Patients and physicians nationwide are leveraging health information technology to make their health care interaction more efficient and effective without necessarily having to be face-to-face. The use of existing and emerging technologies—such as cell phones, personal health records, mobile apps, and monitoring devices–are creating ways for patients and providers to monitor health conditions remotely.

Endocrinologist, Dr. Gail Nunlee-Bland shared her story with ONC about several telehealth studies she has done with elderly patients to help improve their diabetes self-management.

To learn more about Dr. Nunlee-Bland’s practice and health IT programs, see Part I of ONC’s interview.

Benefits of Telehealth for the Elderly

ONC:

You recently completed a telehealth program, tell us more about it.

Nunlee-Bland:

This telehealth program was funded by the National Institutes of Health (NIH). The primary goal was to reduce patients’ hemoglobin A1C to less than 7 percent. Patients were provided a laptop, and we had a nurse educator conduct virtual visits with the patients in their homes. They were shown how to use video conferencing, which the elderly patients really liked because they didn’t have to leave the comfort of their home for an appointment. The system was tied to the educational portal so they could review materials online with a workbook that would help them manage their care. Since the elderly patients weren’t very computer-savvy, there was a real need to begin with basic computing education. There appears to be a digital divide regarding age—those over 60-65 are less likely to adopt electronic technology to manage their health. It’s important to have a higher level of involvement with elderly patients, to help them understand the value of computers and technology. They were pretty easily convinced to join the telehealth program once we discovered if they had a computer or Internet access, but there was more work to make sure they were comfortable with the technology because self activation is a factor too.

A total of 47 diabetic patients participated in the study with 26 in the telehealth intervention group and 21 in the control group. The 26 participants who had telehealth visits were 4.58 times more likely to reach the desired hemoglobin A1C target of less than 7 percent.

The remote patient visits were mutually beneficial—the nurse enjoyed the interactions, and the patients could upload their blood glucose readings, weights, and blood pressure measurements automatically, which the patients and the nurses really liked. Remote monitoring seems to be a better model for care. This allows you to see  if the patient is really managing their own care without disrupting their daily lives with an appointment. When they’re at home, they don’t get the “white coat hypertension,” that unexplained increased blood pressure that sometimes happens when they visit their doctor.

We had another component where the cell phone was integrated into the EHR and PHR called the DC CCI Diabetes Cell Phone Projects. We send text reminders to patients’ cell phones so they remember to update their missing health measures like weights or glucose levels. The younger patients liked that. For the older generation, we still had to call them for those kinds of reminders, because they frequently turn their cell phones off unless they’re making or expecting a phone call, so the telehealth program was more suited to them. In that project, they were very compliant with their appointment times so the nurses could obtain their data at that time. I think you have to tailor the technologies to the age group.

ONC:

Were there any surprises?

Nunlee-Bland:

We found most of our patients do have computers or access to the Internet—82 percent have access to a computer with Internet, and 95 percent have cell phones too. I looked at insurance demographics of patients who signed up for a PHR who had either Medicare, private insurance, or Medicaid.…Of the 298 patients who signed up for a PHR, 17 percent of the Medicare population signed up for the PHR, compared to 43 percent with private insurance and 40 percent with Medicaid insurance.  The main reason cited for the lower participation in the Medicare population was lack of internet access and computer skills.

Patient Activation Spells Success

ONC:

Did any personal successes stand out for you?

Nunlee-Bland:

We had one patient who is wheelchair bound involved in the cell phone project. It was harder for him to make a physical trip to the doctor; but, he had his cell phone strapped to his wrist and was an avid user of the mobile health technology. He would answer the questionnaires and was self-motivated, so when we checked the system we always knew his readings were current. His diabetes was well controlled remotely, and we hope we won’t have to treat him for any complications from diabetes in the future.

We correlated participants’ HgbA1cs with their input of blood glucose readings in their cell phones, and as a result, saw a significant drop in A1c versus those that didn’t participate in either the cell phone or PHR project.

For more information on health information technology, visit HealthIT.gov.