Andrew R. Watson, MD, MLitt, FACS, Department of Surgery, Division of Colorectal Surgery, Colorectal Surgeon specializing in Inflammatory Bowel Disease Surgery. Vice President, UPMC International, President Elect of American Telemedicine Association, talks about how remote monitoring technology is helping elderly patients avoid unnecessary trips to the ER.
Interview conducted by Ivanhoe Broadcast News in August 2017.
What is telemedicine and how does this works?
Dr. Watson: Telemedicine is the natural evolution of healthcare in the digital world. It is the consumers and providers understanding that we can reach out to patients wherever they are, and it’s evolving like much of medicine does. Just like laparoscopy evolved, and transplantation evolved, we’re learning how to do this. But what we’re doing is we’re working with patients in remote and rural areas. We now are doing remote patient monitoring, getting data from patients at home and we’re also able to do live video right to their phones.
This sounds like something that younger patients would be comfortable with, how are you finding it’s being received across your patient population?
Dr. Watson: Age is an interesting process with telemedicine because we always thought the older patients wouldn’t adopt it, but we’re actually seeing age bias. Our first two patients, the average age was ninety, the average age of our first eleven hundred patients is seventy four. And with that, our satisfaction is over ninety percent which speaks for itself. So we really have not found age to be a problem whatsoever.
Does that surprise you that some of your older patients were willing to adapt to the technology? And do you know why that is that maybe, are they open to suggestion?
Dr. Watson: I was very surprise that patients of all ages accepted this, but in particularly the elderly. But it makes sense because for the elderly they would have to find someone to drive them. Family members have to take time off work. They don’t want to drive at night and over the hills in the winter, it just makes sense, when you ask the patients what they want they want access to providers. We always assumed that it was a face-to-face visit; but that assumption has not held true.
In your mind are there drawbacks to telemedicine? Is there still something that is needed or lost when you don’t have that face-to-face?
Dr. Watson: People wonder about telemedicine and the drawbacks, there are very few. The only one I can think about truly is sometimes it’s hard to do a full physical examination, you have to supervise someone doing it. But what’s really important is the fact that it saves the patient time, money and it’s much more humane. We’re just taking healthcare back into the homes in the communities where it belongs. The benefits far outweigh any drawbacks.
Specifically about the program here at UPMC, tell me about how this is set up and how it works?
Dr. Watson: The remote patient monitoring is one of the most powerful forms of telemedicine that we’ve seen because it’s at home and the patients can do it on their own time when and where they want it. And it’s free to the patients, which is most important. We actually ship them a box with what they need using UPS, it takes them about ten seconds to turn everything on, and they are immediately and securely connected to our call center and our nurse experts that handle their information. They use the tablets and have a blood pressure cuff and a scale that are all connected wirelessly. They are immediately asked questions and they can take their blood pressure, get their pulse, their weight, and we all checks the data and values to make sure that their safe. This information comes back into our call center and if there are very high alerts or low alerts or critical alerts the call center takes care of it. They actually work with the patients to prevent them going to the ER or the hospital that may be unnecessary. One of the critical tie backs is all this information flows back into our electronic health records.
Can you give me the list of the steps that the patients have to take every day?
Dr. Watson: There are three types of programs that we have. One of the programs is a tablet with peripherals and those peripherals include a blood pressure cuff, a pulse oximeter, and a scale. Some of our other programs such as inflammatory bowel disease and our advanced illness care use just the tablet only without any peripherals. And we’re also working on a bring your own device program where the patients actually use their own cell phones, so it’s much easier for them and they’re very familiar with the platform.
Which patients and what disease states with this monitor would be appropriate for that?
Dr. Watson: We use remote patient monitoring for any disease state truly. Right now what we’re focusing on is congestive heart failure, the very sick patients that have been readmitted. We’re also using it for inflammatory bowel disease patients, and we’re using it for advanced illness care patients. Also we’re using it for tobacco treatment services as well. So it’s a wide spectrum from this very sick congestive heart failure patient to the very light touch tobacco treatment services where were trying to get patients off nicotine addiction.
