1 7 Portals Powering Patient Engagement

7 Portals Powering Patient Engagement(click image for larger view and for slideshow)

The Center for Connected Health (CCH), a division of Partners Healthcare in Boston, has integrated its home monitoring systems with Partners' homegrown electronic health record (EHR). Patient data collected at home, including blood pressure, weight and blood glucose, is transmitted electronically to -- and is now viewable in -- the EHR.

While the information was previously available to providers and patients on a Partners website, the integration with the EHR makes it accessible within the clinical workflow. That makes it easier for clinicians to use the data because they don't have to interrupt their work to go a website, said Joseph Kvedar, MD, director of CCH, in an interview with InformationWeek Healthcare.

CCH's home monitoring program began several years ago. At that time, noted Kvedar, Partners decided not to integrate the data with its core clinical system because there was not yet good evidence that home monitoring could improve the outcomes of patients with serious chronic conditions.

When positive results began to come in, physicians saw the value of the monitoring data in disease management, Kvedar recalled. But they'd tell CCH that they couldn't refer any more patients to the program because it wasn't integrated with their workflow and took too much time. That was when Partners gave the go-ahead for CCH to send the data into the EHR, he said.

At this point, the home monitoring program is focusing on high-risk patients with congestive heart failure (CHF), diabetes and hypertension. CCH has published studies showing that its program can reduce readmissions of CHF patients by 50%; can result in a 1.5 percentage point drop in the HbA1c of patients with diabetes; and in patients with hypertension, can lead to a significant drop in systolic and diastolic blood pressure after six months.

Kvedar attributes much of the success of home monitoring to its ability to engage patients in their own healthcare. In addition, he said, the availability of near-real-time vital signs data allows providers to intervene when a patient is not doing well and help that person get their condition under control.

The monitoring devices send the data via cellular networks to the Partners' EHR through dedicated interfaces. Although CCH could theoretically enable patients to use their smartphones to transmit the data, that's not being done right now. Instead, the data is uploaded through the HealthPAL hub from MedApps or through QualComm's 2Net Hub.

"We like these simple home hub devices that capture short-range signals and move them over the cellular network to our database in a secure manner," Kvedar said.

CCH is just starting to grapple with mobile apps, which were not foreseen when the home monitoring project began six or seven years ago, he added. Today, he noted, the boundary between home and mobile patient monitoring is starting to blur.

The biggest challenge with patient monitoring data, from a workflow perspective, is how to deal with the flood of information in a way that makes it useful and not burdensome. Partners is presenting the raw data in the EHR as a kind of flow sheet that anyone with access to a patient's record can view, Kvedar said. The relevant data can be cut and pasted into the patient record.

While some physicians like to view the monitoring data when they prepare for patient visits, nurses and pharmacists are the ones who mostly keep an eye on the incoming data and decide what to keep in the record, he noted.

In phase two of the project, he said, CCH's goal is to "apply some decision support to this so it isn't a string of raw numbers, but has some meaning behind it."

This decision support will obviously include alerts for important changes in health status, such as weight gain in a patient with heart failure. But Kvedar also envisions it presenting more subtle facts about a patient's condition.

"Say you're following a patient with hypertension that's difficult to control. If that person's blood pressure typically spikes in late evening three times a week, you might be able to tie it to diet or some stress in their life. You get a much richer tapestry of what's going on with a patient than just taking the person's blood pressure in the office a few times a year."

Besides Partners, some other organizations are also mounting efforts to connect remote patient monitoring data with EHRs. For example, WellDoc, which has an FDA-approved mobile app called Diabetes Manager, has integrated it with the Allscripts EHR and is in the process of testing the integrated system at George Washington University Medical Center in Washington, D.C. And eClinicalWorks has said that the next version of its EHR, due out this summer, will "consume" monitoring data and make recommendations to doctors, based on clinical protocols.