In you first paragraph you stated, “… connected health has the opportunity to add great value.” That is where I see the greatest barrier/competition, to exist.

What could prevent the opportunity from becoming an accomplishment?

In your September 13 Roundtable Discussion – Up from Crisis, Peter Ubel provided what I thought was a very telling comment regarding how the health care industry might use the electronic medical record when he stated, “you have to look at how people will behave with that technology.” You then labeled technology as simply an “enabler.” What health care needs, you said, was a new business model in healthcare delivery. But what would be the catalyst for development of the new business model?

Behavioral economics became the topic of discussion – the strong emotional forces that can stymie or stimulate consumer support. The public only cares about “what’s in it for me.” The physician cloaks the same question in terms of “How do I remain cost-effective?”

Connected care’s long-range competition is, perhaps, in the catalyst for a new business model.

Tracy Moorhead suggested shifting focus to prevention and wellness could be a catalyst (as opposed to acute and reactive care). The terms were later restated as “continuous care” vs. “episodic care.”

But what if there is no shift in focus?
• What if Behavioral Economics come into play and fear prevents a shift?
• What if the political winds blow in a new direction (whatever that might be)?
• What if UnitedHealthGroup cuts all new initiatives (including its telehealth network), for whatever reason, and the public sees it as a failed telehealth venture?

I’m not suggesting there will be no change. In that same Roundtable Discussion, Jason Hwang offered, for example, what I believe are excellent possibilities: putting tools in the hands of the patient – decentralizing healthcare. Connected care is enabled by technology … but not totally effective until the patient takes over his or her own care.

I’m suggesting that connected care might find competition in the focus of future healthcare reform. This is, fortunately, potential competition that can be minimized by addressing the possibility in advance.

As you know, I work in the field of medication compliance. I DO see signs that things are changing although it is not driven by the Connected Health Vision as such, rather by "Payment for results".

Put simply, if we are to show that a particular therapy works then we need to start measuring compliance. In recent months I see evidence that pharmaceutical companies start to embrace this as a future mainstream activity. By recording dosage events in a way that is communicable they have a better evidence base, as well as opening the possibility for an objective discussion between patient and professional about compliance on a individual level, a discussion that is directed to improving outcomes.

Gordon's point about consumer behavior is going to be central - if patients perceive medication adherence monitoring as being "Big Brother" then we will be stymied. If they see it as potentially beneficial, even a necessity, then it will open the door for many more opportunities.

I am glad Chris has restarted this conversation as it is important to understand how connected interventions fit into the larger picture of healthcare.

While I agree with Joe's implied point that the connected solutions will be judged as part of a category and compared with other categorical solutions - telephonic outreach, health education classes, etc. I think we do ourselves a bit of a disservice if we lump all internet and cell phone solutions into one category. Those of us who take these interventions seriously - as I know Joe does - and their capacity to demonstrably impact health and costs should think to compare them other interventions. I think in a lot of cases connected health interventions will compare favorably on outcomes and costs.

I think the scenario where these solutions don't become accepted is one where we forget to be rigorous about their development and measurement and forget that evidence based medicine is about evidence. I know the that internet speed and some of the "competition" from B2C solutions may seem to imply that there is a whole new world order but I believe we need to adapt those approaches to healthcare and not the other way around.

We'll be successful by showing that these solutions have the same rigor, the people who build them have the same rigor, and their impacts are just as real as what they are being compared to.

I totally agree with many of your thoughts, and strongly feel that the stimulus to adopt change may have to come from the consumer end in conjunction with governmental legislation.

The challenge has been how you get from ground zero, were most patients are operating now, to the fully integrated environment all of us recognize we need to be. Our experience has taught us that any solution that attempts to change entrenched behavior needs to be “brain dead simple” or have a very strong stimulus.

Current technology has proven, though multiple studies like the ones conducted by your organization, that workable solutions are offered to the consumer it can greatly help the problem, but they must be introduced in a way that is inclusive of not only the patient, but their whole support group.

Look at solutions like http://mybuddycheck.com, http://www.healthvault.com , and http://www.googlehealth.com for such ground level personal technology solutions. If enough people use these solutions then the medical community will be encouraged by sheer weight of numbers to adopt these widely accepted systems.