Successful implementations are 'not about the technology'

BOSTON—Without exception, all successful implementations are due to the people involved understanding that it’s not about the technology, said Jonathan Shankman, vice president of analytics for AMC Health, speaking during the mHealth + Telehealth World Congress 2013. “It’s about actual information and getting that information in front of clinical eyes so something can be done with it. Too many people forget about that last piece.”

He also said it’s important to determine who can best benefit from different types of applications. The ten years of EHRs now available allows data analytics teams to identify the patients for whom telehealth will be the most impactful.

AMC Health is a telehealth clearinghouse that thrives on flexibility, Shankman said. “No two implementations are alike. The organization has partnered with Geisinger Health System since 2008 on a project specifically designed to reduce readmissions. The challenge is taking the existing good process and making it better and having it reach more people. Geisinger already had an elegant transitional care process and proven health navigator. [Mobile technology] has helped identify gaps in care and keep patients out of the hospital.”

The Geisinger partnership has resulted in a 20 percent drop in readmissions “because the technology allowed them to extensively expand their reach.”

Alan D. Snell, MD, MMM, former CMIO for St. Vincent Health, shared the organization’s trial to reduce readmissions that was part of a Beacon community grant awarded to the Indiana state health information exchange. St. Vincent was awarded a subcontract of $750,000 for a clinical trial on reducing readmissions for patients with congestive heart failure and chronic obstructive pulmonary disease because those two diagnoses account for the most 30-day readmissions in that county.

They sought a vendor that offered videoconferencing and embedded educational content. Once they invited hospitals to participate, they enrolled 330 patients in the study. Two hundred were recently discharged and the rest were nonrandomized patients that had not recently been hospitalized. They did, however, have numerous chronic conditions. “We went after the sickest patients we could find,” said Snell, with the highest utilization and costs.

There was a 4 percent readmission rate in the intervention group and 12 percent in the control, compared to a national average of 20-21 percent for those diagnoses, he said.

“The other really amazing results we found as part of the study had to do with patient engagement,” said Snell. Equipment was delivered to patients within 24 hours of discharge. Patients—and some were over 90 years old—videoconferenced with clinicians six or seven times during the 30-day period. Snell reported great compliance. In fact, when it came time to remove the equipment from patients’ homes, some asked if they could pay for the program themselves.

Patient engagement was measured using the four-level patient activation measure and they found that both the control patients and the sickest patients moved up one whole level of engagement.

Snell cited one patient who had 13 hospital admissions in 2011, which cost the health plan $156,000. During the course of the program, she had just one overnight stay for a total cost of $2,500.