Medical innovation isn't the same as it was five years ago. It isn't the same as it was one year ago. Cutting-edge advances in nanotechnology and molecular and genomic medicine seem to occur on a monthly basis. In fact, just last week, the first self-replicating synthetic cell was created. How do we make sense of news like this? What does it mean (or does it mean anything) for hospitals?
Such a dizzying pace of innovation isn't helped by the pressures of reform legislation. Hospitals are struggling to understand the potential impact of comparative effectiveness, episodic bundling, the Acute Care Episode (ACE) demonstration project, and the medical excise tax and how these products of the Patient Protection and Affordable Care Act will affect the future of their medical enterprise. The passing of reform legislation has awoken hospitals to major problems with the way they plan for clinical service line growth, as well as with the way they acquire and deploy new clinical technologies. Hospitals find themselves pressured by physicians and consumers to provide care in innovative ways and, in increasingly competitive markets, hospitals have realized that they are unprepared to make principled and deliberate decisions about which service lines to grow, which to defend, and where partnership and divestment strategies make sense. While innovation has changed over the past few years, the dollars involved and the high stakes have not. Moving forward, hospitals cannot afford to get it wrong - scarce dollars, reputations, and political capital hang in the balance at the prospect of poor investment decisions.
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The Cleveland Clinic recently released data from a 2008 pilot project involving at-home monitoring of diabetes, heart failure, and hypertension patients, representing the first physician-driven pilot in the U.S. to follow multiple chronic diseases remotely. The study found that patients with diabetes and hypertension were able to decrease the number of physician office visits they required, with diabetic patients increasing the number of days between appointments by 71 percent and hypertensive patients increasing the number of days between visits by 26 percent. These findings indicate that patients are better able to manage their own conditions using remote monitoring capabilities and that at-home interventions can have a significant impact on chronic conditions.
Through the study, Cleveland Clinic's Epic Systems EMR was linked with Microsoft's online Health Vault service, which incorporated at-home heart rate monitors, scales, glucometers, blood pressure monitors, and pedometers depending on patients' individual diseases. The 250 participating patients regularly took measurements using these devices, which were then uploaded to Health Vault's web-based data storage platform. Health Vault then automatically inputted data into the hospital EMR and the patients' Cleveland Clinic personal health record for physicians to view and monitor.
Contrary to diabetes and hypertension results, heart failure patients in the study demonstrated an increased number of physician visits, with a 27 percent decrease in the number of days between office appointments. These results may indicate that remote monitoring of heart failure patients can alert physicians early on to slight changes in patient conditions which can signal significant implications for the disease, subsequently requiring in-person physician visits. Further studies are needed to quantify the benefits of remote monitoring for chronic diseases, as well as the advantages garnered from continual patient education and the active involvement of patients in their health care.
Good morning! I recently came across an article about a remote monitoring pilot taking place in the UK. As hospitals continue to look for cost savings opportunities amidst recession and reform, some are considering how new technologies like remote monitoring can reduce readmissions and lower the cost of providing care at home to patients with chronic diseases like diabetes and heart failure. I thought this article was particularly interesting as it highlights one of the largest pilot projects to date using the technology.
In England, even the NHS has recognized the need to do more with less and manage chronic disease more effectively over time. Philips, long known for their big budget diagnostic equipment like CT scanners, is hoping their Telehealth Solutions can prove to the NHS that their system is a cost effective way of managing chronically ill patients. As the US continues to look for ways to reduce readmissions and better manage these patients, these data will likely become extremely important for our health care system, as well.
For more information on how TI can help with telemedicine and remote monitoring strategy for chronic disease management, please contact me at WynnP@advisory.com. And continue reading for more detail on the pilot itself.
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