High Quality, Low Cost HealthCare Video Interview Series: John Holland Talks Patient Telemonitoring at AMC Health
Last week, Dr Oliver Kharraz talked about finding doctors and getting appointments online at ZocDoc. Today, John Holland, Senior Vice President, Business Development and Research at AMC Health, talks about patient telemonitoring. AMC Health's remote patient monitoring systems are used in chronic disease care, post-discharge programs and recently won FDA approval to be used in a clinical study. Studies have shown remote patient monitoring to increase quality of care and reduce costs. Indeed, telehealth [telemonitoring, telemedicine] seems like a "no-brainer" to me, increasing healthcare quality and efficiency while reducing costs.
And now, watch the video:
To see other videos in this series, please go to this page. And if you have a story to tell that can reduce healthcare costs and raise quality of care, please comment below or email me at firstname.lastname@example.org Thanks!
Video transcript (by TranscriptionStar)
Joan: Hello, I’m Joan Justice from HealthWorks Collective and I’m speaking with John Holland, Senior Vice-President Business and Development and Research of AMC Health. AMC Health is a leading provider of Telehealth Solutions and their Remote Patient Monitoring systems are used by Healthcare providers in Post Discharge Programs, chronic disease care and they’ve also been used by pharmaceutical companies in clinical trials. In all instances Telemonitoring has been shown to improve quality and reduce cost. John, tell us a little about AMC Health and remote patient monitoring?
Interviewee: Well, we've been doing this for I guess since the mid 90s if you would include a company that we purchased and then AMC Health itself started doing this in 2004, so we were one of the old timers in the field. We provide an array of services. We do remote biometric monitoring, so we monitor heart rate, blood pressure, blood sugar, oxygen saturation, temperature a whole variety of things with little devices in the home.
We also use interactive voice response to collect patient recording symptoms typically or if they're doing better or worse. Then these two kinds of data together the objective biometric data and the subjective data on how the patient is feeling, give a very good window into how the patient is doing actually having them to go and visit them at home. Our customers originally were healthcare agencies, where we could save some business, and then expanded into things like integrated delivery network such as the [Indiscernible] [0:01:57] health system, and then the most recent set of businesses that we've been looking at are clinical trials where we just provide services for pharmaceutical companies.
Interviewer: Okay. Tell us a little about the post discharge service for hospitals?
Interviewee: Well, as you know 30-day readmission rates are a very hot, hot issue that.
Interviewee: And very often patients are readmitted because of gaps in care. There's sort of study I think which shows that if a patient doesn’t have a primary care provider appointment when they're leaving the hospital and doesn’t make one. You know the chance of readmission is 10 times greater than if they seek a physician for a follow up visit. Same with post discharge medicine, medication did you get a prescription? They fill your prescription, so with guiding your health system had a very effective program where the nurse case managers calling high-risk patients after they were discharged for once or twice a week. They ask this question and then if there's a problem they solve it.
It was very effective, but when they try to expand it they realized that they didn’t have the personnel to make all those phone calls, because you don’t just make one phone call, you make well, and the line is busy and you make another call, and you get to their answering machine and we find that it actually takes 3.5 attempts to get through to somebody. So the nurses --
Interviewer: That sounds surprising.
Interviewee: - were spending their time looking for gaps and care rather than closing gaps in care. And then they were looking to us and asked that we could co-develop this interactive voice response program. No devices in the home, just telephone, so in our system now when the patient is identified as high-risk calls them once or twice a week for the first month, and asks us question. Did you get a prescription? You fill it. You have a follow up appointment. Are you going to be able to keep it? You need any lab test or anything like that, and then it would ask a few questions about symptoms, so heart failure patients ask that they have shortness of breath, ask if they have swelling which indicates to blood fluid [phonetic] [0:04:08].
Any wrong answer in one of those questions creates an alert and the case manager calls the patient and fixes it. So if you figured that the readmission rate was about 30% that means about a third of the calls that the nurses were making initially were to actually do something and two‑thirds would find out that the patient was fine. Now, there are only calling on major problem so a 100% of their calls were to solve a problem.
Interviewer: Yeah much more efficient.
Interviewee: And then the results have been striking. They published a study of this in Medical Care with 875 patients, they had about 2000 match controls and they found that they reduced the readmission rate by close to 20% and the risk of readmission was reduced by 44% that's rather large and we're a very low cost program.
Interviewer: Yeah it sounds great. Tell us a little bit about the health partners' clinical trial in Minneapolis the one with the pharmacist and blood pressure?
Interviewee: This is a very interesting study. Pharmacists are the most trusted professional in the United States. We surveyed to get back over here. And they setup a program where they identified patients from their electronic health record who had hypertension and whose blood pressure was uncontrolled when they were in the office.
So these are patients who are on treatment. Their blood pressure is still not good, and they referred to them to this, as if they wanted to participate. One hundred some odd patients fully controlled randomized trial, so half the patients at intervention, half the patients just got some education and they had a blood pressure monitor and they've monitored a couple of times a week. Then they would then go to a pharmacist, not an MD. And the pharmacist to have and it meet with the physicians that as long as they follow a particular protocol they could adjust meds. And the result at six months was a 19 over a 11millimeter reduction in blood pressure. I may have that wrong maybe 21 over 9, but nearly its --
Interviewee: -- about 20 over about 10 millimeters reduction compared to a much smaller reduction probably, and that's what they published they've analyzed the 12 month and 18 months data and those results are still holding, so it was a pretty striking. To put it in context if you did a clinical trial of a drug that control blood pressure versus placebo we would not expect that much of a difference.
Interviewer: Yeah great.
Interviewee: So, it's about adherence and then it's about getting the right drugs rightly.
Interviewer: And talking about clinical trials wasn't there a clinical trial on Lisinopril that the FDA just approved Telemonitoring?
Interviewee: Yes. We're very excited about that. For years, the whole clinical trial process is pretty badly broken. Its much too expensive and so nobody is willing to invest in drugs in fact when its drying up, there are thousands of promising drugs on people shelves right now that won't get study, its too expensive. We just had a protocol approved by the FDA for a Phase II trial to repurpose Lisinopril which is commonly used ACE inhibitor for multiple sclerosis. And what was exciting about this approval is almost all of the interactions and the year long study are going to be remote [Phonetic] [0:07:30], and it cut the cost of the study by about a two-thirds.
Interviewer: And it is easier for the patients too?
Interviewee: Much easier for patients so instead of coming in 13 visits in a year long trial, you got to come in for two, one on first day, one on last day.
Interviewer: That's amazing. That's wonderful. Well, I thank you so much John for this. I think the Telemonitoring will become an integral part of our healthcare system and actually it's really hard to imagine why it wouldn't. Thanks so much.
Interviewee: You're welcome, as my grandmother used to say from your mouth to God's ears.
Joan Justice is currently the Senior Curator for HealthWorksCollective. She holds both a nursing and a graduate business degree, and has worked in domestic and international marketing management for several major healthcare corporations. She lives in Charlottesville, Virginia.