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Wednesday, October 11, 2006 | Ateret Haselkorn
The diffusion of telemedicine has brought forward a shift in thinking regarding not only how care is delivered, but also where and by whom. Many experts in the field now define the exam room as where the patient is, as opposed to basing it on the location of the clinician. Remote care is remote for the doctor. This inherently implies a shift in care setting, but also in the flexibility and availability of care. Patients can now be “examined” in their homes, at the gym, during their commute, at random and at scheduled moments of their day. And as access to the patient is broadened, the definition of “provider” subsequently changes. The diffusion of telemedicine will lie behind an expansion that will include dieticians, personal trainers, friends, family, and the patient himself. The connection of a widely dispersed care team that includes and emphasizes the patient will be central to achieving high quality remote care.
What will motivate patients to assume greater responsibility for their care? How can health delivery systems prepare their workforce for the cultural shift that will follow?
Motivation to become responsible ... the best grant applications I have reviewed that focus on home care all include this issue. They have decided to use a form of 'technology assisted coaching' to help motivate patients to comply with certain elements of their care program. Technology augments, but never can replace, the human voice. The industry has already seen care delivery role shift from physicians to PAs. This shift will continue and expand to ‘personal care coaches’ as the first point of contact for chronically ill patients. Motivation to become responsible … will not be driven by patient financial incentives nor by a capitated payment structure, since ultimately the cost of non-compliant will not be born by the patient.
Since the roles of the employees of health care systems were defined a generation ago, the habits of physicians and nurses will be the biggest obstacle for mainstream adoption of new ‘remote care’ role models. I suspect the new role models will be filled by new, younger, less expensive, part-time employees while demographics work to reduce the size of the existing work force. I would be surprised if these phone-coaches were locally based.
Special Projects Manager John Muir Health
Past Co-Director of the California Telehealth & Telemedicine Center (2000-2002)
Posted by: William Halverson 10/11/2006
I'd like to say that people will participate because they know its good for them. Some will. A group that is currently not engaged in healthy behaviors will 'convert' when they get access to rich educational content and their own physiologic information. We have seen evidence of this already. Another group will need incentives. The best current example of a program that offers incentives is Virgin Life Care's Healthmiles (www.virginlifecare.com). Still others will convert when something is done to make it harder for them to lead an unhealthy life -perhaps steeper premiums for their insurance coverage. All of these are better thann what we have now, but there will still be folks who insist on leading a self-destructive lifestyle for whatever reasons.
Director Center for Connected Health
Joseph C. Kvedar, M.D., is the Founder and Director of the Center for Connected Health, applying communications technology and online resources to increase access and improve the delivery of quality medical services and patient care. Dr. Kvedar is also a board-certified dermatologist and Vice-Chair of Dermatology at Harvard Medical School. In his role with the Center for Connected Health, Dr. Kvedar launched the first physician-to-physician online consultation service in an academic setting. He is also leading important research into novel approaches for connected health in a variety of medical specialties, including post-operative care in the home, wound care, and remote monitoring of patients with chronic diseases. Dr. Kvedar is a past President and member of the governing Board of the American Telemedicine Association (ATA). Dr. Kvedar is also Chair of the American Academy of Dermatology (AAD) Task Force on Telemedicine. Dr. Kvedar is internationally recognized for his leadership and vision in the field of connected health and the application of communications technologies to improve healthcare to patients. Dr. Kvedar is co-editor of a new book, Home Telehealth, which was published in May 2006. He is a frequent lecturer and has authored over 60 publications on telemedicine and connected health. In 2003, Dr. Kvedar was honored by the New England Business and Technology Association for his extraordinary leadership in the field.
Posted by: Joseph Kvedar 10/12/2006
Would these phone coaches need a clinical background? It seems that hospitality and being organized are the desired characteristics that a modern health worker can exhibit. This feeds into a concierge model of care, with former travel agents and property managers taking on the role of care coordinator or personal coach.
Manager, Research and Forecasting HealthTech
I lead projects that examine and predict a variety of medical innovations, including Remote Health Services. In the past, I headed research on obesity management, sensors, and organ assist devices. I also run HealthTech's work on innovation and adoption strategies for healthcare, including developing software tools designed to improve and expedite technology planning processes at health delivery systems.
Posted by: Ateret Haselkorn 10/16/2006
Pharmaceutical companies have demonstrated some success in patient compliance for their clinical trials using technologies like - RFID enabled pill bottles - PDAs with daily capture of vitals - Automated phone reminders
If planned and incentivized effectively, ensuring patient compliance is not an impossible task. The bigger issues are around freedom of choice and striking an optimum balance of incentives/disincentives and motivation.
Posted by: Push Virk 12/12/2006
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