Managing chronic diseases has historically been an expensive proposition for healthcare organizations, requiring labor-intensive home visits and constant care plan revisions that too often result in costly hospital re-admissions.
Automated telehealth and care coordination systems have started improving the chronic disease management process in the home, but market watchers report that adoption rates are still in the early stages.
Some physician clinics are making steady progress in leveraging automated care coordination technology, however. With help from Dallas-based Phytel, the Elmhurst (Illinois) Clinic near Chicago is striving to create “a healthcare system that actually produces health,” said CEO Donald Lurye, MD.
Philosophically, the key to this new initiative is to focus on managing chronic diseases because it is emblematic of how care should be delivered, he said.
“The future belongs to people who are expert at managing a relatively small number of chronic diseases that are debilitating and slowly cause people’s health to deteriorate – where I’d like to be is getting diabetics to manage their disease rather than have to amputate their legs,” Lurye said. “Technology can help us do that. While it is impossible for physicians to keep track of everyone who has a chronic disease, we have partnered with Phytel to reach out to folks and get them through the door.”
The system uses electronic medical record data to identify the chronic patients who are overdue for office visits and generates reminder phone calls. To date, Lurye estimates the system has issued more than 2,500 of these calls.
Once they come in the door, the system helps physicians identify how patients are doing – legible charts are accessible by any clinic physician with Internet capability. Lab tests and medication lists are instantly available so “we don’t spend time chasing them down,” Lurye said.
Having these pieces in place should help the clinic with its goal to become an accountable care organization when the designation comes about in 2013, he said.
Children’s Medical Group of Saginaw Bay (Michigan) is using an EMR system from Horsham, Pa.-based NextGen to manage chronic asthma in children. Partners Jeffrey VanGelderen, MD, and Robert Thill, MD, launched the program in 2009 as part of a Blue Cross/Blue Shield of Michigan initiative to improve practice quality and is now designated as a Patient Centered Medical Home. The title has resulted in a 10 percent reimbursement increase that should boost revenue by $15,000 a year, VanGeldern said.
“We were talking about disease registry and managing chronic illness and we wanted to do all those things,” he said. “This was an opportunity to improve our medical practice and that is what drove everything.”
With asthma patient records available, the physicians use the system’s flow sheet to capture diagnostic and treatment information for evaluation. The template is used to designate an education and action plan.
“Because of electronic records, we can do more,” VanGeldern said. “We can call back patients, track their care and monitor monthly reporting to see how well we’re doing. It has transformed our practice.”
The physicians are currently developing templates for other chronic childhood conditions, including ADHD and obesity.
Gathering ‘Intel’
With the introduction of its Intel Health Guide remote patient monitoring system, the Santa Clara, Calif.-based technology giant is actively working in the healthcare field, addressing the need for better chronic care management. Charles Goodwin, director of Intel Health Guide’s business line, said the company got involved in the telehealth field after research showed active computer use by seniors at home.
“We saw the demand from elderly users and that led to us looking at how technology can be used to help people age in place,” he said. “Combined with the shortage of healthcare workers, the need for increased quality and lowering costs, we are working with the healthcare industry to build infrastructures for medical records.”
Using the platform and telehealth equipment, Health Guide expands on collecting vital signs and adds an educational component, interactive surveys and videoconferencing to drive more patient engagement and empowerment, getting them actively involved in their own care, Goodwin said.
As a longtime homecare nurse, Julie Cherry felt “limited in what we could do” to manage the trajectory of chronic illness and co-morbidities – especially during the period immediately after hospital discharge when patients are most vulnerable.
“There is a black hole after discharge when the patient is back home but not getting care and that is where things go wrong,” said Cherry, Intel’s director of professional services. “So how do we ensure that when a patient is discharged they continue to get the support they need? Nurses can only touch so many patients at a time, so the solution is to use technology that connects nurses to a system that ensures patients are monitored on a frequent basis. This technology works to identify problems early on so that nurses can intervene appropriately.”
Key connections
Effectively managing chronic illnesses requires a panoramic view of a patient’s condition, and technology from Culver City, Calif.-based 4medica helps complete that picture by providing drug-to-lab correlations in a real-time, graphic format, said CEO Ravi Sharma. To provide the best insight for drug-to-drug interaction, the system provides drug-to-lab checking.
The “magic” in the system is that it gives physicians an actual view of chronic patients’ trending values – the kind of information they could only visualize with paper charts, he said.
“Our founder, Dr. Oleg Bess, said it was ‘ridiculous’ to have to visualize that way and after talking to other physicians, we found many felt the same way,” Sharma said.
Historically, physicians will look at a lab value, prescribe a medication and move on to next patient. Too often, however, issues would arise afterward, he said.
“We looked at the problem and said it should be managed differently,” Sharma said. “Physicians should be alerted to potential conflicts on the lab report. It’s the proactive way of handling it. By monitoring the lab tests and adjusting the drugs accordingly, physicians can effectively manage the disease and patient’s lifestyle.”
