The frustrations of delivering medical care are many: unequal access, limited resources, excessive costs, non-compliance, and legal documentation to name a few. Our systems based practice is being disrupted through large scale efforts on the policy side and simultaneous grassroots efforts by tech saavy patients who both create apps to track their own health and gather support groups to learning from each other. During my first year as a medical resident I’ve had the opportunity to see a model of healthcare that has had impact on both a systems and individual practice.
In a cardiology heart failure clinic run by one of my preceptors, Dr. Littmann, an effort to reach some of Charlotte, NC’s most disadvantaged population and cure their hearts has been established. Those referred to the clinic have frequent outpatient visits to check the status of their particular heart failure therapy and are consistently telephoned at their homes for continuity of care. Many of these individuals have seen improvements near cure of their heart failure. Hospitalizations become less likely because they are followed so closely from their natural habitats. The practices employed involve evidence based medicine using the appropriate medications in the correct demographics.
This model is a brilliant one, which focuses on what happens between office visits instead of when the patient has a scheduled appointment or something goes wrong and they end up in the emergency department. Similarly, in Norway, researchers are using technology as a way to improve both patient education and personalized support with Chronic Obstructive Pulmonary Disease (COPD). The app created by SINTEF focuses on bringing together multiple aspects of the patient care experience. Patients use the app to log daily how they are doing with their disease. This data is analyzed by the medical center which can support and recommend next steps to prevent a COPD exacerbation. It targets decreasing recurrent hospitalizations by catching these potential problems early and providing available outpatient support when needed. This applies several core concepts of integrating technology in the medical landscape:
1. Patient engagement: Patients can track their own data and give as much or little information as they like. This user centered approach gives the power to the patient in keeping up with their health. As a result, patients have to be willing to make a personal investment to improve or maintain good health.
2. Ease of Use: An app can be put on a tablet making it more widely available than if an entirely new device was required. There are still limitations in terms of who has access to tablets but distribution is growing across the world and one could imagine a way for a non-smart phone to be used to meet the same objectives.
3. Support: This app isn’t a dead end. The data doesn’t get sucked into your phone only to be withdrawn years later if you remember you stored it. The data entered is monitored, analyzed and used presumably by individuals trained to spot the signs of a COPD exacerbation before it happens.
4. Systems-Based Practice Integration: Few apps look at the impact on health that occurs at a regional level which is where healthcare really matters. In order for tech to truly disrupt medicine it must be adopted in a way that improves our systems. This app puts resources towards educating and monitoring patients from home instead of at the hospital or clinic. It aims to reduce costs, burden for the patients and demands of healthcare professionals by focusing on prevention. The model takes an active role in managing health at the right times.
In many ways these two models (heart failure clinic and COPD app) are similar in approach. It recognizes that health is dynamic and chronic diseases need a sufficient amount of TLC to prevent mortality. While one focuses on clinic visits and phone calls, the other allows an integration into a system that may be more easily accessed by those with travel limitations. I think both models (if adopted more widely) have the potential to improve our global efforts to all live healthier lives.
Photo Credit: Ian Broyles