Ochsner taps apps for hypertension patients

New Orleans-based Ochsner Health System was one of the first U.S. systems to begin managing patients with chronic conditions using tech giant Apple's new HealthKit data-sharing platform in conjunction with the Apple watch and iPhone.

Clinicians and researchers around the country are excited about the technology's potential because of the ease of connecting HealthKit to electronic health-record systems and feeding data from patients' Apple watches and other wearable devices into their personal health records.

Ochsner was one of the beta testers for Apple's HealthKit application. Last fall, it succeeded in importing a patient's personal health data through HealthKit into its EHR system.

In February, Ochsner launched a monitoring program for hypertension patients using devices linked to HealthKit, said Dr. Richard Milani, Ochsner's chief clinical transformation officer. To be eligible, patients must have blood pressure readings outside the controlled range of 140/90. Enrollees are given a new Apple watch, but they have to provide their own Apple iPhone, one that's new enough to connect to HealthKit.

Ochsner clinicians ask patients to obtain a wireless blood pressure cuff, which connects with HealthKit, then to the EHR. Other EHR developers, including Cerner Corp. and Athenahealth, also tout their connectivity with HealthKit and the Apple watch. Duke University Health System and the Mayo Clinic are among the provider systems that have integrated HealthKit with their EHRs and are using the connection to improve care for patients and conduct research.

With patient self-monitoring, “instead of three or four data points a year, we can get three or four data points a week,” Milani said. “If they're overweight and they need to be on an exercise program, we tell them it would be a great idea if they got an activity tracker. And we provide them with advice about what they can do to improve their own health. We provide some medication adjustments if needed.”

Milani said, “We're seeing pretty good responses.” After seven weeks, 16 of the 40 enrolled patients have attained controlled blood pressure status. “A lot of that has to do with the lifestyle changes and the feedback loops they're getting from wearable technologies as well as home devices.”

On April 20, the day the Apple watch hit retail stores, Andres Rubiano, 54, a patient at Ochsner, strapped on one of the new devices as part of Ochsner's remote-monitoring hypertension program. “The Apple watch will serve as a buddy, nudging and encouraging me to make changes in my lifestyle that will help me better control my blood pressure,” he said in an Ochsner news release. “This could be a game changer for me.”

By the end of this year, Ochsner may have as many as 125 patients enrolled in its hypertension program using the Apple watch. Milani said the technology enables “a much more intimate” level of communication between care providers and patients. Given their success so far, “we're looking to see (if) a subset of patients with chronic disease could benefit additionally by utilizing the watch,” he said.

One of the biggest challenges for any remote-monitoring program using patient-generated data is organizing the clinical workflow to deal with a potential deluge of information, Milani said. Ochsner has addressed that issue by creating integrated practice units that include non-physician caregivers, who focus on a particular clinical problem, such as high blood pressure.

Providers launching a patient-monitoring program using wearables or other mobile devices need to educate their clinicians who might be unaware that their EHR can receive data from patient-monitoring devices and mobile apps, said Dr. Ricky Bloomfield, Duke's director of mobile technology strategy. Program planners also need to discuss the technology with affected clinicians to understand their workflows and specific needs. “Technology is not the bottleneck, it's the workflow,” Bloomfield said.

In addition, he said, health systems must work with attorneys and compliance officers on patient consent language and issue a statement on the scope of clinician responsibility for data supplied in real time by patient devices.

Andy Daecher, who heads the Internet of Things consulting practice for Deloitte, said payment reform, the need for greater clinical efficiency and “the consumerization of data” pouring out of wearable devices and mobile apps will force more providers to incorporate patient-generated data into their care processes.

“The whole patient experience is going to become more and more important,” Daecher said. “The wearables will just push consumer expectations to rise. We're moving faster than any of us thought.”