envisioning the use of Skype or other real-time video. But there were a number
of advantages to using recorded video as opposed to live video.
"One, patients can take their medications at any time and two, if the phone is out of cellular or Wi-Fi range, the video can still be made and stored in the phone until it encounters a signal," Garfein said. "Then the video will automatically be uploaded to our secure server."
For security purposes, if a patient records a video and is out of communication range, it's stored on the phone until a signal is detected. Once connectivity is established and the video is transmitted, it is deleted off the patient's phone. In addition, health workers are permitted to stream patient videos off a secure server, but the system doesn't allow them to download it to their computer.
Smartphones for the new trial period are now being distributed to patients. Verizon awarded the program a $300,000 grant in addition to phones and cloud computing service valued at approximately $2.5 million. The trial will run until Sept. 30, 2014.
In the future, Garfein wants to deploy the VDOT system as "widely as possible," to health departments throughout the United States. He added that the development team is also working with University College London in England on a project to see if VDOT can work with patients that are difficult to track, such as homeless people.
Garfien envisions VDOT having two parts in the future.
"One component would be utilization as a service for health departments in the U.S. and abroad," he said. "The other would be a research component or components that are [also] designed to see if we can improve adherence to treatment by adding motivators or different types of reminder systems to help the patient to remember to take their pills."
In addition, Garfien said he'd also like to make the app available for use on personal smartphones. Right now, it's restricted to just program-provided phones.
While the technology may seem like a no-brainer for both patients and county health officials, a number of obstacles had to be overcome -- and need to be hurdled in the future as well -- for the system to really take root in San Diego County permanently.
Moser explained that some people just aren't technology-savvy and aren't interested in using technology. In addition, because patients are often required to stay at home in the early stages of treatment, they prefer daily contact with someone.
Another hurdle could be future funding. Garfein is using the current trial to estimate the costs of maintaining the program without grant money. Moser added that as far as she knows, insurance companies aren't reimbursing for VDOT services. So while the county saves travel and staff time using VDOT, if the IT cost ends up being higher, some decisions will have to be made.
"Certainly health departments will need to decide whether they can finally take on this technology," Moser said. "Technology has a way of creeping up in cost at times. There's maintenance, phones, service and we're just going to have to sort of go down the road and hopefully it will be cost-effective."
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