One hundred patients with diabetes have signed up for a telemonitoring pilot spearheaded by HEALTHeLINK, the regional health information organization (RHIO) serving Western New York State. The nonprofit’s innovative approach to telemonitoring could serve as a model for the rest of the nation, according to Todd Norris, Western New York Beacon Project Director.

HEALTHeLINK is one of the 17 Beacon Communities tasked by the Office of the National Coordinator to positively impact quality, cost and population health through the use of healthcare IT. The RHIO is focusing on several initiatives to "move the needle in a positive direction" for diabetes care management, which is its specific goal under the Beacon Community Program. With more than 60,000 diabetic patients under the care of 250 healthcare providers, Western New York has one of the largest diabetic populations per capita in the country, Norris said. The telemonitoring pilot, which will accommodate 150 patients, is one of 12 interventions the RHIO is deploying for diabetic care.

Blood pressure readings and other vital signs pertinent to diabetic management are downloaded from mobile devices and transmitted to healthcare providers in the form of alerts through HEALTHeLINK's health information exchange platform, which is powered by OptumInsight, formerly Axolotl. The RHIO, however, has adjusted the traditional model to address known barriers to telemonitoring adoption.

"One of the problems with telemonitoring is the information overload on providers and the impact on their workflow," Norris explained. In the traditional model, healthcare providers are directly connected to the home devices and are involved in the handling of equipment. When HEALTHeLINK created the program, it sought to eliminate the operational burden on healthcare providers.

The RHIO also didn't want to be in the telemonitoring business nor did it have the resources. So it hired two partners in the community to provide the services, which include interpreting the readings, taking action in real time and troubleshooting.

"This allows the experts to do their thing," Norris said. To avoid information overload in the form of voluminous weekly reports comprising all readings, the telemonitoring service providers disseminate what information is critical for healthcare providers to see, he said.

The pilot was designed to address the big challenges of patient and especially provider buy-in. Mobile devices are being used, so patients aren’t "tethered" to their homes. HEALTHeLINK experienced some resistance from healthcare providers, but with the traditional barriers gone providers are “slowly turning around," Norris said.

The cost is approximately $250 per patient per month. Norris pointed out that the elimination of one emergency department visit per patient pays for the program and also contributes to better health of the diabetic population. With economies of scale, the cost per patient per month for 40,000 patients would be $150 per month. At this level, Norris said, "You're going to see lively acceptance."

The telemonitoring pilot was designed and implemented to have "minimal impact for the providers and maximum impact for the community," he said. If the health outcomes are favorable and cost savings are achieved, which Norris anticipates, HEALTHeLINK intends to approach local payers and other community partners to deploy and expand the telemonitoring services. On a grander scale, the RHIO's model can be adopted in communities across the country, which is one of the broader goals of the Beacon Community Program.