Hospitals Are Prescribing Home Surveillance to Save Lives

As the US healthcare system faces turmoil, hospitals around the country are changing the way they practice medicine. Using new monitoring technologies, doctors are beginning to get an uninterrupted view into the medical lives of their patients after they leave the office.

The technology includes bluetooth enabled devices like blood pressure cuffs, weight scales, pulse oximeters, and modified tablet computers. The real breakthrough, however, is that the data is now able to interface directly with a patient's own medical record. But that kind of tracking system could also bring about new privacy concerns.

University of Virginia partnered with the Virginia-based startup Locus Health to build a program that has tracked nearly 7,500 patients from home since 2013. Monitoring high-risk patients helped bring down hospital readmissions—the number of patients returning to the hospital because of complications—by 45 percent. This is particularly important because of a provision outlined under President Obama's Affordable Care Act in 2012 that required hospitals to curb readmissions.

"Every American ought to have universal access to quality healthcare and in my mind the limitations to universal access are not political. They are issues of affordability," says Dr. Richard P. Shannon, the Executive Vice President of Health Affairs at UVA.

One example of the UVA system is Building HOPE. The program gives parents of single ventricle heart disease patients, a rare and life-threatening congenital heart condition, a way of providing their doctors with a near real-time assessment of their children from home.

It's been an important tool for Kelley and Taylor Shipley, a couple in Virginia Beach. Their son, Cayden, arrived into the world last year, with a heart missing its left ventricle, the result of a single ventricle heart disease. Cayden will need three risky and complicated procedures during the first few years of his life, the first of which took place just four days after his birth.

After his initial surgery, Cayden spent five weeks at the hospital recovering, preparing to head home for what is known as the interstage period—the four to six months between his first and second surgery. This phase requires regular monitoring, so doctors introduced the Shipleys to Building HOPE.

The program runs on specially enabled iPads where parents input data. It also includes a scale for measuring the baby's weight and a pulse oximeter which measures oxygen in the blood—a key indicator cardiologists use to track the status of the baby.

"You just sort of get in the habit of reaching over and grabbing the iPad throughout the day," Shipley said. "We entered data every time he ate, every time he had a wet diaper, every time we checked his oxygen, and every time we weighed him. So in total it was about 25 times per day and it just became routine."

The iPad isn't inherently groundbreaking since it's merely replacing the old method of filling out paper forms and giving parents instructions. "The key, which is what I think is so revolutionary about what we're doing, is that once the parents enters the information in the ipad, it interfaces with their electronic medical record for us back at UVA," said Dr. Jeff Vergales, a pediatric cardiologist at UVA.

This seamless communication works: Historically, the mortality rate for the interstage period was between 10 and 15 percent, but now those death rates are falling to under 5 percent.

Children's Mercy Hospital in Kansas City Missouri implemented a similar program called CHAMP in April of 2014. In that time a total of 72 patients with the same condition as Cayden have been monitored.

"Based upon historical data, we should have expected to lose anywhere between 7 and 14 of those kids, but through this interstage period, we've had zero deaths in that time," says Richard Stroup, the director of Heart Center Informatics at the hospital.

While programs like these could reduce costs and readmissions, they also make personal data vulnerable to exposure. With intimate details about health and medical records on the line, health care systems will have to do more to protect their patients from being hacked—a real threat around the world.

"I think data security is always an issue," Shannon told me. "We need to be HIPPA compliant with all of these devices…but data security, as is true of all information platforms, is a big issue. I think that's a

issue."

Even so, Shannon wants to take the programs to the next level: predicting health problems before they occur. Much like weather forecasting, where algorithms can use data to predict what will happen, doctors will know who will get sick ahead of time.

This might already be paying off. Scott Magargee, senior vice president at Locus Health, said the data from their monitoring program showed a significant percentage of heart attack patients were being readmitted on day eight or nine after being discharged. When the doctors noticed, they started asking patients to come back for a follow-up visit on day seven. There has been a 40 percent reduction in readmission rates for heart attack patients since.

"When we're able to more efficiently manage a patient from home, it allows us to afford care to more people," Shannon said. "If we're going to realize the right that every human being in America has—to accessible and affordable healthcare—that's got to be enabled by technology."