Experiences at Cleveland Clinic with HealthVault

The local Cleveland paper published a good article today that highlights the work between Cleveland Clinic and Microsoft HealthVault.  Back in November, these two announced a joint agreement to work together to test the efficacy of using consumers’ self-reported, biometric readings for improving care delivery.  In this case, Cleveland Clinic customers who are managing a chronic condition, e.g., hypertension, take periodic measurements that are fed, by way of the HealthVault repository to Cleveland Clinic’s EPIC EMR.  Once in EPIC, the physician can track and trend readings and make adjustments to treatment plan as warranted. The article gives a real world example of a truck driver, who is one of 30 early users of the service, to manage his blood pressure.

Couple of key points can be pulled from the article.

1) The consumer appreciates the flexibility to take the needed measurements when it is convenient to them and their schedule.  Might such flexibility and convenience lead to better compliance and better outcomes?  Maybe AHRQ needs to do a study on that as part of their Comparative Effectiveness largess.

2) The physician likes the ability to more proactively manage a patient’s chronic condition with use of near real-time data (at least real-time compared to standard practice).  Might this lead to better care at a lower cost through better dosing of medications and other modifications to treatment plan?

But also raises some questions:

Does the use of such systems impact payment/reimbursement schedules?  Is payment reform required to insure that a physician/hospital is reimbursed for such services that typically fall outside the domain of most payment schedules? This remains one of the biggest stumbling blocks for any telehealth program.

How does this type of system fit into the workflow of what is already a hectic schedule for most practicing physicians? Is it primarily the responsibility of the nursing staff to do the day to day monitoring and reporting and bring the physician in when readings exceed certain pre-defined limits, or is it left to the physician to oversee all aspects?  Many physicians I talk to tell me time and time again, not enough attention is paid to process and workflow.  Incorporating such a system into a practice can significantly alter the care delivery model, thus special attention needed here.

In addition to chronic care cases, what about episodic care?  Such a telehealth system may dramatically drop re-admissions after a given procedure if a patient is monitored post-discharge.  Yes, we all know how important it is to address chronic care and compliance as these are huge cost drivers to healthcare today, but re-admissions is also a significant cost and should not be overlooked.

Arguably, the best part of the article is the consumer’s apparent feeling of empowerment.  They are no longer a bystander in their care but an active participant. They are no longer waiting for a doctor’s availability or complying to a clinic’s schedule but are self-reporting based on their availability and need.  Lastly, knowing that the care provider is actively monitoring one’s progress may result in a subtle form of pressure that helps keep the consumer in compliance.

This is the future care model.  What boggles are minds is why it has taken so long for us to get here.