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, MD 
Director 
Center for Connected Health 
Partners HealthCare
© 2013 Center for Connected Health – All Rights Reserved

Content Conﬁdential – DO NOT DUPLICATE.

•  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


Connected Health Goal
Integrate care into the
day-to-day lives of our patients


Ideation &
Feasibility
Connected Health Innovation Process


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


Connected Health Benefits
Improved
self-care1 Just-in-time
care2


Connected Health Components
Feedback
Loop


Heart Failure Monitoring
Connected Cardiac Care
50%
Drop in
Readmissions


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


Average drop of HbA1c: 1.5
69% achieved a drop in BP
Diabetes and Blood Pressure Connect


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
DropinHbA1c
Average drop HbA1c by # of uploads
J Diabetes Sci Technol 2012;6(6):1328-1336



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
%ofSubjects
%ofSubjects
Am Heart J. 2012 Oct;164(4):625-31.


•  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


Components of Self Care
Social
Networking Gamification Incentives Coaching
Feedback
Loop


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


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
%Adherence
Reminder group
No Reminder Group
Arch Dermatol. 2009;145(11):1230-1236.


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
PercentChange
Quarter (1 Quarter = 3 weeks)
Percent Change in Average Daily Steps Per Quarter
C, n=30
I, n=27


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


Customized
Program Design
Readiness
To Change
Connected
Health Data
Practice
Location
Analytic
Engine


0

2000

4000

6000

8000

10000

1/9

1/11

1/13

1/15

1/17

1/19

1/21

1/23

1/25

1/27

1/29

1/31

January

2/1

2/3

2/5

2/7

2/9

2/11

2/13

2/15

2/17

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


Meet Michael Snyder


Genetic Risk
Source: Cell 148, 1293–1307, March 16, 2012


Glycated HgA1c (%):
(Day Number)
Glucose(mg/dL)
Day Number
-150 200 250 300 350 4000 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


Customized
Program Design
Motivational
State
Connected
Health Data
Genetic
Profile
Analytic
Engine


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


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


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

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