Och­sner taps apps for hy­per­ten­sion pa­tients

Modern Healthcare - - INNOVATIONS - By Joseph Conn

New Or­leans-based Och­sner Health Sys­tem was one of the first U.S. sys­tems to begin man­ag­ing pa­tients with chronic con­di­tions us­ing tech gi­ant Ap­ple’s new HealthKit data-shar­ing plat­form in con­junc­tion with the Ap­ple watch and iPhone.

Clin­i­cians and re­searchers around the coun­try are ex­cited about the tech­nol­ogy’s po­ten­tial be­cause of the ease of con­nect­ing HealthKit to elec­tronic health-record sys­tems and feed­ing data from pa­tients’ Ap­ple watches and other wear­able de­vices into their per­sonal health records.

Och­sner was one of the beta testers for Ap­ple’s HealthKit ap­pli­ca­tion. Last fall, it suc­ceeded in im­port­ing a pa­tient’s per­sonal health data through HealthKit into its EHR sys­tem.

In Fe­bru­ary, Och­sner launched a mon­i­tor­ing pro­gram for hy­per­ten­sion pa­tients us­ing de­vices linked to HealthKit, said Dr. Richard Mi­lani, Och­sner’s chief clin­i­cal trans­for­ma­tion of­fi­cer. To be el­i­gi­ble, pa­tients must have blood pres­sure read­ings out­side the con­trolled range of 140/90. En­rollees are given a new Ap­ple watch, but they have to pro­vide their own Ap­ple iPhone, one that’s new enough to connect to HealthKit.

Och­sner clin­i­cians ask pa­tients to ob­tain a wire­less blood pres­sure cuff, which con­nects with HealthKit, then to the EHR. Other EHR de­vel­op­ers, in­clud­ing Cerner Corp. and Athenahealth, also tout their con­nec­tiv­ity with HealthKit and the Ap­ple watch. Duke Uni­ver­sity Health Sys­tem and the Mayo Clinic are among the provider sys­tems that have in­te­grated HealthKit with their EHRs and are us­ing the con­nec­tion to im­prove care for pa­tients and con­duct re­search.

With pa­tient self-mon­i­tor­ing, “in­stead of three or four data points a year, we can get three or four data points a week,” Mi­lani said. “If they’re over­weight and they need to be on an ex­er­cise pro­gram, we tell them it would be a great idea if they got an ac­tiv­ity tracker. And we pro­vide them with ad­vice about what they can do to im­prove their own health. We pro­vide some med­i­ca­tion ad­just­ments if needed.”

Mi­lani said, “We’re see­ing pretty good re­sponses.” Af­ter seven weeks, 16 of the 40 en­rolled pa­tients have at­tained con­trolled blood pres­sure sta­tus. “A lot of that has to do with the life­style changes and the feed­back loops they’re get­ting from wear­able tech­nolo­gies as well as home de­vices.”

On April 20, the day the Ap­ple watch hit re­tail stores, An­dres Ru­biano, 54, a pa­tient at Och­sner, strapped on one of the new de­vices as part of Och­sner’s re­mote-mon­i­tor­ing hy­per­ten­sion pro­gram. “The Ap­ple watch will serve as a buddy, nudg­ing and en­cour­ag­ing me to make changes in my life­style that will help me bet­ter con­trol my blood pres­sure,” he said in an Och­sner news re­lease. “This could be a game changer for me.”

By the end of this year, Och­sner may have as many as 125 pa­tients en­rolled in its hy­per­ten­sion pro­gram us­ing the Ap­ple watch. Mi­lani said the tech­nol­ogy en­ables “a much more in­ti­mate” level of com­mu­ni­ca­tion be­tween care providers and pa­tients. Given their suc­cess so far, “we’re look­ing to see (if) a sub­set of pa­tients with chronic dis­ease could ben­e­fit ad­di­tion­ally by uti­liz­ing the watch,” he said.

One of the big­gest chal­lenges for any re­mote-mon­i­tor­ing pro­gram us­ing pa­tient-gen­er­ated data is or­ga­niz­ing the clin­i­cal work­flow to deal with a po­ten­tial del­uge of in­for­ma­tion, Mi­lani said. Och­sner has ad­dressed that is­sue by cre­at­ing in­te­grated prac­tice units that in­clude non-physi­cian care­givers, who fo­cus on a par­tic­u­lar clin­i­cal prob­lem, such as high blood pres­sure.

Providers launch­ing a pa­tient-mon­i­tor­ing pro­gram us­ing wear­ables or other mo­bile de­vices need to ed­u­cate their clin­i­cians who might be un­aware that their EHR can re­ceive data from pa­tient­mon­i­tor­ing de­vices and mo­bile apps, said Dr. Ricky Bloom­field, Duke’s direc­tor of mo­bile tech­nol­ogy strat­egy. Pro­gram plan­ners also need to dis­cuss the tech­nol­ogy with af­fected clin­i­cians to un­der­stand their work­flows and spe­cific needs. “Tech­nol­ogy is not the bot­tle­neck, it’s the work­flow,” Bloom­field said.

In ad­di­tion, he said, health sys­tems must work with at­tor­neys and com­pli­ance of­fi­cers on pa­tient con­sent lan­guage and is­sue a state­ment on the scope of clin­i­cian re­spon­si­bil­ity for data sup­plied in real time by pa­tient de­vices.

Andy Daecher, who heads the In­ter­net of Things con­sult­ing prac­tice for Deloitte, said pay­ment re­form, the need for greater clin­i­cal ef­fi­ciency and “the con­sumer­iza­tion of data” pour­ing out of wear­able de­vices and mo­bile apps will force more providers to in­cor­po­rate pa­tient-gen­er­ated data into their care pro­cesses.

“The whole pa­tient ex­pe­ri­ence is go­ing to be­come more and more im­por­tant,” Daecher said. “The wear­ables will just push con­sumer ex­pec­ta­tions to rise. We’re mov­ing faster than any of us thought.”

“We’re look­ing to see (if) a sub­set of pa­tients with chronic dis­ease could ben­e­fit ad­di­tion­ally by uti­liz­ing the watch.”

DR. RICHARD MI­LANI

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