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Overview of Cell Phone Use in Health Care Role in DoD Stability Operations

Overview of Cell Phone Use in Health Care Role in DoD Stability Operations. Eric K. Noji, MD TATRC Deputy Director, USAMRMC & OTSG Medical Informatics Consultant. 9 July 2008. Cell Phones in Health Care Topics. Background – Market forces Clinical Applications AMEDD initiatives

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Overview of Cell Phone Use in Health Care Role in DoD Stability Operations

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  1. Overview of Cell Phone Use in Health CareRole in DoD Stability Operations Eric K. Noji, MD TATRC Deputy Director, USAMRMC & OTSG Medical Informatics Consultant 9 July 2008

  2. Cell Phones in Health CareTopics • Background – Market forces • Clinical Applications • AMEDD initiatives • USG initiatives – PEPFAR/USAID • Stability Operations • ATA Proposal • Conclusions

  3. Cell Phone World Market Background • By FY09 - 3.3 Billion cell phone users (half the world’s population) • CY2008 - the worldwide mobile industry becomes a $1Trillion industry • 0 to $1 Trillion in 20 years: equal to a growth rate of 30% sustained for 20 years (previously unequalled by any other industry at any time in human history) • A 1 percentage point increase in mobile penetration in developing • countries is correlated with an increase of 4.7 percent of average per capita income. • – Telecommunications Management Group, 2007 • In 2007, worldwide, non-voice services accounted for 19% of total • mobile services revenues, and this keeps growing, reaching more than 26% • by the end of 2012. Worldwide consumer spending on non-voice mobile servicesin 2012 will exceed $251 Billion per annum

  4. The Role of Cell Phones in Clinical Care – Consultation/Education/Research

  5. CONVERGENCE LIFE SCIENCES HEALTH & WELLNESS Healthcare Services Healthcare IT Biopharmaceuticals Medical Devices Health & Productivity Behavioral Health Work/Life Balance Disease Management Disability Management Wireless Health WIRELESS TECHNOLOGIES Wireless Wide Area Networks (WWAN) Wireless Local Area Networks (WLAN) Wireless Personal Area Networks (WPAN)

  6. Cell Phone Applications • Clinical consultation • Education • Research • Biosurveillance • Real-time access to weather information - critical for those whose livelihoods are dependent on the fishing industry; improve access to instant data so fishing communities can be better prepared when a natural disaster strikes.

  7. Cell Phone Applications • CardioNet, a mobile cardiac telemetry technology • HealthPia - blood glucose monitor for diabetes patients integrated into a cell phone, enabling diabetes patients to test glucose levels, record results, and then send them to a caregiver using the same device they carry for making phone calls • Emerging markets: Implants and cell phones • data gateway and display device providing active, real-time feedback, coaching, and rewards for healthy, compliant behavior. • Biotronik in Germany has already released pacemakers that communicate to physicians via a mobile phone • Other implants: glucose monitoring, pain management, implanted defibrillators, weight management for the severely obese, and drug delivery

  8. The Impact of a Video Cell Phone Reminder System on Glycemic Control in Patients with Diabetes Mellitus • WRAMC Endocrinology sponsored R&D effort (MAJ Bell/COL Vigersky) • Hypothesis: patients with diabetes mellitus who are given a cell phone with a video reminder system will improve glycemic control in the short term (6 months) & that the knowledge obtained will carry over to the long term (1 year) • N=170; prospective, randomized, controlled study • 18 month study; $200K funded • Impact will be measured by reduction in A1c levels, number of high and low blood sugar fluctuations, mean daily blood glucose levels, amount of time spent in target blood glucose range, and responses to a general quality of life questionnaire, stress related to diabetes, and a diabetes-specific quality of life questionnaire.

