Connected Health: Improving Patient Care Through New Technology

Improving Patient Care Through New Technology | FMCNA

Fresenius Medical Care North America (FMCNA) is adopting and supporting new Connected Health technologies that empower patients to monitor, collect, and share health and treatment data with their physicians and care providers. Mobile technology not only increases patient autonomy and engagement, it can lower costs and improve outcomes for those with chronic conditions.

A significant shift in medical practice orientation has been occurring over the last few years. The shift is from focusing on treatment episodes to proactive health planning, managing patient populations, striving to both improve quality of care, and lower costs.1 This shift is not a typical part of a physician’s training and day-to-day focus.

Managing patient populations requires coordinated and proactive participation by various supporting clinical and nonclinical staff and several different types of care providers and physicians. Chronic disease such as chronic kidney disease and comorbidities including diabetes, hypertension, and congestive heart failure are top cost drivers in these populations. Entities that take up management of patient populations assume risk in trying to reduce costs and optimizing care quality and outcomes.2 Management of risk in patient populations is accomplished by collecting and analyzing clinical and cost data to provide targeted and timely interventions.

Connected Health is an emerging model of health care delivery that leverages technology to collect and analyze such data by connecting patients and providers, resulting in improved patient outcomes and reduced costs. Technology can empower patients to collect, visualize, and distribute personal health care data, including patient-reported outcomes and patient-reported experiences. Connected Health technologies improve communication among patients, providers, and caregivers through connected devices and systems. By supporting continuous and ubiquitous data collection, as well as ongoing patient and provider communication outside of the clinic or hospital setting, Connected Health improves chronic disease management and outcomes. Connected Health achieves more information-driven, efficient, and less costly patient care, particularly in patients with chronic conditions.3,4,5 Its “Anytime, Anywhere” mode of care delivery brings the right information, at the right time, to the right place and the right person to maximize the efficacy of treatment.6

Mainstream use of mobile technology such as smartphones, tablets, and other devices creates integration opportunities for biosensing wearables, such as digital blood pressure monitors and glucose sensors. Through connected technologies, these nontraditional sources of high-value personal and social data can be integrated into electronic health records (EHRs) and data warehouses to generate sophisticated analytics and care interventions.

Connected Health and new technologies in health care don’t come without concerns and risks. Some well-articulated concerns include:

• Regulatory and privacy compliance risks
• Data quality and reliability
• Data overload
• Patient information security

Advanced new techniques for secure communications between devices and systems, data integrity verification, user authentication, and data encryption are being developed to provide robust protections for Connected Health utilization.

Connected Health in the Health Care Industry

Changes in consumer behaviors, the explosive integration of technology in everyday life, and the ability to yield improved patient outcomes through better care make a compelling case for Connected Health as an emerging core component in the health care industry. Five primary drivers describe the value proposition of Connected Health’s place in the health care industry:

1. More device and mobile app options. Devices such as Fitbits and other wearables are affordable and are now widely used. Mobile apps that can store and display data are readily available. Personally collected data can be shared with systems and providers for data integration, analysis, and health care interventions.
2. Prevalence of consumer wearables. New technologies offer health management insights through step counters, hours slept, stress maps, heart rate, feedback around mindfulness, and even predictions of adverse health events.
3. Emerging advanced, patient-centered analytics. These improve diagnostic accuracy through visualizations and decision support tools.
4. Comprehensive patient care. Data is communicated and coupled with clinical interventions resulting in:
   • Improved overall patient outcomes
   • Better medical adherence
   • Improved patient engagement
   • Personalization of care, from home to any other care venue
5. Business value. Business leaders see:
   • Support for providers and patients using cost-effective technologies7
   • Improved relationships and personalized care

Connected Health at Fresenius Medical Care North America

FMCNA is innovating with Connected Health to support patient autonomy and improve patient and caregiver experience. New FMCNA Connected Health technology includes:

• Home dialysis machines that collect and share treatment data
• Real-time data exchange for home therapies
• Electronic prescribing
• Virtual or telehealth visits between patients and providers
• Remote therapy instruction programming on the
  dialysis machine
• Remote home machine technical monitoring and support to eliminate disruptions in treatment delivery

As an example, the Liberty Cycler supports daily transmission of treatment data from Fresenius Kidney Care home dialysis patients to home therapy clinicians via a modem connection. A new cycler with bi-directional connectivity will: perform near real-time in-home therapy adjustments made by a physician; deliver post-therapy real-time treatment data to home therapy clinicians; and deliver machine data to RTG Technical Support.

The new cycler with Connected Health technology delivers a well-balanced, improved feature-set to enhance the peritoneal dialysis patient experience. Peripherals, such as a blood pressure monitor, weight scale, and the cycler, are Bluetooth connected using an FMCNA gateway device. The gateway links the cycler to the Fresenius Cloud at the start of treatment to fetch new cycler programming downloads. The gateway facilitates seamless collection of pre- and post-dialysis treatment vital signs. At the end of treatment, clinical data is transmitted to the home therapies staff and machine data is distributed to Technical Support. This provides a continuous improvement loop, enhancing treatment reliability and experience for home therapy patients.

