Intelligent Medicine Blog

A reader recently submitted a comment based on our posts about the support required for better health decisions and the new technology products being developed to provide this support.  The comment focuses on the significant barriers to health system and user adoption and the hurdles to widespread use of such personalized, information-rich health products.

Let’s start with the inability or disinterest of many individuals to use health monitoring and therapy optimization innovations that would allow them to play a greater role in managing their own care.  Our reader commented: “Unfortunately, I think the majority of the population is just not motivated enough to take a proactive role in their health care, especially in preventive health care, unless they have immediate financial incentives.”

We discussed this topic with Dr. Joseph Kvedar, Director of the Center for Connected Health, a unique organization formed by Partners HealthCare to engage patients, providers, payers and policy makers on new ways to deliver quality care outside of traditional medical settings.  Dr. Kvedar talked about two small studies that have preliminary, but very relevant findings.  The studies looked at different technology-based patient physiologic monitoring and personal data-driven coaching interventions.  The coaching included the use of online communications and virtual, computer-based intelligence coaches.

Say hello to your virtual coach

He noted that the studies show simply providing accurate physiologic information to an individual has almost no benefit on its own.  However, Dr. Kvedar continued, “By monitoring a relevant physiologic signal–like blood pressure or whether you took your medications or not–and presenting that information to the individual in a way that is maximally engaging to them–such as in a dynamic website–we estimate that 10% of individuals will move to a healthier behavior.  These are the ‘manage what you measure’ types and what they need is the measurement presented in the right way.  If we add data-driven coaching, meaning that the individual feels that someone–virtual or real–is helping them, the percent of individuals that will move to a healthier behavior goes up to 50 or 60%.  The remaining 40 or 50% are probably people who are not yet ready to contemplate that they need to change behavior to become more healthy.“

This research suggests that the right technology products, implemented in the right way, might be adopted by a majority of people.  A requirement is that the new connected health tools are designed to be highly personalized and connected to data-driven support at the same time.  The reader’s comment also points out ways to capture and support even more people, perhaps even the lagging 40-50% Dr. Kvedar mentioned: incentives.  We have financial, social, aspirational and other incentives as part of most of our daily decisions, and health and wellness should be no different.  For example, if I take my medications as prescribed and monitor and share this through a connected health system, and if this personal behavior slows or prevents my disease progression in a way that reduces expensive interventional care in the future, shouldn’t I be rewarded for that by health insurers, employers and product innovators with lower copays, free or reduced priced medicine, wellness rewards or other incentives?  There are many studies underway to test incentive-based behavior change, some integrating novel connected health tools.  An article published last week in Technology Review describes a program at the Innovations in International Health project at MIT, where tuberculosis patients using a medication adherence diagnostic device tied to mobile phones are rewarded for their drug taking consistency with cell phone minutes.  If we develop connected health products and systems with the right features, support and incentives, real people will use them.