Here’s a guest post from my new friend Joseph Kvedar M.D., Founder and Director of the Center for Connected Health, who I was lucky enough to meet at October’s Health 2.0 Conference in San Francisco. Here he writes about the connection between connected health and health engagement. Let us know what you think.

Connected Health is an innovative care strategy that has as its goal behavior change, and thereby improved quality, access and efficiency. Connected health involves the use of monitoring and communications technologies as tools to improve consumer/patient adherence to their care regimen. When the strategy works optimally, more care decisions are made by the patient and by non-physician providers. Patients stay healthy with fewer interactions with the traditional part of the care delivery apparatus. Providers can take a population view of their patients and render care just-in-time in contrast to when an office visit is scheduled.

One example of this approach applied to a very sick population is our connected cardiac care program. Patients with congestive heart failure send in daily updates including automatically transmitted vital signs and answers to questions about their health status. Nurses are able to pick out exceptions and intervene before the patients decompensate and wind up in the emergency room or a hospital bed. The result is lower admission rates, improved quality and improved well being on the part of the patients.

We consistently hear from many of the patients participating in our Connected Cardiac Care program that they feel even better when their readings and vital signs are good. It relieves their mind, and their family’s, knowing that they are doing well and that their healthcare providers are keeping a watchful eye on their condition every day.

Another good example comes from the opposite end of the spectrum; from people who would be considered generally healthy, but wish to be more active. In a recently completed trial called step-up, we studied the effect of an avatar coach as a tool to encourage people to be more active. One group of folks had a smart pedometer to help them measure their activity. A second group had the same pedometer but also had access to the ‘virtual coach’ on a regular basis. The virtual coach was a computerized agent, but the agent was informed by the individual’s step counts and thus able to alter her coaching script depending on how well the individual was performing relative to goal. The difference in the two groups was dramatic: the virtual coach group was about 3 times as active as the control group.

These two examples illustrate the four core design principles we apply to connected health programs: accurate physiologic data, shared with the owner in a meaningful, customized way, coaching from a source that is informed by the same data and optimized provider involvement.

So what does that have to do with engagement? Well, everything, really. For some individuals, access to their own physiological data, minute by minute is quite engaging. This is a small group. They are folks who ‘manage what they measure’. For a much larger group, the coaching component is required to engage. Our estimates are that for folks with chronic illness, we can engage about 50% with one of these two approaches.
Of course another very important story involves the other 50%. We have some preliminary evidence that they are folks who tend to have worse health outcomes.

How do we engage these folks? There are many, many clues in the Health Engagement Barometer report. One way may be through their social networks. We don’t know for sure, but I’m willing to bet we’ll be able to measure ‘strength of coaching’ over time, and we’ll find that the two most powerful coaches are one’s physician and one’s social network. The research in the Barometer report is consistent with this.

To help gauge the impact of social networking, the Center for Connected Health recently conducted an online survey of 260 individuals recruited from five online psoriasis support groups. Nearly half of all study participants reported improvements in their quality of life (49.5%) and psoriasis severity (41%) since joining the site. Key reasons cited for continued use of online support sites included availability of resources (95.3%), convenience (94%) and the lack of embarrassment when dealing with personal issues (90.8%).

One important activity for those of us in connected health will be to devise accurate segmentation tools so we can provide the most efficient tools to engage with any individual and keep them focused on their health.

As I reflect on the New Rules of Health Engagement, connected health is consistent with all of them. Our biggest challenge, by far though, is rule #10 - Consider the risks of not engaging. While I fully agree that for those of us who are in any way in the health care value chain, new rules of engagement apply, I hope we can find compelling strategies to engage those consumers who are not info-entials, those who for whatever reason are not engaged in their health at all. Our nation’s physical and financial health depends on it.