Connected Health's Impact on Patient Outcomes

Clearly, health care focus is shifting from volume to value, and the goal is to keep populations healthy rather than just treat the disease retrospectively. In the new value-based models where the traditional approach of episode-based care is disrupted and organizations like Fresenius become accountable for total cost of care, connected technologies can positively influence patient behaviors and drive improved results while engaging and empowering patients and consumers. Remote support through Connected Health can reduce patient visits to the hospital/provider, lower health care costs, and improve timely access to medical consultations.8,9

Remote patient management (RPM) provides a means to overcome some of the barriers to increasing patient uptake and adherence to home modalities. RPM is a framework for monitoring patients at home via digital wireless technology, extending the interactive contact of conventional clinical settings to include the patient’s home. These technologies can improve clinical outcomes through earlier recognition and correction of problems.

In diabetes management, Connected Health solutions resulted in weight loss, improved glucose levels, and lower cholesterol.10 Patients used a pedometer and a digital weighing scale to collect data and share it with a health coach. This activity, coupled with a mobile app for logging daily activity and food intake, resulted in improvements in self-care, diet, and exercise, and reduced feelings of depression and isolation.

In a Mayo Clinic study published in 2017, researchers tested a health program available online or through a mobile app that provided information about healthy lifestyles, and asked patients undergoing cardiac rehabilitation to report dietary and exercise habits. Compared with a group of patients participating in a conventional care regimen, those using the digital program lost more weight, improved lifestyle habits, and had fewer cardio-related ER visits and rehospitalizations.11

Telemedicine solutions, such as Temple University’s COPD Co-Pilot, measures COPD disease status based on patient-reported symptoms and digitally measured pulmonary functions. As a result, treatment plans may be adjusted remotely, and, in very serious cases, the patient may be referred to urgent care.12

Conclusion

Connected Health is transforming health care through the innovative use of new technologies that empower patients to collect and manage data and that improve communication among patients, providers, and caregivers. Data aggregation, analysis, and sharing enhance patient and provider insights, as well as improve patient outcomes. The ability of Connected Health to support continuous care outside of the clinic or hospital walls and to make real-time adjustments in home care improves the experience of home therapy patients. Connected Health opportunities to impact chronic disease management will evolve as new tools for data capture and secure communication continue to emerge. FMCNA will continue to leverage new technologies to deliver high-quality patient care, which will be ever more important in the emerging value-based care delivery models.

Meet Our Experts

Ahmad Sharif, MD, MPH, SCPM
Senior Vice President, Chief Medical Information Officer, Fresenius Medical Care

Ahmad Sharif oversees clinical IT systems for FMCNA and formerly served as chief medical information officer for a Tenet Health market. He was awarded a full scholarship to attend classes at Harvard University, holds an advanced project management certification from Stanford University, and completed his master’s degree in public health and management from the University of North Texas.

Harvey Cohen
Vice President, Global Digital Solutions, Fresenius Medical Care

Harvey Cohen received his bachelor’s degree in economics from the University of Massachusetts. He has career-spanning expertise in delivering complex global software solutions. Prior to joining FMCNA, he held software development, product service delivery, architecture, strategy, and data management roles in technology, e-commerce, and patient remote monitoring and personal emergency service industries.

References

Connected Health: Improving Patient Care Through New Technology
by Ahmad Sharif, MD, MPH, SCPM & Harvey Cohen

1. Jones ER, Hostetter TH. Integrated renal care: are nephrologists ready for change in renal care delivery models? Clin J Am Soc Nephrol 2015 Feb 6;10(2):335–9.
2. Nelson K, Rafalski E, Bailey S, Marinescu R. Managing rising-risk patients in a value-based world. Conference paper, 2015 Congress on Healthcare Leadership, Chicago. https://www.researchgate.net/publication/275033033_Managing_rising-risk_patients_in_a_value-based_world.
3. Lee EK, Wang Y, Davis RA, Egan BM. Designing a low-cost adaptable and personalized remote patient monitoring system. 2017 IEEE International Conference on Bioinformatics and Biomedicine, Kansas City, MO.
4. Nuovo, Jim (ed). Chronic disease management. New York: Springer, 2007.
5. Pal, Susmit. How IoT is helping to address chronic disease management. Electronic Health Reporter, n.d. Accessed January 6, 2018. http://electronichealthreporter.com/iot-helping-address-chronic-disease-management/.
6. Ibid.
7. Li P, Xu C, Luo Y, et al. CareNet: building regulation-compliant home-based healthcare services with software-defined infrastructure. 2017 IEEE/ACM International Conference on Connected Health: Applications, Systems and Engineering Technologies, Philadelphia.
8. Ibid.
9. Lee et al. Designing a low-cost adaptable and personalized remote patient monitoring system.
10. Landro, Laura. How apps can help manage chronic diseases. Wall Street Journal, June 25, 2017. https://www.wsj.com/articles/how-apps-can-help-manage-chronic-diseases-1498443120.
11. Widmer R, Allison TG, Lennon R, et al. Digital health intervention during cardiac rehabilitation: a randomized controlled trial. Am Heart J 2017 June;188:65-72.
12. Smith HS, Criner AJ, Fehrle D, et al. Use of a smartphone/tablet-based bidirectional telemedicine disease management program facilitates early detection and treatment of COPD exacerbation symptoms. Telemed J E Health 2016 May;22(5):395-9.