believe it’s been demonstrated that, on average, people who wear a Fitbit will walk about 1,800 more steps a day just by becoming aware of their activity level.”

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“The second piece of the puzzle is how to keep people engaged and motivated around the feedback loop. In general, the more chronic illness you have – things like high blood pressure and diabetes—the more you veer away from fitness and health.”

“The challenge tends to be more about that engagement piece. So we focus on that. With that background, I anticipate that, in the next several years, we’re going to learn more and more about how to personalize these experiences, draw people into their care in a way that’s quite compelling, and we’ll see real demonstrable improvements in care using the combination of feedback loops and some behavioral motivational overlay.”

Have you seen mobile health apps engage patients with their health?

Dr. Kvedar: “It’s hard to measure this. One company that seems to have done a good job – but I'm not aware of any published data on this – is My Fitness Pal. When they sold the company, they had something like 50 million active users. That’s a pretty good scale for a mobile app.”

“I have used MyFitnessPal and, what’s a little bit surprising is that it’s hard to use for more than a day or two without getting frustrated. It requires a lot of effort on the part of the user. We like to think about the future of this industry as being based on devices and services that are frictionless, require almost no user input for the data and allows us to focus on the motivational components.”

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“Any time you have to self-input a number or a value, it tends to significantly lower the population that will interact with the app. Most mobile apps don’t really have that automatic data gathering feature yet.”

“We see some companies getting this right, typically for a weight scale, blood pressure cuff, or other medical device. But, most mobile apps do not have data gathering features yet.”

Have you seen remote patient monitoring improve health outcomes among patient populations?

Dr. Kvedar: “As a matter of fact, we’ve published on this several times. We published a study in the American Heart Journal in 2010. A couple years back, it showed that for a cohort of individuals in an employer group –employees – compared to a control group, those who had a remote monitoring solution for six months, had a statistically significantly lower systolic and diastolic blood pressure. That’s one example.”

“We’ve also shown that people in a diabetes remote monitoring program had lower hemoglobin A1C and better glucose control. A third example would be heart failure, which is the granddaddy of remote monitoring use cases. For heart failure tele-monitoring, we’ve consistently seen a lowering of readmission rates – up to 50 percent – and we’ve studied it many, many different ways.”

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What are the biggest benefits you’ve encountered from telehealth physician consults?

Dr. Kvedar: “The e-consult or virtual visits programs augments the relationship with the patient in a very positive way, and connects patients with their providers in a much more fluid way. More provider connectivity and more patient engagement always leads to better outcome.”

“There’s a patient convenience component and a patient engagement component to the virtual visit model that’s very compelling. This is why you see Walgreens, CVS, and United Healthcare Group offering them.”

“Rapidly, we’re coming into a phase of adoption where health plans are starting to offer coverage for virtual visits. As a result, there will be a consolidation around a price point and valuefor this kind of activity. It’ll be mainstream before long. On the patient side, it’s convenient. On the health plan side, there’s a belief that it will streamline costs.”

“There used to be a fear that this kind of activity would add healthcare utilization. The idea was that a virtual visit would lead a doctor to require a patient to come in. We’ve shown that this is a rare outcome so they seem to have relaxed their worry about that.”

“The value to the provider is a little more elusive, but as we get more and more into risk-sharing, more into accountable care, the value pops up. It enables some increased efficiency. As patients become more engaged, providers have a better sense of how their patients are doing. That leads to improved outcomes, which generally correlate with more efficient care delivery.”

How does remote monitoring benefit patients and doctors alike?

Dr. Kvedar: “On the remote monitoring side, it’s really the development of strategies that will enable providers to achieve a one-to-many care delivery model. What that means

is that a home care nurse can work from a computer dashboard and oversee approximately one hundred heart failure patients at any given time. Since the patients are uploading vital signs, the software flags those patients that need the nurse’s attention.”

“The nurse can direct attention to the individuals who are most in need on any given day. That enables a very efficient model of care delivery. Unlike virtual visits, which is a one-to-one model, remote monitoring is a one-to-many model. You can monitor many different individuals and reach out to the patients who need your help at any given point in time. It improves efficiency in that way.”

“Patients tend to feel more connected with remote monitoring. They feel tethered to their provider. They feel cared for. They feel accountable because someone in the doctor’s office is watching their health data and is usually calling them on the phone when the vital signs aren't where they should be. That accountability helps patients to improve outcomes as well.”

What type of wearable devices do you see growing consumer demand in the fitness space over the next several years?

Dr. Kvedar: “I anchor my thinking around providing care to people who are already patients and chronically ill. I don’t typically focus on the future of wearables in the fitness space, but I do think the smartwatch is a really interesting trend. It seems inevitable that it will take off.

 It will probably take one or two iterations to get it right, but having so much data collected in one device, rather than five different devices, seems like a winning proposition."

" There are other devices coming out now that I think are really interesting. One of them that I like – and this generally falls under the heading of using technology to sense aspects of health that we’re not used to sensing – is the Muse.”

“The Muse is a portable headband and takes a full EEG. Based on how they’ve set up the mobile experience, it enables you to focus, to use mindfulness, and measures your brainwaves, and creates a biofeedback loop to help improve stress relief. It’s a Canadian company that is growing quickly.”

“I think that’s the category that will grow fast –new things that enable us to either sense something we’re not used to sensing, like brain activity, or use music as a tool to release stress through biofeedback.”

“There have been a number of news stories recently that claim Fitbit is dead and that activity trackers have peaked and are on the decline. I don’t actually believe that. I think activity trackers are quite powerful. As I’ve said though, they’ve got to be paired with some kind of motivational messaging that keeps you engaged long-term.”

“In the fitness and wellness space, people generally are pretty engaged with their own motivation. Really, any tracking for most of those folks is powerful because they love numbers and they love to achieve goals.”

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