1 Modern
`Healthcare
`
`
`
`Sent: Friday, February 11, 2000 9:31 PM
`To: 118701
`Subject: HHN: Web helps nurses manage patients
`
`Chronic Illness Care
`Web helps nurses manage patients
`John Morrissey
`
`02/07/2000
`Modern Healthcare
`Supplement (Eye on Info)
`73
`
`Copyright (C) 2000 Crain Communications, Inc. All rights reserved.
`
`Four nurses juggle the care of 700 chronically ill patients in and
`around Sacramento, Calif. And their caseload could swell very soon.
`
`Mercy Heart Institute. which employs the nurses as case managers,
`hopes to monitor at least 1,000 patients without hiring anyone else. But
`this development is just fine with the case managers. Same with most of
`the patients.
`With the aid of a two-way lntemet connection between nurses and
`patients, the heart institute‘s program on managing congestive heart
`failure allows nurses to monitor the current roster of patients more
`closely. it also allows patients to be added and trees nurses to focus
`on problem cases. Nurses flag those cases through daily patient
`feedback.
`
`From simple monitors installed in their homes, patients enter Vitals
`and answer questions posed by a case manager through an electronic
`connection. Measured against normal ranges and previous readings, the
`information confirms a stable situation or prompts immediate action.
`
`The same type of online daily monitoring by Santa Clara County
`(Calit.) Individual Practice Association is capturing the attention of
`congestive heart failure patients identified as "challenging" -- they're
`lax in following instructions and regimens for preventing a medical
`tailspin.
`
`The 55 patients chosen as prospects for the program last April had
`multiple hospitalizations and emergency room episodes to show for their
`lax compliance. About 80% now use the lntemet-based program, which has
`greatly facilitated managing their conditions, says Lawrence Bonham,
`MD., the practice association's chief executive officer. "It gets us in
`better touch with these patients,“ he says. “Prior to that, we didn't
`know who was stable and who wasn't.“
`
`
`
`Bosch Ex. 2013
`Cardiocom v. Bosch IPR2013-00468
`
`1
`
`

`
`Both healthcare organizations are testing the capabilities of‘l:leal1lI
`51-lerg jxlgtwgkis system, which is designed to actively and
`cost-effectively manage chronically ill patients.
`
`The Health Hero system includes:
`
`* A secure Internet-based data center.
`
`* A software package for case managers to compose care plans for
`individual patients.
`
`* A simple consumer-oriented "app|iance“ kept in patient homes. The
`device receives messages from case managers and sends them information
`on patients, such as weight gain and adherence to medication regimens.
`
`The Mountain View, Calif.-based company is racing toward the next
`managed-care challenge as the cost of treating chronic illness increases
`as a percentage of total U.S. spending on healthcare.
`
`In 1990 direct medical costs for people with chronic conditions
`totaled $425 billion, 60% of the nation's medical~care costs. By 1995,
`direct medical costs had risen to $470 billion, 70% of total U.S.
`medical-care expenses, according to the Robert Wood Johnson Foundation.
`
`The American Heart Association estimated that spending on congestive
`heart failure in 1999 was $20 billion, with $15 billion resulting from
`hospitalization or nursing home care.
`
`Before the Intemet-based program was launched, Mercy Heart
`Institute, a division of Mercy Healthcare Sacramento, already had a
`thriving 2-year-old program of aggressive "telephonic surveillance,"
`which had reduced rehospitalizaticn of congestive heart failure
`inpatients by 79%, says Richard Miller, M.D., director of the institute
`and Mercy's care-management programs.
`
`Miller says nurses were allowed to make some independent decisions on
`adjusting medications for congestive heart failure by following
`algorithms -- precise directions based on information provided by
`patients when nurses call them.
`
`Though successful so far, the telephone-based case-management program
`is “quite labor-intensive" and limits a nurse's caseload to 150 to 200
`patients, he says. Also, contact dwindles to a few times per month for
`patients who haven't had a hospital episode for a while. Case managers
`have to concentrate on recently discharged patients, following them
`three to four times per week.
`
`A six-month pilot project at Mercy Heart Institute has shown, however,
`that most patients respond to instructions and requests for daily
`information in a two-way exchange with nurses communicating over the
`World Wide Web.
`
`A small device called a Health Buddy was installed in the homes of 115
`patients participating in the pilot. Nearly 90% of the patients complied
`with the daily routine, delivering daily electronic reports for case
`managers.
`
`
`
`2
`
`

`
`With the reports, nurses can scan all their cases and flag worrisome
`symptoms, medication questions and failure to follow doctors’ orders. 80
`instead of starting the day by trying to catch a water-weight gain -- a
`common sign that fluid is building up and diuretics aren't working -
`nurses already knew the conditions of their patients and could
`concentrate on intervention rather than investigation.
`The shift to personal contact for only high-risk cases and exceptions
`to normal readings meant that most patients talked less frequently with
`a caregiver. But that didn't generally make people feel neglected.
`
`“Patients still feel equally if not more connected with the nurse,
`because they feel they're communicating every day instead of twice a
`month,“ Miller says.
`
`Adds Bonham of Santa Clara County IPA: “Patients are happy with the
`process. Our patient-satisfaction surveys have come back strong; over
`90% say they like it and it's easy to use."
`
`The experience with daily reporting has shown that phone calls alone
`leave many problem situations undiscovered, says Miller.
`
`"By reporting every day, we have long-term trends that we didn't have
`before,“ Bonham says.
`
`In the first two weeks of daily feedback, Mercy already had detected
`unstable patients and “given them much more rapid treatment than they
`would have othenivise received,“ Miller says. The algorithms that nurses
`use were changed after the institute realized congestive heart failure
`patients experienced “daily fluctuation of three or four or five pounds.
`That was a real eye-opener."
`
`The California test sites were at the forefront of aggressive care
`methods, but they didn't have the steady reporting to pick up subtle
`trends. Patients with congestive heart failure wait an average of five
`days after a change in symptoms before seeking care, Miller says. The
`daily monitoring “theoretically should shorten that five-day delay
`substantially."
`
`Both organizations are researching the costs and outcomes of the
`Internet reporting program, and Mercy is converting all 700 patients to
`the system.
`
`Calculating that it can handle 300 to 400 cases per nurse, the
`institute believes it can conservatively enroll 1,000 patients to be
`monitored by the four case managers, Miller says. The heart institute
`has implemented the program at three of the seven hospitals that make up
`Mercy Healthcare Sacramento and is starting the program at the remaining
`four, he says.
`
`Santa Clara County IPA is aggressively identifying other candidates
`who have trouble following their care plans, Bonham says.
`
`Photo Caption: Bonham
`Art Caption: Aging and chronic illness
`
`Folder Name: HHN
`Fielevance Score on Scale of 100: 82
`
`
`
`3