You had mentioned the scale and the blood pressure cuff, are those congestive heart failure patients required to do a little bit more monitoring and why?
Dr. Watson: How patients interact with remote monitoring depends on the type of disease. For congestive heart failure, they’re actually asked questions five days a week and they take all of their vital signs every day of the week. For advanced illness care, which is our end-of-life care program, they’re asked questions twice a week. Finally, for the inflammatory bowel disease program, they’re asked questions once a week. What this is highlighting is how dynamic this platform is, you can scale it up and scale it down based on needs.
What are you finding, I know it’s too early to have final numbers but do you have any antidote information or how this is working in your mind?
Dr. Watson: So far the outcomes are very positive, what we’re seeing is a trend towards less hospitalization less ED utilization and also, it’s very humane. We’ve had a number of stories, we actually collect these where one patient every time they go to the hospital with cystic fibrosis they are getting intubated and they were on their way to the hospital because they did not have a medication; and our call center is able to do a video call and get them the medication at home and keep them at home where the father and the daughter wanted to be. So it’s very safe in that regards. We’re also seeing a very high compliance rate, which is over ninety percent, which means every time we asked them to answer a question or take a vital sign they’re doing it. In fact, our inflammatory bowel disease pathway right now has ninety four percent compliance, so the early outcomes are very favorable.
How many patients are enrolled in this program?
Dr. Watson: In the first year we enrolled eleven hundred patients.
Can you speak just a little bit about alert in the call center, what is alert and what is the process at that point?
Dr. Watson: One of the real arts of remote monitoring that we are learning here is how do we filter the incoming data? Patients now have access to us by sending data which could be vital signs or responses to questions; we have to be careful what’s happening there. Some of the data might be a red alert; it’s a critical value, a low blood pressure or a high heart rate. What we’re able to do is make sure that those critical values are responded to immediately. And there are other values that are less critical but are still important; we also respond to those but in a slightly lower priority, they’re obviously all important. Then all the other data that’s not alerting flows into graphical and summary reports and goes back to the primary care physicians and their specialists in their own electronic health records.
What makes this program here at UPMC unique? And what gives you the best chance of success here?
Dr. Watson: UPMC is unique in that it’s a payer and provider. Our remote monitoring program was designed and launched as a payer and provider program. It’s just like an accountable care organization; you’re trying to provide a distinct value based on population health, which includes intelligence from the payer or the insurance side and the intelligence from the provider side using all the physicians, nurses, and all health professionals. We also created a centralized model; we have one program, we’re also shipping the kits directly to the patients. And we’re trying to drive value through having the cheapest central operating model possible, scalable to the tenth degree. But all of this is about the patients and so as new patient needs arise, we want to respond to those immediately and as fast as we can. We spent about a year and a half trying to find a vendor, and it was a long process but a good process; we learned a tremendous amount in that time period. What we found is that one vendor stood out above all others, which was biffy, and they’ve been a fabulous partner for us; we’ve invested in them as well. What we found is that they had given us really state-of-the-art technology and the platform; really they’re look and feel is what we wanted, so that our UPMC brand is exposed to our patients in a safe and meaningful fashion. And that our central nurses and doctors feel this is easy to use and valuable, and we certainly found that to be the case.
What are your plans for expansion and next steps?
Dr. Watson: Right now we’re in the process of going through in great detail the outcomes that we had; clinical, financial and operational. In the coming months we’re going to be adjusting and growing the programs and we want to expand likely to COPD; chronic obstructive pulmonary disease. We want to add bring your own device programs, such as programs like pain management, or hypertension management, maybe even getting into maternal fetal medicine, but we’re growing these into various risk areas. Some are kind of light touch where the patients use their own devices and some again are the more chronic and more complicated diseases such as COPD but we’re very excited about next year.
Is there anything I didn’t ask you?
Dr. Watson: One thing that should be mentioned is the fact that we made a big deal about telemedicine and the prefix tele doesn’t matter, this is just medicine. When you asked the patient what they want their fine with it. So for us at UPMC we believe this is humane, it’s a very powerful tool for population health, and it’s just natural for patients so we’re very excited about its future.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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