mHealth masters: The activated patient

mHealth masters: The activated patient

Terry Duesterhoeft is president and CEO of A&D Medical, which manufactures and distributes advanced biometric monitoring solutions including blood pressure monitors, weight scales, activity trackers and other health monitoring devices for consumer and professional use. Prior to joining A&D, he was the president of Honeywell HomMed and spent more than 10 years with GE Healthcare in marketing and product development executive roles, including leadership of Global Marketing for its general imaging ultrasound, a $1B business. Additionally, he spent several years in entrepreneurial healthcare ventures as one of the early members of ZONARE Medical Systems, XStor Medical and Vasamed. He has an MBA from the University of St. Thomas, St. Paul, Minn., and a BS in Mechanical Engineering from the University of Minnesota.

Q. What’s the one promise of mHealth that will drive the most adoption over the coming year?

A. The 10,000-foot, top-level promise of mHealth is that it will drive a higher level of consumer involvement in self-managed health and, in tandem, a greater connectivity between an individual and his or her care providers. These two things coupled together have the potential to 1) improve health outcomes, 2) lower the overall cost of care and 3) improve quality of life.

Statistically speaking, when patients – or people in general – are active participants in monitoring what’s happening with their health on a regular basis, their health outcomes improve, at a lower cost.

Numerous studies have shown that patients who are “activated” – or have the skills, ability and willingness to manage their own health and healthcare – experience better health outcomes at lower costs compared to less activated patients.

To quantify those levels of patient engagement, Judith Hibbard of the University of Oregon has developed a “patient activation measure” – a validated survey that scores the degree to which someone sees himself or herself as a manager of his or her health.

Looking at more than 30,000 patients, Hibbard and her associates found that those with the lowest activation scores – that is, people with the least skills and confidence to actively engage in their own healthcare – incurred costs that averaged up to 21 percent higher than patients with the highest activation levels, even after adjusting for health status and other factors. And the patient activation scores were shown to be significant predictors of healthcare costs, which has profound implications for planning around the reduction of costs in healthcare systems in the long-term.   

Q. What mHealth technology will become ubiquitous in the next 5 years? Why?

A. Based on the uptick we have seen throughout the health IT space around the move to more consumer-centric devices, wearables and health apps, I anticipate that in the near future the ability to have a personal, mobile health ecosystem as the central management of an individual’s health, driven by and around the consumer, will become the industry’s modus operandi. In that environment, where devices and applications work together, we will see overall technology costs come down and utility go up.

If we look at how mobile technology has impacted what we do in everyday life and the resulting impact on individual productivity, we can extrapolate how the same changes could be applied to the management of health. Technology has morphed very quickly to allow people to manage the environment of their homes: from 1,000 miles away, you can now use a mobile app to make sure the doors of your home are locked, the lights are off (or on) and the temperature is set to a cost-effective degree range.

We are now seeing the same flexibility from some applications and devices with regard to health. For example, from the balcony of a cruise ship a consumer can climb on a scale to get his or her weight and use a monitor to take blood pressure, aggregate that data on an app on a phone, track and trend the data points to ensure the salty cruise food is not impacting his or her hypertension or chronic heart failure (CHF) condition and, if concerned, upload the data to Microsoft’s HealthVault to have those results reviewed by a care provider.  

That seems space-age advanced at this point in time – but all the technology and apps exist. In the next five years, we will see that type of personal health management become the norm.

Q. What’s the most cutting-edge application you’re seeing now? What other innovations might we see in the near future?

A. “Big data” is the topic of many a health IT conversation, article and think tank debate, around speculation of what it could mean for everything from individual patient treatment to treating larger patient populations, and everything in between. 

That said, wherever people fall in terms of their speculative theories about big data, the general consensus is that mass quantities of data are, at the end of the day, simply mass quantities of numbers. They don’t mean much unless they are underpinned by analytical structure. 

The applications with potential in our brave new data-centric world – and there are any number of them currently available – have the capability to turn those mass quantities of data from biometric sensors and devices into usable (and by that I mean actionable) information, while also automating the feedback, call to action, or information provided to the individual. 

In terms of what we might see in the future and based on the current capability of applications to aggregate data in an impactful way, I anticipate increases in the amount of biometric information which can be generated by wearable sensors.

Q. What mHealth tool or trend will likely die out or fail?

A. Proprietary ecosystems or individual devices which do not 1) support the previously-discussed model, 2) scale in a massive way, or 3) provide clear and measurable value above and beyond what others provide will not survive in the long-term.

For example, what company today would invest in developing a blood pressure monitor that only provides a blood pressure reading and relies on the user to manually write the values down and take that to a physician? In the very near future, no consumer would purchase such a product, when any number of similarly priced Smart Bluetooth (BLE) devices are available that automate the data collection and reporting process.

The devices and tools of the (very near) future must be able to connect into a system that either aggregates the data to make it actionable or allows the patient to gather specific information based on input from a care giver, family member or personal research, to help them manage a chronic disease.

Q. What’s your biggest fear about mHealth? Why?

A. My biggest fear is that the breakneck pace of technology combined with the hegemony of the current healthcare infrastructure will ultimately slow the adoption of solutions in such a way as to miss capitalizing on technology’s greatest strengths.

Demonstrating the clear value of a technology-centric mHealth ecosystem is not something that can be done overnight, and the change needs to occur at all levels of the healthcare continuum – from patients to pharmacists to physicians and other healthcare providers. Proving the value proposition to those myriad parties happens slowly – and yet technology maintains its steady march forward, threatening to leave behind the marketplace that includes swaths of patients and providers who could benefit from its capabilities. 

One potential resolution to this is realized when health IT companies work in conjunction with healthcare providers or organizations such as the FDA to ensure new or developing solutions are structured around the real-world pain points for all facets of the care continuum.

Q. Who’s going to push mHealth “to the next level” – consumers, providers or some other party?

A. A close look at the historical tech landscape of 40 (or even 30) years ago clearly indicates that the latest technology was typically driven by the military or enterprise, but all that has changed. With the integrated circuit and the relentless drive of consumer electronics and the development and evolution of the web and mobile computing, the world is vastly different today. Consumers now get the newest technology before it reaches the organizational level of either the military or the enterprise.

This provides an opportunity for disruption, and the marketplace winners will be those who focus on the consumer and providing differentiating value for them. At the end of the day, when the dust clears, new economy usually equals old economy.

Q. What are you working on now?

A. At A&D Medical we have the luxury of having a presence in both the consumer and the professional healthcare markets. As a result, we get to be close to the needs, problems and changing dynamics of customers, users and industry partners in both.

As a result, what we are working on now is twofold: technology and education. 

The easy part is the technology component, providing a platform which bridges the care continuum. Allowing a consumer who buys one of our blood pressure monitors from a retailer to manage their blood pressure through our A&D Connect App and a secure WellnessConnected account in the cloud, add blood glucose management to that same experience if they want to (even if the device is from another manufacturer) and, finally, give them access to integrate directly into the telehealth service from their provider. 

In addition, we are working to ensure those same patients can also synchronize their data and their devices with their employers’ health plan services, as well as add other mobile experiences like weight or condition management from other partners.

The harder part is the educational work behind the scenes, which is necessary to help drive the distribution, logistics, economics and services which we will need to adjust to allow us to capitalize on the use of technology within the care continuum. As vendors in the Health IT space, we need to continually demonstrate how technology – the right technology – can provide substantive benefits for improving health outcomes and lowering the overall cost of care to consumers and healthcare providers.