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9/7/2011
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Telemonitoring Pilot Attacks Diabetes

Health information exchange's project aims to keep diabetic patients out of the ER; if it works, the technology could pay for itself.

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As part of a larger project to reduce the burden of diabetes on patients in western New York, Buffalo-based health information exchange HealtheLink has launched a pilot to test the effect of telemonitoring on diabetics' health. A premise of the 18-month pilot is that telemonitoring will pay for itself by reducing the enrolled patients' emergency room and doctor visits.

While the evidence for that remains uncertain, the pilot is set up to measure clinical and claims data for the study group and compare it to data from a control group of similar patients, Todd Norris, western New York Beacon Project director for HealtheLink, told InformationWeek Healthcare. HealtheLink will make quarterly reports to the Office of the National Coordinator of Health IT (ONC), which is funding the study through its Beacon Communities program. The study will end March 31, 2013.

The first 100--of 150 projected--patients have already been enrolled in the telemonitoring program. Primary care doctors in four practices--all of which are using electronic health records (EHRs)--signed the patients up for the study, using specific criteria. The patients have moderate to severe forms of diabetes which are not completely out of control, Norris observed. So telemonitoring can be expected to help these patients avoid ER visits, which such patients typically make once or twice a quarter.

Up to now, telemonitoring has been a difficult sell to physicians. Not only haven't they been paid for it, but the equipment is expensive and the monitoring of data is very labor-intensive.

To overcome these barriers, HealtheLink has contracted with two local homecare services--affiliated with Catholic Health System and Kaleida Health--to provide the equipment, train patients on its use, and do data monitoring and analysis. If a nurse or a physician assistant working for one of these services sees that a patient's vital signs are outside specified bounds, the clinician will notify the patient's physician.

Moreover, with their patients' consent, doctors can view all of the telemonitoring data on HealtheLink's website and can trend the information in various ways. In the near future, they will also be able to have the data downloaded to their EHRs.

"So now this becomes part of the primary care physician's normal workflow, and they're notified when a patient gets out of bounds," Norris noted. "And when somebody pricks their finger or does a blood pressure check, the data enters the health information exchange. Then the provider has the ability to go into our virtual health record and look at it, and they can do trending of the data so they can see the hours of the day or the days of the week when this patient's blood sugar spiked or dropped, so that doctor can plan a regimen for that diabetic patient."

The use of new technology will encourage patients to take their own blood pressure or blood sugar readings more regularly. Instead of being forced to record these vital signs at home, as the older telemonitoring methods required, patients can use mobile health applications to enter their vital signs and transmit them to the telemonitoring services from cellular phones or wireless mobile devices. The data is stored on the device and "once the connection is made, it will send the data," Norris said.

All of this will cost about $250 per patient per month during the pilot phase, he pointed out. However, he said, "If you take away one ER visit per quarter, it pays for itself." In addition, the cost could drop as low as $150 per patient month if a payer were using telemonitoring with, say, 40,000 patients.

That's still a very sizeable $6 million per month. But Norris said that HealtheLink has been discussing the pilot with local payers, and one health plan is sufficiently enthused that it has pledged it will continue paying for 50 diabetic patients to be telemonitored for five years, even if they switch plans.

Some participating physicians are interested in having the monitoring data pushed to their EHRs, Norris said, because they view it as part of their clinical transformation projects. Instead of waiting until the telemonitoring service notifies them that a patient is having a crisis, "they'll now have the ability to be proactive and ward off these emergencies," he said.

The telemonitoring project is part of a larger cluster of innovations that HealtheLink is implementing to address the problem of diabetes, Norris added. Among the other interventions that the health information exchange is investigating are a community patient portal that will push test results and transcribed reports to Microsoft HealthVault, so patients can view and store their own data, and a community medication history that will include prescription and "fill" data from pharmacies, hospitals, and other healthcare facilities. The latter is very important for diabetic patients, he said, "because out of 100 diabetic deaths, three or four are related to medication errors."

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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