Long Distance Dedication: Remote Health Monitoring

Information technology plays an important role in many aspects of our society and is an emerging force in the healthcare industry. One area of health IT that shows great promise is remote health monitoring, which during the past 10 years has risen from humble beginnings to become a significant player in healthcare.

MDNG spoke with Joseph Kvedar, MD, director of the Center for Connected Health in Boston, MA, who explained that “remote health monitoring involves the use of sensor technologies, primarily to gather physiologic information about patients that allows care providers, as well as patients, to make decisions about the care without actually being in the same room.”

Remote health monitoring is designed to help empower patients in becoming more actively involved with their personal health management. Patients with a chronic illness, such as diabetes, asthma, or chronic heart failure, need to be motivated to follow management plans and make necessary lifestyle modifications in order to minimize the chances that they’ll develop additional complications that could further jeopardize their health, thus requiring expensive treatment. The feedback provided by constant monitoring can help reinforce adherence and good health practices. Researchers in remote health monitoring have even found that patients who use the technology make fewer unnecessary doctor visits and are less likely to require hospitalization. Remote health monitoring can also help reduce healthcare costs. “If an organization plans patient visits every three days at a cost of $100 per visit, for example, over a 60-day period, the cost is $2,000 for 20 visits”. Mark VanderWerf, president of American Medical Development (AMD) Telemedicine, said that incorporating remote health monitoring into such a patient’s care may mean that patient “might only visit [the doctor’s office] seven to nine times in the 60-day period, so for each 60 days, you save in excess of $1,000.”

Remote health monitoring systems also provide tools for patients that enable them to learn about and understand their illness, so they can walk into a doctor’s office feeling more confident. Companies like Health Hero Network, Inc., Medtronic, Inc., and iMetrikus, Inc. have worked hard to incorporate educational modules into their products as a way to encourage self-management. MDNG spoke about the advantages of incorporating remote health monitoring tools into patient care with R. William Vandivier, MD, clinical director of the Chronic Obstructive Pulmonary Disease (COPD) Center at the University of Colorado Hospital. “I think ultimately they [the patients] get better care,” he said.

Hey, Buddy!

Self-management and education are essential parts of the treatment plan for patients who have a chronic illness, according to Health Hero Network, Inc., which has incorporated tools into its monitoring systems to enable patients to take a more active role in their own care. The Health Buddy System®, a user-friendly four-button device with a large screen, is the company’s flagship program. It “integrates home health monitoring technology with clinical information databases, Internet-enabled decision support tools, health management programs, and content development tools.” With the ability to support 130 programs—10 with National Committee for Quality Assurance certification—that remotely monitor 30 different conditions (eg, cardiovascular, endocrine, psychiatry), the Health Buddy can be used by practitioners in just about any medical specialty. Its educational content “can be combined into programs that address a single disease state or comorbid conditions or even trimorbid conditions,” says Suneel Ratan, Vice President of Business Development at Health Hero. “That’s the first degree of personalization for the patient—it’s personalized to their condition.”

The Health Buddy also sends a daily transmission of specified patient data based on a set of rules established by the healthcare professional depending on what illness is being monitored. Patients will spend about 10 minutes with the Health Buddy answering questions (eg, “How are you feeling today?”) and connecting other devices that measure vital signs so the information can be uploaded into the system. “It will assess [the patient’s] behavior and [give them] coaching about their behavior,” said Ratan. “They’ll be assessed about their knowledge of their condition and given feedback and [further] education about their condition.” The device dials into a set 1-800 number overnight and uploads data and results to a physician interface—which can manage up to 200 or 300 patients—for care managers and care providers to view the following morning. Patients whose vital signs and symptoms show an adverse change will be automatically placed at the top of a contact list, making it easier for a care provider to follow up with those patients at a higher risk, reducing the amount of time spent on the phone. This way, they’re “only managing the 5-7% who are showing up as high-risk for signs and symptoms on a given day,” said Ratan.

