can you be your own doctor from home using mhealth technologies?
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Presentation given by Joseph C. Kvedar at ISHSH 2013TRANSCRIPT
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Can you be your own doctor from home using mHealth technologies? Joseph C. Kvedar, MDDirectorCenter for Connected HealthPartners HealthCare
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• Founder & Director, Center for Connected Health • Associate Professor, Harvard Medical School • Co-Founder & Chair of Scientific Advisory Board, Healthrageous • Board Member, Care Continuum Alliance; Continua Health Alliance
Joseph C. Kvedar, MD
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Connected Health Goal
Integrate care into the day-to-day lives of our patients
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Ideation & Feasibility
Connected Health Innovation Process
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Product develop.
r Program develop.
Trial/Test
r
Spin-out License
CCH Service
Internal Hand-off
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Technology is an enabler to provide care remotely
Benefits include improved engagement, outcomes, and efficiencies
Mission is to facilitate the adoption of Connected Health
About the Center for Connected Health
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Connected Health Benefits
Improved self-care 1 Just-in-time
care 2
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Connected Health Components
Feedback Loop
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Heart Failure Monitoring
Connected Cardiac Care
50% Drop in
Readmissions
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Data Includes 332 CCCP enrollments among 301 unique patients discharged from the CCCP program prior to July 1, 2009. Results are similar within more recent cohorts of enrollees discharged from the program prior October 1, 2009 and prior to January 1, 2010.
Proportion of CCCP Enrollees with One or More Hospitalization
39.80
13.30
58.10
100
One year prior to CCCP enrollment (point estimate and 95% C.I.)
One year following CCCP disenrollment (point estimate and 95% C.I.)
Percent
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Average drop of HbA1c: 1.5
69% achieved a drop in BP
Diabetes and Blood Pressure Connect
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Greater engagement is associated with greater pre-post HbA1c change
Practice engagement correlates strongly with better patient outcomes
• Patients with greater than 15 uploads had average 1.5 pre-post HbA1c change
• P< 0.03 between no uploads and uploads groups
0.43
1.34
1.53
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
no uploads 1 - 15 uploads > 15 uploads
Dro
p in
HbA
1c
Average drop HbA1c by # of uploads
J Diabetes Sci Technol 2012;6(6):1328-1336
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Proportion with 10mmHg or greater drop in SBP
C I P<0.05
Decreases in Blood Pressure from Self Monitoring
Proportion with 5mmHg or greater drop in DBP
P<0.05
C I
% o
f Sub
ject
s %
of S
ubje
cts
Am Heart J. 2012 Oct;164(4):625-31.
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• Most users do not access the website – “I didn’t look at it online, I didn’t need to, I thought that’s
what my provider was doing”
• Provider engagement is very important – “If I forget to send it in, after a couple of weeks, she calls
me.” – “I stopped using it for my reasons, but no one ever called
and asked why I stopped so I never pursued it”
Focus Group Feedback
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Sentinel Effect
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Components of Self Care
Social Networking Gamification Incentives Coaching
Feedback Loop
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Text-message Reminder
Participant reads message and applies sunscreen
Sends SMS when the tube is opened
Tues. Sunny. High 68, Low 53. Please apply your sunscreen today.
Remote Monitoring Data Repository (RMDR)
Simple Reminders Can Have A Powerful Effect
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Adherence Rate for Sunscreen Use
Weekly Adherence Rates (mean +/- SEM)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
Study Period
% A
dher
ence
Reminder groupNo Reminder Group
Arch Dermatol. 2009;145(11):1230-1236.
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The Power of Activity and Coaching
-20.00
-15.00
-10.00
-5.00
0.00
5.00
10.00
15.00
Q1 Q1-Q2 Q1-Q3 Q1-Q4
Perc
ent C
hang
e
Quarter (1 Quarter = 3 weeks)
Percent Change in Average Daily Steps Per Quarter
C, n=30
I, n=27
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Habituation
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Improving physical activity behaviors in T2DM (Text 2 Move)
Primary Outcomes: Change in physical activity levels Secondary Outcomes: Change in HbA1c in patients Change in stage of behavior change
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Customized Program Design
Readiness To Change
Connected Health Data
Practice Location
Analytic Engine
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0
2000
4000
6000
8000
10000
1/9
1/11
1/13
1/15
1/17
1/19
1/21
1/23
1/25
1/27
1/29
1/31
January
2/1
2/3
2/5
2/7
2/9
2/11
2/13
2/15
2/17
2/19
2/21
2/23
2/25
2/27
February
3/1
3/8
3/15
3/22
3/29
March
Text2Move
Contemplation Preparation Action
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Meet Michael Snyder
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Genetic Risk
Source: Cell 148, 1293–1307, March 16, 2012
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Glycated HgA1c (%): (Day Number)
Glu
cose
(m
g/dL
)
Day Number
-150 200 250 300 350 400 0 450 500 550 600
160
150
140
130
120
110
100
90
80
6.4 (329)
6.7 (369)
RSV Infection (Day 289-311)
Life Style Change (Day 380-Current)
HRV Infection (Day 0-21)
4.9 (476)
5.4 (532)
5.3 (546)
4.7 (602)
Personalized Prevention in Action
Source: Cell 148, 1293–1307, March 16, 2012
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Customized Program Design
Motivational State
Connected Health Data
Genetic Profile
Analytic Engine
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Content:
Psychological Factors
Tactics:
Genes Coaching
Games/ Contests
Health Info & Social Support
Incentives/ Punishments
Text
Rich/ Multi-Media
Avatar/ Agent
Voice
Interactive Software
Physiological Functions
Behavior
Environmental Factors/ Socioeconomic Status
Content:
Tactics:
Specimen Collection
EMRs
Sensors
Text Analysis
Online & Offline Behavior Tracking
Analytics
Input Output
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Connected Health Benefits
Improved self-care 1 Just-in-time
care 2
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The cHealth Blog: chealthblog.connectedhealth.org
www.connectedhealth.org
Annual Symposium: Oct 24-25, 2013; Boston
LinkedIn Group: Connected Health Community
Twitter: @connectedhealth @jkvedar
Ways to “Connect”
Contact Me: [email protected]
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