Can you be your own doctor from home using mHealth technologies?

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

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

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  

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1/29  

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January  

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2/9  

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2/15  

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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: jkvedar@partners.org

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