Health IT’s potential to change businesses and lives

Health IT is driving significant efficiencies across all of healthcare, and during this National Health IT Week, we hope more people get a chance to consider the value of the connections and data that drive our healthcare system forward.

Through connected care and remote patient monitoring, the application of digital technologies is redefining how best to learn from patients and understanding how and why they use prescribed medical therapies. The results have been profound.

As the world leader in connected health devices for remote patient monitoring, we at ResMed have a unique understanding of what it takes to connect the healthcare world. Reflecting back on some of the insights I was lucky enough to hear and share at Stanford Medicine X earlier this month, we know data can inform and advance better healthcare – from patient to physician, from hospital to home and from caregiver to consumer.

We've all been hearing about the revolution of digital or telehealth for the last several years – always looking to the future and what it will bring. In reality, digital health is making a positive impact on patient quality of life, chronic disease progression and healthcare system costs today. Treating and managing sleep apnea with connected, smart devices and solutions serves as a promising case study on how the cloud and digital solutions are transforming care now.

Within the past quarter of a century, millions of sleep apnea patients – a condition prevalent in a number of serious conditions, such as Atrial Fibrillation, heart failure, type 2 diabetes, stroke, obesity, and more – began receiving care by way of continuous positive airway pressure (CPAP) therapy. Payers began to take notice. In the mid 2000s, Medicare put in place a rule that required home medical equipment providers (HMEs) to prove their patients were adherent to CPAP therapy, with actual usage data off of their machines. No proof, no pay. HMEs had to document usage of a certain number of nights with CPAP, for a certain number of hours over the first 90 days of therapy in order to get full reimbursement for the care they provided.

Caring for these patients is labor intensive: First, the patient gets a prescription from his/her doctor and must go to an HME to get set up on therapy. Because every patient's face is unique, patients must try-on different styles of mask to find the best fit. Because the HME won't get reimbursed if the patient doesn't adhere to therapy, the HME needs to consistently follow-up, making sure the patient is comfortable, answering questions and doing what it takes to support therapy compliance. After the first visit to get set-up on therapy, patients may return home with a lot of questions about their therapy—and may even be uncertain about whether it's working or not. Previously, to get their sleep data off the machines (to show evidence of therapy adherence) the patient had to physically deliver or mail a data card from their device to the HME. If you're an HME, this requires a lot of time and paperwork. If you're a patient, it can be overwhelming. Manufacturers can make smaller, quieter, easier-to-use and more comfortable devices and masks, but that does not solve for the lack of efficiency in the overall process.

In 2011, Medicare began rolling out a new "competitive bidding" process, designed to reduce reimbursement so that it was more in-line with the private insurance companies – cutting it almost in half. This presented a major problem for HMEs, and for patients who depend on CPAP treatment for their health and quality of life.

Anticipating these regulatory changes, we developed devices with built-in wireless communications capabilities and a series of SaaS-based automated solutions to go with them. Every ResMed device now houses a cell chip that broadcasts usage data to the cloud. HMEs can now verify patient compliance online, troubleshoot machines remotely using machine-to-machine communications, and automate compliance coaching, allowing them to place live calls only to the patients who need it. This allows our customers to both provide higher quality care by increasing adherence and patient engagement, and lower their own costs by taking a significant amount of labor out of a labor-intensive care model.

The platform has completely changed the way care is provided.

For HME customers, the approach has dramatically reduced the labor that goes into caring for patients. Almost all patient follow-up has been automated, which has yielded increased patient adherence to treatment. A study published in Sleep & Breathing found use of U-Sleep, our cloud-based patient management solution, used to access and analyze patient usage data, resulted in 59 percent reduction in labor for HMEs. A separate study conducted by Kaiser Permanente of 1,455 randomized patients – the largest-ever randomized, controlled study on obstructive sleep apnea in the United States – found that patients who received support from U-Sleep achieved Medicare-defined CPAP adherence 21 percent more than the average study participant over a 90-day period, without additional provider intervention.

For patients, our connected care model has completely transformed their care experience. With the myAir patient engagement app, patients can view a simplified version of their own therapy data, assess what's working and what isn't and get specific coaching tips on their device and mask based on issues they may be facing. More than 1,000 patients sign up to myAir every day, and these patients regularly achieve adherence levels of around 85 percent, significantly above the industry average

The approach has been successful, but what can it do for the system at large?

• We are continuing the process of integrating into EMR systems to help improve care for sleep apnea patients throughout the entire care continuum, and to turn data into practical information that increases our understanding of population management and chronic disease.
• This level of data has the potential to revolutionize our understanding of patients. With more than 750 million nights of de-identified sleep therapy data, we are only beginning to scratch the surface of what big data and machine learning can do to improve therapy.
• Ultimately, we're aiming to find and treat the millions of undiagnosed sleep apnea patients in this country, and save our economy the associated long-term costs of their care, and to do so through an efficient, data-driven care model that lowers costs while improving outcomes

The evolution of sleep apnea treatment as a response to regulatory pressures is an early example of how connectivity and data can transform healthcare, allowing us all to reach more patients, improve care, and manage costs.

Jim Hollingshead is President, Americas at ResMed.

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