Putting Patients in Charge

Putting Patients in Charge

Web-based platform built on the software-plus-services approach helps people with chronic conditions treat their diseases more effectively

The Center for Connected Health (CCH), a division of the Boston-based Partners HealthCare medical network in the U.S., wanted to create a flexible technology platform that could help patients manage chronic conditions. Using Microsoft® products and a software-plus-services approach, the CCH developed the Connected Health Care Suite (CHCS). With the CHCS, patients have a powerful tool to monitor their conditions carefully while keeping in close touch with healthcare providers.

The visit to the doctor’s office one day in October 2007 changed Jerry Bello’s life forever. That’s when he was given the news that an A1c blood test—which measures blood sugar levels—revealed that Bello has type 2 diabetes, a chronic disease that affects nearly 8 per cent of the U.S. population.

It’s a diagnosis that no one wants to hear, and Bello, a busy 63-year-old business manager of Keegan Werlin LLP, a medium-sized Boston law firm, is no exception. Left untreated or poorly managed, type 2 diabetes can lead to expensive, serious, and potentially crippling medical consequences.

Bello quickly made up his mind to be highly proactive in managing his disease—a good start, since a person’s reaction is critical in the early stages of diabetes, and can make a huge difference in the patient’s long-term prospects. Bello began scouring the Internet for information, went out of his way to talk to other diabetics, and got a referral to a strong medical team specialising in diabetes treatment at Massachusetts General Hospital.

There was another key component that, in the time since the initial diagnosis, has helped Bello tremendously—a technology solution created and run by Partners HealthCare, a large medical network in the Boston area.

The solution was designed and is operated by the Center for Connected Health (CCH) at

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Partners HealthCare, with core components that include Microsoft products. It combines commonly used equipment such as glucometers—blood sugar monitors—and Web-based technology that allows a patient to upload medical information and then view it on a secure Web site. The result is an easy-to-use system that lets patients with chronic conditions play an active role in monitoring their health —making rapid adjustments in behaviour, such as eating and exercise, to reduce the effects of their condition.

“I had heard about the CCH system from a relative, and my doctor strongly supported my participation,” says Bello. “This Web-based tool was incredibly helpful for me in the first 12 months after I was diagnosed with diabetes. During that period, I used it to monitor my diet, testing different foods. I’m Italian, and unfortunately a lot of Italian foods, such as processed pasta, are bad for diabetes. The technology, including the Web site where I can monitor my blood sugar readings, helped me keep close tabs on what I was eating and how it affected my blood sugar so I could closely manage my condition by making changes in my lifestyle.”

The solution created by the Center for Connected Health at Partners HealthCare is one of many initiatives by the medical industry and technology companies designed to improve the quality of healthcare while lowering its cost and complexity. At the CCH, the project that Bello and other patients are benefiting from—known as the Connected Health Care Suite, or CHCS—was started with a goal of finding ways to let patients with chronic conditions easily collect and understand information about their health. In addition to diabetes, the system helps patients with other long-term but manageable conditions such as hypertension and obesity.

Douglas McClure, Corporate Manager for Technology and Operations at the Center for Connected Health, says: “We wanted to figure out how to capture data from a range of devices, including medical devices such as glucometers and blood pressure monitors, along with patients’ home computers. Then, we wanted to determine how we could make that information easily accessible to both patients and healthcare providers in a dynamic, interactive way to improve healthcare outcomes.

McClure and his colleagues at CCH decided to use a combination of software and Web-based services to create the CHCS. It employs a number of Microsoft

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products and solutions, including the Microsoft HealthVault™ platform. The CHCS has a range of features, such as support for comprehensive records systems, online access to data for patients and their doctors, online communications between patients and providers, and integration with a variety of medical devices and computers.

It also provides special devices that help upload information. In Bello’s case, he uses a small, dedicated modem that provides a link between a standard telephone line and his glucometer to upload blood sugar readings to a password-protected database that holds his medical information. Once in the database, Bello can log on to a password-protected Web site to review his medical data.

CHCS also provides tools for managing programmes, such as identifying, enrolling, and discharging participants, and providing inventories of technology used to enter data into the system.

Collaboration between patients and doctors is a key part of the CHCS. In the Remote Monitoring and Management of Diabetes Programme, for example, clinicians and patients share a Web-based “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.

Bello says: “The notes feature is a big benefit, because it allows me to annotate each blood sugar reading that is uploaded to the site. I can note what I ate just before the reading, or how much exercise I got. Then I can discuss those findings with my healthcare team.”

Secure messaging is integrated with the patient’s electronic medical record to support ongoing discussions between patients and providers, and to deliver a more detailed medical record for future reference.

Dr. Michael Myers, Medical Director for Hawthorn Medical Associates (HMA) in North Dartmouth, Massachusetts, says: “The CHCS system provides a tremendous biofeedback loop that benefits both patients and the medical professionals who are assisting with their treatment.” HMA, which employs about 400 people, including 53 doctors, is part of the Partners HealthCare medical network. Diabetes is a large part of the HMA practice, which has about 140,000 patients.

Bello is representative of the ideal patient who can benefit from a technology solution such as the CHCS. He is highly motivated to treat his diabetes without medication, and is willing to undertake the easy, daily steps required to gain more control over his condition and long-term prospects.

“The benefits have been amazing,” he says. “I know a number of people who were diagnosed with diabetes after I was, but who don’t have access to this Web-based system. They don’t seem to have the amount of knowledge that I have. I think a big part of it is that when simply presented with a medication or told to follow a specific health routine, people don’t have the same motivation to truly understand their condition. With this Web-based tool, I get immediate feedback on how the food I’m eating or the exercise I’m doing affects my blood sugar levels. Then I can quickly make adjustments.”

Bello put the system to good use on a trip to Tuscany in central Italy, where the pasta abounds.

“I took readings with my glucometers two or three times a day, and uploaded them to the Web site,” he says. “This is one of the amazing things about this Web technology. It’s simple to use, even on an overseas trip, and gives me immediate access to my readings on the Web site. I discovered that I could get away with eating some pasta as long as it was home made, and was accompanied by a lot of fresh vegetables and exercise. Walking around all day helped bring my blood sugar readings down to normal.”

The relative simplicity of the technology for patients such as Bello, and the immediate feedback that is available on the system’s Web site, can potentially revolutionise the course of healthcare for millions of people.

“It’s so easy to use, and it becomes like a game,” says Bello. “I’m always trying to figure out what I can do to keep my diabetes under control. If I see high readings, it bothers me and I become motivated to change the numbers.

The system, with its easy-to-use technology, can ultimately help more people take more control over their health. That, says Myers, can deliver enormous benefits to the healthcare industry as a whole.

“More and more we’re seeing patients who want to be in control of their illnesses and treatment programmes,” he says. “This tool provides that capability. It benefits patients and practices such as ours because we can deliver a higher calibre of care to patients using data that’s meaningful and actionable. That’s what improving healthcare is all about.

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