February 21, 2011 8:15PM
Needham Heights, MA, USA
Bernard P. Wess, Jr.
Remote testing of patient vital signs and conditions of clinical variables is not just high technology. It is a means to gather both more accurate clinical data and also save millions of dollars from borderline cases subject to the "white coat effect". Expect greater use of the "medical home" to reduce costs and risk.
Everyone is familiar with the "white coat effect," your author included. It is the tendency for the condition being observed to worsen or exaggerate in the presence of (or waiting for) a clinician. Blood pressure is a good example of a vital sign that can rise on entry to a physician's office.
In an article in the Telegraph website in Medical News, Stephen Adams reports on a new study from the British clinical quality control organization, NICE.1 The National Institute for Health and Clinical Excellence (NICE) reports as many as one in four people experiences a surging pulse rate on entering a GP’s surgery in the UK.2
Since, the NHS in England spent £83 million on beta-blockers alone in 2011 and side-effects are a reality with most pharmaceuticals, more accurate classification of patient conditions should save providers and insurers many billions of dollars related to blood pressure treatment in the U.S.
NICE recommends in a clinical guideline update that patients be followed outside the medical office, at home and work, for a 24-hour period to determine if the "white coat effect" is present in a patient.
Following a patient over time outside the clinic can result in more accurate diagnostic information and a major reduction in costs and care and unwanted side-effects.
A Systems Solution
If a patient is added to a "surveillance" group for remote follow-up, they can be tracked and monitored by an integrated care system. The physician asks a nurse to enroll a patient and the software "follows" the patient through a set of pre-defined rules for a diagnostic or treatment episode. Using an inexpensive device for remote patient data capture, the patient becomes engaged in managing their own care as a full partner in the healthcare delivery process. Blood pressure readings can be taken at home and entered into the clinical information system — a useful and meaningful adjunct to the office visit, particularly for patients who do have accurately diagnosed hypertension.
Using personal clinical rules, integrated care information systems can communicate through inexpensive telecommunications: text messages, calls, email and letters to intervene in the patient's life effectively and as often as necessary to achieve accurate diagnostic information.
The Life Sciences Universe product is enabled to design, build and operate simple or complex insurance, clinical and financial rules for all lines of business and risk and to create and monitor patients assigned to "watch" or "surveillance" groups within Centers of Excellence, defined by the insurer or the provider of care.
Patients can create and send "clinical tweets" ™ which are brief clinical messages, such as bp-systolic=120, with clinical values taken from informal clinical home devices or more sophisticated real-time medical devices installed in the home, for example, a pulse oximeter.
Patients can use cell phones, smartphones, home computers and send and receive clinical messages created by personalized follow-up rules. These are not time consuming to create and they can be quickly designed and attached to a patient by a care or case manager or received by a care manager by the mobile healthcare systems.
To enable enterprise-scale systems implementation, the entire product is written in Oracle and supports Oracle cluster processing, 64-bit architecture and full, secure Internet processing using Oracle Sun Web Services. Advanced transaction processing, audit and control is implemented using Oracle Advanced Queues for clinical, administrative and financial transaction processing that guarantees delivery of web transactions to secure queues for immediate processing.
Numerous tools are provided to balance real-time, clinical and analytical processing of patient rules. Full audit trails are created for all patient communications both sent and received.
1 Steven Adams, "Millions of high blood pressure patients are wrongly diagnosed", Telegraph, 22 February 2011, http://www.telegraph.co.uk/health/healthnews/8339545/Millions-of-high-blood-pressure-patients-are-wrongly-diagnosed.html
2National Health Service, National Institute for Health and Clinical Excellence, http://www.nice.org.uk/
3NICE, "Hypertension (update): guideline consultation", 22 February 2011 – 22 March 2011, http://www.nice.org.uk/guidance/index.jsp?action=folder&o=53224
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