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`March/April 2000
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`Vol. 17, No. 2
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`The Leading Edge in Medical and Healthcare Informatics
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`SPECIAL SEDTmN: ANNUAL DIRECTORY OF MEDIcAL SOFTWARE AND HARDWARE VENDDRs ?
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`Wireless Technology Transforms Healthcare . eHealthcareWDrlcl Conference Report
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`Positive Outcomes, Lower Costs - Security Threats From Within
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`Improving the Dissemination of Healthcare Information . Biomedical Computing and Informati w
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`US $18.00/CAN $27.00
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`1
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`lyzing trends, and communicating with
`specific patients.
`Care managers monitor their patients’
`ongoing conditions on a daily basis, often
`educating each patient on ways to better
`manage their health. Patient responses to
`care managers’ questions (sent via the
`Health Buddy to Health Hero’s Website)
`are presented graphically. This allows
`managers to quickly and easily assess
`their patients’ signs and symptoms, be-
`havloral activities, and trends so they can
`focus on people under their care whose
`conditions require closer attention (see
`Figure 2).
`
`The Health Buddy links patients
`to their care management
`team via the internet.
`
`The Health Hero service is a flexible,
`customizable platform that can be used in
`any setting for any disease or combination
`of diseases. It is currently being used in a
`number of congestive heart failure pro-
`grams around the country, as well as in
`programs for asthma, postcardiac surgi-
`cal patients, patients with comorbidity,
`”and geriatric wellness.
`
`The Case oi “Mitch”
`Mitch Brown*, a 68 year-old man with
`congestive heart failure, diabetes, and hy-
`pertension, is hospitalized for chest pain
`and shortness of breath. These episodes.
`occur almost monthly, often triggered by
`Mitch’s failure to take his medications or
`follow his prescribed diet.
`During a two-day hospital stay at
`Mercy Heart Institute, doctors examine
`Mitch and rule out an acute cardiac is-
`chemic event, modify his medication reg-
`imen, and provide him with additional
`counseling on the importance of a low-
`salt diet. But before Mitch goes home this
`time, he is given a Health Buddy and
`trained on how to use it.
`Now Mitch is linked to his care man-
`agement team via the Internet. Each day,
`he receives personalized guidance on self-
`care, reminders to take his medicine, and
`information on how best to manage his
`three chronic diseases. He also uses the
`Health Buddy to receive and respond to
`questions from the Mercy Heart Institute
`
`to Palm‘s health bodily Pmmnemmw
`usweonmnm
`
`Figure 2. The Health Hero Network is a unique interact-based communications link between
`chronically ill patent: at home and their healthcare providers. Working from the Health Hero
`Network Website, a healthcare provider (1) is able to send daily, proprogrammed inquiries to the
`patients Health Buddy (2), which then prompts the patient to respond The Websites software
`compiles the information mosived back from the patient (3) and focuses the healthoare provider’s
`13W” (4) on time patients whose conditions require attention. Source: Health Hero Newark, inc
`
`care management nurse about any symp-
`toms he maybe experiencing. The nurse
`reviews his answers daily by accessing a
`secure Website provided by Health Hero
`Network, Inc. Specific alerts and remin-
`ders, guided by preestablished protocols,
`are sent to Mitch via the Health Buddy. in
`situations that are particularly urgent or
`complex, the care team can connect with
`Mitch continuously or schedule a home or
`office visit.
`
`A year passes. Mitch, who is being
`supervised by Richard Miller, M.D., dl~
`rector of the Mercy Heart Institute and
`Mercy’s care management programs,
`hasn’t been hospitalized since. Moreover,
`he has a greater sense of confidence in
`his ability to manage his own diseases
`while feeling secure in being in constant
`contact with his care management team.
`
`Conclusion
`Disease management and care manage-
`ment systems provide practices with
`many key value components,
`including
`cost-effective approaches to managing
`large populations, reliable outcomes as-
`sessment and management tools, central—
`ized data management and retrieval, and
`patient follow-up and case management
`by exception.
`
`Technology~driven disease manage-
`ment, as demonstrated by communica-
`tions platforms such as Health Hero,
`helps care managers provide iow~cost,
`proactive healthcare by freeing them
`from the burden of manually monitoring
`patients. under their care. This enables
`..............................................................................
`
`Net-based care management
`is closing the gap between
`patient and provider.
`
`managers to focus on patients who are
`most in need and enhances their ability to
`identify potential problems before expen~
`sive intervention is necessary. The end
`result: cost
`reduction and improved
`patient outcomes—the primary goals of
`practice management.
`*Mitd1 is fictional, but the case described in
`this article is based on the actual experiences of
`Health Buddy users. a
`
`Joan M. Kiel, Ph.D., is chairman of the depart-
`ment of health management systems at Duquesne
`University in Pittsburgh, Pennsylvania, and is the
`section editor for this column. Julie Cheitlln Cherry,
`R.N., M.$.N., is director of Clinical Services for
`Health Hero NehNork, Inc. (Whealthherocom).
