Eden Internal Medicine of Eden, North Carolina believed it could improve its game in treating diabetes and high blood pressure patients.
THE PROBLEM
Diabetes patients were initially checked and monitored between visits. Patients with uncontrolled diabetes with elevated A1c levels were not closely monitored between visits to reduce sugar levels.
For example, if the patient has extremely high blood sugar levels during today’s visit, a three-month average on the A1c test, staff will have no way to closely monitor the patient between visits until the patient comes for the next visit in three months.
This means that the patient has been uncontrolled or partially controlled for three months. Uncontrolled diabetes leads to many complications for the patient. CMS and other HEDIS star rating and quality metrics require better A1c control.
“There are limitations with Bluetooth technology,” said Dr. Dhruv B. Vyas, owner and partner at Eden Internal Medicine. “Bluetooth is inconvenient for patients who are not tech savvy and don’t have a smartphone, making it difficult to monitor them for glucose control between visits.
“Bluetooth devices sometimes cause transmission errors and a problem with the devices syncing, which means that staff and patient spend more time troubleshooting device connectivity issues,” he continued. “Many patients do not have a smartphone or have an aversion to technology, which limits the use of such devices.”
Then there is patient responsibility and compliance monitoring. It was difficult to manage patient accountability and compliance without an instant blood glucose test taken between visits while they were at home.
“Some patients may need close blood glucose monitoring and monitoring to maintain diet and exercise regimes,” Vyas said. “Without immediate access to daily blood glucose levels for the doctor’s office, it is difficult to advise such patients to improve their lifestyle and / or change medication.”
Then comes high blood pressure. First, the blood pressure was checked between visits.
“Monitoring blood pressure between visits and adjusting medications to bring blood pressure to the target is key,” Vyas said. “Patients with uncontrolled blood pressure and recent medication changes require frequent doctor visits, which is difficult for many patients.
“Then there is the treatment of the patient with white coat hypertension,” he continued. “It is difficult to treat the patient with labile hypertension or white coat hypertension based on the readings in the office. The patients may have extremely high blood pressure in the office, but supposedly normal blood pressure at home.”
Aggressive treatment of such patients can lead to a hypotensive episode and syncope, he added. Monitoring such patients with reliable equipment would provide accurate data in their home settings when they are comfortable and not anxious, he said.
The unreliability of current cellular blood pressure monitors has also been a problem. Some of the existing cellular blood pressure monitors were not as accurate, and it was difficult to treat patients based on these numbers. There was a need for reliable cellular blood pressure monitors that provide consistent readings based on which medication can be adjusted.
And again restrictions on Bluetooth technology.
“Bluetooth BP devices work for people with smartphones and tech-savvy people, but not for people with a regular phone in rural areas who have a technology phobia,” Vyas said.
SUGGESTION
Eden Internal Medicine relies on smart meter technology. The technology offers cellular connected devices such as blood sugar and blood pressure monitors, which transmit the readings immediately to the patient files or to a dashboard.
“Using cellular technology removes the barriers that patients face who rely on technology,” said Vyas. “Thanks to the intuitive data platform of smart meter technology, diabetic supplies and test strips can be automatically delivered to your home when the strips run out. Unlimited test strips are supplied with the Smart Start program. The technology has excellent troubleshooting support staff, reducing patient and staff time.
“Smart meters are reliable and accurate, and provide consistent blood pressure and glucose readings that are within acceptable standards of standard deviation,” he added. “The technology enables flexible device distribution, including delivery directly to the patient, and manages the entire device and data logistics. It also offers training and support for providers, patients and nursing staff. “
MARKETPLACE
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TO THE CHALLENGE
Eden Internal Medicine has integrated smart meter technology into its AstuteDoc care management platform.
“AstuteDoc’s intuitive software offers dashboards, care plans, interventions, data charts, time management, billing export and many more features, as well as dedicated care team members embedded in the medical practice,” explained Vyas.
