This document discusses patient self-care through the use of technology. It begins by discussing how technology can facilitate a "shift left" of healthcare delivery from acute to chronic care settings. It then discusses the importance of empathy in designing technologies for patient self-care. Examples are provided of technologies that have been designed and tested to improve patient outcomes for conditions like hemodialysis and congestive heart failure. The document advocates that patients can successfully manage highly complex medical therapies at home with the right technologies and emphasizes exploring what else patients may be able to do to manage their own care.

1. Joseph Cafazzo, PhD PEng
Patient: Heal Thyself:
The use of technology to facilitate
patient self-care
ISHSH 2013

2. EMPATHY
in design

4. ‘Shift Left’ of Healthcare through Technology1
$1 $10 $100 $1,000 $10,000
0%
100%
COST of CARE/DAY
QUALITY
of LIFE
Healthy,
Independent Living
Chronic
Disease Management
Doctor’s
Office
Community
Clinic
HOME CARE and LTC
Assisted Living
Skilled
Nursing Facility
RESIDENTIAL CARE
Community
Hospital
ICU
Specialty
Clinic
ACUTE CARE
1) from Intel, and Center for Aging Services Technologies (CAST)

5. PATIENT
SELF-CARE

7. EMPATHY
in design

8. BUILD
CONCEPT
EVIDENCE
EVALUATE
DESIGN
EMPATHY
in design
USABILITY
PILOTS and RCTs

13. Poor Design

14. “We have a serious training problem that needs to be
corrected”
“We need to know how our equipment works: when the
battery is changed, it defaults to its own location.”
“We’ve got to make sure our people understand this”
Senior Air Force Official

17. AdverseEventsinHealthcare
•IOM 1999: 44, 000 to 98, 000 US deaths annually
due to medical error
•Baker, Norton 2004: 9, 000 to 23, 000 deaths
annually due to preventable adverse events

18. Solis PCA Pump
3.5 years
12 iterations

19. Export to PDFExport to PDF
Early Software and
Hardware Prototypes

20. High Fidelity Usability Testing

21. – Latch design
– LED placement
– Remote dose cord feedback
– Lock rotation direction
– Battery compartment closure
Hardware Design

22. Screen Design
• Visibility of pump status
• Drug name & concentration

23. Workflow Design
• Task-based Menu Structure
• Therapy/Qualifier/Drug
• Streamlined pump programming sequence
• Consistent with pump programming software

24. Export to PDFExport to PDF
Solis VIP

25. Impact

26. PATIENT
SELF-CARE

27. 51
NDNG

32. Improved Health Outcomes : Home Hemodialysis
– Normalization of blood pressure without the need for anti-hypertensive medications
– Normalization of abnormal wall thickness of the heart
– Restoration of impaired heart function
– Improvement in peripheral circulation
– Improvement in sleep quality
– Improvement in nutritional determinants
– Elimination of dietary restriction
• Patient autonomy
• Cost effective modality
Chan et al : KI, 2002, Chan et al: NDT, 2003 Chan et al: AJKD, 2003,
Hanly et al: NEJM, 2001
Pierratos et al: JASN, 1998

33. Patient-PerceivedBarrierstoHomeHemodialysis
(Cafazzo and Chan, 2007)
• Perceived burden on family members
• Fear of self-cannulation
• Fear of a catastrophic event in the absence of nursing
support
• Low self-efficacy

34. 58
quecojones
NomadicEntrepreneur

35. 64
So if patients can do a highly invasive,
potentially fatal therapy at home successfully
with improved health outcomes and lower cost
then ....
WHAT ELSE CAN PATIENTS DO?

42. Available in ten languages
Néih hóu
Bonjour Guten Tag
Zdravstvuite
Buenos días
Nî hâo
Annyong ashimnikka
Hello

43. Downloads:
>80,000
more than
10,000 active
daily users

45. THEME:
Fast, discrete transactions:

46. Glooko

47. iBGStar

48. 85

56. “… thought about trends and what to do when the alert popped up”
“… I tested more often at lunch”
“… rewards motivated me to test more”
“… she initiated more conversations about her blood sugars”

60. Type I
(Lisa Min) Type 2
(Shivani Goyal)
Artificial Pancreas
(Isabelle Dutil)

61. The (near) future: The Artificial Pancreas

62. The goal:
mHealth
AP dashboard

64. BLOODPRESSURE
TRANSMITTED
AUTOMATICALLY
TOBLACKBERRY

65. American Journal of Hypertension,
20(9), pp. 942-948, 2007
Pilot Results
Diabetic Hypertension

68. NO CHANGE
- 9.1 mmHg systolic
- 4.6 mmHg diastolic
+

70. SELFAWARENESS
MEDADHERENCE

73. 70,000 downloads
15,000 > 2 weeks
6,000 all 30 days

78. App Definition Statement
Help people control their Asthma through
tracking, reminders, trend analysis,
environmental health factors, and easy
access to their Asthma Action Plan.

84. Export to PDFExport to PDF

92. Congestive Heart Failure Client

102. RCT Study design
• N=100
• duration 6 months
• daily measurements before 10 am - reminder call
• alert algorithm - messages direct to cardiologist
• control group - usual care

103. RCT Results
Congestive Heart Failure
150 pg/mLBNP
7.4 %LVEF
no change in the control group
7 pointsself-care

106. @JosephCafazzo