mHealth: Toward a Hospital Without Walls (Video)



This 25 min presentation by Telcare‘s CEO Dr Jonathan Javitt at the Technion Social-Mobile-Cloud Meets Medicine Conference on the 17th December 2013 is a real treat for anyone who wants to quickly get up to speed on the mHealth opportunity in 2014.

Some key takeaways for me:

…the 2000 year old model of healthcare is broken forever… …it used to be that you went to the Doctor, you told him what the problem was and he either looked at the entrails of a chicken or said a magic incantation or he actually listened to your story, he diagnosed your disease, he gave you a treatment and you either lived or you died and that was the end of the encounter… …and that worked well and that’s what we did for acute illness and it wasn’t until the turn of the 20th century that your chance of being helped by your Doctor was greater than your chance of being harmed by your Doctor but once we invented antibiotics the balance shifted and for a 100 years we did very well by treating acute illness. The problem we have now is that 70% of healthcare spending is on chronic illness and that model just doesn’t work, that model of ‘see me in 6 months and we’ll see what’s going on” doesn’t work…

…the next big leap, the one we’re in the middle of right now is the how do we engage the Patient in managing a chronic illness because the good news is that we can reduce or eliminate nearly all complications of the major chronic illnesses that we face but the bad news is that the Patient is the one that has to do the work and saying to the Patient here’s what you do and come back in 6 months and tell me how it’s going just isn’t going to succeed, it doesn’t succeed ever…

…study published by Sopol where he looked at prescription non-adherence to diabetes medication across hundreds of thousands of Americans just from claims data and showed that if you look at the Patients who are most to fill their prescriptions versus those who were least likely to fill their prescriptions half of the costs associated with diabetes is accounted for right there in that difference in adherence – a $4,800 difference associated with ‘did you leave me and go to the drugstore and get your medicines’…

Wallgreens the healthcare equivalent of Amazon

…thousands of Americans die on their way to Hospital because you don’t know until the wheezing goes from sub clinical to clinical that you’re in trouble and if you don’t have the rescue meds you’re talking about a life threatening condition…

…I’ve been spending the last couple of years of my life on a company focused on diabetes because these are people who spend less than a hour a year with their Doctor… …they leave the encounter completely confused, about what to do they remember almost nothing of what was said by the Doctor and then they have to spend the next 8759 hours trying to be their Doctor and the tasks they are asked to undertake are beyond comprehension for a lot of people. A lot of people who have diabetes didn’t graduate from high school much less from Technion and the result is frustration, futility, it’s highly inconsistent adherence and often they just give up and don’t bother treating at all because they feel pretty well…

…well now all of a sudden we have a number of devices – ours is not the only one – where every time you test your blood sugar the data goes right up to the cloud and you can get immediate feedback. And it’s not about the device it’s about the effect you create by taking the Patient out of the silo that’s the important thing to remember it’s not the technology it’s what you do with it because all of a sudden you can get actionable guidance from your Doctor, you can get actionable guidance from the care team – because it’s not really the Doctor you want to hear from it’s the nurse case manager, it’s the diabetes educator, by and large endocrinologists are good at doing diagnosis and making big changes in care but it’s that nurse diabetes educator who is going to help you figure out how to balance the carbohydrate…

…the Mother of the kid with diabetes doesn’t spend her day by the phone and she’s no longer calling the school nurse to find out if her kid has tested yet or if her kids okay. It turns out in the United States the child with diabetes is most likely to miss lunch because the child is required to line up at the nurse and show the nurse the glucose reading before they are allowed to go to lunch… …all of a sudden we’ve got the information going by radio to the school nurses computer and the kid goes straight to lunch and now doesn’t have a late afternoon hypoglycaemic attack. So just with that little technological change you change the whole ecosystem of care and that’s what it’s really about, it’s about empowering the care team so that rather than calling a thousand people with diabetes to identify the five people who are running low, the ten people who are running high and the fifteen people who aren’t testing at all it’s right there on your dashboard and you can drill down and spend the nurse time on those people. We’ve just finished a study with the largest HMO in the United States showing that with this technology you cut the staff time in half. Well when the fully burden of cost to the organisation of a nurse hour is $150 cutting that staff time in half is probably the hugest gift you can give any healthcare provider organisation…

The Patient is no longer alone there is a network of care

…the proof for this is now coming in. If you connect the Doctor and the Patient. If you can liberate from a dumb device up to the cloud and give a Patient feedback you double or triple adherence to testing depending on how much support is added to it… …I have a paper coming out in US Endocrinology next month showing an employer who saved $3,300 per diabetic employee per year on people using this system… …just by putting a radio chip inside their glucose meter and adding a little bit of coaching over the telephone and it’s technology that Patients and Doctors like…

Big Imagination or Big Data

Watch to the end of the video to learn about how Jonathan sees the future of mHealth being not about Big Data but Big Imagination…

My thoughts:

This published paper is going to be very significant milestone for the mHealth market. If you head up the healthcare plan for a major employer (like a police force) in the USA you’ll be able to show that by simply moving your diabetic employees over to using the Telcare service you can save $3,300 per employee.

The Telcare device costs only $149. The strips are price matched (so cost the same as whatever you’re already spending) but you won’t be wasting any like you did with your unconnected alternatives. A SIM card offering unlimited mobile calls, messaging and data tariff costs less than $300 (eg. T-Mobile’s new ‘uncarrier’ plans to be announced at CES). The most expensive Apple iPhone you can buy (the 5S 64GB) costs only $849.

So by moving every diabetic employee over to this more advanced management system you would still save over $2,100 even if you also gave each Patient a brand new top of the range iPhone and unlimited SIM card.

Imagine all the ways you could use those extra dollars to help engage and help these Patients take even more control over their own care eg. with todays exchange rate that Patient could have a documented 3GDoctor consultation every 10 days and you’d still be saving money!

If you’re responsible for the care for Diabetics here in Europe and would like to make some history and discover how much impact Telcare’s management system can make in our differently structured healthcare systems please read this and don’t hesitate to get in touch.

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