Medical Device Daily
It stands to reason that most people would be more comfortable and receptive to healthcare instructions and monitoring at home. Two technology giants along with Mayo Clinic (Rochester, Minnesota) are using this as a premise for a study to investigate a new model of healthcare delivery for patients at increased risk of rehospitalization or emergency department visits. Telemedicine is being put to the test in a year-long experiment focused on reining in costs and improving patient outcomes through personalized care and ongoing disease management.
"The ultimate goal of the study for most patients, providers and payers is to promote safe independent living," Gregory Hanson, MD, Mayo Clinic Department of Primary Care Internal Medicine, one of the principal investigators in the study, told Medical Device Daily. "That's the ultimate goal for changing the healthcare system. We hope as we do this that we'll also improve clinical outcomes. If we can do that and reduce unnecessary medical expenses, then that's the grand prize."
The study centers on the use of a computer tablet-like device designed to promote patient engagement and more efficient care by combining the in-home patient device with an online interface allowing clinicians to monitor patients and remotely manage care.
"We brought the Intel Health Guide to the marketplace in 2008; it's a remote patient monitoring technology for the home. We're trying to find ways for technology to reduce the cost of care and improve the quality of healthcare," Ray Askew, Intel (Santa Clara, California) Health Guide marketing manager told MDD. "There have to be ways to reduce the number of hospital visits and bring care to places where patients are more comfortable."
The Intel Health Guide was FDA cleared and commercially launched in 2008.
"Intel Health Guide allows users to receive messages from care providers and includes medication or other reminders, as well as the ability to visually interact with care providers," Askew said. "The care programs can be as specific as weight measurements, or it can issue a survey, such as How are you feeling?' or as basic as diet reminders, such as Eat an apple today and avoid Twinkies.'"
Patients with heart failure, for example, may get reminded to check their weight and blood pressure each day. The standalone computing device then automatically relays that data to the healthcare provider. It can also play patient education videos.
The 12-inch computer tablet has a touch screen that rotates and can be installed on virtually any type of surface. After that, no maintenance is required by the user.
GE Healthcare (Waukesha, Wisconsin) also is a partner in this effort to develop new patient-centered delivery care models. With the number of seniors expected to rise dramatically and increasing numbers of patients experiencing chronic disease, the current focus on face-to-face clinic interaction with the provider is not a sustainable delivery model, according to GE. Technology could enable new care models to help rein in costs and improve patient outcomes through personalized care and ongoing disease management at home and in the community.
Mayo Clinic will conduct a year-long study to determine if home monitoring of patients with chronic diseases will reduce hospitalizations and emergency department (ED) visits. The study will include 200 high-risk Mayo Clinic patients over the age of 60 who receive care in Rochester, Minnesota. The goal is to evaluate the effectiveness of daily in-home monitoring technology in reducing hospitalizations and ED visits compared with usual medical care.
Hanson said that patients were chosen from a database that was developed to track previous hospitalizations. They have a mix of health problems ranging from heart failure to chronic obstructive pulmonary disease. The top 10% of patients at risk for rehospitalization were chosen. In addition to tracking the patients' care, the study will examine the economic impact of telemedicine.
"It's going to be challenging," he said. "We're interested in summing up the economic costs of the technology and the clinical infrastructure needed for monitoring balanced against reduced hospitalizations and emergency department visits. We'll look at both sides of the equation."
Mayo built a special practice to support the study by hiring three mid-level nurse practitioners who specialize in geriatrics from within the Mayo staff along with several RNs with geriatric experience. The group is housed in a room that's outfitted to monitor the patient.
Patients will be instructed to measure their vital signs such as blood pressure, pulse and weight, and respond to questions specific to their diseases on a daily basis, with all data reviewed by the clinical care team working with their primary care provider.
The technology, which includes videoconferencing capability, allows the care team to assess the patient for signs and symptoms suggesting clinical deterioration to facilitate early medical intervention. The hope is that early recognition and treatment of a change in clinical status will reduce the need for ED visits and hospitalizations.
GE Healthcare and Intel first reported their joint efforts to market and develop technologies for independent living and chronic disease management and to extend care from the hospital to the home in April 2009. The two companies plan to invest $250 million over the next five years for the research and product development of home-based health technologies. In addition, GE Healthcare is selling and marketing the Intel Health Guide in the U.S. and the UK.
Telemedicine, both the idea and ensuing technologies have been around for a long time, but they have yet to reach the mainstream. Hanson said it's going to be important to demonstrate that the technology and efforts improve outcomes, and do so in a cost-efficient manner.
The 40 patients who have been enrolled so far are doing a good job of adapting, Hanson said.
"Once they get used to the equipment, they enjoy it," he said. "They like the extra contact and the reassurance that Someone is keeping an eye on me.' I suspect at the end of study, some folks will be disappointed because they do become enamored of it."
Lynn Yoffee; 770-361-4789