Chronic Disease management & The Role of Technology

Dr Vivek Mahadevan

There are various diseases that are ideal candidates for chronic disease management programmes. We will have a look at one of them which has been a major contributor to both patient mortality, as  well as morbidity globally, namely  diabetes Mellitus says Dr Vivek Mahadevan. Head- Client Solutions Group, HealthFor.


Achronic disease is one that persists for a period of three months or more. In a majority of cases improvement is slow and they do not get cured completely. Diabetes, hypertension, congestive heart failure, asthma, chronic lung disease, renal failure, liver disease, arthritis and depression are some chronic ailments with a high prence rate worldwide.Chronic diseases have a major impact on the lifestyle of the patients and affect their physical and mental wellbeing. They influence a patients daily routine as well as their patient family. They also take up scarce resources, such as specialist doctors, and other elements. In addition to the human suffering caused, these lifestyle diseases have an economic impact too, as they affect the older and experienced work force of a country.

It has been proven that early screening and diagnosis of chronic diseases can significantly reduce the morbidity and decrease the need for hospitalisation. Prevention and continuous monitoring is the mantra and this is a vital ingredient of any chronic disease management programme. The management is made even more complex when a patient suffers from more than one disease. An integrated approach to healthcare delivery is required and sharing of information among healthcare professionals is of the utmost importance in order to deliver a treatment regimen to tackle these multidisease conditions.

Challenges to the Treatment of Diabetes
From what we have discussed regarding the treatment of diabetes, it seems that a chronic disease management programme is the logical course to follow. So is this being followed unanimously? Well, its not as simple as that.


Providers across the world are still using the tools of acute care in trying to fight chronic diseases. This is due to a lack of awareness even among professional care-givers. Sharing of information among providers is not happening to the extent necessary for effective collaborative care. One reason for this could be that except for the patient, there are no demonstrative benefits to the caregivers in sharing the information. Primary care physicians are wary of referring their patients to specialists as they fear losing their revenue from the patient.

Patients are not adequately educated about the benefits of taking an active role in the management of their disease. They are not aware about the ways in which they themselves can reduce the morbidity and mortality of the disease.

The Role of Technology

Diabetes decision support systems
A diabetes advisory system can be used for the management of insulin dependant diabetes mellitus.

Image Analysis in Diabetic Retinopathy
This is focused on automatic detection of lesions in digital retinal images for the purpose of screening for diabetic retinopathy. Algorithms have been shown to be able to detect various lesions.

Smart Bandages
Smart bandages can be used to monitor wounds. The bandage contains sensors that detect the humidity, temperature and the types of bacteria present in the wound. This will help doctors to track the healing process from a remote location by analyzing the data transmitted via the net or even by phone.

Implantable Glucose Sensors
Because of the limits of wearable needle-type sensors in clinical use, fully implantable glucose monitoring systems (IGMS) represent a promising alternative.

Transdermal Glucose
Sampling and Detection Worn on the forearm like a watch, the GlucoWatch Biographer samples glucose through intact skin, quantitates the amount of glucose extracted, and converts that measurement to a glucoselevel value.

A person suffering from diabetes for a long period of time runs the risk of getting foot ulcers and can also suffer from damage to peripheral nerves. Pictures of the affected foot can be uploaded via the net for a doctor to review.

Hand held devices
The latest development in diabetes technology employs some of the latest mobile communication technologies.The aim is to support patient self-management to enable the patient to have access to information and advice at any time and in any form.

Electronic Health Records
Providers will use Electronic Medical Records to capture clinical information of the patient. HealthFores EMR has a robust disease management system that creates a series of logical workflows and alerts. Once a clinician selects a patient diagnosis; for e.g. diabetes mellitus, the system will create a treatment regimen wherein the system will prompt regular monitoring of blood indicators such as fasting and post-prandial blood sugar, HbA1c, etc. Reminders to the doctor can be generated if the patient has not done the required lab tests every three months. Alerts can be sent to nursing staff, dieticians, lab staff and across the entire continuum of care along with treatment recommendations.

Health Portals
HealthFore provides patient portals which the patient can access online to update their own health information. The portal will also contain education content & will provide a collaborative medium for patient-provider interactions & diabetics support groups.

Early screening and diagnosis of chronic diseases can significantly reduce the morbidity and need for hospitalisation.

Pervasive Healthcare
Pervasive healthcare is all about continuously monitoring a patient by taking regular readings of certain vital parameters like blood pressure, blood sugar, ECG etc. The values are cross-referenced with a list of pre-determined values and an alert is sent to the treating physician if there are variations. Blood pressure readings measured at home are more accurate as it reduces the 20-40 percent of false positives at a doctors clinic due to the so-called White Coat Syndrome.

Healthcare Blogs
Blogs are also a common forum for people to exchange information. There is no dearth of good blogs dedicated to healthcare topics.

The patient needs to take charge of his own treatment. This will lead to him taking informed decisions regarding lifestyle changes and regular monitoring of vital parameters outside the doctors office. It has already been demonstrated how timely management of the disease can significantly reduce both morbidity and mortality due to diabetes.

The whole method of delivering healthcare revolves around the patient. Instead of confining oneself to doctorpatient interactions in the clinicians office a patient can interact with his providers from a remote location. This increases the frequency of interactions and also provides timely advice and monitoring of a patients condition. We are thus talking about changing the dynamics of a typical doctor-patient relationship. This kind of patient empowerment involves providing more information to the patient, doctors, family and the community.

Patients should be able to view their health information, obtain educational materials on the management of the disease and be able to communicate their concerns and queries to the physician. Physicians need to be aware of the progress in the management of chronic diseases and make adequate use of the tools available to offer better treatment to their patients.

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