  9. The Impact of a Video Cell Phone Reminder System on Glycemic Control in Patients with Diabetes Mellitus • Study group: will receive a daily 15-second video from their provider reminding them to take their medication and to test their blood sugar and an educational “tip-of-the day.” • Reminders will be personalized and recorded by their provider. • Ninety diabetes educational “tips-of-the-day” will be created and delivered (password protected) on a rotational basis. • Video message will be programmed to be viewed by the patient on a daily basis at a mutually agreeable time. • During the second 6 months, the patients will be followed by their provider at least quarterly with quarterly review of blood glucose and hemoglobin A1c measurement

  10. Cell Phone Use for TBI“Personal Tele-Rehabilitation for mild Traumatic Brain Injury (mTBI) Patients” Goal: To develop an evidence-based support program for mTBI patients & their families that enhances their ability to meet therapy goals while at home utilizing cell phones & data responses uploaded to a secure central server. 10

  11. Personal Tele-Rehabilitation • Utilize cell phones for TBI care • -Provide daily prompts & upload • results to a web server • 3 phase U.S. Army expansion • (up to 10,000 patients) • Consortium of expertise • USAMRMC/TATRC • Academic Research Partner • Commercial vendor • Prior Clinical Uses • Diabetes • Stroke Rehabilitation • Funding: $1.37M

  12. Phasesof Implementation Phase I: 100 Patients: NARMC CBHCO’s Evaluate the impact of using cell phone-based technology on rehabilitative care, on efficiencies of case management and user acceptance of the technology in order to make decisions about large-scale implementation. Phase II: 1000 Patients Phase III: 10,000 Patients

  13. Personal Tele-Rehabilitation for mTBI Patients Use the patient’s existing cell phones Used for frequent patient daily adherence reminders in the form of text messages or data exchanges. Web-based software platform that sends & receives information between the Case Manager & TBI patients Designed to augment care provided by the Case Managers Patient’s self-report data automatically sent back to web server 13

  14. Accomplishments • Technology Platform identified • Secure bidirectional prompts from Case Manager to Patient utilizing web based platform • Concept of Operations developed • Protocol Design Development nearly complete • Outcome Measures identified • Staffing requirements identified • Program Manager and Consultant hired • Project Liaisons (Case Managers at remote sites soon hired) • Consultants (Clinical & Technical identified) • Phase I - Kick off meeting August 5, 2008 14

  15. Clinical Outcomes Cell Phone Enabled Rehabilitative Care Patient responds to prompts to get to appointments* Patient attends therapy & medical appointments Decreased symptoms & complaints; resolution of impairments* Patient has cognitive problems that interfere with getting to TBI-related therapy & medical appointments. Improved life satisfaction* Participation in life roles and activities* Use of cell phone-based tool* Improved carryover in daily life Patient responds to prompts to practice/employ treatment recommendations* Case manager makes real time adjustments to plan of care and/or intervenes Case manager monitors details of care & obtains family perspectives via website* Patient responds to prompts to solicit input from family

  16. Regional View: CBHCO-WI CBHCO-WI Rock Island Arsenal, IL – Ft Lewis PEB (select few DC-PEB) UNCLASSIFIED/FOUO

  17. Regional View: CBHCO-VA CBHCO-VA Virginia Beach, VA - DC-PEB UNCLASSIFIED/FOUO

  18. Regional View: CBHCO-MA CBHCO-MA Concord, MA – DC-PEB UNCLASSIFIED/FOUO

  19. Cell Phone Markets in Africa • The number of mobile subscribers in Africa at the end of 2005 was 114M; forecast to rise to 378M by 2011 – 22% growth rate and 265M net additions in 6 years • 95% of the subscriber base in Africa is pre-paid, indicating excellent prospects for SMS based services tailored to the African market • As Africa relieves its debt burden, continues to liberalize its telecoms markets and open up to further competition and foreign investment, the mobile sector will be a vital component of future growth in a continent with an under developed fixed line telecoms infrastructure

  20. $10 million public-private partnership (GSM Association DevelopmentFund, Accenture Development Partners, Motorola, MTN and Voxiva) to leverage technology to connect health systems in 10 PEPFAR-supported countries by 2010- Phones-for-Health to support treatment for 2 million HIV-infected people, support prevention of 7 million new infections, and support care for 10 million people infected and affected by HIV/AIDS in an accountable and sustainable way.- System allows health workers to report data from the field using their mobile phones, as well as PCs and PDAs.- Data is mapped and analyzed by the system and made immediatelyavailable to health authorities at multiple levels via the web.- The system also supports SMS (text messaging) alerting and notificationand tools for communication and coordination with field staff.

