Can technology improve adherence?

January 25, 2016

Doctors put a great deal of thought and effort into developing treatment plans for patients, but typically have no way of knowing-beyond results at follow-up appointments-whether the patient is actually following it. But advances in technology are giving physicians and their staff new tools for improving and tracking patient adherence.

Doctors put a great deal of thought and effort into developing treatment plans for patients, but typically have no way of knowing-beyond results at follow-up appointments-whether the patient is actually following it. But advances in technology are giving physicians and their staff new tools for improving and tracking patient adherence. 

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“I see a role for remote wearable devices and implants in improving patient adherence. In fact, it’s already happening,” says John Meigs, Jr., MD, FAAFP, president-elect of the American Academy of Family Physicians. Meigs cites the development of devices such as blood pressure cuffs, glucose monitors, and pill bottles that can detect whether patients have taken medications as scheduled. “The technology exists to capture, store, and transmit vital patient data,” he says. 

The potential for wearable and implantable devices to improve adherence becomes even more powerful when combined with consumer electronic devices, says John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center in Boston.

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Beth Israel has several projects underway that leverage the capabilities of Apple products, he says. One is an app for the iPhone that, in combination with the Apple HealthKit, transmits data from devices such as bathroom scales, blood pressure cuffs, and sleep apnea monitors to Beth Israel physicians. The data is entered automatically into the patient’s electronic health record. 

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If a patient with congestive heart failure experiences a sudden weight gain, for example,  “that patient-generated healthcare data tells me I need to tell that patient to double their Lasix intake and get rid of salted snacks” so as to head off a likely visit to the emergency department.

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The effectiveness of such devices depends, of course, on patients being able to afford them. But Halamka points out that providing these devices to patients is a better use of funds than paying for a trip to the ED or a hospital readmission. “In this world of value-based payments, we have to ask what is the total cost of wellness versus the cost of sickness,” he says. “If we’re willing to pay $5,000 for a stay in the intensive care unit, why wouldn’t we pay $299 for a device you can wear?”

Beth Israel is also developing an app, called the electronic patient report of outcomes (EPROS), designed to capture and transmit more subjective patient data such as pain level or loss of appetite. Physicians can adjust the patient’s medications in real time based on the data the patient provides. 

The growth of consumer-generated health data will present physicians with a series of new problems, he adds, including what Halamka terms “provenance.” “What is the source of the data? How much should I trust it, and what should I do if it shows a life-threatening situation?"

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For example, he says, heart rate data transmitted from a running shoe may not be as reliable as that from a pacemaker made by a company such as Medtronic with a long track record of reliability. “I don’t think there’s any medical or legal precedent to say it’s the responsibility of the care team to monitor all these body parameters and respond in real time against some generic standard like ‘Medtronic good, running shoe bad,’” he says. “So getting the data is easy. Turning it into actionable wisdom is much harder.”