Telemedicine "Buddy" Offers Radical Approach to Managing Health of the Mentally Ill

Sound: [beep, beep, beep –] OK, it says your blood sugar reading is within normal range. Continue [beep]…fade out

Karen Fortin has just entered her morning blood sugar count into a small electronic box sitting on her kitchen table.

It’s called the Health Buddy, and it helps Karen monitor her diabetes -- and her depression.

Each morning, Karen answers questions posed by this little machine.

And sometimes it gives her instructions.

Karen: [Reading] It is important for you to continue to monitor your feet and legs of any changes. If you have any questions, concerns, please contact your health care provider. Continue. [beep].

Karen is 50 years old.

But with 50 pounds of extra weight on her small frame, and short grey hair, she looks older.

One reason is that in addition to her diabetes, she also suffers from severe depression.

Many people with serious mental illness, also have chronic physical ailments.

Louis Josephson: Mental illness can get in your way of managing your health condition because you’re not thinking clearly about things, you’re anxious about things, and that is gonna be confusing for people.

That’s Louis Josephson.

He’s the CEO of Riverbend Community Mental Health in Concord.

He says some Riverbend patients are so anxious about their health, they regularly visit emergency rooms.

Karen, who suffers from panic attacks, was one of them.

Karen: I was constantly going to the hospital with chest pain, and , y’know, Concord Hospital and I were getting on a first name basis. And I don’t like that! I don’t like that at all!

But several studies have shown that daily monitoring of diseases can keep small problems from becoming crises.

And people who get daily reminders of good habits are better at sticking to difficult regimens.

But no clinic has enough staff to check in daily with all of its patients.

So Josephson at Riverbend got the idea of using the Health Buddy to do it.

He’s working with researchers from Dartmouth Medical School.
And they’re running the first national clinical trial using telemedicine for people with both chronic mental and physical illnesses.

Louis: One of the things we’re measuring in the study is reduction in emergency room care for both psychiatric crises and medical crises.

When patients answer the Health Buddy’s questions, there is a person on the other end monitoring them.

In Karen’s case, it’s her nurse, Marcia Harrison, who calls the system very efficient.

Marcia: I can review the data on multiple people in just a few minutes by opening my work list on the protected web site shows me who’s having red flags.

And when she does see a red flag – a high blood pressure reading, for instance – she tells case managers to take action immediately.

That helps those workers better manage their hefty case loads and gets people care when they need it.

Dr. Justin Starren is a former Columbia Medical School researcher.

He ran an eight-year telemedicine study that showed how it improved the health of diabetics.

Starren says systems like the Health Buddy point to the future of health care.

Starren: Instead of thinking of treating your patients like working in an assembly line, where you just sit there in your office and patients come to you one after one another, it’s thinking of managing patients much more like an air traffic controller, where you’re monitoring hundreds or thousands of patients and seeing who is on a good trajectory and who is on a bad trajectory and intervening with those that need the help.

Critics of telemedicine raise privacy concerns.

And Starren admits the technology still has a ways to go.

Like computers 15 years ago, these devices use proprietary software and don’t talk to each other.

But Starren sees a day when telemedicine applications will run on cell phones.

When they do, he predicts that Health-Buddy-like systems will go mainstream – for two reasons.

First, Starren says, they can save the health care system a whole lot of money.

Starren: When they have problems, we catch them when they’re small problems, not when they’re in the emergency room costing thousands of dollars.

Second, research shows that the devices reduce patients’ anxiety – to the point that patients don’t want to part with them.

Starren: Every time we had one a doctor would give it to a patient and the patient was not about to give it back. That’s because, Starren says, that device became a lifeline to their doctor.

Here in New Hampshire, the year-long study has yet to run its course.

But already, Riverbend is hoping to scale up and give units to many more patients even after the study is over.

For NHPR News, I’m EG.