Monday, November 19, 2007

Telehealth's Impact on Disease Management

AdvaMed, an advocacy group of medical device manufacturers, diagnostic product firms, and healthcare information technology providers, recently released a report developed by the Center for Telehealth at the Medical College of Georgia. Key report findings follow.

The report, which is based on a review of published studies on telehomecare and remote monitoring, as well as several current case studies, focused primarily on how these technologies have impacted the care of patients with diabetes, congestive heart failure and chronic obstructive pulmonary disease. Among the findings in the report:

● A study of 281 congestive heart failure patients who received telehomecare found that they experienced a 60 percent reduction in hospital admissions, a 66 percent decline in emergency room visits and a 59 percent reduction in pharmacy utilization. In contrast, the control group experienced increases in all of these areas.

● When patients with severe respiratory illness requiring long-term oxygen therapy were remotely-monitored, hospital admissions decreased by 50 percent, acute clinical problems decreased 55 percent and hospitalization costs went down by 17 percent.

● A study of 400 diabetes patients found that those monitored by in-home glucose meters and video conferencing showed significantly greater improvement in reducing average blood sugar levels than those who did not receive such monitoring.

These are impressive results, to be sure. Additional studies of the use of telehealth with such at risk patients are clearly warranted, if the reimbursement case is to be made.

Free Microchips to Alzheimer's Patients

The October 23-November 5 issue of the Florida Medical Business News featured a story about a joint venture between VeriChip and the Alzheimer's Community Care of West Palm Beach. VeriChip is offering free VeriMed radiofrequency implantable microchips to 200 patients with the disease. There are two goals for the undertaking. The first is to demonstrate that the product and the data base can raise care standards and improve the efficiency of care delivery. The second goal is to help persuade health insurance companies and CMS to provide reimbursement for the service. If one of the 200 patients is found wandering, law enforcement officials can take the patient to one of 12 hospitals with chip readers located in Palm Beach, Martin or St Lucie Counties. The chip contains a 16 digit number which enables medical personnel to access information stored by VeriChip. The patient database includes identification, next of kin contact information, allergies, medications, advance directives, and other pertinent material.

Friday, November 16, 2007

The Art Of Medicine

In the 25th Anniversary issue of Health Affairs, we find a compelling article by Dr Jerald Winakur. He reminds us that the ability to listen is a fundamental aspect of the "art" of medicine, and in so doing, warns against against the sole use of technology to assess patient status.

"One of the great lessons I have learned as I worked at my profession over the years is that the "art" of medicine is the honed ability to listen. The practice of medicine—at least the day-to-day, year-in, year-out primary doctoring that I do—involves, in large measure, interpreting stories. Words, not data; nuance, not numbers are the commodities exchanged between my patients and me. I ask a few questions over and over. The answers come in an infinite variety.

By listening to our patients’ stories, doctors glean and process most of the information we need not only to treat ailing bodies, but also to care for our fellow humans as unique beings. It is my job to evaluate and formulate from a constellation of symptoms and concerns and worries, from a blizzard of outside data of often questionable validity. Add to this a mix of freighted family and past medical history, a tendency toward superstition and phobia and fears, and a conglomeration of tidbits and details picked up in the mass media or from well-meaning friends.

I have also learned that it is not necessarily what patients tell me but what they don’t tell me—what I observe from years of being alert to nonverbal cues—that is often even more important. Those aspiring diagnosticians who are unwilling or incapable of reading this invisible text, who study only a check-marked questionnaire scrawled by the patient while she sat in another room, or who stare remotely into a computer monitor at a robotic encounter, never understand—never begin to hear—the complete story."

Sensei for Weight Loss

Check out this item from the 11/14/07 issue of Business First of Louisville. I hope the service is eventually made available from all cell phone carriers.

Sensei Inc., a joint venture between Humana Inc. and Card Guard AG, has introduced a new health and weight management program that uses cell phones as personal coaches. The program, called "Sensei for Weight Loss," currently is available to Sprint and AT&T customers.

Users go online to enter personal information such as desired weight, food preferences, meal times and exercise routines, and the program generates a customized nutrition and fitness plan. Throughout the day, the program delivers messages to the user's cell phone, such as weekly shopping lists, meal recommendations and motivational tips.

The program also records the user's eating choices and fitness activities and tracks progress toward goals. "Sensei for Weight Loss" is designed to help consumers make healthy choices throughout the day. For example, if someone plans a homemade lunch but then decides to eat out, the program can recommend an alternative meal that fits within the user's nutrition plan.

Boca Raton, Fla.-based Sensei was formed in 2005 by Louisville-based Humana, one of the nation's largest health benefits companies, and Card Guard AG, a Swiss health care technologies firm.

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