Remote monitoring to reduce readmissions, pre-empt admission in the first place

By Jonah Comstock
(Left to Right) Gienna Shaw, Virend Somers, Alain Labrique, Alan Snell, Frances Dare, and Craig Kiser.

(Left to Right) Gienna Shaw, Virend Somers, Alain Labrique, Alan Snell, Frances Dare, and Craig Kaiser.

Most discussions about remote monitoring these days focus on its potential to reduce hospital readmissions, lead to earlier preventive care, and reap cost savings. The pressure is beginning to build as Medicare penalties for preventable readmissions have recently begun to take effect. Now hospitals are seriously looking at what works, what doesn't, and how to go forward in an effective and cost-effective way.

At a breakfast this morning co-located at the mHealth Summit and organized by FierceMobileHealthcare, Dr. Alan Snell, CMIO at St. Vincent Health in Indianapolis, reported positive results from a study of 200 patients that aimed to determine the effect of remote monitoring technology, including video conferencing, on readmission rates. The intervention group had a 5 percent readmission rate, compared with 20 percent in the control group. Snell sees the potential of the technology as even bigger than that.

"Our effort now is not just focused on readmission going forward, we want to focus on keeping patients out of the hospital, period," he said. "We see every hospitalization as a potential failure."

Along those lines, Michael Breslow spoke later in the morning from the main event's keynote stage about an intensive ambulatory care pilot Phillips is launching next year. The program, targeted at the 5 percent of the population that suffers from multiple chronic diseases (and is responsible for 50 percent of healthcare costs).

“One of the greatest weaknesses in our current system is the lack of reliable systems to make sure patients don't fall through the cracks,” he said. “These so-called dropped balls are pervasive and particularly problematic in that 5 percent of the population [that has] multiple chronic conditions.”

The pilot involves 500 patients with multiple chronic conditions who will be provided with a suite of at-home services including monitoring, a dedicated health coach, and a specially designed tablet for regular communication in terms of reporting vitals and responding to surveys and enabled for two-way video communication.

Virend Somers, a consultant at Mayo Clinic, pointed out that the integration of data is as important as the data itself: "If you have someone with heart failure and your technology indicates he's walking up the stairs and his heart rate is up, that makes sense," he said. "But if he's supine and his heart rate's 120, there's something wrong."

Alain Labrique, founding director of the Johns Hopkins University Global mHealth Initiative, said that patient engagement and reporting is a key component: "Sometimes we like to say the most powerful use of a phone is as a phone," he said. He also said they're looking at new technologies that monitor the speed at which a person pushes buttons or slight quavers in their voice, to turn the phone into a monitoring tool for certain degenerative conditions.

The breakfast panel spoke about the challenges that these new opportunities create. Of particular concern to Somers and Labrique was how to deal with the large influx of data.

"The question is 'Where does data go and what happens to it?' Remote monitoring is one of the most multi-specialty ideas I have ever encountered," Somers said, saying the work brings in cardiologists, engineers, and informatic specialists. "We have to be careful not to excessively burden the patient with too much interaction or excessively burden the physician with too much information. We need effective filters."

Mayo Clinic is training a dedicated team of specialists to integrate and process the data. But down the road, Somers and Labrique agreed, a sophisticated computer could pick up some of that slack.

If the suffusion of data provides a challenge, it also provides an opportunity, Snell pointed out, in the field of care customization. Using predictive analytics, hospitals can identify the patients most likely to be readmitted and give them extra help and attention. He stressed that all patients don't need all technology, and for remote monitoring to really be cost-saving, everyone should have just what they need.

Part of what they need is education, Snell said.

"The longer shelf life, once you wean patients off the monitoring, is 'While you had them connected, did you take the opportunity to educate them on how to best take care of their particular condition?'" he said.