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EHealth consultant Sananet has been piloting the Health Buddy telemedicine technology in the Netherlands for several years, with encouraging outcomes in diabetes, COPD, and heart failure, as well as benefits for everyone involved in care: patients, doctors, nurses, health insurers and government agencies. Here is what telemedicine technology looks like in the Netherlands, recently posted on YouTube.

Sananet reports the following results from its telemedicine in chronic care pilots:

• 30% reduction in hospitalization for heart failure patients in a telemedicine study from the University of Maastricht.
• Reduction in length of hospital stay for COPD patients from 13 days to 9 days on average in a telemedicine study from the University of Utrecht.
• In diabetes patients with an HbA1c of 8% or higher, a reduction in HbA1c of 1.5% compared to 0.6% in the control group in a study in Almere.

Although many think of telemedicine and telehealth as the remote collection of data from blood pressure monitors, digital weight scales, blood glucose monitors, and respiratory monitoring devices, Sananet achieved all of these results using a telemedicine system focused on educating and supporting patients at home in a simple daily text-message health dialogue about symptoms, behavior and knowledge.

Related posts:

Dutch Ministry of Health Recognizes Health Buddy for Best Practice in Telemedicine

Telebegeleiding met Health Buddy

Partners in Health has been improving chronic care in rural communities in Rwanda through an innovative model of care inspired by Paul Farmer. The regional hospital sees its mission as training community members to extend care into the community and monitor patients at home in order to prevent disease complications and the need for hospitalization. The hospital tracks symptoms and medications using electronic medical record (EMR) systems based on open source technologies. Meanwhile, the United States continues to neglect reforming our crisis-oriented health system because “we can’t afford it”, and the cost of chronic care continues to explode as the population ages. With far fewer resources, but with more creativity and courage, innovative leaders in Rwanda are creating new models of care based on prevention because they can’t afford not to. Maybe we can learn something from Rwanda.

Last week I spoke at the On Lok Lifeways Conference on October 22, 2008 in San Francisco, entitled “Sustainable Long Term Care: Ethics, Technology and International Perspectives.” The organizers asked me to draw insights from my experience in developing new models for chronic care as the founder and former CEO of Health Hero Network, and to compare that to what I had learned while traveling in Rwanda with Partners in Health last year. Here is my presentation.

In the most innovative models of care on both continents, health care providers have discovered that delivering better care with fewer resources can be possible with a proactive approach to supporting and monitoring patients at home rather than waiting for the inevitable complications of neglect. On both continents, healthcare providers have discovered that technology can be a useful tool to improve the effectiveness of care providers and to increase rather than replace personal touch.

In the United States, our healthcare system too often still penalizes rather than rewards prevention, especially in the largest fee-for-service system, Medicare. When it comes to innovation in disease management and prevention, we claim that we “can’t afford it,” while in a much poorer country in the heart of Africa, the government and the health system are working together to embrace innovation in home and community-based care because they can’t afford not to do it.

We have something to learn from innovations arising in places like Rwanda, where necessity truly is the mother of invention. Learning from such innovations can help us expose some of our own false dichotomies that too often have become an excuse to stifle innovation.

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It looks like Health Buddy is getting traction in the Netherlands, thanks to Sananet. Telebegeliding means telehealth coaching, or guidance at a distance using telemedicine technology, in Dutch.

“Telebegeleiding thuis geeft mensen met chronische ziekte meer veiligheid en zelfvertrouwen.”

At TEDGlobal 2007, William Kamkwamba showed us how necessity is the mother of invention, making a windmill out of simple scrap materials to power his home in Malawi. Without any money, but armed with a book from the library and some ingenuity, this teenager from a rural village in Malawi gave a fitting answer to an earlier speaker’s opinion that renewable energy is “too expensive” for developing countries.

A short video from our visit to one of the last remaining families of mountain gorillas living on a 14,000 foot volcano on the border of Rwanda and Congo.

I had the opportunity to visit the district health center in Rwinkwavu, Rwanda, where Dr. Michael Rich explained why the Partners in Health model of care is able to achieve better medication adherence in Rwanda than even our best practices in the United States.

