The use of at-home medical devices to connect doctors and patients via the Internet can help patients and their physicians work more efficiently together to manage chronic conditions, according to research at the Cleveland Clinic.
In December 2008, the Cleveland Clinic and Microsoft (Redmond, Washington) collaborated on a pilot project that pairs the hospital's electronic medical records (EMR) system with the software company's online HealthVault service to monitor patients' health conditions.
More than 250 participants enrolled – 26% with diabetes, 6% with heart failure and 68% with hypertension – making it the first physician-driven pilot project in the country to follow multiple chronic diseases in a clinical setting, the hospital noted.
“As you think about where we're going with the healthcare delivery system, there has been a lot of discussion up until now about how we finance healthcare and how we increase access to healthcare,“ C. Marin Harris, MD, chief information officer at the Cleveland Clinic, told Medical Device Daily. “Once that happens, or even if it doesn't happen, the challenge for the healthcare system is designing a delivery system for the 21st century that allows us to address the aging population that is outstripping the number of physicians, physician offices, and hospital beds that we have to care for those individuals.“
So, Harris added, “this project is important because it is an example of how we can fundamentally transform the healthcare delivery system, be able to provide services in a high quality fashion but in settings,“ that are less expensive and “far more convenient for the patient as well.“
According to the Cleveland Clinic, nearly half of all Americans are now diagnosed with at least one chronic condition, accounting for 75% of nation's healthcare spending.
“The prevalence of chronic disease is rising at an alarming rate in the U.S., absorbing an ever-increasing portion of the nation's healthcare dollars,“ Harris said. “If we are to lessen this strain on our nation's economy and healthcare system, we have to change our thinking about how and where healthcare should be delivered, while developing innovative, cost-effective solutions that allow patients to proactively manage their healthcare.“
In the Cleveland Clinic-Microsoft pilot project, participants used at-home heart rate monitors, glucometers, scales, pedometers or blood pressure monitors, depending on their disease. These devices uploaded the patient's data to HealthVault – a security-enhanced, Web-based data storage platform for patients – which then connected to the patient's personal health record at the Cleveland Clinic, MyChart, by Epic Systems (Verona, Wisconsin) and the EMR system used by the patient's healthcare providers at the hospital, MyPractice, also by Epic.
Harris told MDD that the concept of remote healthcare monitoring is not new, but in the past it was done with people making it work. A nurse would call the patient at home and ask them to do certain things; record the values manually; take those values to the doctor; have the doctor react to the information; and then call the patient back.
“In our model, everyone – the nurses, physicians, and the patients – had all the electronic tools that they needed to make this model work without additional human intervention,“ Harris said. “It essentially created the virtual offices, if you will.“
According to Harris, the results of this observational study suggest that at-home medical devices can help patients and doctors better track chronic conditions, coordinate treatment schedules, manage medication regimens and schedule timely interventions. “Ultimately, such improvements make for more efficient healthcare, healthier patients, and possibly a reduction in healthcare costs,“ he said.
The project found a significant change in the average number of days between physician office visits for patients, Harris noted. Diabetic and hypertensive patients were able to make doctor's office visits less often, increasing the number of days between appointments by 71% and 26% respectively, indicating that patients had better control of their conditions.
According to Harris, a diabetic patient typically sees their doctor three or four times a year. This project found that the use of at-home devices reduced that number of office visits to two or three, while still managing the patient's condition with the same clinical outcomes as in the past.
“As we think about the next 20 years, there will be 77 million people going from being 35 to 55, and from being 55 to 75, which is the peak utilization of healthcare services,“ Harris said. He said that the use of at-home devices is one way to care for a larger number of people without increasing the number of doctors available.
The project found that heart failure patients, however, visited their doctors more often, decreasing the number of days between visits by 27%, indicating that patients were advised to see their healthcare provider in a more timely manner.
“When treating heart failure patients, timely intervention is crucial when complications arise, so that we can prevent serious problems that may require emergency room visits or readmissions,“ said Randall Starling, MD, section head of Heart Failure and Cardiac Transplant Medicine at the Cleveland Clinic.
Theoretically, the fact that heart failure patients using at-home monitoring devices saw their doctor more often than in the past could be a good thing not just from a clinical perspective, but also financially, Harris noted. Although heart failure patients are a relatively small percentage of patients in the country, they spend disproportionately more of the healthcare dollar because when they get sick they usually end up in the emergency room or in the intensive care unit, Harris said. By seeing the doctor more frequently, heart failure patients may avoid the more costly ER visit or ICU stay.
“Making it easier for patients to more actively engage in their ongoing health and wellness is a necessary step in trying to manage the increasing onset of chronic disease worldwide and the costs associated with this alarming trend,“ said Peter Neupert, corporate VP of Microsoft Health Solutions Group. “The results of this pilot are promising and demonstrate how cost-effective and flexible technology solutions can support patients in better monitoring their chronic conditions from where they live and work.“
Amanda Pedersen, 229-471-4212;