Updated 3:27 p.m.
CLEVELAND, Ohio — The use of at-home medical devices to connect doctors and patients via the Internet can help both groups more efficiently manage chronic conditions, such as diabetes, high blood pressure and heart failure, according to research at the Cleveland Clinic.
In December 2008, the Clinic partnered with Microsoft Corp. in a pilot to monitor patients with chronic conditions at home. The pilot paired the Clinic’s electronic health record system, which patients know as MyChart, with Microsoft’s online HealthVault, which enabled patient statistics such as blood pressure readings to be stored online and accessed by Clinic doctors.
Nearly half of Americans have been diagnosed with at least one chronic condition, accounting for 75 percent of the nation’s health care spending, the Clinic said.
“The prevalence of chronic disease is rising at an alarming rate in the United States, absorbing an ever-increasing portion of the nation’s health care dollars,” said Dr. C. Martin Harris, chief information officer for the Cleveland Clinic, in a written statement. “If we are to lessen this strain on our nation’s economy and health care system, we have to change our thinking about how and where health care should be delivered, while developing innovative, cost-effective solutions that allow patients to proactively manage their health care.”
More than 250 participants enrolled in the pilot: 68 percent with hypertension, 26 percent with diabetes and 6 percent with heart failure. It was the first nationwide physician-driven pilot to follow more than one chronic disease remotely, the Clinic said.
The results of the pilot are in: Clinic researchers found a “significant change in the average number of days between physician office visits for patients,” according to a Clinic statement. Diabetic patients increased the number of days between doctors’ appointments by 71 percent and hypertensive patients, by 26 percent, indicating better control of their conditions.
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However, heart failure patients who participated in the pilot went to the doctor more often–decreasing the number of days between visits by 27 percent. This likely means patients were being advised to see their health care providers in a more timely manner, the Clinic said.
“You might think that is a bad thing,” Harris said during a telephone interview Monday following a press briefing about the pilot at HIMSS10, the annual health IT conference, in Atlanta. But for heart failure patients, seeing a physician more often can mean heading off costly emergency room or hospital stays when their condition turns acute, he said.
Through the pilot, the Clinic learned that it is “absolutely possible” to deliver chronic disease care through health information technology, Harris said. Clinic physicians plan to continue using health IT as part of their “existing standard of care,” he said.
There were a few surprises along the way. Clinic patients quickly adopted the heart rate monitors, glucometers, scales, pedometers and blood pressure monitors meant for home use and asked for more technology. “We realized patients were ready to push that barrier a lot further,” Harris said.
One patient even took his glucometer with him on the road. “He drove all over the country,” Harris said. “Our definition of mobile is probably behind the patient’s.”
What’s next for the Clinic now that its observational pilot with Microsoft has ended? Two things, Harris said: “We have to engineer this to become our standard of care, based on our practices today.” Clinic physicians are considering adding asthma patients to their home monitoring practice, he said.
The other is to “think through a rigorous study design” to scientifically measure how home monitoring and health IT can be used to improve patient outcomes and lower health care costs. “We need to prove that this model makes a difference,” Harris said.
