Testing Technology vs. Enabling a System of Chronic Care – Results of the NIH Tele-HF Trial

by Randy Williams, MD FACC, CEO of Pharos Innovations

The results from the National Institutes of Health (NIH)-sponsored Tele-HF trial are in, and the findings are worth considering . The results are counter to most of the findings of other studies examining telemonitoring for heart failure and at face value are disappointing to us, and the industry. Upon closer examination, however, this study offers us an excellent opportunity for further innovation, refinement of solutions and continuous improvement. It also provides a snapshot of how significant the challenges remain in transforming U.S. healthcare – from a system that is episodic, reactive, acute care based to a system of care that incorporates proactive, interactive, continuum-based chronic care management. 

The genesis for this study stretches back nearly 10 years, from conceptualization to the results we see reported today. This randomized, controlled multi-centered trial was designed to compare an automated, daily symptom and self-reported weight monitoring technology with “usual care” in reducing hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The boldness of vision should not be underrepresented: Tele-HF is the largest study of a non-pharmacological intervention for heart failure ever conducted. 

At a high level, the results showed “no significant differences” between the group receiving usual care and the group randomized to receive telemonitoring. I cannot say that these are the results we were hoping for. However, I urge those in our industry and other key stakeholders to take a closer, more informed view, and to reach their own conclusions and insights. 

The Details

First, I want to thank and acknowledge the great work of the investigators, study sites and everyone involved in this trial. It was a long process and everyone worked with the utmost integrity and professionalism. We were privileged to have been selected for participation.  I also want to acknowledge the value of conducting large, multi-centered, randomized, controlled trials in terms of advancing medical science. 

The patient interventions in this study took place in 2006-09 and omit many of the processes and techniques Pharos uses today to achieve the necessary critical mass of physician and patient involvement. Here are the limitations of this particular study – from my perspective: 

Will Mobile/Wireless Apps Be the Breakthrough for Retail eHealth & Remote Monitoring?

Two slides from Mary Meeker’s presentation at Web 2.0 this week really caught my attention.

Compare the proportions that users pay” for desktop Internet services vs. mobile Internet services (the area inside the red lines — click on the graphics to see larger versions).

 MS1

MS2

What do these slides tell us?

Adieu, LifeCOMM

“Qualcomm pulls the plug on LifeComm”  announced Brian Dolan of mobihealthnews recently. 

As demonstrated by e-CareManagement blog readership, there has been a lot of interest in LifeCOMM.  My first blog post on LifeCOMM in 2007 has been single the most commented on post and the second most widely read blog post.

It’s taken me a while to sift through my thoughts and feelings about saying “Goodbye” to LifeCOMM. At first I was deeply disappointed, but after further reflection think that LifeCOMM wasn’t the right type of platform for today’s consumer mobile health market.

Disappointment

My first reaction was one of disappointment.

HITECH Overlap: Medical Home, Telehealth, Health IT/Exchange

What’s the commonality among Medical Home, Telehealth, and Health IT/Information Exchange initiatives?

They all relate to care coordination.  As shown in the diagram below from the Kansas Health Policy Authority (KHPA), there’s a lot of overlap.

Overlap

A larger copy of the slide is available in this March 2 PowerPoint presentation by Marcia Neilsen , Executive Director, KHPA.

What are some of the implications?

What’s the Best Way to Get Hospitals Involved in Care Coordination?

Pay them to do it, take money away when they don’t — make hospitals accountable for their role in avoiding unnecessary readmissions.

Hospital

Mark E. Miller, Ph.D., Executive Director, Medicare Payment Advisory Commission testified recently in front of the U.S. Senate Committee on Finance. He opened his remarks by stating:

The health care delivery system we see today is not a true system: care coordination is rare, specialist care is favored over primary care, quality of care is often poor, and costs are high and increasing at an unsustainable rate.

About a quarter of Mr. Miller’s testimony focused on an issue that hasn’t received much attention: avoidable hospital readmissions . Here are some key excerpts:

Data Incompatibility Remains A Barrier to Remote Patient Monitoring (RPM) Devices Reaching the Mainstream

The Continua Health Alliance is doing a good job in getting remote patient monitoring (RPM) devices to become plug-n-play — where devices and peripherals from different manufacturers complying with Continua Guidelines will be able to talk to one another.

Continua’s work-to-date is a necessary, but not yet sufficient effort to make RPM devices mainstream.

Knocking down the barrier of device-incompatibilty exposes the bigger barrier of lack of data interoperability among RPM technologies and between RPM devices and health care IT systems.  Jonathan Edwards, research VP and lead telemedicine analyst for Gartner, nails the issue:

Three New Reports On Aging and Technology

Older Americans 2008: Key Indicators of Well-Being, AgingStats.gov, Federal Agency Forum on Aging-Related Statistics

Healthy@Home, commissioned by AARP and the Blue Shield of California Foundation

State of Technology in Aging Services, Center for Aging Services Technology (CAST)

These reports are succinctly profiled with links to the full studies at Profiles of older health care consumers: living longer, longing for technology on Jane Sarasohn-Kahn’s Health Populi blog. A great read!

Hospital as Mainframe, Wireless Technology as Liberator

Sometimes the serendipity of airplane readings provides for insightful connections.  I thought I’d share one from this week’s travels.

The aha of “hospital as mainframe” came from reading Eric Dishman’s epilogue in Dr. Mike Magee’s excellent recent book, Home-Centered Health Care:

As with mainframe computers only a couple of decades ago, today we have to make a pilgrimage to that hospital mainframe to wait ever so patiently as we time-share those miraculous modern medical capabilties that have been gathered there.  In the midst of already ballooning healthcare costs, growing ranks or un-and under-insured, and epidemics of age-related illnesses and injuries, this mainframe model cannot scale to meet the needs of ouj aging population where neither the dollars nor the doctors will exist to deliver healthcare business as usual.

Just as we moved from mainframe to persional computers that are now part of our everyday lives at home, work, and play, so, too, we must redistribute healthcare expertise and equipment from  mainframe megaplexes to our homes and to our personal lives. Eric Dishman is General Manager, Health Research & Innovation Group, Intel Corporation. Disclosure: Intel has been a client of Better Health Technologies.

OK, sounds good…and just HOW is all this going to happen?

What Will Microsoft’s HealthVault Mean to the Telehealth Community?

My colleague Tim Gee and I are guest bloggers on the Get-Connected Forum at the Center for Connected Health.  We speculate on:

What Will Microsoft’s HealthVault Mean to the Telehealth Community?

Our bottom line:  HealthVault overall is a positive for telehealth industry growth and scale, even though it will speed the inevitable commoditization of remote patient monitoring (RPM) devices.

Microsoft’s HealthVault: User Manual = C-, Strategy to Create a New Ecosystem = A

Would you like to have the experience of being parachuted into a deep forest with no map of where you are or clues about how to get out?  If so, I suggest that you go directly to Microsoft’s new PHR at www.healthvault.com and just TRY to figure out where you are or where you’re headed.

Initial confusion put aside, I think HealthVault is strategically brilliant.  While I’d give Microsoft a C- for explaining HealthVault (HV), I’ll give them an A for laying the strategy and foundation for what can become an extremely powerful platform for the appropriate, free flow of interoperable and transportable personal health information (I’ve chosen my words carefully here).

Here are four initial impressions about HealthVault — please comment as I’m still trying to figure out myself exactly what HV is and isn’t.