Today, our correspondent Wil Dubois — a longtime kind 1 himself that works as a clinical diabetes educator — takes a comprehensive look at the mobile program Called HealthSlate, that has been promoted heavily at large health care professional conventions within the past couple of years:
Diving Into HealthSlate
I am on line masquerading as a 65-year-old kind two grandmother named Donna.
It is not as pervy as it seems.
I am test-driving the brand new HealthSlate diabetes tele-health program, and Donna is your company’s sample individual that allows me kick the tires of the new platform, which combines education, guidance, support, and more, for people with diabetes who do not have access to classic diabetes education. Currently it is being rolled out to type 2s.
Next up, later this year, will be a version for women with gestational diabetes, and we sort 1s are on HealthSlate’s horizon after that.
What’s HealthSlate? It is the cellular wellness tool that causes traffic jams on the trade show floor of this annual American Association of Diabetes Educators (AADE) assembly when the company passes out free touchscreen tablets. The pills come fully loaded with software that helps diabetes educators their game up through “edutainment and gamification” of their organization’s core self-care principals. Over the past few years, HealthSlate has passed out 5,000 tablets to CDEs, and they report that in any given month, between 500 and 1,000 of these are utilized.
Now, however, HealthSlate has moved from this educator’s office. Right into your residence.
Available as an Internet portal or cellular app that is both Android and IOS friendly, HealthSlate can do the following:
- Wirelessly track activity, glucose, and blood pressure
- Generate reminders for all from taking your meds to walking your pet
- Connect users to personalized training and peer assistance
- Supply docs and educators tools to help its users in the clinic side
What makes HealthSlate’s approach unique is that it is intended to associate with existing education programs, rather than replace them like for example the Livongo model does. HealthSlate CEO Dan Sheeran says the goal is to “enable the 90% of people with diabetes that don’t get diabetes education to do this without having to visit a clinic.”
Work really started on HealthSlate three years ago, and pilot research started almost exactly a year ago. The business has now conducted four pilots and one clinical trial, with a total of approximately 130 patients enrolled. Industrial roll-out started at the start of this year.
“Virtual and Cellular tools should improve the existing care team’s abilities, not compete with them,” Sheeran adds.
The program comes packaged with videos to provide diabetes education. Topics include healthy eating, physical activity, eating out, parties, medications, sick times, sex and travel. There are a number of good tips in here, including the idea of finding “liability friends” and even a section on affording diabetes care. The target of the videos is to provide 100 percent of the material of a whole 10-hour course the AADE offers.
Do not panic.
HealthSlate knows attention spans are short, so the videos are on average only 2.5 minutes, and they are fed to the consumer at the rate of four per week over 12 months. It is possible to skip around and see them as you desire. Despite pretending to be Donna, I had been all over the sex movie thing, but found it ironic — that was a frequent theme for most of these educational videos, IMHO.
Blood Sugar Logging Made Easy
Let us face it, no mater how slick the program interface, logging blood glucose is a drag, which explains why the majority of programs become dropped pretty quickly. What’s needed are ways to automatically log. Seamlessly. Without a great deal of effort.
HealthSlate is about the situation. The program talks to Fitbits, Misfits, wireless scales, and the Apple Health Kit. They simply finished compatibility with Bayer and OneTouch meters for USB downloads, even though that’s not in the area yet. In the future, Sheeran expects to incorporate HealthSlate with Dexcom CGMs and Medtronic insulin pumps.
Wiz-bang Diet Help?
HealthSlate’s strategy to food logging is what Sheeran calls for their “wiz-bang feature”
Rather than typing in what you eat or selecting foods from a very long list, you use the camera to photograph meals and upload the photo to the program, where — believe it or not — a dietitian on the other end will offer an evaluation of this meal. This feature is called “concierge food guidance.”
I like “wiz-bang feature” myself.
No, this photo feedback isn’t instantaneous (however), but Sheeran says users generally get opinions from a dietitian within an hour. That’s not fast enough for a bolus choice, but it might help people sharpen their carb-counting skills on the foods they are eating. To accomplish this, HealthSlate works with a community of dietitians nationally, in most time zones, we’re told.
I had been eager to test this feature, therefore ready a dinner my inner-Donna would eat, then clicked the “Insert fresh meal” button and then picked the “Take photo” choice, which opened the iPad camera. I could pick that photo or snap a second, and eventually I uploaded the picture into the HealthSlate server.
Well… I tried to.
The following morning the HealthSlate was “uploading to server” and my food was really getting chilly.
Sixteen hours later I finally had the quote on Donna’s dinner in the dietitian, which had been quite a bit higher than my own quote. Donna’s dinner (that I ate) had been lasagna casserole, two slices of a demi baguette, and a side salad with blue cheese dressing. My carbohydrate count was 44. My HealthSlate dietitian pegged the meal at 87 carbohydrates and noticed that Donna had been 42 grams above the carbohydrate limit set in her treatment program.
