Connecting consumers and physicians through technology will revolutionize health care, saving costs while challenging prevailing attitudes that “getting better” begins and ends with a doctor’s appointment or hospital admission. Chances are, however, the only health care technology most of us see are heavy machines bolted onto the floor and blinking electronic monitoring devices in doctor’s offices or emergency rooms. Commonly known as telehealth, patient-centered technology involves devices consumers already use such as smart phones. But telehealth is slow in coming. As doctors, we are trained to perform tactical interventions ranging from life-saving surgery to treating broken bones. Moreover, numerous obstacles hinder patients’ use of technology. Such questions as who pays and what to charge, who is liable when something goes wrong, state-licensing requirements, cybersecurity and integrating patient-generated data into existing systems underscore the challenges. Dr. Amar Setty Before we get to a point where consumers are actively involved in their own health care by routinely providing data to their doctors, we must test various approaches to work through technical bugs and administrative burdens. That’s where the Maryland Health Care Commission comes in. An arm of the state health department, the commission has awarded telehealth grants among a diverse group of health care providers statewide. Until there is a demonstrable return on investment to unleash private sector investment, Maryland’s public sector is filling a void by testing telehealth solutions. This is more than handing out money: outcomes are tracked, lessons learned are monitored and there is an emphasis on ensuring pilot projects evolve and become sustainable. This agency of the Maryland Health Department is positioning the state as a national leader in telehealth, providing a road map on arriving at the promised land of the medical profession: health care efficiency, patient-centered care and a healthier population. Most recently, a project launched last month focused on rehabilitation services for opioid addicts in Montgomery County. The project links a county social services agency and non-profit drug rehabilitation Mosaic Community Services to refer more addicts into medically assisted treatment, a proven approach to reduce physical dependency. Using technology to enable communication among addicts, caseworkers and physicians is key to correctly administering treatment drugs and behavioral counseling and closes a logistical gap when in-person interaction is not possible. Last year, a Crisfield-based primary care and mental health provider reported results of its grant-funded project focused on children who suffer from asthma, obesity and depression. A key goal of this telehealth approach is to improve patients’ self-perception of their health. Remote patient monitoring equipment included blue-tooth enabled scales, peak flow meters and Fitbits each of which were synced with mobile phones or personal computers. The peak flow meter, a device to test breathing of asthma patients, saves readings automatically so children do not have to write anything down and risk losing it. Recording data allows patients and doctors to track various medications used in treating asthma. Similarly, electronic monitoring of weight and food intake enables children to track progress on reducing obesity. For children suffering from depression, applications track activities such as playing outdoors or reading a book to better focus their attention. According to Anchor Health Services, which led this initiative, giving young people equipment to monitor progress gives them something to work toward. Anchor Health plans to expand the pilot project and also bills itself as a leader in using telehealth to connect patients and doctors across Maryland’s Eastern Shore. Targeted to three hospitals in geographically diverse parts of Maryland, the first grant-funded telehealth projects began three years ago. The goal of these projects is to sync acute care hospitals with long-term care facilities to reduce unnecessary hospital admissions. Nursing homes and their senior populations are frequent users of ambulances and emergency rooms, so videoconferencing and sharing of vital signs between physicians and patients appropriately avoided disruptive and costly transports. Atlantic General Hospital and a Berlin, Md.-based nursing home operation estimated savings of more than $200,000 per month from reduced hospital admissions. In all, the Maryland Health Care Commission provided grants to 14 organizations across the state at a cost of less than $1 million, illustrating that trying innovative technologies need not cost a fortune. And the Maryland General Assembly recently passed an interstate medical licensing measure, a crucial step for a small state where health care is often practiced across state lines. Achieving good health is a lifelong process transcending physical settings to include preventive and wellness measures as well as managing particular health conditions. Maryland is quietly leading a data-driven revolution putting patients in charge of their health care. We are evolving from the passive “following doctors’ orders” approach of decades past, to patients engaging with health care providers real-time, on their own terms. DR. AMAR SETTYThe writer is a practicing anesthesiologist who is working to implement technology-based solutions to improve health care.