September 10, 2012

Using HIT to Combat Diabetes
By Sonia Rupcic, MPH, and Margaret Griffin
For The Record
Vol. 24 No. 16 P. 8

It’s no secret that diabetes mellitus poses one of the most significant challenges to the US healthcare system. As of 2010, approximately 25.8 million Americans had diabetes and that number is growing, according to the Centers for Disease Control and Prevention.

When it comes to controlling the disease, there are no easy solutions. Building on two decades of national prevention initiatives, Health and Human Services attempted to formally stem the rise of diabetes through Healthy People 2010, which outlined goals for diabetes health outcomes and service utilization. However, the program did not meet objectives for prevalence and incidence. Instead, these rates worsened substantially.

Now, as part of Healthy People 2020, the government has issued a new set of goals for the next decade that attempts to reverse these alarming trends.

Taking Action
The increasing prevalence of diabetes—and its tremendous burden on public health—is worrying for a host of reasons. Researchers estimate diabetes lowers life expectancy by up to 15 years, and the condition is associated with a host of comorbidities, including hypertension, heart disease, blindness, amputation, stroke, and kidney disease. In 2007, diabetes cost the United States $174 billon in direct and indirect expenses.

To meet the challenges of diabetes, the healthcare system must adapt from its current acute care model to one that addresses ongoing disease management needs. Heightened care coordination in concert with new systems for promoting self-management will be critical to controlling diabetes. For these reasons, many healthcare providers have endorsed information and communication technology (ICT) as a central pillar of emerging chronic care models.

Galvanized by these concerns, last year a group of healthcare and technology leaders founded the Healthcare Technology Action Group (HTAG) to promote the innovative use of ICT for realizing Healthy People 2020 goals. HTAG’s membership includes a diverse array of experts in the public, private, and nonprofit sectors, all with a passion for tackling America’s diabetes epidemic. The group includes leaders in diabetes care and innovation from the American Diabetes Association; the Children’s Hospital of Philadelphia; Johnson & Johnson; Prodigy Diabetes Care; Stanford University; the University of California, San Francisco; URS Corporation; WellPoint; and xLeo.

HTAG embodies the conviction that the country’s healthcare impasse can be relieved only through cooperation across fields, facilitated by technology.

“HTAG is precisely the type of cross-industry innovation that is needed to realistically improve healthcare,” says Brian Wasikowski, director of HIT alliances and customer support at Janssen Diagnostics, Inc and an HTAG member. “A primary challenge in today’s healthcare landscape is the abundance of care services, diagnostics, and therapeutics available, and the decision to apply the right resource at the right time is increasingly complicated. [HTAG] is taking a very pragmatic approach to look at the synergy of patient involvement and the provider with proven technology. Looking to the future, the burgeoning availability of data will drive a transformation where the provider and patient have an expanded virtual relationship not as centered on the office visit.”

With financial backing from HCL Technologies and research support provided by the Healthcare Innovation and Technology Lab, HTAG identifies and develops innovative models for delivering care and supporting self-management for diabetes patients. The group holds regular conferences to discuss cutting-edge developments in diabetes technologies. It also spearheaded a benchmarking study that abstracted lessons from highly diffused commercial developers, such as Apple and Amazon, and applied them to the field of diabetes IT.

Going Mobile
This fall, HTAG will launch a pilot program built on the premise that technology can support healthy behaviors, a notion that HTAG member Tim Gilchrist, director of e-business strategy and innovation at WellPoint, believes is possible. “From my perspective, diabetes has a huge behavioral component that can be improved with technology. The education toward compliance for type 1 and 2 [diabetes] is a major gap that intensifies the illness and contributes to preventable clinical interventions,” he says.

The pilot will use mobile technologies to extend the continuum of care into the community and ensure ongoing support for diabetes self-management. It also will incorporate key lessons from the earlier benchmarking study to avoid the pitfalls encountered by other projects. For example, rather than relying on pre- and postsurveys to gauge patient feedback, the pilot will utilize data generated by the platform itself to create algorithms that predict patient behavior. The content of the mobile platform will conform to patient preferences by analyzing every click patients make and every website they browse. It also will track the order in which patients browse websites.

These are lessons the giants of Silicon Valley learned long ago, and HTAG is betting they can be incorporated into healthcare programming and help reverse the nation’s debilitating diabetes trends by 2020.

Hurdles to Clear
Still, the transition to technology-facilitated support for ongoing disease management will present new challenges to the healthcare system. Even as the US government has set aside several billion dollars to fund technology pilot programs, issues around capital costs and digital literacy threaten hopes for scaling up.

Additionally, these technologies will spark health improvements only if they are deployed in a culturally competent context, notes Eva Moya, PhD, an HTAG member and a former member of the Healthy People 2020 advisory committee. Moya, who works to improve the lives of underserved and underprivileged communities along the US-Mexico border, also mentions cost as an important issue, especially when it comes to supporting self-care behaviors. “For technology to make the most good, you need to make it accessible and affordable,” she says.

In the future, HTAG members will continue to anticipate and work through these challenges, identifying and piloting innovative strategies for realizing Healthy People 2020 goals. It is through the cross-disciplinary work of these advocates and the practical application of IT that America will stem the tide of diabetes and its impact on our population.

— Sonia Rupcic, MPH, a global health anthropologist, and Margaret Griffin, a research associate, work at the Healthcare Innovation and Technology Lab, a cross-disciplinary public health teaching and research organization.