Overview
Country or Region: United States
Industry: Healthcare providers
Customer Profile
The Center for Connected Health (CCH), a business unit of Partners HealthCare, creates solutions for delivering quality patient care outside traditional medical settings, using remote-monitoring technology, sensors, and online communications.
Business Situation
The CCH wanted to create a flexible, scalable platform for remotely managing chronic medical conditions in patients.
Solution
CCH implemented the Connected Health Care Suite, a platform for managing medical conditions based on Microsoft® products and using a software-plus-services approach.
Benefits
n Flexible, scalable platform for applications, devices, and services
n Better management of medical conditions
n Improved overall healthcare for patients with chronic diseases / “This platform…will help streamline the steps needed to test and implement new ideas that use remote monitoring, remote care, and self management of specific chronic diseases.”
Joseph Kvedar, M.D., Director, Center for Connected Health, Partners HealthCare
The Center for Connected Health, a division of the Partners HealthCare medical network in the Boston area, in the U.S., wanted to create a flexible medical information technology platform to help patients manage chronic conditions, such as diabetes and hypertension, outside traditional medical facilities. Using Microsoft® products and a software-plus-services approach, Partners—along with Microsoft Gold Certified Partner Claricode—designed and implemented the Connected Health Care Suite (CHCS). The CHCS is a highly flexible, scalable Web-based platform that can capture, store, and display electronic medical records and information online. It can also receive data from a range of hardware devices and third-party software applications, and provide a communications gateway for patients and healthcare providers to collaborate on treatment programmes.
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Situation
Partners HealthCare is a large, integrated healthcare system in the Boston region, in the U.S., which provides patients with a broad base of services and facilities, including primary and specialty care, community hospitals and health centres, and medical research and teaching practices associated with Harvard Medical School. Partners, which was founded in 1994 by Brigham and Women's Hospital and Massachusetts General Hospital, employs about 50,000 people, including 6,000 doctors. In 2008, Partners delivered about U.S.$6 billion worth of healthcare services.
A division of Partners is the Center for Connected Health (CCH), which evaluates and creates solutions and programmes that can help deliver quality patient care outside traditional medical settings. A key task of the CCH is to find and implement combinations of remote-monitoring technology, sensors, online communications, and cumulative medical data to improve the treatment of diseases and conditions that require ongoing care—such as diabetes, hypertension, and weight control. Participants in the CCH programmes are patients and providers at Partners-affiliated practices and hospitals throughout New England. CCH also works with businesses that are interested in helping employees manage their health more effectively, contain healthcare spending, and improve productivity and satisfaction.
Starting in 2007, the CCH began considering how to address two different challenges and opportunities. The first was a large and growing amount of medical data that was being accumulated through various CCH outpatient programmes. In response, the CCH created its Remote Monitoring Data Repository.
Douglas McClure, Corporate Manager for Technology and Operations at the Center for Connected Health, says the second challenge came in finding a way to use the newly organized data.
“After building the data repository, we asked, ‘What kind of technology platform can we create to get most value from the mountains of data being collected?’ We wanted to figure out how to capture data from a range of devices, including medical devices such as blood pressure monitors, glucometers, and weight scales—all from the patient’s home,” he says. “Then, how could we make that information accessible to patients and healthcare providers in a dynamic, interactive way to improve healthcare outcomes?”
For the technology platform to be successful, it had to provide flexibility and scalability to meet the needs of many different types and sizes of treatment programmes and healthcare practices. It had to support different kinds of software and hardware, and be able to make the most of Web-based services and locally installed software. It also had to be easy to access and use for both patients and providers, delivering a mechanism for healthcare providers to innovate in responding to the needs and requests of patients managing long-term health conditions.
Solution
To meet the challenge, CCH adopted a software-plus-services approach using Microsoft® products, technologies, and solutions to create its Connected Health Care Suite (CHCS). Designed and implemented with the help of Claricode, a Microsoft Gold Certified Partner specialising in medical software, the CHCS provides a combination of comprehensive records systems, online access to data, online communications between patients and providers, and integration with a variety of medical devices and computers.
To create the CHCS, the CCH and Claricode used several Microsoft products, including development and database software. They also used the Microsoft HealthVault™ platform, which provides online storage of medical records and applications that patients and healthcare providers can use to view and share health information securely. HealthVault also supports input from a wide range of medical devices, systems, and applications created by various solution and hardware providers.
The CCH and Claricode began implementing the CHCS in 2008. Since then, the two have been continually modifying and improving the technology. The clinician, patient, and caregiver interfaces within CHCS manage the interaction between the different parties involved in a treatment programme. CHCS also provides tools for programme and workflow management. Operational supports range from clinical user management, such as identifying, enrolling, discharging, and managing patients, to inventories of technology used to enter data into the system.
The CHCS was launched with two pilot programmes—one involving remote monitoring of patients with heart conditions and the other for diabetics. These are two of the most common chronic medical conditions that lead to high healthcare costs and repeat admissions or visits to hospitals or doctors’ offices.
The programmes illustrate the software-plus-services approach. Both use small software applications that enable Internet-based communications between medical devices—such as cardiac and diabetic monitoring equipment—and a HealthVault database provided by the CCH. Based on input from the devices, doctors and other healthcare providers can closely monitor how patients are managing their conditions without repeated in-office visits. Armed with this information, the providers can follow up with their patients by e-mail or telephone. They can also establish and modify individual treatment programmes that might include, for instance, alerts sent to computers or mobile phones regarding medications, or e-mails suggesting diet and exercise routines that can help stabilise conditions.
