Connected health as a tool for patient engagement kvedar 11.7.13

Connected Health as a Tool for Patient Engagement

Joseph C. Kvedar, MDDirectorCenter for Connected HealthPartners HealthCare

© 2013 Center for Connected Health – All Rights ReservedContent Confidential – DO NOT DUPLICATE.

Connected Health Goal

Integrate care into the day-to-day lives of our patients


Connected Health Innovation Process


Ideation & Feasibility

Product develop.

r

Trial/Test

r

Spin-out

Program develop.

License

CCHService

InternalHand-off

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


Connected Health Benefits

Improved self-care1 Just-in-time

care 2


Connected Health Components


FeedbackLoop

Heart Failure Monitoring

Connected Cardiac Care

50% Drop in

Readmissions


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


Average drop of HbA1c: 1.5

69% achieved a drop in BP

Diabetes and Blood Pressure Connect


http://images.google.com/imgres?imgurl=http://www.blogbanquet.com/Blood_Pressure_Monitors/Omron%20HEM-780%20Automatic%20Blood%20Pressure%20Monitor%20with%20ComFit%20Cuff.jpg&imgrefurl=http://www.blogbanquet.com/Blood_Pressure_Monitors/home.htm&h=280&w=280&sz=15&hl=en&start=8&um=1&tbnid=F-O2fGLf7n4uPM:&tbnh=114&tbnw=114&prev=/images?q=omron+cuff&svnum=10&um=1&hl=en&rls=GGLJ,GGLJ:2006-41,GGLJ:en&sa=N

http://images.google.com/imgres?imgurl=http://www.blogbanquet.com/Blood_Pressure_Monitors/Omron%20HEM-780%20Automatic%20Blood%20Pressure%20Monitor%20with%20ComFit%20Cuff.jpg&imgrefurl=http://www.blogbanquet.com/Blood_Pressure_Monitors/home.htm&h=280&w=280&sz=15&hl=en&start=8&um=1&tbnid=F-O2fGLf7n4uPM:&tbnh=114&tbnw=114&prev=/images?q=omron+cuff&svnum=10&um=1&hl=en&rls=GGLJ,GGLJ:2006-41,GGLJ:en&sa=N

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

no uploads 1 - 15 uploads > 15 uploads0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

0.43

1.34

1.53

Average drop HbA1c by # of uploads

Dro

p in

Hb

A1

c

J Diabetes Sci Technol 2012;6(6):1328-1336


Proportion with 10mmHg or greater drop in SBP

CI

P<0.05

Decreases in Blood Pressure from Self Monitoring

Proportion with 5mmHg or greater drop in DBP

P<0.05

CI

% o

f S

ub

ject

s

% o

f S

ub

ject

s

Am Heart J. 2012 Oct;164(4):625-31.


Future of Connected Health

• More varied, miniaturized sensors

• Automated, customized motivational messaging


Given Imaging

Given ImagingOMsignal

Exmovere

MD Revolution© 2013 Center for Connected Health – All Rights Reserved

Content Confidential – DO NOT DUPLICATE.

• Increasing interest among clinicians

• Consumers familiar with software

• Payment reform spurring interest

Video and Virtual Visits


The Future of Video Visits


– “I didn’t look at it online, I didn’t need to, I thought that’s what my provider was doing”

– “If I forget to send it in, after a couple of weeks, she [the nurse] calls me.”

– “I stopped using it for my reasons, but no one ever called and asked why I stopped so I never pursued it”

Feedback Loops Alone Are Not Motivating


Sentinel Effect


Components of Self Care

Social Networking Gamification Incentives Coaching

FeedbackLoop


Text-messageReminder

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 MonitoringData Repository (RMDR)

Simple Reminders Can Have A Powerful Effect


Adherence Rate for Sunscreen Use

Arch Dermatol. 2009;145(11):1230-1236.


The Power of Activity and Coaching

Q1 Q1-Q2 Q1-Q3 Q1-Q4

-16.00

-14.00

-12.00

-10.00

-8.00

-6.00

-4.00

-2.00

0.00

2.00

4.00

Percent Change in Average Daily Steps Per Quarter

C, n=30

I, n=27

Quarter (1 Quarter = 3 weeks)

Per

cen

t C

han

ge


Habituation




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


Customized Program Design

ReadinessTo Change

Connected Health Data

PracticeLocation

Analytic Engine


1/9

1/11

1/13

1/15

1/17

1/19

1/21

1/23

1/25

1/27

1/29

1/31

0

2000

4000

6000

8000

10000

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

3/3

3/5

3/7

3/9

3/11

3/13

3/15

3/17

3/19

3/21

3/23

3/25

3/27

3/29

3/31

March

Text2Move

Contemplation Preparation Action


Meet Michael Snyder


Genetic Risk

Source: Cell 148, 1293–1307, March 16, 2012


Glycated HgA1c (%):(Day Number)

Glu

cose

(m

g/d

L)

Day Number

-150 200 250 300 350 4000 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


Customized Program Design

Motivational State

Connected Health Data

Genetic Profile

Analytic Engine


Content:

Psychological Factors

Tactics:

Genes Coaching

Games/Contests

Health Info &Social Support

Incentives/Punishments

Text

Rich/Multi-Media

Avatar/Agent

Voice

InteractiveSoftware

Physiological Functions

Behavior

Environmental Factors/Socioeconomic Status

Content:

Tactics:

SpecimenCollection

EMRs

Sensors

TextAnalysis

Online & OfflineBehavior Tracking

Analytics

Input Output


Automating Healthcare

Implications of Automating Healthcare

• Social Contract

• Privacy

• Accountability

• Economics


• Feedback loops coupled with personalized motivation can lead to sustained behavior change

• Virtual care has great future potential

• Genetic analysis provides a powerful foundation

Takeaways


FeedbackLoop

The cHealth Blog: chealthblog.connectedhealth.org

www.connectedhealth.org

Annual Symposium: October 23-24 2014; Boston

LinkedIn Group: Connected Health Community

Twitter: @connectedhealth @jkvedar

Ways to “Connect”

Contact Me: [email protected]


Health & Medicine

Connected health as a tool for patient engagement kvedar 11.7.13