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BOSTON --When a cluster of telehealth technology and mHealth evangelists compared notes, they came up with a host of tools and strategies -- some new, some traditional -- to chase that much-sought-after, but not-so-easy-to-attain goal: getting patients to integrate digital tools into their lifestyles to improve their health.
"Patient adoption is one of the most challenging areas," said Srinivas Merugu, M.D., chief medical informatics officer at Cleveland's St. Vincent Charity Medical Center and chair of a daily session at the mHealth + Telehealth World 2014 conference. "A critical piece of this is making sure you have patients buying in and making sure they're responsible for their own health."
At the sprawling Veterans Health Administration of the U.S. Department of Veterans Affairs (VA), which serves 8.9 million patients at 1,600 sites -- including 152 medical centers and 900-plus clinics -- many of them in rural areas, "telehealth has been a critical part of our work," said Neil Evans, M.D., co-director of the VA's Connected Health program.
Evans, one of four panelists who threshed out ideas for bringing patients into the remote medicine and mHealth folds, said the VA's "My HealtheVet" patient portal has proved popular, with 2.5 million users.
One of the portal's most-used features is secure messaging that is trusted by veterans to maintain the privacy of communications with caregivers, Evans said.
Home monitoring, clinical-grade wearables in use
Another emerging use of telehealth tech for the VA is clinical home monitoring via video. And a new patient engagement initiative at the agency involves a mobile app, "Mission Health," that encourages veterans to challenge each other to maintain their health as members of teams. This approach is modeled on veterans' own allegiance to their military branches and divisions, Evans said.
Nina Antoniottitelehealth director for Marshfield (Wisconsin) Clinic
"There's a very cohesive culture among vets," he said. "We're trying to take that same psychology to [encourage] my teammates to improve their health as well."
Meanwhile, Maulik Majmudar, M.D., a clinical cardiologist and associate director of the Healthcare Transformation Lab at Massachusetts General Hospital (MGH), said MGH uses both real-time video "virtual" doctor's visits, as well as asynchronous visits in which doctors set aside times to recommend treatments based on reviews of patients' input to carefully designed scripts.
MGH is also actively exploring the market for wearables, more medically sophisticated versions of wrist-based consumer pedometers and exercise appliances.
Another panelist, Nina Antoniotti, telehealth director for Marshfield (Wisconsin) Clinic, which serves 3.8 million patients in rural Wisconsin, said her healthcare system's telehealth efforts are also moving toward wearable sensors to transmit information from patients to caregivers.
"People are adopting them," Antoniotti said of wearable devices. "It's really all about compliance. We really need to look at what are the things that engage patients."
Payer explores wellness incentives
On the payer side, SeeChange Health, a young San Francisco-based firm created by Sean Penwell, M.D., works mainly with insurers to create programs such as personalized health action plans for patients that use incentives to induce compliance. One of the company's customers is UnitedHealthcare, one of the country's biggest medical insurers.
"How do you create the right incentives with the right energy?" Penwell said, adding that his incentive model is based on behavioral economics.
SeeChange has found that, somewhat counterintuitively, motivators such as premium rebates don't work well. Better are cash-equivalent items, such as deposits to healthcare reimbursement card accounts or simple gift cards, Penwell said.
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