With technological advances today, physicians are able to closely monitor their patients - gathering data and monitoring their health status - which is a positive for both for the patients and the medical practice.
In George Orwell’s Nineteen Eighty-Four, the phrase “Big Brother is watching you” is a mantra, or perhaps a threatening warning, that is repeated throughout the story. The translation is that everyone is under complete surveillance by the state authorities. This, of course, is not a good thing.
But with technological advances today, when physicians are watching their patients — gathering data and monitoring their health status — that’s a positive … both for the patients and the medical practice.
“In order to collect data, before, it was a tedious effort; there were just no tools for it,” explains Paulo Pinho, MD, a physician at Pase Healthcare, PC in New Jersey, which has seen an overall decrease in cost to the practice of 19% over the last two years due to increased patient monitoring. “Today, it’s not only that we’re able to [gather data], but I think we’re able to exercise meaningful impact in the quality of care and the cost of care.”
Flipping the playing field
Pase Healthcare is recognized by the National Committee for Quality Assurance (NCQA) as a patient-centered medical home. The practice is also NCQA recognized for the management of patients with diabetes, and a Bridges to Excellence recognized office for the care of patients with hypertension. Effective and efficient monitoring of patients’ health care vitals is critical to achieving and maintaining those designations.
Pinho says using an electronic medical record is the key in getting the most out of the data the practice collects.
“In terms of documentation of certain preventative measure, like colonoscopies, before I had an electronic record that I was using meaningfully, the amount of colon cancer screening tests were very low in terms of my documentation of them in the chart,” Pinho explains.
But as the EMR has enabled the doctor to look at his practice as a whole, he was able to go from a very low percentile to ensuring that near 90% of those patients who are of average risk and require the screening are getting the necessary colon cancer screening.
“And I’ve done that not only with colonoscopies but also mammography and bone densities,” he says.
Tools and barriers
Pinho explains that there is a wide range of tools that make data collection much simpler today. For example, patients are able to submit data through iPhones. There are glucometers that enable patients to report glucose readings, and blood pressure cuffs that patients can get that allow their data to be transmitted to his office. Basically, anything that is done at home can be computerized and entered into the practice’s electronic medical record. Anything that is done in the office is entered automatically.
He cautions that barriers still remain in the form of being able to have these different devices communicate with one another. However, his practice is still able to work around this barrier by interfacing with smaller labs and local hospitals. The practice also utilizes a patient portal program called Relay Health that allows some of the data to come in structured. But it’s still not perfect.
“Unfortunately, when people send in a fax or an email that you can’t manipulate the data on, or a patient jots down their numbers, some of that data is just entered into the chart by one of the medical assistants who sees the patient at the point of care,” Pinho says. “So, some of it is redundant as it requires us to enter in the structured data, and some of it is happening because we’re able to establish interfaces between our electronic health record and labs, radiology facilities and hospitals.”
Pinho says there are significant benefits to monitoring patients’ health status, including showing them how their health conditions have improved over the years. For example, showing patients that their A1C has been reduced from 8 to 6.6 helps them realize that their diet and medication compliance is improving their health — that not only has their cholesterol level been reduced, they decreased their cardiovascular risk from 15% to 6%.
“Being able to show patients this data, and creating these point-of-care tools and worksheets, I think it becomes much more impactful than just giving the patient raw numbers,” Pinho says.
In terms of the impact monitoring patients has on practice workflow, Pinho says it has taken a lot of time, and a lot of training, to arrive at the point the practice is at today. It has become the staff’s mission to track data that they previously weren’t able to track at all.
“It’s difficult to train people in this,” Pinho says. “It’s empowering all staff in the office to do the follow up care. It becomes an office culture, whereas before it was a physician culture. It takes some time, but in the end it’s worth it.”