It’s widely acknowledged that healthcare, as every other industry, is becoming more mobile and that mobile solutions, whether apps, wearable devices or services like remote patient monitoring, hold a lot of promise as digital tools healthcare leaders can use to lower healthcare costs and improve quality of care, which is becoming increasingly important in the ongoing shift from fee-for-service to value-based healthcare delivery.
Mobile health (mHealth) and connected health solutions are projected to grow by leaps and bounds in the next five years, with the mHealth solutions market forecasted to rise by 30 percent to hit $59 billion by 2020, according to MarketsandMarkets, a market intelligence and research firm that covers healthcare IT. There are a number of trends and developments driving this growth, such as the increasing utilization of mHealth apps and connected health devices to help manage chronic diseases, a rising focus on patient-centric care, and the need for more affordable treatment options as healthcare costs continue to rise.
Mobile technology in and of itself is simply a tool, and the big question for physicians and health IT leaders at hospitals and health systems is how do you leverage mobile technology and deploy a mobile solution in a way that impacts clinical outcomes and contributes value to healthcare delivery?
Marcia McKingley, a consultant with the Chicago-based consulting firm The Chartis Group, believes the biggest challenge for healthcare leaders in leveraging mHealth solutions is actually more cultural than technical.
“I think the number-one challenge is just changing the mentality of how medicine is practiced today,” McKingley says. “A few years ago, the physician or care team was okay with the patient writing down information, such as checking their blood sugar level at home and then writing it down on a piece of paper, and then bringing that piece of paper with them the next time they see a doctor,” she says. “Today, healthcare providers need to think about the business differently and invest in the technologies that will give them the capabilities to capture, analyze and present the data and information so it can be used in a more meaningful way and in a more meaningful setting.”
“Another barrier is integration,” she says. “With all the new processes and data that do not fit the traditional IT solutions, the complexity of trying to make your current legacy systems meet the needs of future technology advances is going to be a struggle. That’s a big barrier and it needs to be overcome.”
She continues, “Healthcare organizations need to devise strategies, first by assessing their current state—their current integration and infrastructure—and then identify where the gaps are within their infrastructure and complete those initiatives needed to get them to where they need to be. And it’s also important to have the support of the leadership to back the costs that are associated with developing an infrastructure to move forward.”
There are a number of hospitals and health systems, including the University of Pittsburgh Medical Center (UPMC), Duke Medicine and Partners Healthcare, currently piloting innovative projects using mHealth solutions, such as remote patient monitoring, and they have tackled these very issues and continue to push forward to use mobile solutions in breakthrough ways.
Ravi Ramani, M.D., director of the Integrated Heart Failure Program at UPMC, has led a remote patient monitoring program for congestive heart failure (CHF) patients there for a number of years. Patients enrolled in the program are given home monitoring equipment to transmit data on blood pressure, heart rate and weight to UPMC care managers, who monitor it on a daily basis, and then send the data and alerts to the treating physicians. The overall goal is to allow physicians to intervene when necessary and prevent hospitalizations.
As a result of the program, Dr. Ramani and his colleagues have seen 30-day readmissions rates for CHF patients in the program drop to 12 percent, compared to an average readmission rate of 21 percent for CHF patients at UPMC not enrolled in the remote monitoring program, and the national readmission rate average of 25 percent for CHF patients.
“The program enables better patient care, and but it also helps reduce overall costs of care and helps us to manage a larger group of patients with fewer staff more efficiently,” he says.
On the healthcare delivery side, Ramani attests that the program required a significant culture change for physicians.
“As a physician, I’m used to seeing patients every three to six months and they come to my office, I deal with the acute problem then and there and then move on. Instead of that, I’m getting these vast realms of data, and if you think about every patient, that means I’m getting a thousand blood pressure readings every day. And most doctors are already very busy as it is and now it’s adding a whole new layer to this,” Ramani says.
After a major assessment of the program, which involved gathering input from all stakeholders, Ramani and other healthcare leaders involved in the program made a number of changes and improvements. The program now has a more patient-centric focus and is more efficient for clinicians’ workflow, he says.
