The demand for innovative patient follow-up


Alan Rickman, Carrie Fisher, Debbie Reynolds, and George Michael. In just this past year, we have lost these four, and millions more, to chronic diseases. The CDC states chronic diseases like heart disease, stroke, and cancer are the leading causes of death and disability in the U.S. All of our lives have been affected by one, if not many, of these illnesses.

As health care professionals, we counsel patients to eat better, live healthier, become smaller, faster, and stronger. But we can only advocate for a patient’s health when they are in the clinic. When (or if) they return, often their condition is the same or worse.

One popular mantra among the fitness community is “six-pack abs are made in the kitchen, not the gym,” meaning 1 hour spent exercising can be completely undone by 23 hours spent eating tasty treats. This same principle applies to the treatment of chronic diseases: the path to changing a patient’s life for the better requires more longitudinal treatment than just a single visit counseling session.

The visit quickly becomes a race against the clock. Physicians, nurses, medical assistants, physician assistants, and all other health care professionals have limited time, just like our patients. As much as we may want to coach each one of our patients on to a healthier lifestyle, follow-up takes a huge amount of time and manpower. Thinking we can follow up, especially with chronic diseases, with every patient every day simply is impossible.

But the demands on time are about to grow with MACRA on the horizon, if not the elephant already in the room. Health care professionals must give better treatment for less money. The future depends on the capacity for innovation, particularly those innovations that improve health care efficiency.

Quality improvement trials and other research attempt to address the increasing demand for maximizing efficiency. The boom of modern technology allows for simplification and automation of some complex processes. Unfortunately, many new technologies will not reach patients due to high expense, high maintenance requirement, or simply a better or cheaper product coming available.

Innovations that rely on time-tested and everyday technologies are often the most affordable and reliable. A very promising example is text-based interventions. Text-based interventions rely on the widespread use of cell phones, but do not require iOS Supple Leopard or Android Unicorn Frappucino. They utilize SMS text messaging, and are thus accessible using any phone. With intelligent automation, health care professionals can set alerts for specific responses while tracking patient adherence and improvement. Cost lowers for both the patient and the physician; patient adherence maximizes by the convenience of using a device they always have on-hand. Further, diseases requiring longitudinal following (like COPD, asthma, or depression) can be continuously monitored with relatively small manpower.

Such novelty produces unique challenges, most notably privacy concerns with cell phones. By requesting only actionable, relevant symptom data (like blood pressure, inhaler use frequency, or survey responses), privacy is ensured. Physicians can respond to dangerously high blood pressures while the system continues to remind and record the data of other patients, comparing it against past submitted values for consistency.

Novel applications of technology in health care such as this empower physicians and patients to participate cooperatively in care. The new demands on the health care system require professionals and patients to work together closely for the best outcomes. These demands can only be met with a revolution of innovation. We in health care have incredible minds; let us put them to use once more on behalf of our patients’ health.

Jacob Adney is a medical student.

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