Rhonda Barker lives 45 minutes from Milan Puskar Health Right in Morgantown where she is receiving treatment for diabetes. But making the trip to and from her rural Marion County home can often be challenging, particularly during the harsh winters.
She isn’t alone. Each year, thousands of West Virginia residents travel long, winding roads to receive health care throughout the state. Thanks to innovative technology, Barker and others are now getting the care they need, often from the comfort of their own homes.
Jennifer Mallow, assistant professor at the West Virginia University School of Nursing and Robert Wood Johnson Nurse Faculty Scholar, and her team have developed mI SMART (Mobile Improvement of Self-Management Ability through Rural Technology), a web-based program that allows patients to participate in virtual care while taking advantage of opportunities to enhance their health via technology.
The mI SMART program focuses on patients with chronic conditions such as diabetes, obesity and high blood pressure, and provides tools and resources patients need to improve their overall health. Mallow established the research program through Health Right where providers recommend patients for the program, based on patient need. Once enrolled, each participant receives a computer tablet, blood pressure cuff, glucose monitor/test strips and scale, which they get to keep at the end of the program. Patients also receive free internet access during the 12-week program. 
Mallow’s “big idea” was literally putting pen to paper (well, it was actually a napkin), during a professional conference that she was attending. “The presenter was discussing the need to get providers to patients, but I was like, ‘that’s not good enough; we need to get them to us’.” So she jotted down her ideas on the napkin, pushed it over to her husband Brian, a web developer who accompanied her on the trip, and said, “Can we do this?” Mallow said her husband never says no, so she knew they could make it a reality.
Through the mI SMART program, each patient receives training from Mallow and her program coordinator, Elliott Theeke. The patients participate in a series of health checks and that data is automatically transferred from the health monitoring devices into mI SMART. Patients can complete health care visits, receive feedback from their health care provider and track their progress, all from the comfort of their homes. That data is immediately sent to professionals involved in the care of the patient. Patients can also conduct virtual visits using video conferencing, view medications and watch tutorials/videos that provide additional health education to help them succeed.
Mallow, who was diagnosed with diabetes when she was 17, is passionate about reducing and/or eliminating burdens placed on the patient. “When I became a nurse practitioner, I started to think about those people who don’t have the resources that many of us have. It isn’t that people don’t want to take care of themselves – something we hear often; it’s that life gets in the way. They don’t have the resources they need to take care of themselves. It’s not just medicines and education, it’s everything in their life that gets in the way. I’ve had the resources and motivation to take care of myself, and patients want to do that too.”
The mI SMART program addresses two specific barriers to health care identified in Mallow’s research: multiple chronic conditions and the distance traveled to receive the actual care. Patients who had more than one chronic condition and those who had to travel more than 21 miles were more likely to miss their visits with their health care professionals.
Patients appreciate the ease of the program, including Barker who has seen amazing results. “This program made me accountable and provided me with tools to track and follow my progress – all from the comfort of my own home. My glucose readings dropped three percentage points during my 12 weeks on the program. My husband even joined after seeing my results. Even though we’ve completed the program, we feel like we have the tools to keep going.”
Like any great idea, it takes a village to make the program work, and Mallow noted that they have a great team in place to ensure patient needs remain a priority. “This is a very collaborative approach to care. Depending on the chronic illness, our patients meet with health care professionals who are very focused on the patient’s care. The wonderful staff at Health Right, from counselors and nurse practitioners to pharmacists and those who assist with tracking data, it’s truly a team effort. These people are the ones who make this program work.”
Rebecca Walls, a Family Nurse Practitioner at Health Right and a School of Nursing alum, is just one of many health care professionals who cares for patients in the program, and she sees the positive results on a daily basis. “I’ve seen reductions in the average blood glucose readings (sugar) and weight loss among our patients because we are constantly monitoring their progress and interacting with them. I am honored to be a part of a program that helps to elevate the level of care we give to our patients.”
At the completion of Mallow’s research study in December 2015, 30 patients will have completed the mI SMART program, and many of them will continue to use the system to track their progress and participate in virtual care opportunities. She and her team will review the data to determine if this type of program works – for both providers and patients. And, if the data shows that this type of approach to health care is feasible, she hopes to attract additional funding and roll the program out to a broader base in West Virginia.
Mallow continues to develop collaborative partnerships with colleagues to incorporate mI SMART to address other chronic illnesses, such as loneliness and other issues that affect the overall health of the patient. “If we don’t take care of the people in our state, no one else will. We want to improve the health of West Virginians and expand this program statewide so that those who need it, have the care they deserve.”