overview of cell phone use in health care role in dod stability operations col ron poropatich, md...
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Overview of Cell Phone Use in Health Care
Role in DoD Stability Operations
COL Ron Poropatich, MDTATRC Deputy Director, USAMRMC
&OTSG Medical Informatics Consultant
9 July 2008
Cell Phones in Health CareTopics
• Background – Market forces• Clinical Applications• AMEDD initiatives• USG initiatives – PEPFAR/USAID• Stability Operations• ATA Proposal• Conclusions
• By FY09 - 3.3 Billion cell phone users (half the world’s population)
• CY2008 - the worldwide mobile industry becomes a $1Trillion industry• 0 to $1 Trillion in 20 years: equal to a growth rate of 30% sustained for
20 years (previously unequalled by any other industry at any time in human history)
• A 1 percentage point increase in mobile penetration in developing countries is correlated with an increase of 4.7 percent of average per capita income.– Telecommunications Management Group, 2007
• In 2007, worldwide, non-voice services accounted for 19% of totalmobile services revenues, and this keeps growing, reaching more than 26%by the end of 2012. Worldwide consumer spending on non-voice mobile servicesin 2012 will exceed $251 Billion per annum
Cell Phone World MarketBackground
The Role of Cell Phones in Clinical Care –
Consultation/Education/Research
Wireless Wide Area Networks (WWAN)Wireless Local Area Networks (WLAN)Wireless Personal Area Networks (WPAN)
Health & ProductivityBehavioral HealthWork/Life BalanceDisease ManagementDisability Management
Healthcare ServicesHealthcare ITBiopharmaceuticalsMedical Devices
WIRELESS TECHNOLOGIES
CONVERGENCE
Wireless Health
LIFE SCIENCES HEALTH & WELLNESS
Cell Phone Applications
• Clinical consultation• Education• Research• Biosurveillance• Real-time access to weather information - critical for
those whose livelihoods are dependent on the fishing industry; improve access to instant data so fishing communities can be better prepared when a natural disaster strikes.
Cell Phone Applications• CardioNet, a mobile cardiac telemetry technology • HealthPia - blood glucose monitor for diabetes patients integrated
into a cell phone, enabling diabetes patients to test glucose levels, record results, and then send them to a caregiver using the same device they carry for making phone calls
• Emerging markets: Implants and cell phones– data gateway and display device providing active, real-time
feedback, coaching, and rewards for healthy, compliant behavior.
– Biotronik in Germany has already released pacemakers that communicate to physicians via a mobile phone
– Other implants: glucose monitoring, pain management, implanted defibrillators, weight management for the severely obese, and drug delivery
The Impact of a Video Cell Phone Reminder System on Glycemic Control in Patients with Diabetes Mellitus
• WRAMC Endocrinology sponsored R&D effort (MAJ Bell/COL Vigersky)
• Hypothesis: patients with diabetes mellitus who are given a cell phone with a video reminder system will improve glycemic control in the short term (6 months) & that the knowledge obtained will carry over to the long term (1 year)
• N=170; prospective, randomized, controlled study• 18 month study; $200K funded • Impact will be measured by reduction in A1c levels, number of
high and low blood sugar fluctuations, mean daily blood glucose levels, amount of time spent in target blood glucose range, and responses to a general quality of life questionnaire, stress related to diabetes, and a diabetes-specific quality of life questionnaire.
The Impact of a Video Cell Phone Reminder System on Glycemic Control in Patients with Diabetes Mellitus
• Study group: will receive a daily 15-second video from their provider reminding them to take their medication and to test their blood sugar and an educational “tip-of-the day.”
• Reminders will be personalized and recorded by their provider.
• Ninety diabetes educational “tips-of-the-day” will be created and delivered (password protected) on a rotational basis.
• Video message will be programmed to be viewed by the patient on a daily basis at a mutually agreeable time.
