Will Technology Lower Health Care Costs?

For the past six months, I��ve been working with Byron Davies of the Medical Informatics Department at Arizona School of Health Sciences (a unit of A.T. Still University of Osteopathic Medicine) under a grant from St.Luke��s Health Systems. We applied for, and received, the grant, because we and St. Luke��s believed that technology is one of the only ways to lower health care costs, and that it could be used more effectively, especially in remote monitoring of patients with chronic diseases, who are the ones costing the health care system billions of dollars.

We decided to start with studying diabetes, for obvious reasons. (It��s an epidemic).Like most researchers, we started with a theory, and we thought if we could prove it we could change the world. But now that we��re a ways down the road, we��ve come to learn some really interesting things.

We used a focus group approach. We know this isn��t the most accurate way to do research, but we thought we could at least start here and learn what questions to ask in a larger investigation. We have done two focus groups so far, both in disadvantaged communities, with the incredible help of the Arizona Association of Community Health Centers and its members (more about them in the future! THEY ROCK!) We will do a third group to check our results, so this little interim report is only a snapshot. But what an illuminating snapshot!

The groups consist of a combination of patients, payers, and providers: diabetics, nurses and doctors, diabetes educators, and insurance companies. First, we arrange for lunch �� .

Then we introduce the health system crisis and the role of chronic disease in healthcare costs.We introduce ��healthcare transformation�� and disease management as overall solutions, with the focus on using the best care today to avoid higher costs down the road.We contrast the advances in medical technology with the relative paucity of technology for self-management, including behavioral change.We talk about possible roles for technology in self-management.

And then we listen �V to learn what people think about the technology they use, what they think about technological possibilities for tools to support self-management, and what they value in human support of self-management.

There have been some big surprises for us along the way, and likely there will be more before we finish the groups. Bottom line: patients are indeed using technology, even though its clumsy and often not really working for them. They��re not really averse to it, but they often use it incorrectly, for reasons of education, availability, and affordability.

For example, they monitor their blood sugar, using glucometers with the wrong test strips, because they don��t know that the strips and glucometers aren��t interchangeable. Many patients carefully monitor themselves and produce useless data!

Clinicians want to see an easy-to-use, easy-to-read, standardized glucometer that supports data uploads for computer-based trending. There are too many different glucometers and too much payor-related ��churn��.

Another problem is that clinicians fear getting too much data about their patients with no reimbursable time to do anything with it. Right now, the insurance reimbursement system favors critical intervention, rather than prevention. No one is reimbursed for helping a patient use a glucometer correctly, or for trending the data that is received.
However, this is NOT a reluctance to use technology. Clinicians and patients alike think that real-time transmission of the data to their clinician's computer would make patients more likely to do regular monitoring and more likely to maintain healthy behavior.

What��s more, patients are unconcerned about sharing additional data with healthcare providers, despite all the hoopla about HIPAA.

The major roadblock to technology deployment and adoption, both by providers and patients, is the payment issue.

But for the populations we've looked at so far (community clinics in disadvantaged areas), remote patient monitoring is not the technology at the top of people's lists. First and foremost must come the electronic medical record. EMR's are neither universal nor standardized, so both data collection and data sharing remain difficult and time-consuming tasks. And you can��t do remote monitoring without a cyber-repository for the information.

Actually, in our target populations, the most impressive efforts have come from the diabetes educators and case managers who spend time with the patients on a regular basis, teaching them how best to live with their conditions. Time after time, focused case management of patient with diabetes has been demonstrated to be effective in improving a broad variety of health measures. We��re not finished yet, but I bet that when all is said and done, the best use of technology in the management of chronic diseases will be to make face-to-face interaction more effective and more efficient.