`
`@ MICoupurlNc
`
`MARCH/APRIL 2000
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`2
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`

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`hositive Qutcemes, tower Costs:
`iising .itet-fiasedai'i to Manage Care
`Joan M. Kiel, PhD. with Julie C. Cherry, R.N., M.S.N.
`
`Healthcare has always been a document-
`driven enterprise. In the past, it practi-
`tioners failed to document their proce-
`dures, they were not paid for their. ser-
`vices. The same holds true today, but now
`there’s an added burden: With managed
`care, the restrictions have become tough-
`er. Not only do services have to be docu-
`mented, physicians must also demon~
`strate positive health—status outcomes.
`New internet-based platforms have help-
`ed facilitate the documentation process
`in care management. Now,
`Internet~
`based technology is being employed to
`improve patient outcomes and reduce
`costs as well.
`
`Staying Within the tines _
`Outcomes management, care manage-
`ment, and disease management are the
`terms used to describe the protocol of ser-
`vices that will result in providing the high-
`est quality care at the lowest cost for
`treating a particular diagnosis. The field
`of care management itself is based on the
`collection and analysis of data and the
`development of multidisciplinary inter-
`..............................................................................
`
`The internet creates
`
`an ideal platform for disease
`on."......................................................................
`management applications.
`
`ventions to treat a diagnosis. For exam-
`ple,
`let’s say data collected statewide
`show that the average hospital stay for a
`50-year-old male with Chronic Obstruc—
`tive Pulmonary Disease (COPD)
`is 4.2
`days with areadmission rate of less than
`3 percent. However, your practice's aver-
`age length of stay for COPD patients is
`5.0 days with a readmission rate of 10
`percent. Therefore, you can conclude that
`given similar populations, you need to
`reengineer your practice’s service deliv~
`ery—in other words, reassess the “man-
`agement" of outcomes based on those
`averages. Insurers use this data to dictate
`the maximum length of stay they will pay
`for;
`thus,
`they will not reimburse pro-
`viders that exceed the limits. What’s
`more, providers can be disenrolled from
`networks if they don’t meet the minimum
`positive outcomes. That’s why informa-
`
`tion technology such as McKessonHBOC's
`Compliance Advisor software, for exam-
`ple, can help in both instances—monitor-
`ing the length of treatment .andpatient .
`outcomes to help practices stay within the
`lines drawn by insurers.
`Another major aspect of managed
`care and care management is the neces-
`sity of providing quality care within the
`per—member-per—month (pmpm) cap-
`itation rate. The challenge here is in
`caring for the patient while trying to
`save money and provide treatment in
`the lowest cost setting. One of the
`keys to ensure compliance with
`treatment regimens lies in communi-
`cating with the patient and their
`family. Recent developments
`in
`information technology have en-
`hanced the care management pro-
`cess, helping healthcare providers
`communicate with—and therefore,
`better manage—patients with chron-
`ic illnesses. Of particular note, In»
`ternet—based technology is making
`this easier. The Internet creates an
`ideal platform for disease-manage-
`ment applications that improve both
`outcomes and population manage-
`ment by facilitating communication
`between patients and providers.
`
`Met-Based Care Management
`One product borne out of the concept
`of Net-based care management has
`been developed by Health Hero Net-
`work,
`inc, an innovative Internet
`company in Mountain View, Califor—
`nia. The company has taken Care
`management, which typically in-
`volves, for example, weekly phone calls
`to the patient, one step further by closing
`the gap between patient and provider and
`enabling daily communication between
`them.
`This is how it works: The exchange of
`information occurs through the Health
`Hero service, a two~way, Internet-based
`communications platform that connects
`care providers and patients at home.
`They stay in contact using a personal
`information appliance called the Health
`Hero Health Buddy, an easy-to-use, four-
`button appliance provided free of charge
`to patients in care-management pro-
`
`PractsceManagement
`
`
`
`grams (see Figure 1). Connected only to
`a phone jack, it gives patients a simple
`and convenient way to automatically
`receive thealthcare . information and
`respond to queries from their caregivers
`on a daily basis. This perpetual dialogue
`helps patients feel more informed and in
`control of their conditions while at the
`same time providing healthcare profes-
`
`
`
`
`
` . .iaw’gfimywevsw . M... 9'
`Fgore 1 Health Hero‘s Health Buddy, which
`sits at the point of sell-we in the patient’s
`home, provides the patient with a simple and
`convenient way to automatically receive
`neallhcare information and respond toqueries
`from care managers on a daily basis. Source:
`Health Hero Network, inc.
`
`sionals with ongoing and timely health
`information about their patients. The ser-
`vice gives caregivers access to Health
`Hero’s secure Internet-based network,
`which hosts a set of flexible, Web-based
`tools for managing both single disease
`and comorbid patient populations, ana-
`
`MARCH/APRIL 2000
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