Am I that bad at carbohydrate counting? Maybe. You pick.
Here is how the carb-counting mathematics contrasted:
My Math – 8 to every slice of baguette + 25 for the pasta + 3 to the dressing and salad = 44g.
Dietitians Math – 15 for every baguette + 52 for the pasta + 1 for salad dressing + 4 sunflower kernels + 0 for butter.
OK, kudos on noticing the sunflower seeds on my salad.
But obviously, the gap between 44g and 87g is… huge.
The big issue with this program process is there is no way to judge portion size from photos. You can’t tell how large a plate is out of the picture, or really how big the food items are. While I understand the pasta was only a mere half-cup, you can’t see that in the film, nor will you find my baguette was petite demi-sized.
And what about people who might be eating lower-carb bread instead of the normal kind? Can the reviewing dietitian-on-call have some way of knowing they’re taking a look at the low carb variety?
There are a growing number of programs out there that allow you to submit food photos to get nutrition information (such as Google’s own), and these recognition gaps and portion size are only a few of the problems that restrict their usefulness.
The Good and the Sloppy
This program apparently has sufficient other virtues to create a real difference for a number of folks. In a small study of participants using the service and program in Washington and Oregon states, A1C scores dropped a whopping 1.3% in 12 to 15 weeks, which is far better than any oral medication available on the market. A larger study is underway at this time, the firm tell us.
Still, it seemed to me that a lot of what HealthSlate offers is simply sloppy and incorrect in several ways, and does not view patients. Here is why:
- Regrettably, I found the program to be sluggish overall. I had been frustrated by the amount of time I spent looking at a spinning green circle, waiting for something to happen. I found the 2-3 minute videos wrapped up frequently, taking a painful 5-10 minutes every day to perform and sadly the program does not automatically rotate with the tablet’s orientation. To be certain the app speed wasn’t a issue with my Internet connection, I watched the official preview for Batman v Superman: Dawn of Justice (hello, it had been the first thing I could find) on YouTube without a hiccup.
- As a result of this universally slow loading, I watched quite few of the videos from start-to-finish. But speed was only part of the issue. They were also difficult to watch and listen to, and it is a shame because they’re the meat of this education built into the program. Visually, they seemed like white board PowerPoint slides — a disembodied hand drawing with a magic marker, sound consequences of said marker squeaking while drawing, stock photos, clip art and animation characters. I enjoyed the fact that the animation characters came in various ages, sizes, and colours, leaning towards heavier and older–but they didn’t link to the material in a meaningful way.
- In at least 2 of the videos, when the narrator’s speaking about glucose test strips, the image shown is a jar of urine ketone test strips — a error that’s sure to cause confusion. My internal Grandma Donna was saying, “But wait, my doctor didn’t give me anything that looks like that!”
- Similarly, when speaking about the human body’s natural insulin production, the artwork shown is a Novolog Flexpen. WTF? Stock photos of sufferers assembly with CDEs showcased hairstyles not seen in the real world for quite a while, and I was highly annoyed when an otherwise cool 3D anatomical rendering was unaccountably flipped, showing the liver on the incorrect side of their body.
- I felt talked down to a bit, a frequent issue with AADE-approved education materials, which are inclined to be a bit patronizing and restricted to fifth-grade English.
So in the end, involving slow loading speed, jarring visuals, a patronizing tone and over-stuffed shallow material, the vids endure a death by a thousand pin pricks. This is a shame and a major weakness of the entire program. Hey, if journalist-on-assignment Wil can’t muster the patience to stick with all the videos, how will Grandma Donna take action?
Nevertheless, it is not all bad; I did like the broad range of material covered, and one feature I’ve really admired was the capability to click at the bottom of the movie and read the transcript right, instead of hear it.
Price of Mobile Diabetes Education
Until very recently, doctors or educators who might spend time speaking to you about the phone, emailing you, or even videoconferencing with you’d become exactly zero dollars in insurance reimbursement for this. Luckily, that is beginning to change (even though the landscape changes from state to state). But progressively states, the Feds, and even private payors are starting to realize that some form of telehealth qualifies as valid treatment just as far as a face-to-face visit. This is how HealthSlate is monetizing its program.
Presently, the Medicare Preventive Care Management program (CCM), which pays $500 per year per individual for schooling, is HealthSlate’s primary revenue pool. Practices and hospitals contract with HealthSlate for their service and then bill Medicare under CCM (with providers keeping a cut). The expense for a Medicare patient enrolled in CCM is $10 per month. Copays vary for individuals with private insurance.
The Future or a Dead End?
Considering the gap between the demand for diabetes education and its restricted availability, I think HealthSlate is working hard to place present resources to meaningful usage (no more EHR pun intended). I just think they need to improve their videos — ideally by working with a few savvy patients who can help them comprehend what contrasts — and maintain an open conversation with users to keep on improving content overall.
My internal Donna agrees, and thinks HealthSlate could be a very useful tool to find out more and keep on top of her diabetes.
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