Harnessing technology to transform care - Q&A with Joseph Kvedar, MD, Founder and Director, Center for Connected Health
The Center for Connected Health is creating a new model for health care delivery by developing programs to move care from the hospital or doctor’s office into the day-to-day lives of patients. Dr. Kvedar explains how an emphasis on patient engagement affects the design of personal connected health devices that can help providers and patients manage chronic conditions, maintain wellness, and improve adherence and clinical outcomes.
KVEDAR: Our in-depth experience, combined with the resources available at the Center for Connected Health and within the Partners HealthCare network, enables us to deliver expert opinions and help organizations prepare their products and services for integration into the health care delivery system. The Center’s experienced clinicians and technologists are skilled at working seamlessly with patients and providers to determine potential use cases, identify usability challenges and opportunities, and evaluate technology and workflow issues in medical settings as well as in the home. Our work continues to demonstrate how the right technology, in the right patients’ hands, in the right setting can have a profound impact on care and quality of life.
In one example, working with a company developing a medication adherence device, the Connected Health team designed the protocol, recruited more than 120 subjects, and completed the data analysis to evaluate clinical outcomes. This study is currently in publication review. In another case, we assessed a prototype Bluetooth USB device and software platform enabling data upload from the home. Our team provided a thorough and realistic evaluation of the technology’s reliability and usability and identified key factors for further product design.
ECD: What challenges do telehealth system developers face today, both on the technical side in terms of design requirements, as well as the clinical side in regards to care delivery and technology acceptance?
KVEDAR: One challenge system developers face is how to test their product or service in a real-world environment. In other words, how does the developer of an activity monitor, wireless weight scale, or blood pressure cuff have individuals use these products on a test basis in their home or connected with their provider? Working within a large provider network, the Center can bridge that need and put these devices and systems in the patients’ and providers’ hands.
A second significant challenge is the myriad of platforms and Operating Systems (OSs) currently available in the market. Designing a device or program that is suitable for the iPhone, for example, will need to be redesigned for Android[
], Blackberry, and on and on. Obviously, this requires significant development time and expense. Making all personal health devices plug-and-play so that any sensor or app will work on all platforms, as well as allowing patients and providers to easily and securely share data, are essential requirements for the widespread success of connected health systems. The Continua Health Alliance (www.continuaalliance.org) is creating interoperability standards and guidelines to help streamline the development of these personal health devices and make it seamless for patients and providers to use these technologies.
ECD: Where does security fit in the connected health picture, and how must technology advance to address this and any other area of vulnerability and risk?
KVEDAR: Health care providers are obligated to protect patient privacy and an individual’s health information. E-mail communication is one example of a potential vulnerability. However, there are a number of ways to safeguard against potential security breaches. First, e-mail messages can be encrypted. Providers can also communicate with patients using a secure software platform that has the same functionality as e-mail, but is specific to communication with a health care provider. Secured messaging applications are often part of a patient portal or electronic medical records systems offered by physician practices and hospitals.
ECD: The Center for Connected Health emphasizes patient engagement and supports initiatives promoting disease prevention and management. How should these objectives influence the design of a connected health device?
KVEDAR: That is a very important question. First, the device must be easy for the individual to use. In a recent remote monitoring trial conducted at the Center, we found that for a surprising percentage of diabetes patients, the step of plugging a device into the glucometer and the phone line and then pushing a single button to upload glucose readings was more work than they were willing to do. The technology must be simple and easy to use.
Moreover, we have learned that the most successful technology or product can be personalized to the patient’s experience, goals, or motivation. Patients are far more engaged in their care plan or wellness program when their own personal data is presented back to them – the feedback loop – in an easy-to-understand format. They can track their progress, see how their lifestyle choices are affecting their health, and learn how to best manage their health and wellness.
However, personal connected health data alone is not enough, except for a very small group of highly motivated individuals. Objective data is an important part of the solution, but the success of connected health programs is all about the psychology of engaging participants to motivate them to improve their health. We’re seeing many attempts at engagement strategies, including gamification, social networking, coaching, reminders, incentives, and punishments.
Our friends at Healthrageous (www.healthrageous.com), a health engagement company, offer a good example of a solution specific to an individual’s data, personal habits, and preferences. The company has developed a platform based on dynamic personalization, meaning that each intervention is tailored to meet an individual’s needs (see Figure 1). The goal is to know as much as possible about each individual using machine learning to anticipate the engagement experience that motivates each person to stay on the right track.
Center for Connected Health jkvedar@partners.org www.connected-health.org
