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Going mobile

Technology will play bigger role in 2008

Technology has changed the way Americans bank and shop, so it makes sense that healthcare would develop technology that targets chronic care. Technological advances in DM are making it possible for patients to telecommunicate with their doctors and for physicians to collect health information and change care if warranted. David Whitlinger, president and chair of the board of Continua Health Alliance in Beaverton, OR, says technological improvements are a needed change in the healthcare system.

“The belief is that the healthcare system has to change. That individuals and families will have to become much more a part of the caregiver aspect of delivery of healthcare and, from that, these personal telehealth tools will be key,” says Whitlinger, who is also the director of healthcare device standards and interoperability for Intel Corp. in Beaverton, OR.

David B. Nash, MD, MBA, chair of the department of health policy at Jefferson Medical College of Thomas Jefferson University in Philadelphia, says big players such as Google and General Electric are driving technological advancements in healthcare, and he expects wireless Internet-enabled technology that utilizes cell phones to become a larger part of the market.

“Technology is going to evolve so that the cell phone or its equivalent will be a medical, social, networking tool,” says Nash.

Ariel Linden, DrPH, MS, president of Linden Consulting Group in Hillsboro, OR, says DM companies are now realizing the need to collect daily health data from patients at high risk of hospitalization. Emerging telehealth technology is more effective than the old DM model, he says. 

“We need to move beyond the model of making outbound calls to patients every three months, talking to them for 15 minutes, and expecting that to keep them out of the hospital. We need to take advantage of advanced technology, plus incorporate interventions that are based on the best behavior change science,” says Linden.

Whitlinger expects to see a large number of remote monitoring DM trials focusing on people with diabetes this year.

Whitlinger says he won’t be surprised if those trials are successful, the programs double in size, and telehealth becomes the norm for patients and providers to monitor diabetes daily.

Although he expects growth in the diabetes market, Whitlinger predicts modest movement in technology for chronic disease patients who are homebound or nearly homebound. In addition to helping patients, the telehealth and online improvements will help caregivers, says Jim Giuffre, MPH, president and chief operating officer at Healthwise in Boise, ID. Many baby boomers don’t live in the same region as their parents, but technology is allowing them to keep track of their loved ones.

“New Web-based technologies allow older people to enroll in online programs, including interactive conversations that give them helpful information for managing their conditions. Parents can share this information with their baby boomer sons and daughters, so they can really assist and reinforce their older parents in managing their health,” says Giuffre.

Giuffre expects online social networking to play a larger role in people’s search for health information. With that added networking, health companies will need to confirm the information is medically accurate. “The challenge there is knowing what is evidence-based and what’s not,” says Giuffre.

He also expects more federal demonstration projects involving technology and pay-for-performance—though probably not in 2008.

Gordon Norman, MD, MBA, executive vice president and chief science officer at Alere Medical, Inc., in Reno, NV, expects to see broader adoption and interoperability of technology, particularly in personal health records.

“Without interoperability and standard formats, there’s not going to be much progress.”

Continua leads technology charge

David Whitlinger has crisscrossed the country since the Continua Health Alliance effort was launched in June 2006, building bridges that have laid a foundation that Continua members hope will bring an interoperable telehealth system this year.

Whitlinger is president and chair of the board of Continua Health Alliance in Beaverton, OR, a collaboration of an ever-growing group of 135 companies working to establish a system that allows interoperable personal telehealth products that empower people and organizations to better manage health and wellness.

Whitlinger says creating interoperable telehealth systems is critical as the nation faces a doctor shortage coupled with an aging boomer population. “To a large degree, many in the health policy world believe that the healthcare system simply has to change because of scalability,” says Whitlinger. “Because of the demand for healthcare and the insufficient number of beds, hospitals, and doctors . . . the scalability is going to hit us square in the face in a decade and a half.”

Whitlinger says the idea of greater interoperability germinated in Intel Corporation’s offices in Beaverton, where he is director of healthcare device standards and interoperability. Intel officials sought to take what they learned from other marketplaces and create a team of companies that would develop an interoperable system that would become the telehealth norm.

Whitlinger began reaching out via phone to gauge interest and forged ahead with face-to-face and summit meetings before Continua launched in June 2006.

Continua includes many of the big names in technology, including Dell, IBM, and Panasonic, and health insurers and DM companies, such as Aetna and Kaiser Permanente.

Whitlinger says Continua officials have spoken to CMS about telehealth reimbursements.

“[CMS is] running some of their own trials to see the effectiveness of remote monitoring . . . That’s all building up in some sort of CMS policy in this regard,” says Whitlinger.

Continua plans to have completed interoperability guidelines at the beginning of this year, which will allow companies to go through Continua’s certification process and guarantee out-of-box interoperability. “It will probably be early [2008], but we have already had some plug fests where companies had brought together prototype devices and tested those. Each quarter, we will include those events. By the time the guidelines are published, I expect several parallel products will be certified. The first half [of 2008] will be pretty exciting,” says Whitlinger.

Continua has also signed up ADT Associates to collect remote patient monitoring studies published in the United States and Europe.

With that information, which may be released at the beginning of this year, Whitlinger says Continua will assess common barriers to adoption and then begin talks with payers in the middle of the year.

He expects remote monitoring services and electronic health records that share data across networks to be in Version 1 of the software interface. Whitlinger predicts a handful of those interfaces will be shipped in 2008, possibly in the third quarter.

Continua is a necessary step to address the lack of remote monitoring device interoperability, says Vince Kuraitis, JD, MBA, principal of Better Health Technologies in Boise, ID.

Kuraitis is bullish about the technology and says making devices plug and play will help, but he says there are at least two more fundamental issues: reimbursement and licensing. Interoperability will raise the “ugly head” of licensing across state lines and other legal regulatory issues.

“I think they will be more problematic once we get some of these other things out of the way,” says Kuraitis, referring to the licensing issues.