Richard Milani, MD: Digital Medicine Programs and the Ochsner O Bar

Since 2015, Ochsner Health System has begun developing ways to improve health care outcomes and experience for providers and patients. The driving force behind the changes has come from innovationOchsner (iO), a team tasked with finding pain points in the health care system and developing the technology to alleviate them.

Richard Milani, MD, Chief Clinical Transformation Officer and Vice Chairman, Cardiology, at Ochsner Health System, shared about the hospital’s digital medicine programs that came out of iO, particularly the one for patients with hypertension. He noted that providers are typically “blind” about how their patients are doing between visits to the office every few months, but this program has changed that.

“Instead of getting 2 or 3 blood pressures in a year, we're now getting as many as several hundred blood pressures in a year,” Milani told MD Magazine®.

See the conversation with Aimee Quirk, CEO of innovationOchsner, for background on iO and some of their projects.

What was the impetus for the digital medicine programs and the O Bar?

The impetus behind our digital medicine programs was a recognition we're dealing with an epidemic today in the United States and that's chronic disease care—so, chronic diseases like diabetes or hypertension or heart failure. And again, recognizing that the average patient with a chronic disease is seen by their doctor 2, 3, maybe 4 times in a year, but again the fact that one has diabetes or heart failure that's in control today does not guarantee that next week or even next month they'll still be in control. So, we're blind as to what's happening to patients in between visits.

So, our concept was several fold—the first of which is how can we collect data in between visits and now we live in an age where we can have connected devices and that's the kind of things that we provide back here at the O Bar. A patient with hypertension could be enrolled in one of our programs, come to the O Bar, get a connected device, we ask them to collect several blood pressures per week at least one at a minimum. If not, we send them a text to remind them it's time to take a blood pressure and instead of getting 2 or 3 blood pressures in a year, we're now getting as many as several hundred blood pressures in a year.

What results have you seen with patients in the hypertension program?

Well the first thing is: now we can detect whether or not you're in control or out of control or you're heading out of control long before it ever happens. Secondly, we have now a virtual team made up of pharmacists and health coaches that can adjust your medication appropriately, keep you in control, work on behavior and lifestyle changes, provide you with apps if necessary but other tools necessary to try and reduce your sodium intake, improve your exercise, and so on and so forth. And between the 3 components—drug therapy, behavior therapy, and surveillance—through this data collection, we're able to keep people in better control than usual care.So, we've actually studied this and we've published our work. We've taken people that have been out of control for more than a year and enrolled them into a usual care program or our program and within 3 months we have over 70% of patients in control and those numbers continue to rise each month. Usual care is around 30% of people in control. So, we're able to achieve much higher control levels at very high levels of satisfaction and it's all done virtually, so these are what we call our digital medicine programs we have a similar program in diabetes done exactly the same way. Every time they check their blood sugar, we see it as well as the patient sees it and moreover, if there's an abnormality we can address it right then and there.