As healthcare continues to move to a world of getting patient data outside of a hospital or physician’s office four walls, clinicians will need to figure out ways to incorporate this data into their workflows and care plans. Indeed, as proved in this year’s Healthcare Informatics Top Ten tech Trends, the concept of using wearable technology to help providers to track and care for high-cost patient populations is an emerging one, especially in the case of adults with chronic conditions.
To this end, in the New York metropolitan area, Sunil Malhotra, M.D., has been collaborating with vendors to ensure that patient data is collected and provided as part of the complete picture of a patient’s health. Dr. Malhotra wears multiple medical professional hats—he is an assistant professor, division of pediatric and adult congenital cardiac surgery at the NYU School of Medicine, and director of the pediatric cardiac surgery program at the Children's Hospital of New Jersey at Newark Beth Israel Medical Center.
Knowing that optimizing the flow of information between patients and their healthcare providers will eventually be necessary, Malhotra has begun to team up with the likes of Mana Health, a New York City-based company with a cloud platform that unifies patient data from clinical and non-clinical sources, making it accessible through a unified application program interface (API).
Going forward, Malhotra says he plans to monitor patients using applications that allow patients to enter data manually or through devices. Data would be managed through the ManaCloud, and a care team dashboard will give them information that can be monitored. Today, much of this is manual via telephone and paper journals, he says. Malhotra and Raj Amin, co-founder and executive chairman, Mana Health, recently spoke with HCI Associate Editor Rajiv Leventhal about the impact of patient-generated health data (PGHD), ways it’s being incorporated into physician care plans, and issues that have arisen around data quality and accuracy. Below are excerpts from that interview.
How are you already using PGHD in your specialty?
Malhotra: We have found that there are certain subsets of patients, who are particularly at risk, in which the data needs to be followed both inside the hospital walls as well as outside. For instance, with infants with congenital heart disease, there are a few changes in parameters that could affect their status. It could also be very useful in adult patients with chronic heart disease or lung disease to prevent readmissions. Tracking their data and seeing how they are doing after a bypass or heart valve surgery can keep them out of the ER. There are chronic diseases that can be managed at home, and can be optimized by having a better handle of their medical data.
In my world, with congenital heart defects, the most severe kinds involve surgery or some kind of intervention in the first year of life. Those patients, when they go home, are very fragile, and may be missing one half of a heart, so we measure how well they’re eating, their weight gain, and we send the parents home with a digital scale, so they take down their weight every day. There is also a pulse oximeter, a sensor that reads the percentage of oxygen in the blood and measures the heart rate. Those are the parameters we follow. We have red flags if they have certain critical values that they have to get in touch with the healthcare team, and then we intervene early.
Mana Health has an innovative data platform and structure. We want to use their technology to streamline this data monitoring so that when patients and their families are at home they could use the technology to communicate the data that can be in an easy-to-input format, which providers can readily access and act on. So it makes it much more in real time and streamlined.
How are both providers and patients taking to this “new world” of healthcare data?
Malhotra: This is a world that is very overwhelming. For parents, they have to keep a journal and keep track of these numbers that can be somewhat scary at times, especially when you have a small child recovering from surgery. Our staff tries to get in touch with the families at least on a weekly basis, but there are hurdles of getting the voicemail and not getting a call back.
Providers are very interested in this data, especially to prevent re-hospitalization. If things can be managed before you get to a critical situation, then that is beneficial for them. Maybe the medication needs to be tweaked, or they need to have an outpatient visit by a cardiologist or another medical professional, rather than showing up in an ER. Having that bridge to communication armed with patient data is very helpful to prevent readmissions. Providers have strategies to prevent readmissions, and unplanned readmissions after heart surgery, for example, are going to increasingly be penalized under value-based purchasing. If you think about what the cost is of an unplanned readmission, from the ER visit to days in hospital, it gets to be very costly. Cutting those costs and managing care should be done in a proactive fashion rather than a reactive one. If you’re on to that data you can intervene earlier, it really becomes a no-brainer if you can prevent an adverse outcome, an adverse event or a re-hospitalization, especially in vulnerable populations.
How significant are issues such as data security and accuracy?
Amin: With data accuracy, are you getting data points that are helpful? You’re always going to want to look at the data to make sure that you’re covering the outliers. You’re replacing something manual, making it a more continuous feed. The data accuracy side of this is not the biggest issue; it’s getting data back to provider fast enough so they can be reactive. That’s the biggest thing—how can we improve the efficiency by which the valuable data gets from patient back to care team?
Malhotra: Yes, it’s all about improving the response time. If we can use the data to say, instead of waiting for a diabetic to come in and have a blood test to show their hemoglobin a1c level is off or what have you, we can intervene if there is monitoring. We can then see that their insulin pump or glucose levels are trending higher or lower, and we can adjust dosing. The same thing applies with chronic medication or patients on blood thinners. You don’t have to wait for a significant event such as bleeding or a clot to have the medication altered.
How will PGHD affect the bottom line?
Malhotra: It’s a challenge, as we are at a period with bundled payments, so it’s going to come out of the hospital’s bottom line. It’s a service we have to provide our patients with, and you hope the indirect cost savings with the prevention of adverse outcomes would be realized— just like there are cost savings with preventative medicine and from eliminating fraud, as we have been told. You’d hope these proactive measures will not only be good for the patient but also prevent unnecessary charges that will be far in excess of what this up front charge would be to have these services that monitor the patients. Many payers are going away from fee-for-service, so you try to be forward-thinking in this transition phase. Survive financially and still implement new technology, and take advantage of it to improve care of patients.