WASHINGTON — It's not easy being diabetic.
Life is filled with lots of additional responsibilities: the finger sticks, the glucose monitoring, the hemoglobin A1c testing, the foot and eye exams. So how can things be made easier for diabetes patients and their physicians?
One answer is technology, according to several speakers at a diabetes meeting sponsored by Avalere Health. And for Amand Iyer, president and COO of WellDoc Inc., a Baltimore-based software company, that often means the cell phone.
Cell phone use can help to overcome one of the biggest barriers in the adoption of new technology: cost, said Mr. Iyer, who is a type 2 diabetes patient. “Wireless operators are measured on two things: average revenue per user, and the amount of marketing dollars they invest to [regain] a lost subscriber, which is $343 per lost subscriber per year,” he said. “If you can extend the wireless operator's contract for 1 year by providing a 'sticky' health application, they're willing to share that $343 with you.”
That's exactly what WellDoc is doing: marketing one program as a “virtual coach” that diabetes patients can load onto their phones. “You register online or on the phone and provide your demographic information, phone number, and the drug regimen you're on, and when you're finished, you get a text message that says, 'Click here to download the software,' “ Mr. Iyer explained, noting that it will work on most commercially available cell phones. The software has blood glucose target ranges, high and low alerts, and [information on] what to do for hypoglycemia, and it can be modified for patients with multiple comorbidities such as diabetes and heart failure, he said.
The software also includes a learning library with information on diabetes self-care, and a mobile logbook that users can access on a computer so they can see how well they're meeting their targets. And the cell phone acts as a “nerve center” that communicates with the patient and whomever else he or she chooses, such as a physician, caregiver, or diabetes educator.
Patients can enter useful data for alerting themselves and physicians to preset trends—for example, if the patient is hypoglycemic twice in a 10-day period. Physicians can choose to receive the information in whatever way suits them best, Mr. Iyer said.
“[One doctor may say] 'I don't have a computer; send it to me in a fax the day before [the patient] comes in.' Some doctors with brittle diabetes patients have said, 'Hey, can I actually get the software on my phone? Because I just made this medication change for this brittle patient and I want to see how he is tracking.' “
Mr. Iyer's company also is working with a glucose monitor firm on getting a wireless chip installed right on the meter. “Patients would pull their strips as they do normally, get the feedback on the meter, and get all their alerts and reminders right off the meter.” His company is developing similar modules for other diseases, including heart failure, hypertension, and dyslipidemia.
At Partners in Health, a group practice affiliated with the University of Pittsburgh Medical Center, one technology application that has gotten a good response is electronic “office visits,” according to Dr. Grant Shevchik, the practice's medical director. Patients fill out online questionnaires—“the only physician visit where the patient records the history”—and the messages are sent directly to their physicians for a response. The new service generated 286 “visits” from Aug. 28, 2008, to Jan. 31, 2009, said Dr. Shevchik, a family physician.
“Our oldest patient who has done this is 82,” and many of the others are in the 35- to 44-year-old age group. “These are not the 22-year-olds,” he added.
Not only is the service “affordable, convenient, and efficient,” it also has a CPT code (99444), he noted. The code can be used only once during a 7-day period and the visit must meet several other criteria: It must be patient initiated, it must involve a timely response, and there must be permanent storage of the visit information.
At Johns Hopkins University in Baltimore, employees with chronic illnesses such as diabetes can take advantage of Telewatch, a telephone monitoring program, said Dr. Ines Vigil, associate medical director at Johns Hopkins HealthCare, a health plan that includes 47,000 university employees.
“The employee can call in and type in their blood pressure, last cholesterol-screening results, their symptoms, and their stress levels, and it gets rolled into a system that our nurse case managers and clinical screeners are able to follow over time,” Dr. Vigil explained. “The system will red-flag something if it's abnormal.” If a patient calls in an abnormally high blood pressure or glucose level, “then our clinical screener will inform the case manager to give the member a call,” she said. The patient is then informed about recognizing abnormal values, accessing care, and checking their medications. More than 1,000 people are participating in Telewatch, she said, noting that patients with more serious chronic illnesses talk with nurse case managers more regularly.