In Boston, Mobile Chronic Disease Management is PCMH Approved

Sept. 20, 2013
At Boston Medical Center, a safety-net hospital that often treats low-income, non-English speaking, immigrant patients, leaders are implementing a mobile app that could help with skill maintenance for chronic disease self-management. It’s just the next logical step on this provider’s PCMH journey.

The way Robert L. Sokolove, Ph.D, explains it – he is at the “nexus between soma and psyche.”

As the director of behavioral medicine at Boston Medical Center in both the departments of psychiatry and medicine, Dr. Sokolove says he uses psychology to increase wellness and lower medical symptoms of his patients. He runs a number of clinics and research programs related to the behavioral management of chronic pain, smoking cessation, the behavioral management of hypertension, and stress-related medical disorders, among others.

 “In hospitals like mine, a safety-net hospital that often treats low-income, non-English speaking, immigrant patients, these patients have an array of chronic diseases but really don’t know how to manage [the chronic disease],” Sokolove says. “All of these clinics that I run, teach skills to help these patients manage chronic conditions.

However, the problem is that once patients have acquired the skills, those skills dissipate shortly thereafter, Sokolove says. The way he sees it, the only way they are able to retain the ability to manage their chronic disease is if they are continuously being prompted to keep up.

Thus, Sokolove had a vision for a mobile app that would be able to do just that. After a self-creation effort went awry, he got a cold call one year ago from a Solana Beach, Calif.-based company by the name of OneHealth, which develops behavior change platforms. Immediately, he said he thought the OneHealth app could be the solution to his problem of skill maintenance for chronic disease self-development.

It took a while for the two sides to hammer out an agreement, but it was eventually announced in July and will support Boston Medical Center’s patient-centered medical home (PCMH) initiative going forward. The PCMH is tied to metrics that the hospital must hit in regards to improving the quality-of-care for various chronic diseases.

Currently, Sokolove’s plan is to roll this out at his smoking cessation clinic. His says he wants see how the user experience needs to be “tweaked” at a safety-net hospital, which as noted, provides care for a lower-income patient populations.

“Rolling this out at Cedars-Sinai in Los Angeles or MGH (Mass General Hospital) in Boston would be fairly easy to do. To do it at a safety-hospital net is a unique and particular challenge,” Sokolove says. He says he hopes the patients use the app to talk with each other, get new information on their disease state, and support each other on the skills acquired within the clinics.

 OneHealth’s platform for behavior change has been rolled out to employers and payers. As Sokolove says, rolling it out to an already engaged patient population would be a lot less difficult. He understands there are going to be challenges to bringing this to his patients.

Robert L. Sokolove, Ph.D

“Not being a total fool, that’s why I’m rolling it out very slowly. What we need to do is see what are the variables involved with resistance to use and how can begin to manage those variables to increase usage,” Sokolove says. “There are two questions we want answered. One – what can we do to increase its use by a safety-net population and if we do get a critical number of active users, will it really lower the amount of hospitalization visits through social support and information transfer as a way of coping with chronic illness?”

As the wheel turns on this initiative, Sokolove says there may be a basic roadblock with even getting patients the smartphones to access this kind of app. He says there may have to be grant money included to even get past this particular issue.   Yet despite the challenges ahead, he says taking this next step is essential as part of the PCMH journey at Boston Medical Center.

“The PCMH journey, I think for all hospitals, particularly with the implementation of the Affordable Care Act, is how one changes population behavior for chronic disease self management. For the most part, this isn’t entirely true, but infectious diseases have been handled well through medical interventions, but chronic diseases have not. To just manage chronic diseases requires an ongoing patient-provider relationship that monitors the chronic disease and monitors the treatments for that disease.”

For more on how providers are using mobile to reach out to underserved patients, check out the July/August issue of Healthcare Informatics, which features Gabriel Perna’s cover story, The Promise of Mobile: Connecting to Underserved Populations.

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