Doctor Joseph Kvedar works in an innovative neighborhood.
Not far from his downtown Boston office is the site on which Alexander Graham Bell first transmitted sound over wires for the first time on June 2, 1875, in a precursor to the telephone; where Thomas Edison started his career; and where ether was first used as an anesthetic.
Kvedar and his team use telephone technology, too, but in a vastly different way: as part of systems they’re developing to apply the Internet of Things to healthcare.
Director of the Center for Connected Health—a busy offshoot of the Partners HealthCare collaborative that includes top-rated Massachusetts General Hospital, which is also just a few blocks away—Kvedar is at the forefront of some of the most promising applications of the groundbreaking work to give everyday objects network connectivity: the medical applications, which are moving at such a pace that they’ve inevitably gotten their own acronym. “IoT MD,” they’re called, for Internet of Things medical devices.
“There’s tremendous potential,” says Kvedar, who is trained as a dermatologist. “Before now, we’ve had to think about health care in terms of someone coming in to see me. We’re going to chat, we’re going to do some tests and interact, and that is what I’m going to use to make a diagnosis. And we’ve done it this way since Hippocrates. But now diagnosis can be a constant in your normal life. You don’t have to come to my office for that.”
He’s talking about wearable health and activity trackers and mobile apps to monitor in real time and help treat people with everything from diabetes to obesity, heart disease to cancer.
The center has developed an app called ePAL, for example, to coach patients through the self-management of cancer pain. It found that a remote monitoring program for patients at risk for heart failure succeeded in reducing hospitalization and mortality rates. It created a Facebook support group on which teenagers with asthma share their strategies for living with it, and an experiment that collected information about people with Type 2 diabetes and sent them personalized text messages encouraging them to stay active; more than half followed the plan, compared to 30 percent who did not receive reminder texts. It built a system combining weather reports on smartphones with prompts to apply sunscreen, increasing the use of sunscreen among test subjects. And it has launched a program through which Partners Healthcare patient data collected at home, including blood pressure and other vital signs, is transmitted directly into medical files.
But IoT MD, says Kvedar, turns out to be as much about psychology and economics as technology. And his center just above a post office branch looks more like an insurance office than a laboratory from a James Bond movie busy with scientists in white coats hovering over test subjects wired to monitoring equipment.
“It’s just a bunch of pods,” Kvedar says, laughing at a visitor’s disappointment.
“To be able to gather quantifiable information about your health and learn from it is now largely a solved problem.” Now the challenge, he says, is to understand the human and financial sides.
He and his team, he says, are working next on motivating people to respond to their connected products. Research has revealed that users’ interest level in their Fitbits and Apple Watch health-monitoring functions starts to wane after 30 to 60 days.
“Our question is: How do we keep them motivated and engaged?” Kvedar says.
The positive results with heart-failure patients, for example, lasted for four months, after which they showed no better success rate than patients in a control group.
Now the center, with a grant from the Robert Wood Johnson Foundation, is working on an “engagement engine” to help get patients past this wall. The project will include subjects who are overweight to mildly obese, and find ways to improve their use—beyond a month or two—of wearable sensors, activity trackers, and mobile apps.
“We need to learn more about how people engage with these devices to better understand how they can be maximized,” said Deborah Bae, the foundation’s senior program officer.
That could mean such simple things as providing financial motivation, running team competitions, and sharing data with a doctor, Kvedar says; when diabetics in one study knew their blood glucose readings were being monitored, 69 percent changed their behavior enough to lower their own blood pressure.
The stakes for this are huge, but another challenge is that the savings may be difficult to prove.
“The economic model around wellness is elusive,” Kvedar says. “We all know intuitively that if we were all less sick, it would cost the healthcare system less, but it’s challenging to quantify that.”
Slightly less challenging than it used to be, however. Not only are foundations turning to the Center for Connected Health; a company called MedSentry worked with it to determine the effectiveness of an electronic pillbox that uses light and sound to remind people when to take their medications. It has a deal with Samsung to develop new digital and mobile devices to regulate health and wellness. It runs an annual IoT MD conference, now in its 12th year and capped at 1,000 registrants—up from 50 the first time it was held—this year in Boston starting on October 29. And its parent is a health-care company that is also looking for ways to contain costs.
Kvedar recalls a Partners Healthcare executive telling him that e-visits—virtual interactions between doctors and patients—“are inevitable. That’s just such an amazing statement for a healthcare provider to make. The world is changing. How we get reimbursed is changing. It used to be that the more people came through our brick and mortar environments, the more revenue flowed. But now we’re entering a period when we get rewarded for keeping the costs lower. And these tools are helping us build that future.”
Photo of Dr. Kvedar courtesy of the Center for Connected Health.