Getting Telehealth Right: Engaging Patients and Providers

Telehealth broadly is about creating care connections across boundaries, care that encourages patients’ independence, prevention and wellness; and care that can be leveraged for needed interventions. If we get telehealth right we can reduce impact of what we know is a growing health workforce shortage and concurrently create a healthier, more engaged patient base.
Published Online: November 13, 2016
Getting telehealth right can reduce the impact of the growing healthcare workforce shortage, while creating a healthier, more engaged patient base.
 
Broadly speaking, telehealth focuses on creating care connections across boundaries—care that encourages patients’ independence, prevention and wellness, and care that can be leveraged for needed interventions.   
 
Joesph Kvedar, MD, vice president of Connected Health in the Partners HealthCare System and author of Internet of Healthy Things, envisions using technology to gather real-time biometric data for chronic disease management. Virtual provider visits, cloud computing devices, and mobile devices are increasing our capacity for immediate monitoring and chronic disease management.
 
Virtual provider video visits are trending in the healthcare industry and the government sector in part because legal protections have been put in place in response to concerns about provider liability as the potential for telehealth increases exponentially. Walgreens, CVS, and Blue Cross Blue Shield are actively engaged in developing video technologies for care delivery. HHS' Agency for Healthcare Research and Quality has published numerous papers about the potential for virtual provider visits and using telehealth more broadly. Virtual video production, the agency reported, appears to be a viable approach to patient education and care; professional development; retention; and collaboration.      
 
Cloud computing and mobile devices are increasing the capacity of captured health data and integrated networks, Kvedar said. In 5 years, 20 billion everyday objects will be considered “smart,” because they have sensors and network ability. With existing GPS technologies, social networks, and automated contextual motivational messaging augmented by smart day-to-day objects, virtual artificial health beings could motivate humans to take such actions as exercising, resting, and losing weight.
 
Kvedar also discussed wearables, which are widely available to measure, record, and report steps, sleep patterns, blood pressure, stress, and weight. New and existing technologies need to be able to aggregate and normalize data while concurrently meeting user demand for flawless technological design. The end user is both provider and patient, and the technology must be customizable to the patient and normalized to be useful to the providers.
 
There have been good results for asthma compliance in teens, palliative care pain management, and cancer medication compliance using technology strategies that leverage subliminal messaging, unpredictable awards, and sentinel events, Kvedar reported. Telehealth has generated changes in self care and patient outcomes that have the same power as therapeutics.
 
Teenagers participating in a private Facebook group, which utilized the asthma survey Connect 2 My ACT through periodic electronic prompts developed by providers, had an 80% compliance rate compared to the control group’s 18% compliance.  
 
In another example, palliative care-related telehealth technologies were used to help patients understand how to manage pain. The in-office message to “take the medicine when you need it” often did not resonate at home. However, prompts to rate pain and questions about medicine use were supported by connections to palliative care units when the algorithm-generated response suggested a need for human interaction. As a result, pain levels dramatically improved over the course of these interventions.
 
Kvedar closed the lecture by promising the audience that telehealth and related technologies will not take the place of the doctor: the effect of the patient/ provider relationship is lasting. Patients often do not want to disappoint their doctors. If the design of health technologies is provider driven and supported by doctors, patients will take to the technologies and medical professionals can expect improvements in health outcomes and patient engagement in their healthcare management.

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