Information Technology Reference
In-Depth Information
to and how they communicate with care providers and people in their social network.
Health apps also suggest new questions, such as how an online game can catalyze
learning about a health condition and motivate healthy behavior. For example the
MAHI app for diabetes management increased patients' internal locus of control
(an individual's belief that he can influence future health outcomes) and their will-
ingness to experiment with healthy eating alternatives [
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] . However, currently
there are wide gulfs between the design of new health apps and understanding what
makes them effective. This is clearly an area in need of more study.
Home Telehealth
Patients must manage chronic disease in their homes so it is not surprising that
technology for their use at home has been an active area for research and develop-
ment for many years. These technologies divide into several sub areas.
Subjective data about symptoms or status that patients enter into a portal or PHR can be of
some value to their care providers.
Significantly more value can be obtained from objective data such as weight, blood pressure
or blood glucose. It is becoming more common for patients at home to obtain their own
physiologic measurements.
Technology could provide ongoing advice and assistance to patients in managing their diet,
exercise and medications. With relatively inexpensive equipment and a high speed Internet
connection a care coordinator could make virtual home visits when the data from the patient
indicates one might be appropriate.
Research at Georgia Tech suggests that, in time, it might be possible that technology in the
home could monitor patient behavior to help detect issues like a decline in clinical status for
a patient with congestive heart failure based on changes in their movement patterns or even
a failure to take prescribed medications. This field is called “behavior imaging”, essentially
sensing and understanding patient behavior remotely through various technologies. The
technology is already being provided commercially for use in the assessment and treatment
of behavioral disorders such as autism. [
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These functions, taken as a whole, comprise the still developing field of home
telemedicine. One of the first people to think deeply about the field was Steve
Kaufman who founded HealthTech Services in 1988 where he developed a device
called HANC, a physically large and quite expensive home care nursing robot and
assistant to aid a broad range of home care patients in achieving what he calls “sup-
ported independence”.
Technology with some of these functions has gotten far more compact and inex-
pensive but financial incentives in healthcare have not, at least up until now, facili-
tated its use. In many ways the problem is similar to provider use of email. It makes
perfect sense but it won't happen if providers only get paid for physical visits.
The advent of outcome-based payment could change this dynamic. If providers are
interested in achieving the best outcomes and if technology in the home is shown to
more than pay for itself by helping achieve them, then it would be logical for pro-
viders to see that they are provided even if they have to pay for them.