“AstuteDoc’s complete care management solutions include chronic care management, remote patient monitoring, transition management, annual wellness, ACO quality metrics, incident-to-visit and home care management.
“This platform has been used by many ACO practices, PharmD, doctors, cardiologists, endocrinologists, general practitioners’ practices, nurses, care coordinators and medical assistants,” he continued. “AstuteDoc embeds the PharmD or the medical assistant in the doctor’s office to achieve care management goals and quality metrics.”
The implementation of smart meter technology resulted in better workflow, seamless integration, and employee and patient satisfaction, Vyas reported.
“AstuteDoc’s care providers, staff and PharmD have achieved better results in monitoring their patients’ blood pressure and glucose,” he said. “This has led to better quality indicators for the HEDIS Star rating.
“And patient compliance has improved significantly,” he continued. “The intervention of the care coordinators between visits resulted in an improvement in the patient’s lifestyle and responsibility for exercise and dietary choices. Patients were better informed about their health problems and more motivated to take care of their health. “
Enrolling patients in remote monitoring is much easier for care coordinators with smart meter devices, he added. The immediate transfer of the data and integration with the software was seamless and reduced registration time, he said.
“Monitoring the data was much easier for staff with specific alerts for each patient in order to achieve their goals,” said Vyas. “Tele visits increased during the pandemic and the use of smart meter devices complemented such visits well to provide providers with more data for meaningful disease management. The home blood pressure readings were transmitted for certain visits such as annual Wellbeing used is a required element of CMS. “
RESULTS
In terms of diabetes metrics, Eden Internal Medicine saw an improvement in A1c scores and reduced hospital admissions through improved patient compliance.
“An average of 1.6 improvement in A1c was seen in patients at the next visit in three months,” Vyas reported. “And there was a significant improvement in postprandial hyperglycemia due to close monitoring and intervention between visits. This has resulted in weight loss due to patient responsibility and lifestyle change.
“By creating critical alarm triggers for various glucose levels, we have been able to reduce hospital admissions for hypoglycemia and diabetic ketoacidosis,” he continued. “In the long term, we expect this A1c control to reduce diabetes-induced complications.”
Eden Internal Medicine has received a HEDIS Star Rating of 4.95 for United Healthcare Medicare.
Regarding the hypertension metrics, the patients’ blood pressure was lowered by intervention between visits.
“Patients with labile hypertension or white coat hypertension had somewhat normal levels at home that are documented in the EHR,” explained Vyas. “The remote patient monitoring blood pressure readings can be used once a year during doctor visits for BP Control’s CMS quality metrics goal.
“There were two patients with syncopal episodes that appeared to be due to low blood pressure at home on the same medication, while those patients had high blood pressure in the office,” he continued. “Medication counts were now reduced based on home blood pressure readings to correct over-medication problems. Patients had more energy, no episodes of syncope, and fewer medications.”
ADVICE FOR OTHERS
“Any healthcare provider organization considering using similar technologies needs to investigate cellular technology platforms built into care management software, or EHR,” advised Vyas. “The reliability of the device and the consistent support from the manufacturer are just as important for the success of this program.”
Vyas strongly advises against using Bluetooth technology unless patients are tech savvy and have a smartphone. Providers should use remote monitoring technology for high-risk patients, set specific critical alerts, and set intervention / care plans to get them to desired goals, he added.
“For better implementation of the remote monitoring program, it needs to be intertwined with other care management programs such as CCM, TCM, AWV, PCM, etc. to maximize the benefits for value-based patient care, which translates into better quality outcomes and outcomes,” he said.
“Such programs are extremely difficult to implement unless you have dedicated staff or a nursing company to handle the day-to-day requirements of the program and critical alerts because the providers don’t have time to handle the workload.
“And a PharmD-supported program also provides significant value to the practice, patient, ACO and Medicare benefit plans,” he concluded. “The best performing practices achieve their goals through the best-coordinated nursing team efforts, workflow, and intelligent technology.”
Twitter: @SiwickiHealthIT
Email the author: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