The collaboration between patients and doctors is a significant component of the CHCS. In the CCH’s Diabetes Remote Monitoring Programme, for example, clinicians and patients share a workspace where patient blood glucose measurements are combined with patient notes to foster an ongoing dialogue about the patient’s success in managing his or her disease. Secure messaging is integrated with the patient’s electronic medical record to support the discussion between patient and provider and to deliver a more detailed medical record for future reference.
Joseph Kvedar, M.D., Director of the Center for Connected Health and Associate Professor of Dermatology at Harvard Medical School, says: “We created the CHCS system using the software-plus-services approach to provide powerful data collection capabilities, decision support, clinical rules, and a range of disease and behaviour-management tools.”
Benefits
Basing the CHCS on a software-plus-services architecture helped CCH implement a highly flexible, scalable platform for providing remote care to patients with ongoing medical conditions. Even in the early stages of development, the CHCS system is delivering important benefits to the Center for Connected Health, its affiliated healthcare providers, and patients. These include better management of chronic diseases and conditions, resulting in savings in medical and financial resources and overall improvements in long-term medical care.
A Flexible, Scalable Platform
The software-plus-services approach allowed the Partners HealthCare and Claricode development teams create a highly flexible and scalable system that can be easily modified to include new healthcare providers, new programmes, and different types of devices and applications for entering data.
“Depending on the programmes and the providers we are working with now—and will be working with in the future—we might need any number of combinations of software, services, and various devices to create the right solution,” says McClure.
“The benefits of using a software-plus-services approach built on Microsoft technology is that we can quickly adapt to a specific clinical need.”
“In some cases, we might provide all of the software, services, and hardware,” he says. “In other instances, we may just provide selected services over the Internet, basically disappearing in the background while a clinic delivers the software and devices. The software-plus-services approach provides enormous flexibility, allowing us to respond in either example.”
He also notes the efficiency of avoiding a more traditional approach of using solutions based on dedicated hardware and locally installed software.
“Using software-plus-services, we were able to develop the Connected Health Care Suite relatively quickly without going through a huge, time-consuming evaluation of all the products on the market and trying to figure out how to integrate them into our solution,” he says. “Instead, Microsoft technologies and the software-plus-services approach allow the CHCS to plug in to existing systems and devices with ease.”
Better Management of Medical Conditions
Even in the early stages of production, the CHCS demonstrated benefits in helping patients and their healthcare providers manage diseases.
“This platform can manage new programmes, devices, and patients much more easily than previously possible,” says Kvedar. “It will help streamline the steps needed to test and implement new ideas that use remote monitoring, remote care, and self management of specific chronic diseases.”
The programmes implemented on the CHCS platform are delivering powerful metrics. For example, the Connected Cardiac Care programme offered to heart-failure patients who often need frequent hospitalisation, has led to a 50 per cent reduction in hospital readmissions with improved patient outcomes and lower total cost of patient care. The programme has also resulted in a 33 per cent reduction in home visits by nurses, yielding savings that will cover the cost of implementing the CHCS programme.
Michael Myers, M.D., Medical Director for Hawthorn Medical Associates—a North Dartmouth, Massachusetts-based clinic that is using the Diabetes Remote Monitoring Programme powered by CHCS—has witnessed first hand the benefits of using the CHCS.
“Our nurse educator and our dietician—the people in our diabetes centre who are constantly in contact with patients—report that they’re getting positive feedback from patients,” he says. Patients get to use diabetes monitoring equipment techniques and equipment with which they’re already familiar, but the equipment is configured to send results automatically back to the CHCS.
“I can easily track and monitor, for example, the progress of their A1c blood levels, their LDL cholesterols, the last visit that they had, or their blood pressure rates,” Myers says. “It’s easy for me to determine if all those things are looking good, without requiring the patient to come in for a visit.”
Improvements in Overall Healthcare
The CHCS system also makes it easy for staff members at the Center for Connected Health to analyse information and determine which remote monitoring programmes are most effective. By measuring the effectiveness of each programme, the CCH can focus on initiatives that deliver the greatest increase in healthcare quality. This is critical for improving the overall quality of an organisation’s services. It is also vital in addressing new medical payment models such as the “pay-for-performance” model, in which healthcare organisations and doctors receive part of their pay based on patient health outcomes.
“Using software-plus-services with Microsoft products contributed enormously to the innovation of the Connected Health Care Suite,” McClure says. He notes that in addition to the metrics that Partners has gathered through the initial programmes, research shows that better self-
management by patients and automated feedback systems result in higher patient engagement and better health outcomes.
“The platform supports multiple disease management programmes that help monitor patients with a wide variety of devices, different types of data, and various information service providers,” says McClure. “It allows for managing a much larger set of patients than previously possible. And, with Web-based services, each doctor and disease management practice can modify the solution to suit their patients’ unique needs.”
Software + Services
Software-plus-services is an industry shift driven by the fast-growing recognition that combining Internet services with client and server software can deliver exciting new opportunities. Microsoft is dedicated to helping individuals and businesses take advantage of these opportunities. By bringing together the best of both software and services, we maximise capabilities, choice, and flexibility for our customers. The broad software-plus-services approach unites multiple industry phenomena including software as a service, service-oriented development, and the Web 2.0 user experience under a common umbrella.
For more information about software-plus-services, go to: www.microsoft.com/softwareplusservices