Throughout his career, Steven Steinhubl, MD, has seen several innovative approaches to patient care based around analyzing population health data to determine a single best practice for the treatment of a specific subset of patients. These approaches have seen positive outcomes, but they inherently create barriers to a more personal approach.
"It's a great step forward, but it falls short of really taking care of the individual," he says. "Mobile technology allows care to be more personalized and allows us to better understand the people we're caring for."
Dr. Steinhubl is a cardiologist by training who was recently appointed director of the digital medicine program at San Diego-based Scripps Health, where he leads studies on the clinical effectiveness of mobile devices and mHealth at the Scripps Translational Science Institute. The main goal of these studies is to provide needed evidence to providers and payers alike on the ability of mobile technology to improve patient outcomes and create cost savings within the healthcare industry.
Currently underway at STSI is the "Wired for Health" study, which aims to determine if mobile interventions can reduce healthcare spending among patients with diabetes, high blood pressure or heart arrhythmias. "It's the first real attempt to look at and understand the role of mobile technology in helping patients take control of their chronic conditions," says Dr. Steinhubl, and reduce their reliance on costlier interventions necessitated by poor health management.
The study's participants are all Scripps Health employees or family members who have been identified as "high-resource utilizers" because of frequent hospital or physician visits, says Dr. Steinhubl. About half of the anticipated 200 participants have been enrolled.
A randomized group of half of the study's total participants will receive a wireless mobile health device to help manage their condition. Readings from the blood pressure monitors, heart monitors and blood glucose meters will be gathered and delivered over a cloud-based platform for clinician review.
Patients in the intervention group will also be able to track their health data through an online portal or on a mobile device, and both groups will be enrolled in a disease management program over the course of the six-month study. Researchers at STSI will then track the number, purpose and cost of any needed health inventions outside of the disease management program received by all participants.
Dr. Steinhubl hopes the results will confirm the researchers' hypothesis that using mobile technology in this fashion decreases healthcare resource utilization while improving patient outcomes, engagement and satisfaction. However, he realizes a 200-patient, six-month study will not provide conclusive evidence of the benefits of mobile technology. "It won't be practice-changing, but it's not designed to be," he says. "It's designed to get information we need on how individuals take to the technology and where the challenges are" to lay a foundation for the future research that will provide the evidence necessary to increase mHealth adoption across the healthcare industry.
Dr. Steinhubl believes mobile technology could be the key to transforming the healthcare industry for the better. "Currently, between one-half and two-thirds of physician office visits are for chronic disease management," says Dr. Steinhubl. Technology currently exists to track symptoms and monitor progress remotely for many of these conditions, from diabetes to depression, holding the potential to decrease the number of these visits and reduce total healthcare expenditures while providing more consistent and responsive disease management for the patients. "I believe we can knock off 75 percent of those chronic condition visits through home monitoring and wireless data transmission to providers," he says. That kind of result will not be seen for a few years, but it is within reach.
"It's possible, the challenge is just working it into the healthcare system," says Dr. Steinhubl. "And that's why we [at STSI] see our biggest responsibility as developing evidence to convince patients that this is the most convenient and safe option, convince payers this is inexpensive and convince providers that even though this is changing the paradigm a bit, it's something they will enjoy because it will help their patients."
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