Diabetes Management Via Cell Phone

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Seeing CrunchGear get excited about HealthPia's upcoming offering of their Diabetes Phone seemed premature. It's a great idea, consisting of an integrated glucometer that checks a diabetic's blood sugar, uploads it to an online data center, and offers suggestions on how to manage a particular reading. It eliminates the common problem of patients losing their record of their blood sugars or forgetting to bring them to their office visits.

I just wonder who will monitor this record of blood sugars on an ongoing basis. I don't see physicians devoting their precious medical assistant's time to tracking these online records down, and wanting to be responsible for managing these trends outside of a clinic visit. The unfortunate truth about fee-for-service medical care is that any care provided outside of a clinic visit isn't reimbursed, such as telephone calls.

I can see that the diabetes disease management programs that health maintenance organizations (HMO) run could be interested. These programs hire nurses to monitor the health of many patients with chronic illness, and by improving their health, decrease their hospitalizations, decreasing the cost of care. HMOs are interested in decreasing the cost of care since they receive a set amount of money per patient, and have to take care of the patient with that set amount. The healthier the patient, the more profitable the HMO.

This conundrum brought me back 6 years ago to my time at Medicalogic, an internet based electronic health record (EHR) company. At the time, we partnered with Nokia and their subsidiary LifeChart who had a spirometer that uploaded peak flow readings to a central server to monitor the health of asthmatics. LifeChart needed a way to get these readings into the record that the physician recorded chart notes, and that was the business Medicalogic pioneered - an internet based EHR. That is to say, the readings could be uploaded electronically to Medicalogic's data server where both physicians and patients could view the readings and the status of their asthma.

The difficulty lies in who will pay for these devices, and for the physicians to participate in the increased technology and work it takes to care for these patients. Patients are unwilling to pay for the devices, as you see that devices only are widely adopted when covered by insurance. Physicians are reluctant to do more uncompensated work. Physicians don't want to pay for EHR, neither the software nor the hardware costs.

Until disease management programs see these devices, and the interfaces with EHRs, as critical to the success of keeping their patients healthy - I don't see them reimbursing for the costs involved. I posted recently about Viterion's success in keeping Congestive Heart Failure patients out of the hospital. When these new devices can show similar successes in cost reduction, then you'll see insurance companies stepping up to pay for them and the physician's fees in monitoring them.

As for the expense of the EHRs, hospitals and health groups have recently been granted an exception from Stark laws, and now can pay for EHRs for physicians. In the past, government policy prohibited this in order to decrease physician dependence on a particular institution, and increase competition among hospitals. Recent changes were due to the realization that EHRs are so important in improving the quality of healthcare, that this is more important than the anti-competetive provisioning of EHRs. EHRs completely change the workflow of a physician's office, and for the better. It does lock physicians to the group paying for the EHR, which the institutions love since they often make significant profits off of their ancillary care such as laboratory tests and x-rays. I'd argue that the quality improvements are worth this anti-competetive risk.

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About the Author


MD, FACP, FASN

Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.

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