Electronic Health Reporter

Guest post by Sid Nair, vice president and global general manager, Dell Services Healthcare & Life Sciences.

If you’ve ever watched a person go through the first stages of coping with type 2 diabetes – and with the disease at epidemic levels, many of us have a close friend or relative with the disease – you’ve seen them struggle to put into practice all the information, advice and strategies they are given.

This is true of most people with newly diagnosed chronic diseases, not just diabetes. To avoid complications, and the huge costs in both suffering and money that come with them, they have to learn a new way of living. Medication and other treatments can’t take the place of lifestyle changes. And despite their best efforts, many people are defeated by the challenge.

We now spend 70 percent of our healthcare dollars on chronic disease care, much of it to treat complications that lifestyle changes could avert. All that money isn’t really helping. People continue to suffer and to lose years of productive life. If we could find a way to help these people improve their health, we could dramatically reduce both suffering and costs.

Chronic disease patients need tech support

One thing we’ve learned here at Dell is that in helping hospitals implement an electronic health record (EMR), at-the-elbow tech support makes a big difference. And learning to use a new EMR has many of the same challenges as learning to live with diabetes.

To go live with a new EMR, doctors and nurses have to learn a new way of working. It’s more than just a software change. It’s changing everyday habits that have kept the operation running for years. That’s why it is crucial to have someone to guide the caregivers through the first days and weeks. The right support lowers users’ frustration, increases their confidence and makes the difference between a quick, smooth transition and a drawn-out, rocky transition.

That kind of tech support could also help patients with diabetes and other chronic diseases learn a new set of habits. For diabetics, even a simple thing like breakfast can be a challenge. If you can’t pick up your usual donut, what’s the alternative? Friendships can be harder. “No, sorry, I can’t go to happy hour for chips and a margarita,” isn’t what your friends want to hear. Add in blood sugar checks, medication and a new exercise routine, and it can be overwhelming. None of it is fun, and all of it distances you from friends and daily comforts.

Diabetes education classes can help, just as training classes for doctors and nurses can help them learn a new EMR. But patients also need the same at-the-elbow tech support for their new life that caregivers need for their new EMR. They need a knowledgeable, friendly healthcare tech support agent who can suggest a happy hour walk with your friends or what to drink instead of a sugar-loaded margarita. Or tell you about a healthy breakfast sandwich that is right on your way to work. Or how to tell your mom that you won’t be eating her famous pancakes at Sunday brunch. Someone to boost your confidence and make you feel like you can succeed at this new life.

New technology makes at-the-elbow support possible for patients

Sadly, most of patients are pretty much on their own. The result is confusion, loss of confidence and a sense that it is all just too hard. And that means expensive complications and more suffering.

 The good news is that new telehealth technology can bring at-the-elbow support to patients at home, at a price that is affordable. While support can’t be literally at a patient’s elbow, secure video conferencing can give patients access to doctors, nurses and health coaches who can answer questions, give advice on medications, food, exercise and how to lose the unhealthy foods without losing the relationships that are tied to them. And most patients already have the technology needed – a smartphone, tablet or computer.

Remote, Internet-connected monitoring devices (such as glucometers to measure blood sugar, spirometers to measure breathing ability and smart pill containers to alert patients and caregivers if a dose is missed), can give both patients and caregivers feedback about what is working and what isn’t.

Because telehealth visits allow patients to interact with caregivers in their own homes, where they are more at ease, they are more likely to remember and understand the advice they are given. Like the tech support that helps medical staff use a new EMR, telehealth can help reduce frustration and build confidence for chronic care patients, helping them make a smooth transition to their new routines.

And the new technology allows a single caregiver to provide home visits to dozens of patients without leaving the office. That makes intensive, at-the-elbow support affordable.

The proof: better health, lower costs

This isn’t just a theory. A Veteran’s Administration study using telehealth with 70,000 chronically ill veterans showed a 25 percent reduction in hospitalizations compared to patients not using telehealth. That’s a key indicator that the overall health of the patients was better. A study in 2011 of two groups of Medicare patients with chronic illnesses found comparable reductions in cost that were due to improved health of the patients.

A 2013 study by the telehealth company Health Net Connect of 24 congestive health failure patients found that telehealth and remote monitoring significantly reduced the number of patients who needed a repeat admission to the hospital. Of the 12 patients who used telehealth, only one had to be readmitted within 30 days of discharge. In the control group, seven had to be readmitted. The study authors linked the improved health of these patients to the telehealth visits, which fostered in patients a better understanding of their disease and how their actions affected their symptoms.

Hospitalizations and emergency room visits are two of the biggest costs in chronic disease care, and access to telehealth and remote monitoring appear to reduce the need for these services. Patients suffer less, and costs go down.

Medicare and Medicaid now reimburse physicians and hospitals for services provided via telehealth technology, and private health plans are quickly following suit. So the time has come to use this great new technology to make real progress on chronic care outcomes.

Telehealth is not just for chronic care, it’s also being used to expand access to care in all kinds of ways. But that’s a topic for another blog.