Bill Siwicki

The Einstein Medical Center wanted to decrease readmissions for liver failure patients by 50 percent. Caregivers had a longtime interest in the potential for remote patient monitoring and turned to telehealth technology to address this mandate. Thus far, since implementing the RPM processes, the hospital has gone more than two months without any readmissions. "The problems we encountered included issues that come up with all patients with a severe chronic illness," said Richard Kalman, MD, assistant professor of medicine SKMC in the department of digestive disease and transplantation in the division of hepatology at the Albert Einstein Healthcare Network in Philadelphia. Despite requiring all patients to attend follow-up appointments within two weeks, the readmission rate still was 40 percent. Patients often would come to the clinic and be readmitted directly because they were too sick, or would be called to come to the hospital for severe laboratory abnormalities, or would present to the emergency room feeling sick due to non-compliance. And some readmissions were unavoidable, of course. The hope with the initiation of the telehealth remote patient monitoring program was to find problems when they were still small and could be managed as an outpatient, thus avoiding a readmission. Einstein Medical Center uses remote patient monitoring technology from Vivify Health. Other vendors of remote patient monitoring technology include Biotronik, Boston Scientific, GE Healthcare, LifeData, Medtronic, Philips Healthcare and Spacelabs Healthcare. "The technology allows our patients to have a remote visit within 48 hours of discharge with one of their liver providers, and also allows the patient to relay information including symptom assessment and vital signs to the liver clinic as well as to our partnered visiting nurse program," Kalman explained. "The device is set up with the help of the visiting nurse, and the patient then uses the device to log symptoms and vitals." The program, which lasts for 30 days, is not currently integrated directly with the organization's EHR, but the online portal is user-friendly and allows for good communication, he said. Telemedicine technology allows the liver team to find small problems before they become major issues that might require hospital admission. The team is constantly adjusting blood pressure pills, diuretics and medications to control high ammonia levels that can lead to hepatic encephalopathy. "One example that comes to mind is of a rather cantankerous older gentleman who is on the list for liver transplant," Kalman recalled. "He would always claim that his blood pressure was elevated in the office because he disliked doctors so he never allowed me to prescribe a blood pressure pill. This technology allowed him to take his blood pressure at home, and I was able to demonstrate that his blood pressure was more than just white coat hypertension." His blood pressure is now under much better control, and although he has not yet reached the top of the transplant list, when he does, he will have a decreased risk of stroke and cardiac pathology because his blood pressure is under good control pre-operatively, Kalman added. The remote patient monitoring technology is not just having an impact on patients and readmissions, it is having an impact on value-based care. "The impact of this technology on value-based care is simple," Kalman said. "It allows the patient to provide more data to providers, thus allowing for more efficient and timely care that also allows for less frequent office visits and improved communication." Twitter: @SiwickiHealthIT Email the writer: bill.siwicki@himssmedia.com

The National Institute on Aging awarded a $4.5 million grant to the University of California Berkeley and People Power, an IoT software provider, to support research on smart home solutions for caregivers of dementia patients. People Power is creating customized systems through behavioral research on targeting everyday stressors for caregivers and dementia patients. The new technology gives caregivers proactive alerts that identify abnormal qualities in patient activities. The tool increases the safety and quality of life for people living with dementia, said Robert Levenson, MD, a professor at the University of California, Berkeley. “For the past 15 years, my laboratory at University of California, Berkeley, has been studying the cognitive and emotional changes in people with dementia, specifically individuals with Alzheimer’s disease and frontotemporal dementia,” he said. “In the beginning, we were focused on the individuals with dementia,” said Levenson. Over time, he spoke with caregivers about the challenges they were facing and decided to alter his research to include them. “We’re now focused on the challenges of caregivers who work with individuals with dementia,” Levenson said. “Many caregivers develop serious mental and physical health problems as they deal with the stress and burden of caregiving.” The current study is “attempting to understand the types of solutions and technologies that can reduce the negative effects of caregiving,” he added. With People Power, they’re developing in-home technology that can reduce caregivers’ everyday stressors. Through the NIA grant, they’ve begun research on the main stressors for caregivers and how the integration of technology can reduce these everyday challenges. “The majority of a caregiver’s stress is a result of troublesome behaviors from the individual with dementia,” Levenson explained. “The inability to predict these troublesome behaviors contributes to a caregiver’s likelihood of developing particular illnesses like depression, anxiety, a decline in their immune system and more.” Through the research, they’ve determined caregivers are faced with two common challenges. The biggest is the anxiety that comes with being the sole caregiver for an individual with dementia. Caregivers are constantly worrying about the individual’s behaviors and how these will result in the individual injuring themselves – like if they forget to turn off the stove or wander away from the home. The second is a little more subtle, but researchers found there’s a gradual sense of social isolation that impacts caregivers over time. As dementia progresses, the caregiver’s life becomes increasingly focused on the individual with dementia, resulting in caregivers gradually becoming isolated from their social circle. “Through the utilization of artificial intelligence, the services can intelligently learn the habits of both the caregiver and the person living with dementia,” Levenson said. “Using this data, the in-home solution can mitigate factors in the home like noise, lighting and temperature to diminish the chances of distress for the person with dementia and the caregiver,” he continued. “This controlled environment, created through automatized tracking, can help eliminate potential triggers and simplify the caregiver’s role.” In terms of the research, they will conduct a formal evaluation of how the in-home technology influences the lives of the individual with dementia and their caregiver. They’ll monitor their health and wellness and determine if the in-home technology helps impact the negative effects of caregiving. “The challenge for in-home technology is that in order for it to be widely adopted, it must become individualized,” Levenson said. “Every person with dementia and every caregiver are different, so we need to create personalized solutions that are flexible and can meet the needs of both.” For technology to provide real value, it needs to be able to learn and evolve, he added. With the use of AI, the microservices are able to evolve their services based on the caregiver’s and dementia patient’s habits to provide solutions that improve their lives. Twitter: @SiwickiHealthIT Email the writer: bill.siwicki@himssmedia.com

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