Telemonitoring health catches on in Hawaii
By Greg Wiles
Advertiser Staff Writer
By Greg Wiles
Dew-Anne Langcaon recently received a text message on her cell phone reminding her to take a blood-glucose reading.
Another message relayed that she'd had a high reading and should review what caused it. A third cheered "Good work. Your last glucose reading was on target. Keep up the good work."
Welcome to the newest wrinkle in home telemonitoring.
Langcaon, 44, is one of a handful of people in Hawai'i using gee-whiz technology to monitor and manage diabetes.
The system employs traditional medical monitoring equipment, Bluetooth wireless technology, cellular telephones, special software and the Internet. Langcaon is able to have her blood-glucose readings almost effortlessly and automatically zipped from her glucose meter to her cell phone to computers that read and analyze the results.
A text message is then sent to her cell phone either nudging her to do better or reinforcing her good habits.
"They make you feel bad when you need to do some work," said Langcaon, who is part of a healthcare firm, Ho'okele Personal Health Planners, that's marketing the system in the state. The same system can be used to monitor people with congestive heart failure, hypertension and obesity problems.
"But they make you feel good when you've done a good job."
Such sophisticated wireless systems are expected to grow in number if studies under way show they are cost-effective and may present a partial solution to Hawai'i's vexing nursing, doctor and specialist shortages.
"It's really the next wave of healthcare," said Dale Vincent, director of telemedicine at the University of Hawai'i's John A. Burns School of Medicine.
Already systems with less ground-breaking technology are being used elsewhere in the state. UH has a UH Telehealth Research Institute that researches use of telecommunications and advanced computing in the delivery of patient medical care and training for doctors.
On Moloka'i, Kaunakakai resident Wilford Lee has used a device the size of a telephone to monitor his heart condition and a high-level defribrillator in his chest. When a light blinks, he hits a button on the device and places a microphone-like gadget onto his chest for anywhere from 10 seconds to three minutes to ingest data from the defribrillator.
The device is connected to a phone jack and the data is automatically sent to Honolulu for review. Should Lee have ventricular arrhythmia and the defribrillator shocks his heart back into a regular rhythm, he can use the machine to send an EKG to his cardiologist, Dr. Joana Magno, in Honolulu.
Magno can also be notified if certain conditions are detected. She also can watch the data in almost real time at a secure Web site set up by the system's maker, Boston Scientific.
"It's made living with the condition a little simpler," said Lee, 73, explaining that, otherwise, he'd have to go to Molokai General Hospital, which would hook him up to a different machine and then send the data to Hono-lulu. There's also the added peace of mind knowing the system is there.
Said Magno, a busy heart specialist, "Checking pacemakers remotely has been done for many years, but not to this degree of sophistication."
Telemonitoring has probably been around since the start of telecommunications, but in recent years more applications have been evolving as researchers look at ways to use wireless technology, cell phones, the Internet and software to improve on patient care. Earlier this year a study determined home telemonitoring appeared to be a promising patient management tool.
It "empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions," said the study published in the Journal of American Medical Informatics Association.
Yet the study and others question whether the results can be sustained if all of the cutting-edge home telemonitoring will be kept cost-effective if spread to a wider audience. For now the Hawaii Medical Service Association, the state's largest health insurer, doesn't reimburse Langcaon for the diabetes system. There is Medicare reimbursement for Boston Scientific's Latitude system.
The system Langcaon uses is made by Confidant Inc. and costs a total of $500 for Cingular customers for the first three months and includes materials and consultations with a nurse. After that the price drops to $40 monthly. Other pricing is available for long-term contracts.
Dr. Joseph Humphry, medical director at HMSA, said that some of the new wireless home-monitoring technology looks promising, but he added that studies need to be done examining how much difference the devices make in patient care.
Something like the diabetes and obesity monitoring systems offered by Langcaon's Ho'okele Personal Health Planners may be beneficial for the right people, but questions remain if all people will do well with the system, he said. Medical insurers weigh such factors in deciding reimbursements.
"I have no problem for highly motivated patients, this is absolutely the right thing to do. You don't need validation," Humphry said. The question is whether it will work as well for people who aren't as diligent about managing their chronic diseases, he said.
But "clearly some of this technology is going to make things much more efficient and convenient for all of us."
That could be the case with an upcoming project between the University of Hawai'i medical school and Hawaii Medical Center, the set of facilities previously known as the St. Francis hospitals. According to UH's Vincent, the study will monitor dialysis patients at home, with one focus being how it can improve healthcare delivery.
"The goal there is to see if we can detect if they are having problems and if we can intervene early so they don't have to go to the emergency room," said Vincent, explaining that besides possibly improving patient care, it has the potential to lower healthcare costs.
"If it can prevent one hospital stay for one night, it can pay for itself for a year."
There too is the possibility that people will take an increased role in management of their health when using the systems and that Hawai'i will need to make greater use of the technology as it copes with a lack of specialists and nurses in parts of the state.
"I think there's no question that that's going to be a significant part of Hawai'i's healthcare in the future," Vincent said.
Reach Greg Wiles at firstname.lastname@example.org.