|
||||||
|
|
|
|
|||||||||||
|
|||||||||||||
| ||||||||||||||||||||||||||||||||||||
In an era of increasingly indispensable personal electronic gadgets, the notion of consolidating their functions into fewer devices seems a no-brainer.
For those with chronic conditions such as diabetes, technical convergence makes even more sense. With medications, meters, pumps, injections, and the need to carefully track and document vital signs, some diabetes patients may welcome a bit of help from technology.
Now the call is being answered, literally.
Whether this will result in widespread adoption and better self-care for patients or simply more work for clinicians as they strive to manage a new stream of information is the central question as this new frontier of electronic medicine is explored.
CELL PHONES
Several medical companies are developing smarter, more convenient monitoring equipment and are using telecommunications technology to create multipurpose portable devices for patient use. One of these companies is HealthPia America, a Newark, N.J.–based telemedicine venture that has developed a cell phone that also serves as a blood glucose monitor and features a pedometer.
The company introduced its Diabetes Phone in May 2003 and is working on a pilot study with Children's Health Services Research at Indiana University School of Medicine. The objective of the study, funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, is to see how adolescent users with diabetes like the phone. Researchers also will survey the children, their parents, and their care providers about how to upgrade the service for commercial purposes, and follow up with a clinical trial. HealthPia America CEO Steven Kim says he anticipates approval from the Food and Drug Administration pending the results of these studies.
But how does it work? An embedded electronic biosensor in the battery pack is the key to making the cell phone double as a glucose meter. The sensor reads blood glucose levels from a strip, then the data is uploaded to the cell phone's display. The phone can be programmed to send the information instantly to a health care provider, parent, or guardian.
Movement and exercise also can be monitored with the built-in pedometer. The phone can be programmed to send an alert to the caregiver or clinician via short-message service if there is no pedometer reading for the pre-programmed length of time. The care manager can call back to check if the patient is okay, and if there is no response, prearranged emergency procedures can be initiated. This feature could be especially useful for detecting insulin reactions or comas in diabetes patients.
The biggest advantage of the Diabetes Phone is its alarm features, which allow a physician to set specific parameters, according to Bernard Shagan, MD, chief medical director for HealthPia America. Shagan recently retired as co-chair of endocrinology at Monmouth Medical Center in Long Branch, N.J., where he ran the diabetes education program. If the phone reports continuously high blood glucose, for example, a doctor can react in real time, he notes.
Other diabetes-cell-phone projects include research at Oxford University in the U.K. to test a system similar to that of HealthPia America. In another venture, British patients with diabetes have been able to register since 2002 with Sweet Talk, a message service that reminds them via cell phone to take their insulin and offers general education about living with diabetes. And in 2003, IBM announced its "Bluetooth" short-range wireless technology could be used to intercept a person's heart rate and send it to a cell phone.
PDAs
Roche Diagnostics, maker of the Accu-Chek line of diabetes-care devices, also has been working on wireless products, says Nancy Lonsinger, vice president of consumer marketing. Several of the Accu-Chek meters have infrared capabilities for downloading, she says, through which the products can "beam" information on glucose results to a personal digital assistant (PDA), for example.
Pocket Compass software, which originated from a desktop product, allows patients to store their diabetes information in the PDA for quick access to charts, graphs, and trends. The data can also be sent to a secure web site or via e-mail. Because infrared capabilities are limited by distance, the information cannot yet be transmitted wirelessly with the Accu-Chek system.
PDA-managed diabetes care is not entirely new. TheraSense (now owned by Abbott Laboratories) released its FreeStyle Tracker diabetes management system in June 2002 for use with its blood glucose meter and the Handspring Visor PDA. FreeStyle Tracker may have been launched a little before its time, however, and due to lack of a market, was discontinued last fall, an Abbott spokesman says.
"What we're finding in the wireless world is that no single device is the answer or the solution," says Claudia Tessier, executive director of the Mobile Healthcare Alliance. Which system to use—cell phone or PDA or maybe something else—depends on the personal preference of the patient, she says.
"We think there are huge applications," says Joseph C. Kvedar, MD, founder and director of Partners Telemedicine, a service of Partners Healthcare System in Boston. The possibilities of marrying technology with feedback on diabetes, obesity, and cardiovascular disease are limitless.
COMMUNICATION AT A COST?
While reacting in real time is certainly a benefit, a potentially heavy stream of data (from any number of patients) coming into a busy clinician's office in real time could be more burdensome than beneficial for clinician and patient alike. Shagan suggests that a central monitoring service with a physician's assistant collecting and sorting the data could help ward off such dilemmas.
Overloading practitioners with patient information is counterproductive, concurs Kvedar. He is leading research with Motorola, Inc., to test Motohealth, a system that uses body sensors to transmit a patient's health data, such as blood pressure and glucose level, to a care provider using a Motorola mobile phone. The initial trial is monitoring patients with congestive heart failure.
"There is no question that communications technologies that are familiar to our patients, like cell phones, will be an important part of health care in coming years, especially for patients with chronic conditions," Kvedar says.
Another barrier to cell-phone diabetes management is working out insurance coverage. Although strips and meters are at least partially covered by law (the level varies by state), it is unclear how or if insurers will pay for the cell-phone service.
Kim of HealthPia America says he does not think insurance companies will cover the phone any time soon, but that there are continuing efforts on multiple fronts to encourage coverage of e-health care, such as physician consultations via the Internet.
"Frankly, from a business point of view, they [insurers] are not as interested in preventive care because every 2 to 3 years, people change insurance companies. So it doesn't help them reduce costs," Kim says.
Kvedar is more hopeful, categorizing the work Partners Telemedicine is doing as "disease management." He says most payers have some familiarity with that concept and are embracing disease management in one way or another because it allows them to spread risk to other parties.
If the new cell phone can be proved to lower the overall cost of care, Kvedar can envision a marketing scenario where the phone is a giveaway in a doctor's office and the service is sold through a service provider partnered with a disease-management firm and paid for by an insurance company.
"I don't know if that will work out, but it is the kind of arrangement we're looking at," Kvedar says. "What is certain is that disease management in the future will be different from the way we do things today."
A signal of what's to come, Kvedar says, may be read in the "outpouring" of support in recent months from the payer community over tools that allow provider and payer to agree on quality metrics. This could allay practitioners' fears about not getting paid for more closely managing their patients.
"If doctors get panels of patients [for which they] are paid based on
performance, that will encourage adoption of these tools," Kvedar says.
"This is all movement in the right direction."
|
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||
|
||||||
|
| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
