An initiative in South Bend will seek to use social media for helping chronically ill patients change their behavior, adding a human dimension to high-tech data-producing tools that have failed so far to yield large health improvements.
Investment in mobile health technology, such as iPhone apps, is doubling every quarter, providing physicians and other health care workers with detailed information about patient conditions. For example, a sensor can be implanted in an artery that sends pressure reports to a smart phone or the cloud.
But the advances have not significantly changed the way that people take care of themselves, says Dr. James Kelly, a longtime surgeon who earned an MBA in 2007 and started the investment and consulting company Cascade Partners LLC, focused on innovative medical devices.
"The uptake of mobile health technologies by the individual patient surprisingly hasn't been that great," he says. "I think ultimately what you have to do is find out what makes them suddenly become interested in their health in general and their specific medical problems in particular."
Such an investigation is part of the enFocus Michiana Venture Fellows' project involving seven Notre Dame ESTEEM graduates who are staying in South Bend for a year. Memorial Hospital, Saint Joseph Regional Medical Center and the South Bend Clinic are among the program's sponsors.
The stakes are high, both for the chronically ill people and for the financially strained health care system, where 1 percent of patients account for 20 percent of costs and 5 percent of patients for about half.
"We see the tremendous costs of things like diabetes and congestive heart failure and admissions and readmissions to acute care centers," Kelly says. "The real problem is not the short term. How do you get someone to modify his behavior who has been smoking all his life, who does not take care of his blood sugars?
"Find out who are the people who can make this person a changed person, how to modify the behavior for this particular individual, what are the kinds of things that will make him modify his behavior and take his medication."
Such people could respond well to social networking that provides behavior-changing support similar to successful programs such as Alcoholics Anonymous, he says. Individuals with similar conditions could meet to talk about, say, their diet or how they feel that drives them to schedule a doctor's appointment.
"We have to explore those kinds of things in the context of treating the disease process," Kelly says. "We have seen social networking work in certain groups of individuals. Those things that have worked there need to be extended to other disease processes. All these situations can be worked on in a more group atmosphere.
"To get them to change, you're going to have to see what makes them tick. Until we are able to really come to grips with those sorts of issues, those things are going to be as important as the application itself and the kinds of technologies we use. Giving ourselves the numbers is one thing, and being able to get people to change is another."
South Bend offers a right-sized laboratory for such a study, he says -- large enough to include a sample population, including uninsured or underinsured chronically ill patients, but small enough so that people notice when a member of the group is missing, unlike Chicago or New York.
"We have a well-defined population that isn't constantly changing," Kelly says. "Once we know the limits of a particular population, we can follow those people longitudinally. Then you get an idea of whether intervention helps or not."
As sponsors of the Fellows program, the hospitals expect progress such as reducing hospital admissions -- even a handful of prevented episodes would save several times the Fellows investment, he says.
"Expectations are being elevated for this group," Kelly says. "They expect us to meet certain milestones. They expect to see some reduction in admissions to the hospital or readmissions, some factors that we have to decide on whether they are successful or not."