Patients Participate in Their Own Care Via Apple IPad

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Hershel D. Sinay 74 has grappled with ulcerative colitis for years a debilitating inflammatory condition of the digestive tract that has made it difficult for him to socialize travel and even get out of bed.

But he is doing much better now, due in part to a new program at the UCLA Center for Inflammatory Bowel Diseases that is using an Apple iPad to help monitor his care 24/7.

In one of the first programs of its kind for inflammatory bowel disease, patients, doctors and specialized nurses at UCLA are all using the wireless devices to help track patients' symptoms and care and to communicate with each other in real-time about disease management.

"Using a tablet like an iPad helps us to reach out and interact with patients during their daily lives and routines so we can intervene early, if needed," said Dr. Daniel Hommes, professor of medicine at UCLA and director of the Center for Inflammatory Bowel Diseases. "We want patients to feel that carrying the iPad is like having a doctor in your back pocket."

Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases that impact the digestive and intestinal tracts and affect 1.5 million Americans of all ages. Symptoms of these conditions include abdominal pain, diarrhea, loss of appetite and weight loss. Studies have shown that close monitoring, early intervention and educational programs aimed at better managing these diseases can have a profound effect on patients' quality of life, their relationships and their work. In addition, this approach has been demonstrated to significantly lower health costs.

The new program at UCLA allows patients to check in with their health care team via the iPad. The device's interactive program asks patients questions to gauge how they're doing in areas of disease activity, quality of life and work productivity. Their answers are instantly transmitted wirelessly to their doctors and nurses for review.

The program even provides traffic reports that patients can monitor when they head to their clinic appointments. The patients are asked to check in periodically and also to complete a program entitled "My Academy," a personalized online teaching program that helps them better understand their disease, explains diagnostic tests and teaches them about medications.

Depending on patient responses, doctors and nurses can intervene in a number of ways, from offering a prescription for new medication or making an appointment for an office visit to helping the patient psychologically cope with the anxiety and isolation that can occur when dealing with a chronic disease.

The care programs are designed according to the principles of value-based health care, in which adding "value" to each individual patient -- measured by disease control, quality of life and productivity -- is the sole aim. UCLA is using a so-called "value quotient," or VQ, which captures the value of health care services to individual patients over time and correlates this with its associated costs.

Sinay, who is a magazine publisher, says that having close access to his doctor via the iPad has been comforting, and it also gives him a sense of empowerment in handling his disease.

"The iPad is the perfect assistant to keep tabs on my condition, and it enables me to take part in monitoring my progress," he said. "It is interactive, and questions can be asked and responded to in quick order. It is empowering in that I have input to my medical team and can see my progress online."

Hommes says that one of the center's goals is to partner with patients in managing their condition and to help them understand what symptoms to watch for and when to seek help. He notes that early interventions often save costs for both patients and the health care system.

The pilot phase of the program has successfully been completed, and now approximately 250 patients are enrolling in the program. According to Hommes, the team plans to expand the program to other chronic disease areas and to optimize it into apps available on tablet PCs and smart phones.

"By providing our services through our virtual UCLA hospital on iPads, we hope to demonstrate not only a significant increase in the quality of our care delivery but also a substantial reduction in costs," Hommes said. "Our next steps include an exploration of offering health plans in which participating patients will be rewarded with a health plan benefit."

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