HEALTHeLINK, the Buffalo-based Beacon Community, has had early successes with its diabetes telemonitoring pilot that identifies high-risk patients through mobile monitoring before they are hospitalized. The pilot, which has enlisted local home health agencies to help monitor patients without flooding physicians with data, has seen both physician and patient satisfaction.
HEALTHeLINK, Western New York’s clinical information exchange that was formed in 2006, began its diabetes telemonitoring program in May 2011 after receiving a $16.1 million Beacon Award from the Office of the National Coordinator (ONC) to use health IT to improve outcomes and care management for diabetic patients. Goals for the program include reducing emergency department visits, hospitalizations, and readmissions for these patients by 5 percent.
Patients use a telemonitoring device at home to transmit twelve measurements, like glucose, fasting glucose, blood pressure, weight, pulse, heart rate, and oxygen saturation, electronically through a secure virtual private network (VPN) to HEALTHeLINK’s health information exchange (Axolotl , San Jose). Patient information is reviewed by one of three home health agencies, Catholic Health’s McAuley Seton Home Care, Kaleida Health’s Visiting Nurses Association of WNY, and Advantage Telehealth, involved in the pilot.
“We recognized early on while we were doing our planning that technology alone is not going to move the needle,” said Dan Porreca, executive director of HEALTHeLINK. “We need to have providers engaged, and we need patients engaged.”
To engage patients from the beginning, a nurse visits and trains the patient on the use of the telemonitoring device and is available to work with the patient as needed, either at the patient’s home or over the phone. So far the pilot has enrolled 116 patients, nearing its goal of 150.
“Physicians are loving [this program] and requesting more of their patients to be enrolled due to the success they’ve seen with care participants,” said Porreca at a NeHC webinar earlier this month on Beacon Community successes. “One specific example is a 71-year-old diabetic patient with congestive heart failure, who three months after joining the pilot, reduced her hemoglobin A1C levels from 9 percent to 5.2; and the physician took her off her diabetic medication.”
To avoid data overload and minimize disruptions to the physician workflow, home health nurses monitor results and determine which health information must be seen immediately by the treating physician and perform patient outreach when necessary. “If you start flooding [physicians] with daily information it becomes a challenge for them to manage all that data,” Porreca told Healthcare Informatics.
Physicians can use the web-based patient record look up pull function within HEALTHeLINK to view all patient results and see trending. This tool has seen a 650 percent increase in use from December 2010 to December 2011, and had a total of 25,000 accessed reports in March 2012—more than all accessed reports in 2010 combined.
The average cost per patient is $216 per month, according to HEALTHeLINK, but costs could drop as economies of scale are realized and price of technology decreases. The pilot will end March 31, 2013, and Porreca said that HEALTHeLINK will review the pilot results, including ED visit reduction, and work with commercial payers to continue the program.