• During the second 6 months, the patients will be followed by their provider at least quarterly with quarterly review of blood glucose and hemoglobin A1c measurement
Cell Phone Use for TBI
“Personal Tele-Rehabilitation for mild Traumatic Brain Injury (mTBI)
Patients”
Goal: To develop an evidence-based support program for mTBI patients & their families that enhances their ability to meet therapy goals while at home utilizing cell phones & data responses uploaded to a secure central server.
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Personal Tele-Rehabilitation
- Utilize cell phones for TBI care
-Provide daily prompts & uploadresults to a web server
- 3 phase U.S. Army expansion(up to 10,000 patients)
- Consortium of expertise- USAMRMC/TATRC- Academic Research Partner- Commercial vendor
- Prior Clinical Uses- Diabetes- Stroke Rehabilitation
- Funding: $1.37M
Phases of Implementation
Phase I: 100 Patients: NARMC CBHCO’sEvaluate the impact of using cell phone-based technology on rehabilitative care, on efficiencies of case management and user acceptance of the technology in order to make decisions about large-scale implementation.
Phase II: 1000 PatientsPhase III: 10,000 Patients
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Personal Tele-Rehabilitation for mTBI Patients
• Use the patient’s existing cell phones• Used for frequent patient daily adherence reminders in the
form of text messages or data exchanges.• Web-based software platform that sends & receives
information between the Case Manager & TBI patients• Designed to augment care provided by the Case Managers• Patient’s self-report data automatically sent back to web
server
Accomplishments
• Technology Platform identified – Secure bidirectional prompts from Case Manager to
Patient utilizing web based platform• Concept of Operations developed• Protocol Design Development nearly complete
– Outcome Measures identified• Staffing requirements identified
– Program Manager and Consultant hired – Project Liaisons (Case Managers at remote sites soon
hired)– Consultants (Clinical & Technical identified)
• Phase I - Kick off meeting August 5, 2008
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Patient has cognitive problems that interfere with getting to TBI-related therapy & medical appointments.
Use of cell phone-based tool*
Patient responds to prompts to get to appointments*
Decreased symptoms & complaints; resolution of impairments*
Patient responds to prompts to practice/employ treatment recommendations*
Patient responds to prompts to solicit input from family
Patient attends therapy & medical appointments
Improved carryover in daily life
Case manager monitors details of care & obtains family perspectives via website*
Case manager makes real time adjustments to plan of care and/or intervenes
Improved life satisfaction*
Participation in life roles and activities*
Clinical Outcomes Cell Phone Enabled Rehabilitative
Care
UNCLASSIFIED/FOUO
Regional View: CBHCO-WI
CBHCO-WIRock Island Arsenal, IL – Ft Lewis PEB (select few DC-PEB)
UNCLASSIFIED/FOUO
Regional View: CBHCO-VA
CBHCO-VAVirginia Beach, VA - DC-PEB
UNCLASSIFIED/FOUO
Regional View: CBHCO-MA
CBHCO-MAConcord, MA – DC-PEB
Cell Phone Markets in Africa• The number of mobile subscribers in Africa at the end of 2005
was 114M; forecast to rise to 378M by 2011 – 22% growth rate and 265M net additions in 6 years
• 95% of the subscriber base in Africa is pre-paid, indicating excellent prospects for SMS based services tailored to the African market
• As Africa relieves its debt burden, continues to liberalize its telecoms markets and open up to further competition and foreign investment, the mobile sector will be a vital component of future growth in a continent with an under developed fixed line telecoms infrastructure
- $10 million public-private partnership (GSM Association DevelopmentFund, Accenture Development Partners, Motorola, MTN and Voxiva) to leverage technology to connect health systems in 10 PEPFAR-supported countries by 2010
- Phones-for-Health to support treatment for 2 million HIV-infected people, support prevention of 7 million new infections, and support care for 10 million people infected and affected by HIV/AIDS in an accountable and sustainable way.
- System allows health workers to report data from the field using their mobile phones, as well as PCs and PDAs.
- Data is mapped and analyzed by the system and made immediatelyavailable to health authorities at multiple levels via the web.
- The system also supports SMS (text messaging) alerting and notificationand tools for communication and coordination with field staff.
