Follow-up on Gadgets, t+ Medical & Disease Management

The disease management blog has commented on gadgets in three prior posts (found by scrolling down or click here). It's not just a matter of population-based health care i.e. consumer support i.e. self-management enabling i.e. patient empowerment programs providing the monitoring devices. We're seeing monitoring devices providing the disease management. Here's another recent example called "t+" that has come ashore, in Research Triangle Park no less. The U.S. based companies must be asking where could this eventually end up?

For more information, check this out.

The Brits don't seem to mind the term "disease management" either. They're not calling themselves "t+Medical Population Care Enhancement Outcomes Optimization Health Solutions."

Hail Britannia!

Gadgets and Disease Management, Part 3: Nanotechnology

Speaking of gadgets, what do persons working in the disease management industry need to know about “nanotechnology?”

After alighting on some interesting references (here and here and here) I found out that the term refers to the precise assembly of atoms or molecules in novel cellular or subcellular forms. While the term in a medical context conjures up an image of weenie machines doing good stuff one chromosome at a time, it usually pertains to old substances in new architectures. One example is arraying silver (which is toxic to bacteria) on plastic catheters to prevent infection. Other novel atomic-level designs of injectable lipids, proteins and even DNA have the potential to deliver “payloads” (for example, chemotherapy) that bind to biologically defined targets. That means a tracer could be used to torpedo a hiding tumor cell or signal the presence of an otherwise undetectable protein or cell-type. It appears earliest iterations coming to market will be categorized less as “devices” and more as pharmaceutical agents.

The disease management blog was a little disappointed, believing we were on the verge of nanogadgets. Alas, there are few useful reports of “nanorobots,” “nanodevices,” and “nanostructures” (coupled with nanodisease nanomanagement of course) swarming through the bodies of the chronically ill, repairing telomeres, dissolving atheroma and resuscitating exhausted beta cells. I’m afraid this atomic-level stuff hasn’t bubbled up to our level of populations…. yet.

Do not despair, however, because the disease management blog discovered ‘nano’ is a very cool prefix to use among your colleagues, especially if you combine it with lots of other opaque futuristic lingo. Consider the otherwise staid observation:

“Advances in medicine will lead to new diagnosis and treatment.”

Thanks to the nanoglitter of this new nanojargon, you can now confidently declare:

“Advances in nanomedicine will lead to quantum leaps in proteogenomic multi-scale microsystem technology.”

As an added bonus, the 'nano' prefix is a useful item to keep in the populationate tool box.

Postscript. My spouse has periodically given invaluable input into the content and editing of the disease management blog, for which I am forever grateful. Her shrewd response to this particular post was to ask if the return on investment from the time and effort to write it should be measured in nanodollars. I told her the check will come in a really really small envelope.

Gadgets and Disease Management, Part 2

Just imagine for a minute a glucose meter "bluetoothed" to a cell phone with text communication linked to a disease management program:

DMNurse51 (12:25:14 PM): hey Auto response from

Kris101(12:25:14 PM): hold on...brb

DMNurse (12:25:25 PM): ok

DMNurse(12:25:35 PM): in cafeteria?

Kris101(12:31:51 PM): WU?

DMNurse51 (12:32:13 PM): did u check u’r noon glucose?

Kris101 (12:32:17 PM): lol no forgot

Kris101(12:32:26 PM): can check b4 1

DMNurse (12:33:39 PM): ‘k. I’ll call mom & let her kno.

I recognize there are HIPAA issues, getting informed consent from an adolescent to participate in something like this isn't easy and that there's malpractice risk. None are insurmountable.

I confess to not authoring a "I'll notify your doctor" in the scenario above, but a) I don't think most docs have the resources to respond to one missed blood glucose meter check and b) wouldn't mind "outsourcing" tasks like this and c) are very supportive of "systems of care" that handle inevitable minor mishaps.

Note that DM Nurse51 could be located the physician's office, out of state or across the globe in India. Note that the nurse was alerted by an ABSENCE of a blood glucose reading.

Idealistic yes. Unrealistic not at all, particularly because glucose meters enabled with bluetooth are already out there. Interactive data bases linked to decision support algorithms are already at hand. There are nurses armed with protocols that know what to do and how to do it.

In the opinion of the disease management blog, medical device manufacturers are perfectly positioned to tie it all together and it's just a matter of time until market forces make it happen so that it becomes a standard of care. What mom wouldn't pay to have this kind of support for their insulin requiring diabetic child?

Gadgets & Disease Management: The Coming Emergence of Medical Device Manufacturers in Population Care

This link to an article named Gadgets that keep you healthy made the Disease Management Blog ponder the role of medical devices in population-based health care. I'm certainly not alone in struggling with the topic, but thankfully I don't have to be like Inverness and be quite so complicated about it. The image of this eye-socket gadget internet-enabled health-vixen speaks to the topic in a much better way.

It's not uncommon for disease management programs to grapple with the role of "hardware" in their programs. Should IVR-enabled scales be offered in heart failure? Should USB-ported peak flow meters be given for free if there is an asthma diagnosis? What is the role of kits that allow home measured A1Cs? I now wonder if that thinking is becoming increasingly backwards. Maybe a better question is to ask is whether population-based health support should be included with the gadgets.

Consider one device that is the topic of the Gadget article: the glucose meter. Being VERY simplistic.....

In the "insurance" business model, meters are an a) expense, b) a mandate c) an exercise in good will d) something that has yet to be proven in prospective randomized control studies to reduce claims expense. Think deductions, co-pays, co-insurance and limits (directed at the strips).

In the "clinical revenue-based" business model, providers want a) payment, b) payment or c) payment for their support of a glucose meter. Think unbundling, coding, direct patient billing and, when all else fails, blaming managed care one more time.

In the emerging consumer-centric business model, glucose meters may well go the way of other consumer goods: either turn into commodities and die or be coupled to support services that ultimately have the potential to create more revenue for the manufacturer than the device itself. Think service contracts and value-adds that morph into an ongoing revenue stream. Smart automobile manufacturers now sell reliable transportation, not cars. Smart computer manufacturers sell information technology, not beige boxes. Should meter manufacturers sell blood glucose control? Should cardiac stent manufacturers include services that minimize the risk of re-occlusion of the involved artery? Will gastric banding manufacturers compete on the degree of weight loss at one year?

The disease management blog predicts the gadget manufacturers are creating a new chapter in disease management, characterized by mergers, acquisitions, partnerships, contracting "coopetition" and OWAs. And note the article above was from India, leading me to believe this is a global phenomenon. It will be interesting to see how the U.S. physician community and health insurers will respond. The eminently savvy readers of this blog probably have a prediction about that, and I agree with you.

Speaking of vixens, as a public service to the gender-male readers of this blog, if you are lucky to have a significant other, this is a reminder of an approaching high profile day. Gentlemen, do yourselves a favor and think at least a card. I don't know why either, but the kind with excessive romance is best and you get bonus points if she wants to show it to her girlfriends. You've been forewarned.