“The way the data was coming, in the form of a list of heart rates, blood pressure and weights, it was about six or seven pages of faxed material, just numbers, and it’s eye-glazing material,” Ramani says. “And we noticed that we were not seeing a response from the doctors in terms of doing what was needed. So, first, we really simplified and streamlined the kinds of alerts the doctors are getting. Instead of list of numbers that’s a six-page fax, we reduced it down to a two-page info sheet with a graphical representation of what’s going on.”
He continues, “We are also working to implement, in the next month or so, a process so the alerts go directly into the electronic medical record, so it’s not an additional source and it’s not outside the doctor’s workflow.”
Ramani and his colleagues at UPMC have also tackled issues with practice variation to make the remote monitoring program for CHF patients more effective.
“We know that there is tremendous practice variation in terms of how doctors handle the same alert, or the same information coming in. So, what we’ve done is develop what we call heart care pathways. It is specific protocolized instructions and orders sent to the treating physician. And what we’re hoping to do through this is reduce variation and really streamline care,” he says.
In North Carolina, data integration for readmissions reduction
The Durham, N.C.-based Duke Medicine began work on a pilot project about a year and a half ago to integrate patient-generated health data into the electronic health record (EHR) using Apple’s HealthKit with the goal of reducing patient readmissions. Through this pilot, patient-generated health data from devices such as activity trackers and blood pressure devices is transferred, with the patient’s permission, via a smartphone to Duke Medicine’s MyChart app connected to the MyChart patient portal and then transfers into the EHR.
Ricky Bloomfield, M.D., director, mobile technology strategy at Duke Medicine, has been leading the effort to integrate Apple’s HealthKit and says the project is still in the pilot stages right now as its being deployed and scaled up at individual clinics.
Ricky Bloomfield, M.D.
“The project is moving a little slowly, but not because of the technology, the technology itself was the easy part. It’s mostly due to the logistical challenges in modifying the workflows of the clinics and getting those pieces in place. It’s the individual workflows and the fact that every clinic might want to do it a different way, because of the staff on hand and the ratio of nurses to clinicians. So, you have to meet them where they are,” he says.
Bloomfield continues, “Right now, the data transfer is enabled by a specific provider for each patient and some of the discussions we’re having right now is whether that makes sense. There’s discussion about whether it should be turned on for every patient and patients can unilaterally send us that data but once that happens, there’s a concern about having all this data coming in that’s not necessarily solicited and how do we triage that data appropriately. Within a specific clinic, who is going to manage this data and triage the data? So it just adds another layer of complexity in deciding how to use that information.”
Despite the small scale of the project at Duke Medicine, Bloomfield and his colleagues are already seeing promising results on an individual level. He recalls one patient participating in the project who was traveling abroad and felt light-headed and then tested his blood pressure using a blood pressure device. As the blood pressure reading was low, the patient’s provider received an alert and then contacted the patient. The provider recommended the patient reduce his blood pressure medication dosage and the patient’s symptoms resolved.
“It’s a simple anecdote and it illustrates to us the power of the technology in being able to monitor patients remotely with their permission and the opportunities that it brings to improve care in ways that are much less costly and much more efficacious for the patient,” he says.
Moving forward in a more big-picture way, healthcare leaders say it’s important to assess how to identify the patients who could most benefit from a mHealth or remote monitoring program, which would typically be higher risk patients. There are also technical issues, such as patients’ internet connectivity at home and what kinds of mobile devices they own, and how involved should health systems and hospitals be in supporting patients’ tech and IT needs, Bloomfield says.
As mHealth solutions are increasingly integrated into healthcare delivery, forward-thinking health systems and hospitals already have moved past the stage of deploying solutions and are now refining and improving their programs with implications for population health and better care management.
McKingley says, “There are a lot of breakthrough mobile innovations coming forward in the industry. It’s come a long way and I think as we continue to try to find our way through with how everything fits together, there is going to be more breakthrough with the technology advancements.”