Qualcomm Wireless Reach Initiative
• Empowers underserved communities through the use of third generation wireless technologies (3G)
• Objective: strengthen economic & social development with a focus on education, governance, healthcare & public safety.
• Wireless Reach creates sustainable 3G projects through partnerships with non-governmental organizations, universities, government institutions, development agencies and other private sector companies.
• Established in April 2006 – 30 projects in 19 countries• http://www.qualcomm.com/community/wireless_reach.html
THAILAND
2007 Life expectancy at birth (years) 72.6
2007 Population 65.1 Million
2006 GDP per capita US $9,200
2007 Internet penetration 12.5%
2007 Mobile penetration 58%
PERU
2007 Life expectancy at birth (years) 70.14
2007 Population 28.7 Million
2006 GDP per capita US $6,600
2007 Internet penetration 21.1%
2007 Mobile penetration 36%
Sources: Paul Budde Communication; The Human Development Reports from the United Nations Development Program; CIA World Factbook
http://www.qualcomm.com/wirelessreach/projects/healthcare.html
Qualcomm's Wireless Reach Initiative Brings Advanced 3G Technology to Vietnam Communities
(Business News & Technology News, 26 Mar 2008)
• Community Technology and Learning Centers in Vietnam’s 64 provinces is part of the Training Online Programs and Incubation for Communities (TOPIC64) initiative
• Supported by USAID's public/private partnership agreement with Qualcomm through its Wireless Reach initiative and other TOPIC64 partners
– Electricity Vietnam Telecom (EVNTelecom), Microsoft, Hewlett-Packard & the Center for Research and Consulting on Management
• Established April 2006• Approximately 24,000 students have been trained with the centers' basic IT training
program, about 840 teachers have been tested and trained about the new curriculum
and teaching methodology
Stability OperationsRole for Cell Phone delivered Health Care?
• “It is DoD policy that stability operations are a core U.S. military mission that the Department of Defense shall be prepared to conduct and support. They shall be given priority comparable to combat operations and be explicitly addressed and integrated across all DoD activities…[1]”
• A critical concern in implementation of this Directive is to “Ensure DoD medical personnel and capabilities are prepared to meet military and
civilian health requirements in stability operations.”
[1] DOD 3000.5, November 28, 2005 “Military Support for Stability, Security, Transition, and Reconstruction (SSTR) Operations”, Section 4.1
American Telemedicine Association Cell Phone Proposal for ASD(HA)
• Identify currently available and planned applications for wireless healthcare that could meet DOD requirements in implementation of DOD Directive 3000.05. The focus will be on applications appropriate for the following areas:
– Disease identification and surveillance– Teleconsultations– Intelligent decision support– Other healthcare applications[1]
• Identify and recommend the most appropriate wireless technology and develop pathways for DOD implementation of such applications that meet national goals, agency needs and requirements.
• [1] For a list of potential applications see http://www.wirelesshealthcare.co.uk/wh/wh_101_contents.pdf
ATA ProposalDeliverables
• An initial assessment of the range of current and planned wireless applications will be completed using existing ATA databases and selected contacts with industry leaders
• An invitation-only, subject matter expert meeting will be held, within 90 days, to identify current needs, priorities and requirements of DOD and appropriate wireless healthcare applications
• A comparative requirements matrix will be completed that compares DOD needs with commercial-off-the-shelf applications (COTS) as well as technology currently under development
• A decision support document will be prepared for the DOD ASD(HA). The report will rely on the requirements matrix as well as discussions with key DOD health affairs offices to identify results and assess potential deployment models for DOD to use in support of its humanitarian relief and stability operations
• Cost: $89K (includes travel costs for 10-12 guests)
Conclusions
• Cell phone market is large and growing world-wide• U.S. Army MEDCOM has active cell phone projects• Wireless health care applications are evolving and
capable of meeting DoD Stability Operations needs• USG involvement (PEPFAR/USAID) in wireless health
care is global – consider DoD partnering• ATA proposal should be funded to accelerate HA
strategic planning for wireless health care use in Stability Operations
