Telemedicine Innovation: High-Risk OB Monitoring

Many times a particular problem inspires an IT solution, but in the case of Memorial Hospital & Health System, a 526-bed regional health center in South Bend, Ind., the reverse was true. CIO Steve Huffman sought to find a use case for an accessible telemedicine product that would address a nontraditional patient group, all the while providing a financial benefit to the patient and the hospital.

What the IT team at Memorial came up with was an innovative remote monitoring program for high-risk obstetrics patients that earned Memorial a finalist award in the Healthcare Informatics Innovator Awards that were presented at this year’s Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando. The Healthcare Informatics Innovator Awards Program recognizes leadership teams from patient care organizations—hospitals, medical groups, and health systems—that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance.

In Memorial’s monitoring program, high-risk OB patients take home the Health Guide monitoring device from the Santa Clara, Calif.-based Intel that performs a health status assessment with vital sign measurements, survey questions, and interaction and visual observation through two-way video calls. The nurse monitors the patient in the application and initiates a weekly web conference to ensure that the patient is following care guidelines and answers any questions, all outside of the weekly OB visit.

Opening New Organizational Doors
A key factor in the project’s success from the beginning, according to Huffman, was the process by which the idea for the program was imagined. In June 2009, Huffman asked a small subset of his IT team to take 30 days to come up with an innovative telemedicine solution to solve a business problem and drive that through the organization. The group researched how telemedicine was currently being used, and came up with their own model, including physician, patient, and IT workflows. The group’s goals were to improve outcomes for mother and baby; identify a way to incorporate the data from the monitoring device and integrate it with Memorial’s EMR; and to utilize a cost avoidance model to prevent ED visits for mothers and shorten length of stay if they were admitted. “It has given new energy to that team,” Huffman says. “It was an awesome project that continues to open new doors and new thinking, so we’ve used that model on a number of occasions since then.”

The University of Notre Dame was invited to participate in the project from a research perspective to validate the value telemedicine brings to high-risk obstetrics. The head nurse at Memorial Maternal Fetal Medicine then took the lead role in building clinical protocols, and IT was trained on the deployment and imaging of the monitoring devices. Soon after, the first device was placed with a mother who was termed a brittle diabetic, meaning her sugars hit rock bottom, particularly when she sleeps. For the pilot, 18 devices total went out to high-risk mothers.

Now, at any one time there can be about 10 patients in the OB telemedicine program, with a rolling pool of devices being issued to the patient, who is typically diagnosed around 20 weeks with gestational diabetes and/or risk for pre-eclampsia (high blood pressure). The monitoring device takes the place of a patient self-recording blood pressure and blood sugar levels in a logbook and reporting them back at weekly OB visits.

Process-Related Tweaks
Since the initial pilot, Huffman’s IT team has made a few process-related tweaks. One was making the monitoring device easier for the patient to install. “How do you package [the device] in a box with it mostly connected, so when the patient gets home, it’s one phone call, and we’re connected,” says Huffman. “We tried to break down some of those technical barriers.”

The next improvement was eliminating connectivity problems when patients were connecting the devices to their home network. To alleviate these problems, the devices were outfitted with 3G cards so connectivity could be immediate. Huffman has since been refining the support model for these devices and adding Spanish language support.

Success Stories
Huffman says it’s still early to have specific metrics of improvement, but one thing he’s certain of is that the high-risk OB telemedicine program has lowered the cost of treatment of this very expensive disease state. With remote monitoring, patient irregularities can be easily detected and a doctor can intervene, or a patient can ask a question, all without a doctor’s visit. “That in of itself can save money and help the patient out,” says Huffman. “It’s a win-win.” Huffman references a November 2006 study, published in the Annals of Internal Medicine, which outlined a $5,439 cost savings as the benefit of monitoring high-risk OB patients from home.

Instead of ROI metrics, patient feedback is mostly what Memorial has so far to prove the merit of this program, and feedback has been overwhelmingly positive. Many high-risk OB patients feel disconnected from care as questions arise about increases in blood pressure, or decreases in fetal kicks, but with the presence of the devices that has been mitigated. An example from patient interviews was if a patient who is being monitored experiences a slightly increased blood pressure over the course of multiple days, a call can be placed from the nurse to inquire about lifestyle changes. In another example, a mother can be placed on immediate bed rest in advance of a weekly visit when her blood pressure indicates a slight trending which does not immediately require hospitalization.

One instance in which the program nearly saved a patient’s life was in the case of the first mother to participate in the pilot, as mentioned earlier, who was a brittle diabetic. She was sending her data to the nurse on a daily basis, and when one day no measurements came through, the nurse became alarmed. She called the patient’s home, work, and finally her husband. Once speaking with the husband, he went to check on his wife to find she needed to be rushed to the ER. Upon returning home, the patient continued to be monitored with the pilot and eventually delivered a full-term baby girl and had a normal hospital stay of three days. In addition to alerting the father, the data received with the device allowed the physician to see trends in his patient’s glucose readings and manage the patient better with the accurate data.

Huffman is currently pondering further uses for this technology. “As we’ve looked at other use cases, specifically patient-centered medical home, how do we take learning from this relatively small pilot and understand it as we prepare for the patient-centered medical home or accountable care organizations, and how do we apply it to bigger population disease states,” he wonders. He says Memorial will eventually invest in monitoring projects with diabetic and chronic obstructive pulmonary disease (COPD) patients. “So we’re trying to see if there is a tie between placing the technology in the home long enough to change behavior, validate that change, and then reclaim the device so you’re not adding a tremendous amount of expense at a critical period."