  21. Qualcomm Wireless Reach Initiative • Empowers underserved communities through the use of third generation wireless technologies (3G) • Objective: strengthen economic & social development with a focus on education, governance, healthcare & public safety. • Wireless Reach creates sustainable 3G projects through partnerships with non-governmental organizations, universities, government institutions, development agencies and other private sector companies. • Established in April 2006 – 30 projects in 19 countries • http://www.qualcomm.com/community/wireless_reach.html

  22. http://www.qualcomm.com/wirelessreach/projects/healthcare.htmlhttp://www.qualcomm.com/wirelessreach/projects/healthcare.html

  23. Qualcomm's Wireless Reach Initiative Brings Advanced 3G Technology to Vietnam Communities (Business News & Technology News, 26 Mar 2008) • Community Technology and Learning Centers in Vietnam’s 64 provinces is part of the Training Online Programs and Incubation for Communities (TOPIC64) initiative • Supported by USAID's public/private partnership agreement with Qualcomm through its Wireless Reach initiative and other TOPIC64 partners • Electricity Vietnam Telecom (EVNTelecom), Microsoft, Hewlett-Packard & the Center for Research and Consulting on Management • Established April 2006 • Approximately 24,000 students have been trained with the centers' basic IT training program, about 840 teachers have been tested and trained about the new curriculum and teaching methodology

  24. Stability OperationsRole for Cell Phone delivered Health Care? • “It is DoD policy that stability operations are a core U.S. military mission that the Department of Defense shall be prepared to conduct and support. They shall be given priority comparable to combat operations and be explicitly addressed and integrated across all DoD activities…[1]” • A critical concern in implementation of this Directive is to “Ensure DoD medical personnel and capabilities are prepared to meet military and civilian health requirements in stability operations.” [1] DOD 3000.5, November 28, 2005 “Military Support for Stability, Security, Transition, and Reconstruction (SSTR) Operations”, Section 4.1

  25. American Telemedicine Association Cell Phone Proposal for ASD(HA) • Identify currently available and planned applications for wireless healthcare that could meet DOD requirements in implementation of DOD Directive 3000.05. The focus will be on applications appropriate for the following areas: • Disease identification and surveillance • Teleconsultations • Intelligent decision support • Other healthcare applications[1] • Identify and recommend the most appropriate wireless technology and develop pathways for DOD implementation of such applications that meet national goals, agency needs and requirements. • [1] For a list of potential applications see http://www.wirelesshealthcare.co.uk/wh/wh_101_contents.pdf

  26. ATA ProposalDeliverables • An initial assessment of the range of current and planned wireless applications will be completed using existing ATA databases and selected contacts with industry leaders • An invitation-only, subject matter expert meeting will be held, within 90 days, to identify current needs, priorities and requirements of DOD and appropriate wireless healthcare applications • A comparative requirements matrix will be completed that compares DOD needs with commercial-off-the-shelf applications (COTS) as well as technology currently under development • A decision support document will be prepared for the DOD ASD(HA). The report will rely on the requirements matrix as well as discussions with key DOD health affairs offices to identify results and assess potential deployment models for DOD to use in support of its humanitarian relief and stability operations • Cost: $89K (includes travel costs for 10-12 guests)

  27. Conclusions • Cell phone market is large and growing world-wide • U.S. Army MEDCOM has active cell phone projects • Wireless health care applications are evolving and capable of meeting DoD Stability Operations needs • USG involvement (PEPFAR/USAID) in wireless health care is global – consider DoD partnering • ATA proposal should be funded to accelerate HA strategic planning for wireless health care use in Stability Operations

  28. Questions? Contact: COL Ron Poropatich 301-619-7967 ron.poropatich@amedd.army.mil

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