The need to have accurate patient health information for clinical decision-making can hardly be over-emphasized. This is most evident when a patient is away from a healthcare facility and hence tracking and aggregating data of his vitals, lab tests and other physiological parameters becomes a challenge. While this has now been simplified with the use of a variety of home monitoring devices, it’s the integration of these devices with applications that are accessible to both the patient (at home) and the providers (in the hospital or physician offices) that still present a problem.
This is where the use of patient portals (now looked at mainly as patient engagement tools by hospitals and care providers), play an important role. Not only do patient portals serve as patient engagement tools, they also help providers comply with critical meaningful use criteria such as providing a means for patients to access their health information online, or to provide a means for patients to send secure messages to their care providers electronically. With the MU stage one and stage two criteria laying the foundation for patient engagement, stage three criteria are touted to include medical device interoperability, both within and outside the healthcare delivery environment.
Interfacing devices for improved healthcare
Home monitoring device integration with patient portals promises to enhance patient engagement, which is essential for care providers. This helps retain patient affinity1 to their healthcare network, as well as get accurate data of key vitals, especially when a patient is home. This ‘supervision’ of care (especially chronic care) would ultimately result in care providers delivering better clinical outcomes in the long run. In fact, devices interfacing with portals have the most profound implications for chronic disease management (diabetics, hypertensive, asthmatics, etc.) as these patients need to self-monitor and self-regulate and report their progress, thereby playing a major role in managing their health. Chronic disease management is also an area important for providers planning to participate in accountable care organization models where keeping a patient healthy equates to reducing costs.
Rapid adoption of patient portals and solutions that support patient care monitoring at home is emerging as a growing trend. A study published in the Journal of American College of Radiology2 in April 2012 found that “nearly 80 percent of patients preferred the patient portal method over other methods of information notification, such as phone calls, letters or in-person clinical consultation.” Kaiser Permanente’s patient portal, kp.org, is actively used by close to four million3 of its members, which is about 63 percent of Kaiser’s eligible member base. In fact, expanding home monitoring device data interoperability with patient portals will itself lead to widespread adoption of patient portals. An interoperable, personal medical device-connected portal will play an important role in laying the foundation for a remote monitored patient medical home device.
Some key essentials of such device connected systems should be:
- Plug-n-play connectivity with various classes of medical devices such as glucometers for diabetics, blood pressure monitors for patients with hypertension or pulse oximeters and spirometers for patients with chronic obstructive pulmonary disease.
- Ability to integrate this information with electronic medical records through a particular standard such as IEEE 11073, HL7 or CCD.
- Ability to provide a patient feedback around his health as well as alert a care provider in case of abnormal values beyond the established reference ranges.
Overcoming interconnectivity challenges
Inter-connectivity of home monitoring devices presents some unique challenges; the key being that most devices are not designed to interconnect with other devices. Therefore, it is difficult to connect individual devices into integrated medical systems or portals.
However, this is now changing with the adoption of open standards and interoperable technologies to integrate the clinical environment. Medical device “plug-and-play” is driving medical device makers to integrate information with EMRs and other clinical applications.
Let us take an example of a patient using a medical device at home (say a BP monitor) on a regular basis. The patient is required to update the information to his physician on a regular basis. Either the patient calls the physician or connects the device to a PC using a USB port and logs on to the patient portal. The medical device data will be read and validated online (with the help of the portal and a remote integration engine). This data can then also go into a hospital EMR (assuming the patient portal is hosted by the hospital where the physician works), and any abnormalities will be reported to the physician. To facilitate a faster response the alerts can sent across as text alerts to the physician’s mobile phone in case of a significant deviation in key vital parameters.
The above figure shows a small representation of some of the features such a system should cater to:
- Ability of the medical device to export data in digital format (using a serial port);
- On the hospital front (or place where the portal is hosted) a server/integration engine which will aggregate the information and store it for further processing; and
- Depending on the standard used by the device, the data will be processed and stored in the EMR by using HL7 standards.
Some of the key efforts towards defining Medical Device Interoperability have been listed below.
- The Continua Alliance
- Integrating the Health Environment-Patient Care Devices Domain
- American Society for Testing and Materials-Integrating the Clinical Environment
- The Health Information Technology Standards Panel
In summary, home based monitoring of patient vitals via medical device interoperability will improve patient care as well as care outcomes in the long-run. Combining this with patient engagement tools such as portals will not only improve care monitoring and delivery but also increase patient engagement and affinity to the hospital network. In lieu of this, hospitals and other healthcare providers should look at customizing their IT landscape to allow home based device interfacing with their portals and other clinical systems.
This article was originally published by Becker’s Hospital Review here.
Dr Kunalsen Sawant is medical physician with more than a decade of experience working with...