The Connected Medical Home

The Connected Medical Home

2014 Snively Symposium in Family Medicine

Joseph C. Kvedar, MDDirectorCenter for Connected HealthPartners HealthCare© 2014 Center for Connected Health – All Rights Reserved

Content Confidential – DO NOT DUPLICATE.

© 2014 Center for Connected Health – All Rights ReservedContent Confidential – DO NOT DUPLICATE.

Partners HealthCare’s Mission

Patient Care

Discovery

Teaching

Community


Partners HealthCare System by the Numbers2013

60,600employees physicians

6,500nurses

8,300

$10Brevenue

1.5Mpatients served annually


The path providers are traveling

© 2014 Center for Connected Health – All Rights Reserved

Content Confidential – DO NOT DUPLICATE.

Need to reduce

cost trend

Changes to org

structure

Investment in pop mgmt

infrastructure

Changes to organizatio

nalincentives

Networkaffiliations

Enhanced primary care coordination

for high risk pts

1

Enhanced access to specialty services

2

Implement new local incentives/compensa

tion

3

New relationships w/community

hospitals & docs

4

3 phases of work for improving population health

Phase 1

Ongoing: IS, analytics and central infrastructure

Primary Care

1

Phase 2

Phase 3


2Secondary Care

3Patient Engagement

4Wellness Promotion

The Goal for Primary Care Under Value-Based Reimbursement

• Patients Healthy and Cared For

• Doctors Take Population and Individual View


Connected Health Goal

Integrate care into the day-to-day lives of our patients


Connected Health Innovation Process


Ideation & Feasibility

Product develop.

r

Trial/Test

r

Spin-out

Program develop.

License

CCHService

InternalHand-off

Connected Health Benefits

Improved self-care1 Just-in-time

care2


FeedbackLoop


Social Networking Gamification Incentives Coaching

Components of Self Care

The Connected Health Technology Platform

RMDR

Remote Monitoring Data Repository

Patient Gateway LMR



PROMs

PROMs: Patient Reported Outcome Measures

Tools for the Connected Medical Home:

Population Management Using Remote Patient Monitoring


Heart Failure Monitoring

Connected Cardiac Care

50% Drop in

Readmissions


30 60 90 120 3650

2

4

6

8

10

Mortality

CCCP CONTROL

Follow Up Period (Days)

Per 1

0,00

0 Pe

rson

Day

s

End of CCCP


0 30 60 90 120 3650

2

4

6

8

10

12

Hospitalizations

CCCP CONTROL

Follow Up Period (Days)

Per 1

,000

Per

son

Day

s

120 days prior to CCCP

End of CCCP


www.telemedroi.com


Average drop of HbA1c: 1.5

69% achieved a drop in BP

Diabetes and Blood Pressure Connect


Greater engagement is associated with greater pre-post HbA1c change

Practice engagement correlates strongly with better patient outcomes

• Patients with greater than 15 uploads had average 1.5 pre-post HbA1c change

• P< 0.03 between no uploads and uploads groups

no uploads 1 - 15 uploads > 15 uploads0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

0.43

1.34

1.53

Average drop HbA1c by # of uploads

Dro

p in

Hb

A1

c

J Diabetes Sci Technol 2012;6(6):1328-1336


Proportion with 10mmHg or greater drop in SBP

CI

P<0.05

Decreases in Blood Pressure from Self Monitoring

Proportion with 5mmHg or greater drop in DBP

P<0.05

CI

% o

f S

ub

ject

s

% o

f S

ub

ject

s

Am Heart J. 2012 Oct;164(4):625-31.


iPad Mini with Verizon LTE

Blood Pressure Cuff

Bluetooth Weight Scale

888-8888

Discharge Planning & Transitions of Care to Home


IVR Reminder Telephone System

Transitioning COPD patients from hospital to home

• Tablet provided during hospitalization

• Pre-filled w/medication & discharge info

• Staff notified of deviations from regimen

• Goals: - Reduce exacerbations of COPD - Reduce readmissions



Virtual Visits & Remote Consults


• Patients and providers from all over the world access Partners’ specialists

• Almost 15,000 consultations completed to date

• Positive patient feedback

Caring for patients from afar: Online Consultations


Providing Access in Rural Areas

• Clinic held weekly for 2-3 hours from MGH

• Over 5000 patients seen

• 3 month wait time

• Cost savings


• Pilot program for college students who are depressed

• Consumer-friendly software

Taking Video Communication Directly to the Patient



Proactive Patient Engagement Using Mobile Technology


Mobility in Health

• Always on and connected

• In the moment messaging

• Capture your health data

• Display information

• Addictive nature of mobile devices


Week 1 Week 2 Week 3 Week 4 Week 5 Week 6-10%

0%

10%

20%

30%

40%

50%

60%

70% Weekly Adherence Rates (mean +/- SEM)

Study Period

% A

dh

ere

nc

e

Reminder groupNo Reminder Group

Text-Message Reminders to Improve Sunscreen Use

Arch Dermatol. 2009;145(11):1230-1236.


Image: CCH

Prenatal Care for at-risk pregnant women

• 74% — Helped to learn to take care of themselves and their babies

• 85% — Felt supported by the OB team


Image: CCH

Get Ready 2 Quit text-messaging program

• Targets patients who may not be quite ready to quit

• Provides real-time, tailored, interactive messages

• Includes practice quit attempt exercise

• 3 month program


Customized Program Design

ReadinessTo Change

Connected Health Data

PracticeLocation

Analytic Engine


Text 2 Move

1/9

1/11

1/13

1/15

1/17

1/19

1/21

1/23

1/25

1/27

1/29

1/31

0

2000

4000

6000

8000

10000

January

2/1

2/3

2/5

2/7

2/9

2/11

2/13

2/15

2/17

2/19

2/21

2/23

2/25

2/27

February

3/1

3/3

3/5

3/7

3/9

3/11

3/13

3/15

3/17

3/19

3/21

3/23

3/25

3/27

3/29

3/31

March

Text 2 Move

Contemplation Preparation Action


• Study aims:– Help patients self-manage pain– Improve quality of life– Decrease incidence of pain crises– Provide psychosocial support

• Funded by The McKesson Foundation

Mobile App for Self-Management of Cancer Pain



Looking to the Future


Meet Michael Snyder


Genetic Risk

Source: Cell 148, 1293–1307, March 16, 2012


Glycated HgA1c (%):(Day Number)

Glu

cose

(m

g/d

L)

Day Number

-150 200 250 300 350 4000 450 500 550 600

160

150

140

130

120

110

100

90

80

6.4(329)

6.7(369)

RSV Infection(Day 289-311)

Life Style Change(Day 380-Current)

HRV Infection(Day 0-21)

4.9(476)

5.4(532)

5.3(546)

4.7(602)

Personalized Prevention in Action

Source: Cell 148, 1293–1307, March 16, 2012


Customized Program Design

Motivational State

Connected Health Data

Genetic Profile

Analytic Engine


Automating Healthcare


Data Aggregation & Normalization EngagementAnalytics

Implications of Automating Healthcare

• Social Contract

• Privacy

• Accountability

• Economics


CONNECTED HEALTH BENEFITS

Improved self-care1 Just-in-time

care2


The cHealth Blog: chealthblog.connectedhealth.org

www.connectedhealth.org

Annual Symposium: October 23-24 2014; Boston

LinkedIn Group: Connected Health Community

Twitter: @connectedhealth @jkvedar

Ways to “Connect”

Contact Me: [email protected]