Health Hero is currently conducting a study in the Pacific Northwest with Medicare patients. Although quantitative results have yet to be analyzed and released, Ratan told MDNG that “physicians in that program are really amazed that they now have patients who have struggled with their conditions for years and got into a place where they were really sick, who are now doing a lot of the things that they need to do everyday to keep themselves relatively healthier.”

All Linked Up

With a focus on providing user-friendly capabilities to upload realtime patient data from biometric devices into personal health records (PHR), iMetrikus is “a pioneer in Internet-based remote health monitoring systems [and] serves those managing asthma, diabetes, pulmonary disease, hypertension, cardiovascular disease, congestive heart failure [CHF], and HIV/AIDS.” Although MediCompass Connect®, which “enables the collection of data that can be shared by members with their care team between provider visits,” is iMetrikus’ main focus, it’s the MetrikLink that may be the more interesting health monitoring resource, due to its ability to connect to more than 30 monitoring devices from different companies. MetrikLink transmits information through a telephone line or over the Internet, enabling authorized members of the healthcare team to easily review patients’ data. As part of MediCompass, it serves as a “universal communication gateway that securely transfers data from health monitoring and point-of-care devices.” Robert Murphy, Senior Vice President of Marketing, told MDNG, that “MetrikLink is really where our core development is and where our unique place in the marketplace is.”

Medtronic offers a similar product called the CareLink Network®. It is “the leading Internet-based system to help physicians and patients better manage chronic cardiovascular disease treated by implantable device therapy.” Participating patients need only turn on the monitor, place a small, computer mouseshaped antenna over their implanted Medtronic device (a variety of the company’s implantable cardioverter defibrillators and cardiac resynchronization therapy-defibrillators are currently supported; Medtronic plans to provide support for additional devices in the future), and connect it to a telephone line anywhere within the US. The CareLink Network enables physicians to review a patient’s signs and symptoms and determine if any changes have occurred since the last office visit. Molly McMillen, Public Relations Manager for Medtronic Cardiac Disease Rhythm Management, says that not only are the implanted devices convenient for the patients (100,000+ currently enrolled), but they “cut the time for routine follow-up by 65 percent.”

On the Flip Side

The companies that create and distribute remote health monitoring products are understandably enthusiastic about the technology’s potential to help improve healthcare outcomes in a variety of disease states and patient populations. But what do some of the healthcare professionals who have studied remote health monitoring and incorporated it into practice have to say?

One benefit of remote health monitoring technology touted by supporters is its ability to increase access to care for geographically underserved areas. Because patients in rural areas often have a much harder time than their urban and suburban counterparts when it comes to accessing medical care, a study is being conducted at the University of Colorado Hospital, under the direction of Dr. Vandivier, to measure the effectiveness of remote health monitoring in patients with COPD who live in urban and rural regions of Colorado. “Urban medicine is kind of different than rural medicine, so we’ve partnered with Kaiser Permanente, and we’re enrolling patients from both of our sites,” Dr. Vandivier told MDNG. “We’re also doing rural medicine, which we’re maybe even more excited about because a lot of patients out in these counties in Colorado that are rural or even frontier— which have even fewer people—have a lot harder time getting their medical care.”

The study, known as the Advanced eHealth for COPD in Colorado Program, is designed to “evaluate the impact of the eHealth approach on reducing healthcare costs and improving quality of life for participants.” The study will provide up to 400 patients with a pulse oximeter, a handheld spirometer (for exhaled breath monitoring), a pedometer, and an electronic communication device, which they will use to make daily reports of their self-monitored health information to healthcare professionals at Kaiser and the University of Colorado, who will in turn provide patients with educational information about COPD and “contact any participant who has a monitored parameter in a questionable range and determine what interventions may be needed.” The study is also looking at the economic impact of remote health monitoring. Results from a pilot program showed that remote monitoring saved “nearly $3,200 per patient over just a 12-week period, largely by alerting healthcare providers to signs of developing problems before they ballooned into larger complications.”

