I recall that in the 1960s, when social legislation and government programs were running wild as part of the “New Society” movement, there was some wag who wrote about “buzz word generators”.  He guessed that there was some device being used to label programs and tools that were all the rage back then, given their amazing consistency.  Such a device took the first word from a list of adjectives or nouns used in an adjectival way.  The second came from a noun list, and the third from a verb form.

This device appears to be still around and busy forty years later, with buzz word labels like customer relationship management, business process outsourcing, enterprise performance management, etc.  But clearly, one of the arenas in which it has been busiest is in generating labels that employ the initials “PHM”.  Just off the top of my head, I can list the following labels:

• Population Health Management
• Proactive Health Management
• Personal Health Management
• Pre-Emptive Health Management
• Prospective Health Management
• Preventive Health Management
• Productivity Health Management
• Performance Health Management

All these have been generated by changing only the first word in each three-word label.  The wide range of “Ps” reflect the gamut of approaches to managing health that are currently being championed and used as solutions to the “health care cost crisis”.  All of them envision the same basic concept of managing health in order to reduce the incidence and prevalence of disease and injury, plus managing chronic disease that already exists, to reduce the incidence and consequences of crises, complications and worsening thereof.

But there is yet another example of PHM, applied to a “Personal Health Monitor” that can be used in any one or all of the above PHMs. These devices share in common the ability to be used to measure the status of an objective clinical metric reflecting the state of the disease or risk condition being managed, with many also having the ability to automatically report the metric to a “response team” that can intervene when necessary to keep the disease or condition under control.

Such monitoring devices can be complex, such as those that measure peak air flow for asthma patients, or blood sugar for diabetes patients.  They can also be simple scales, weighing congestive heart failure patients frequently to watch out for sudden increases in weight suggesting dangerous fluid retention, and blood pressure monitors like those sold over the counter in pharmacies and retail stores.  They can be very expensive, suggesting use only for the highest-risk patients, or cheap enough to be used by almost anyone.

The firm iMetrikus, Inc. in Carlsbad, California for example, offers a system for collecting, storing, and sharing measurements from a wide range of devices, including those that measure, as well as manage chronic diseases, such as blood sugar monitors and insulin pumps for diabetes.   They may report data by phone, online through PCs, or through wireless connections.  Its Medicompass system enables the collection and storage, and access by both patient and provider to a series of measures over time, to track progress as well as watch for danger signs requiring immediate intervention.

These PHMs can achieve dramatic improvements in control of diseases, or promote effective control of risk conditions such as “pre-diabetes” and “pre-hypertension”, where the risks of these becoming full-blown diseases is high enough to warrant their use.  In some cases, they can promote the “reversal” of both diseases and risk conditions, through lifestyle improvements alone, where savings to payers include not just reduced use of sickness care, but even of prescription drugs when lifestyle changes, such as diet, exercise and weight reduction can reduce metrics to a “normal” level.

The iMetrikus Airwatch®  device, for example, has achieved dramatic improvements in control of asthma, with resulting dramatic reductions in sickness care use and costs.  This PHM, when used with 26 severe asthma patients was able to reduce ER visits from 84 or 3.32 per patient in the period before use of the monitor and response system to just 1 or 0.4 per patient in the same length period when the system was being used.  Hospital patient days dropped from 114 (4.38/patient) to 3 (0.12/patient).  ER charges dropped from $2656 per patient to $32, while hospital charges dropped from $4380 to $120 for equivalent periods. [G. Doherty, et al. “The Effectiveness of an Interactive Electronic Lung Monitoring System in the Total Management of Refractory Asthma” Disease Management Health Outcomes 3:2 Feb 1998 89-98]

Limitations of PHMs in PHM

While personal health monitors can achieve significant, often dramatic improvements in the health and sickness costs of some patients with some conditions, they have their limitations in population health management.  For one thing, the fact that the devices and the response system needed to make them effective can add significantly to costs will tend to limit their usefulness to more severe risk patients.  But perhaps the most severe limitation is that they deal solely with the measured condition metrics related to the single condition being managed.

This is particularly true for diabetes patients, since diabetes is a major risk factor for heart, circulatory, kidney and eye diseases, as well as being a frequent companion of depression.  When PHMonitors only track blood sugar, the focus may be too much on this risk factor, while others such as blood pressure and cholesterol are also common co-risk factors with diabetes.  Of course, multiple monitors might be used for these added factors, since they can be tested at home (blood pressure), and tracked by blood tests (cholesterol) or survey monitors which as questions about things such as depression, anxiety, stress, etc..

It seems likely that new, less expensive, and more comprehensive monitors will be developed over time, able to simultaneously check on a number of different disease and risk measures, including subjective attitudes and patient behaviors.  As this happens, the cost of PHManagement is likely to go down as remote monitoring and coaching will be much less costly than using personal contacts by phone or in person.  And who knows, there may also be some other meanings of PHM arise to join the confusing plethora already in use.