The latest from my friend (and font of wisdom) Susannah Fox, is a piece about Internet use amongst the chronically ill. It compliments data from e-patients.net showing that the phenomenon of patients using the Internet as a tool to become proactive with their care skews to younger and healthier individuals. Fox’s recent report notes that of patients with two chronic illnesses, only 52% are Internet users. Likewise, the other study notes that only 27% of patients over 65 define themselves as e-patients.
This is consistent with our observations in rolling out connected health programs in a large integrated delivery network. For instance, in one of our primary care practices, only 60% of diabetics we enrolled in our home glucose monitoring program were Internet users. In our CHF population, it’s even less.
I always note this when talking about technology choices and program design. There are so many really exciting iPhone apps out there for example, but we haven’t tried to deploy one in our setting because the population of patients who would find it useful, let alone familiar, is tiny. This is because we care for a disproportionate number of Medicare recipients (essentially all > 65) and Medicaid recipients (low percentage of Internet access there too). If one is an employer or health plan that insures an employee population, the technological opportunities are vastly more intersting.
So we use lowest common denominator technologies in most of our programs. The best news is that we’ve learned that Internet access is not a must for improved care. For instance with our diabetic population, if the patient uploads their glucose readings (via analog phone line) and if the nurse in the practice (after seeing their data on the website) stays in contact with the patient, even by periodic phone call, their health improves. Its those two variables (patient uploads and provider views of the data) that correlate most strongly with better outcomes.
This is not to knock the Internet or e-patients. We’ll all get there eventually. When my youngest daughter gets old enough to have two chronic illnesses she will surely demand that all health care is delivered via text message! In the meantime, we can use more primitive technologies to achieve the vision of connected health – care where the patient is/when the patient needs it.