Dr. Vandivier told MDNG, “Initially, I actually was skeptical of this sort of mechanism to teach patients about their disease and to administer care to them, but I am a true believer in it now. I think for our patients, it’s really made a huge difference.”

Another remote health monitoring program, conducted by the Center for Connected Health Information, is focusing on “extending the care community beyond the traditional walls of healthcare institutions by bringing healthcare to the everyday surrounding of the health consumer and their families.” Dr. Kvedar told MDNG that the Center runs many programs and initiatives to measure the effectiveness of remote monitoring of patients with chronic diseases. The Center has analyzed “the latest data on years of patients going through that kind of a process” and found that “the hospitalization rate for patients on the intervention is reduced from a former rate of 22% to 5%.” The Center is also looking at how “new models of care that extend and enhance the physician—patient relationship are emerging through innovation of technology and process.”

We had a bit to say on the topic of the patient—physician relationship in our February Cover Story, “The 21st Century Patient—Physician Relationship.”

With regard to his personal experience with remote health monitoring technology, Dr. Kvedar said, “Remote monitoring means that I can take care of almost all of the aspects that I would normally rely on the physical examination in the offi ce to give me without being in the office with the patient.”

Even the government has recognized the importance of using remote health monitoring for patients with chronic illnesses. In fact, on February 15, US Senator Norm Coleman (R-MN) introduced the Remote Monitoring Access Act of 2007, which would “provide for coverage of remote patient management services for chronic health care conditions under the Medicare Program.” The text of the bill included nine statements (or “findings”), including: “Remote patient monitoring can make chronic disease management more effective and efficient for patients and the health care system” and “Utilization of these technologies not only improves the quality of care given to patients, it also reduces the need for frequent physician office appointments, costly emergency room visits, and unnecessary hospitalizations.”

How Could it Help You?

In this month’s Cover Story we discuss the possible effects of the decline in the number of primary care physicians on the healthcare system. When asked if remote health monitoring could help to lessen the impact of this particular problem, Kvedar says, “It should empower the primary care doctor. There are several advantages to having a connective health view of the healthcare system. One of those is that individuals that can make informed decisions about patient care, including patients themselves, do not have to be doctors all the time.” Kvedar further discussed how remote health monitoring may make it easier for the physician to “take more of an oversight role in care. The technology allows for a complete physiologic picture to be in front of a doctor, and perhaps a care provider that’s closer to the action, say a home care nurse, can make decisions about that care much more effectively because of the richness of the information.”

Do You Think Remote Health Monitoring Will Revolutionize the Healthcare Industry?

“I do, because right now we have these very significant pressures on us. One of course is cost pressure, to do more with less. Another is that we aren’t training more primary care doctors—fewer people are going into primary care, whereas the number of patients with chronic illnesses is growing quite rapidly. If we don’t change our model of caring for those patients, something will have to give because primary care doctors are seeing a patient on average every seven minutes.”

Joseph Kvedar, MD

Director, Center for Connected Health

“I think that it’s more a question of technology has evolved and how it continues to evolve, how people market it to consumers, and individuals becoming more accustomed and acclimated to using the technology in their everyday lives. That’s where it becomes revolutionary.”

Robert Murphy

Senior Vice President of Marketing, iMetrikus

“We believe it has the power. We believe it’s going to take a lot of work to do it, but that in the next three to five years, you’ll see a significant increase in the number and types of remote monitoring that are occurring in our healthcare system.”

Suneel Ratan

Vice President of Business Development, Health Hero

“I do think it will revolutionize healthcare simply because it will help us get proper care to people in all sorts of situations. People are so much more electronically savvy these days that for the first time, they’re going to be able to actually use these kinds of systems. I definitely think it is important, but I also don’t think remote health monitoring is a substitute for real people.”

R. William Vandivier, MD

Clinical Director, COPD Center,

University of Colorado Hospital

Connected Progress Report 2006

Council on Aging — The Health Hero® Technology Platform

Medtronic CareLink Network for Heart Failure Patients

Remote Monitoring for Implantable Cardioverter Defibrillator (ICD)Patients