6 questions on patient-generated health data, answered

More hospitals are interested in aggregating and analyzing patient-generated health data to fuel clinical innovation and transform care delivery.

However, implementing a scalable remote patient monitoring program with this data can be challenging. Hospitals must implement various clinical and operational elements to ensure patient safety and privacy, along with staff support, before rolling out such a program.

In a Feb. 21 webinar sponsored by Validic and hosted by Becker's Hospital Review, Ed Marx, CIO of Cleveland Clinic; Jodi Daniel, partner at Crowell & Moring; and Drew Schiller, CEO of Validic, answered commonly asked questions on patient-generated health data and remote patient monitoring programs.

Here are six questions addressed in the webinar.

1. What are the clinical and operational elements health systems need to have in place to support a scalable remote patient monitoring program?

Mr. Marx shared three important elements hospitals need for a successful remote patient monitoring program. The first thing hospitals should look at is alignment. "Always go back to the organization's mission," Mr. Marx said. "For us, it's about providing better care for the sick, investigating their health problems and providing better education. Remote patient monitoring hits on all three parts of our mission."

Secondly, leaders should ensure the organization's culture can support the data initiative. The third element focuses on leadership, according to Mr. Marx. "You could have the best program or the best alignment, but if you don't have strong leadership carrying this through on both the clinical and operations side, it won't happen," he said. Once hospitals solidify these three core tenets, other necessary program components — such as streamlined workflows, interoperability and a strong analytics team — should come easily.

2. What are the lesser-known technical challenges providers may experience when constructing the infrastructure to support a remote patient monitoring program?

Data from in-home medical devices and wearables is continuous in nature — patients may have multiple blood pressure or glucose readings in a day, according to Mr. Schiller. In contrast, clinical care teams are used to seeing a data model that's episodic in nature, where patient data is entered into the chart during a visit before the encounter ends. "These two models are very difficult to reconcile, and that's one of the biggest challenges," Mr. Schiller said.

To get around this, hospitals must ensure they bring in the right data at the right time, using an exception management model. For example, clinicians should be notified if a glucose reading falls out of a certain range, whether through an internal message system or email. This information must be accessible within a clinician's normal workflow so they can see what's happening with the patient at a glance, without going to a separate portal or log-in page. "We've seen a lot of remote patient monitoring programs fail because they relied on a completely separate solution," Mr. Schiller said. "It's really critical to have that embedded in the clinician's workflow."

3. What are some of the greatest misconceptions in regard to bringing in patient-generated health data?

Ms. Daniel outlined three common misconceptions about patient-generated health data. The first misconception: Patient-generated health data poses serious legal and regulatory compliance issues. "There are clearly additional risks in bringing in data from various sources into the healthcare setting," she said. However, these risks are manageable. Hospitals should make data security a regular practice at their organization by conducting a risk assessment for a new data source or tool and developing strategies to mitigate risk.

The second misconception is that remote patient monitoring programs will increase clinicians' workload and force them to sift through mountains of patient-generated health data. In reality, numerous technologies with dashboards, alerts and analytics services exist today to help clinicians make sense of the data at a glance and even reduce their workload.

The third misconception revolves around liability. "Clinicians are concerned about the risk of having volumes of data and not acting on it," said Mr. Schiller. "But I don't think this risk is so different from the data they have now." Providers are already tasked with receiving laboratory results and figuring out which readings aren't in a normal range, or addressing patient concerns after hours without EHR data. Mr. Schiller said hospitals should establish practices and protocols to address this risk upfront, and communicate with patients about their own responsibilities and expectations for patient-generated health data. Hospitals should also implement workflows to triage information, and share waivers with patients about what clinicians will do with the information they receive from patient-generated health data.

4. How do you merge the episodic care model of the in-hospital environment with the continuous care model needed to support RPM?

Hospitals can select specific cases or patient populations to work with to expand their remote patient monitoring program across the care continuum, according to Mr. Marx. For instance, hospitals could give bone marrow transplant patients devices before they're discharged, and then have a nursing team on the outpatient side monitor the data flow and notify physicians if interventions are necessary. "Care transitions are always very tricky, but this would make for a very natural handoff," Mr. Marx said. "And this is just one use case. There are many more examples."

The care team should also provide device management for patients once they leave the hospital, according to Mr. Schiller. "It's important for the care management team to support patients as they use those devices."

5. Are data standards still a market challenge with regard to patient-generated health data and integrating these data points in the clinical environment?

While data standards will always be a challenge for hospitals, they are improving dramatically for patient-generated health data, according to Mr. Schiller.

The two biggest challenges relate to accessing data from devices and bringing the data into the clinical workflow. A lot of devicemakers implement their own form of Bluetooth for security protocols, so hospitals need to work directly with the manufacturer to extract that data. Sometimes the device manufacturer prefers to host the device-cloud connection on its own server, so hospitals can get the data from the cloud via an application programming interface, according to Mr. Schiller. "This poses a challenge, as there are no standards for how APIs should structure information like this in the cloud," he said.

Mr. Schiller said the Consumer Technology Association, which he is a board member of, has three groups of industry professionals working to develop various data sharing standards. He also cited the increased adoption of Fast Healthcare Interoperability Resources — created by the nonprofit Health Level Seven International — for helping to improve the process of delivering data into the clinical workflow.

6. What new CPT codes — or code changes — can we expect to see over the next few years to support PGHD usage?

The 99091 code that covers remote patient monitoring is decades old and holds significant limitations, according to Ms. Daniel. The code only applies to biometric data, refers to a one-way flow of information from patients to providers and works on a fee-for-service basis, meaning clinicians are only paid for the amount of active time they look at the patient-generated health data.  

CMS now has codes for areas like chronic care management, which allow physicians to be reimbursed for some services that don't occur in face-to-face patient interactions, according to Ms. Daniel. The American Medical Association also set up the Digital Medicine and Payment Advisory Group to push for new codes related to remote patient monitoring, which she hopes CMS will eventually adopt.

Mr. Marx concluded the webinar by expressing the need for healthcare providers to advocate for better technology standards on behalf of patients.

"If we don't, nobody will," he said. "We need to continue to push professional organizations, the government, etc., to see the true promise of healthcare and technology merging together to improve the lives of patients around the world."

To view the webinar recording, click here.

To view the webinar slides, click here.


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