Use of at-home medical devices can help patients and physicians efficiently manage chronic conditions

The use of at-home medical devices to connect doctors and patients via the Internet can help patients and their physicians work more efficiently together to manage chronic conditions, according to research at Cleveland Clinic.

In December 2008, Cleveland Clinic and Microsoft collaborated on a pilot project that pairs the hospital's electronic medical records system with the software company's online HealthVault service to monitor patients' health conditions.

More than 250 participants enrolled – 26 percent with diabetes, 6 percent with heart failure and 68 percent with hypertension – making it the first physician-driven pilot project in the country to follow multiple chronic diseases in a clinical setting.

"The prevalence of chronic disease is rising at an alarming rate in the United States, absorbing an ever-increasing portion of the nation's healthcare dollars," said C. Martin Harris, M.D., Chief Information Officer, Cleveland Clinic. "If we are to lessen this strain on our nation's economy and healthcare system, we have to change our thinking about how and where healthcare should be delivered, while developing innovative, cost-effective solutions that allow patients to proactively manage their healthcare."

Nearly half of all Americans are now diagnosed with at least one chronic condition, accounting for 75 percent of nation's healthcare spending.

"Although more research is certainly needed, the results of this observational study are promising, suggesting that at-home medical devices can help patients and doctors better track chronic conditions, coordinate treatment schedules, manage medication regimens and schedule timely interventions," Dr. Harris said. "Ultimately, such improvements make for more efficient healthcare, healthier patients and possibly a reduction in healthcare costs."

In the Cleveland Clinic-Microsoft pilot project, participants used at-home heart rate monitors, glucometers, scales, pedometers or blood pressure monitors, depending on each patient's disease. These devices uploaded the patient's data to HealthVault – a security-enhanced , Web-based data storage platform for patients – which then connected to the patient's personal health record at Cleveland Clinic (MyChart, by Epic Systems) and the electronic medical record system used by the patient's healthcare providers at Cleveland Clinic (MyPractice, also by Epic Systems).

The project found a significant change in the average number of days between physician office visits for patients. Diabetic and hypertensive patients were able to make doctor's office visits less often, increasing the number of days between appointments by 71 percent and 26 percent respectively, indicating that patients had better control of their conditions. Heart failure patients, however, visited their doctors more often, decreasing the number of days between visits by 27 percent, indicating that patients were advised to see their healthcare provider in a more timely manner.

"When treating heart failure patients, timely intervention is crucial when complications arise, so that we can prevent serious problems that may require emergency room visits or readmissions," said Randall C. Starling, M.D., M.P.H., Section Head of Heart Failure & Cardiac Transplant Medicine, Cleveland Clinic. "The ability to monitor weight, blood pressure and activity levels of heart failure patients on a regular basis ensures more timely doctor visits and avoidance of more expensive interventions."

With the use of coordinated secure health information technologies, some healthcare activities that have traditionally occurred only in a physicians office might one day occur wherever a patient may be, including at home or at work.

"Making it easier for patients to more actively engage in their ongoing health and wellness is a necessary step in trying to manage the increasing onset of chronic disease worldwide and the costs associated with this alarming trend," said Peter Neupert, corporate vice president, Microsoft Health Solutions Group. "The results of this pilot are promising and demonstrate how cost-effective and flexible technology solutions can support patients in better monitoring their chronic conditions from where they live and work."