News: Fall 2016

Connecting Care

Keeping track of personal health has become an industry. From off-the-shelf fitness trackers and mobile apps to systematic efforts like the quantified-self movement, personal health monitoring is virtually ubiquitous. Yet long before it became commonplace, Partners Connected Health sought to change the approach to health care delivery: from provider-driven treatment to patient-centered care. Launched twenty years ago, Partners Connected Health uses technology to allow patients to become active participants in their own care. Remote health monitoring, mobile health, virtual care, and many other program to tangible benefits for thousands of patients.
“We are changing the paradigm of health care delivery. That often means that the provider and the patient don’t need to be in the same room at the same time. We seamlessly extend care once patients leave the hospital,” says Kamal Jethwani, MD, Senior Director, Connected Health Innovation at Partners HealthCare.
Remote health monitoring programs, in which patients collect health-related information at home via simple technologies and securely transmit the data to physicians are among the offerings. Custom-designed software helps integrate the data—blood pressure, blood glucose, and body weight, for example—into patients’ electronic medical records and en-ables continuous assessment of chronic conditions and timely interventions.
A series of remote monitoring programs have helped improve clinical outcomes. A case in point: congestive heart failure, which afflicts nearly 5.7 million people in the United States. Almost one-quarter of patients are readmitted to hospitals within a month of discharge and nearly half of discharged patients are readmitted within 6 months. Partners’ remote monitoring program, Connected Cardiac Care, installed in patients’ homes, includes a small touchpad computer, weight scale, and blood pressure monitor. Patients electronically record vital signs, answer online symptom surveys, and stream the data to dedicated telemonitoring nurses who can call patients to discuss symptoms, provide guidance for self-management, or set up physician appointments.
“On average, each patient with congestive heart failure has about 2.7 readmissions per year, and each readmission costs upwards of $13,000. This program was able to significantly reduce hospital readmission rates by almost 50%. By including around 1,000 patients in the program each year,” notes Jethwani.
“Those initial efforts formed the basis of a population-wide move to improve clinical outcomes for patients with congestive heart failure. Remote health monitoring now forms a routine part of the care for several of the most vulnerable patient populations enrolled in the system,” says Gregg Meyer, MD, Partners Chief Clinical Officer.
“We are just starting to realize the benefits of patient-generated data. This pilot program illustrated how we could integrate data from easy-to-use connected devices into health care operations. The program also provided a proof of concept for the integration of the device data into the health record in a format that was actionable. Although we take such integration for granted today, this was a real breakthrough at the time,” says Meyer.
He adds, that feat is a sign of a larger transformation. “The empowerment of patients as co-producers who have been enabled by technology will be one of the major trends in health care over the next decade. Home-based monitoring is just a small part of this shift as we now have options that include wearable technology, patient surveys (such as patient reported outcome measures), remote patient tracking, and the ability to scrape data from smart phones,” explains Meyer.
For heart failure patients, hospital readmissions are largely attributed to a lack of adherence to prescribed medication schedules, and remote monitoring devices can help. For example, an electronic pillbox called MedSentry reminds patients to take medications on time and keep track of complex prescriptions. A pilot study showed that MedSentry increased medication adherence, minimized unplanned hospitalizations and emergency department visits, and boosted overall health-related quality of life.
“Over the years, these remote monitoring tools have allowed us to essentially keep patients out of the hospital—especially during the 30-day window following an initial discharge,” says Joseph Kvedar, MD, founding head and Vice President of Connected Health at Partners.
“We have learned that not all patients with heart failure will benefit from vital sign monitoring, depending on their type of heart failure as well as their baseline medication adherence. We can envision this system as a potential screening tool for the future to determine which patients are likely to benefit from monitoring their own vital signs,” notes Kvedar. Similar home health monitoring measures for blood pressure and glucose levels have led to tangible improvements in clinical outcomes for patients.
Telemedicine is another area of leadership for the Partners team. Partners Online Specialty Consultation service was launched more than a decade ago. The service allows enrolled patients to initiate secure video consultation sessions with their own referring doctors and Partners-affiliated specialists. Patients’ electronic medical records are sorted and shared with the specialists, who then proceed to offer an opinion or address challenging medical issues.