It is not just the fact that Bill Clinton and The Clinton Foundation negotiated a deal on antiretroviral (ARV) drugs. It’s not just the fact that the once complex cocktail regimen of pills can be combined into one generic pill. It is because an army of community health workers visit patients in their villages every day, checking in to make sure everything is OK, and to make sure that everyone is taking their medicine.

Daily support and monitoring at home, working with informal caregivers in the community to surface problems early so that bigger problems can be prevented: That is the key to improving quality of care with limited resources.

Dr. Paul Farmer, as chronicled in the book “Mountains Beyond Mountains” by Tracy Kidder, realized this in Haiti a decade ago, and now the Partners in Health “accompagnateur” system is being rolled out in developing countries around the world. Is there something we might learn from Rwanda?

This is my presentation from the plenary session of Silver Economy, a conference held in Maastricht, Netherlands in November 2006.

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HEALTH HERO NETWORK PARTNER SANANET HONORED BY MINISTRY OF HEALTH FOR BEST PRACTICE IN TELEHEALTH USING HEALTH BUDDY SYSTEM
Sananet Invited by Dutch Ministry to Demonstrate solution using Health Hero Network’s Technology at “The Ministerial Conference and Exhibition E-Health 2005, 23-24, Tromso, Norway

Mountain View, CA – May 23, 2005 – Health Hero Network’s Dutch partner Sananet B.V., an eHealth company offering information and communication technology products and services to improve the quality of health and social services in the Netherlands was selected by the Dutch Ministry of Health, Welfare and Sport (VWS) for a best practice project in telemedicine. Sananet was invited to demonstrate their project using Health Hero Network technology at the Ministerial Conference and Exhibition e-health 2005, May 23 and 24 in Tromso, Norway. The Ministerial Conference is a high-level conference and exhibition sponsored by the European Commission to promote advances in health care enabled by information and communications technology (ICT).

Representatives from Sananet will present their experiences and results with remote health monitoring for heart failure patients in Limburg to public health experts and decision makers from the entire European Union. Sananet will demonstrate the Health Buddy® system used in their telemedicine program sponsored by the Dutch Ministry of Economic Affairs and the Provincie Limburg which covers Heart Failure patients at the Academic Hospital Maastricht, the Atrium medical center in Heerlen and the Orbis medical and care group in Sittard/Geleen. The technology presented in Tromso will include the Health Buddy® appliance for monitoring and coaching patients with chronic illnesses and web-based decision support tools providing health data and services for care providers.

“In the Netherlands we showed that patients feel more safe and their self efficacy improves significantly after 6 weeks using the Health Buddy ® appliance at their home. The results are very promising for the near future and we expect that more patients with chronic illnesses will receive a Health Buddy ® appliance. In the Utrecht region we developed a telemedicine program which covers COPD sponsored by the Asthma foundation, and there we expect the same results. The selection as a Dutch Best Practice by the Ministry of Health for this Telehealth solution will accelerate the structural embedding of telemedicine programs in the Dutch Healthcare System, “ noted Jan Ramaekers, Sananet CEO. “Sananet is honored to have Health Hero Network as a strategic partner.”

“Around the world, people with chronic conditions have similar needs for coaching and monitoring at home in order to prevent hospitalization and improve the quality of care,” noted Steve Brown, Health Hero Network CEO. “Health Hero Network is honored to partner with leading innovators in Europe to advance chronic care, which is a critical necessity given the growing health needs of an aging population.”

About Sananet
Sananet B.V. offers products and services to enable professionals and patients to use sophisticated information and communication technology (ICT) for eHealth. Sananet enables healthcare professionals to link care providers with each other and patient data regardless of time or place, helping to provide efficient relations between different care partners and patients. The simplified communication facilitated by Sananet results in increased quality of care. Sananet’s services include consultancy, network capacity, training and solutions support. http://www.sananet.nl/

About Health Hero Network
Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves the quality of care. Based in Mountain View, California, Health Hero Network’s systems are protected by over 55 issued US patents. http://www.healthhero.com.

This is a presentation I gave on February 22, 2005 at a conference in London about a common theme and issue that affects people and governments in Europe, Asia and America: How can we create a better model of care to serve the rising incidence of chronic illness and the aging population?

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