The Emerging Value of Patient Generated Health Data

Current Trends

A recent blog post from Christina Caraballo explored the Top 5 provider concerns about patient-generated health data (PGHD) and how PGHD will be required to make the transition to a true fee-for-value reimbursement model in the United States healthcare market.  A 2016 Accenture survey showed a steady uptick in the use and acceptance of health apps, activity trackers and connected health devices. So, consumers are embracing the “how” and we can easily agree that the reimbursement drivers will be one powerful “why”; but where is the “what” – are there documented studies that can show true value in terms of financial ROI and better patient outcomes?  In 2013, the National eHealth Collaborative published a Technical Expert Panel report that put a spotlight on a few early adopter case studies showing value in PGHD.  As the Accenture survey showed, there has been a double-digit increase in the PGHD engagement from patients from 2014 to 2016.  So, given the current flow of PGHD, we should be finding new case studies that can effectively demonstrate the “what” of PGHD value.  Let’s take a look at some recent studies that have found PGHD value and then we will discuss what’s next on the journey towards fee-for-value for providers and how PGHD use will still require important guardrails along that highway.

Study Examples

Case report including provider organization Technology Outcome measure(s) Number of patients Outcomes

CHF patients
Brockton Hospital/Signature Healthcare inMassachusetts

blood pressure (BP) cuff and scale both linked via Bluetooth to an iPad

Hospital readmission
medical expenses

25-30 per month

No readmissions

$216,000 in cost savings

Asthma patients
Multiple sites/studies (12 studies)

Bluetooth enabled inhaler sensor

Hospital admissions, ER visits, pharmaceutical costs

96,631 across all 12 studies

$2,101 less per year per patient in total costs

79% average reduction in rescue inhaler use

Diabetic patients
1 physician practice – pediatric endocrinologist

Continuous Glucose Monitors (CSM) integrated with Apple Healthkit using Bluetooth

Ability to easily access information in EHR from outpatient CSM use

96 patients

Feasible to utilize available consumer mobile technology to integrate with EHR

Chronic Heart Failure - Gemany

daily measures weight, blood pressure, ECG, thorax impedance and breathing rate, and for certain indications also oxygen saturation

Ability for patients to manage measurements consistently
Future goals – reduce morbidity and mortality

7220 patients are being monitored in the seven selected projects

Preliminary reports included 20% reduction in mortality, 66% reduction of hospital stays, 21% reduction in hospital readmissions. Improvements in patients’ quality of life.

Hypertension patients – 30 day impact

blood pressure cuff that transmits values via the Bluetooth wireless standard to a gateway device, which in turn transmits values via a mobile cellular network to the monitoring and engagement center’s data servers.

Change in blood pressure

34 patients

average systolic blood pressure (SBP) decreased from 155.9 +/- 18.0 to 133.2 +/- 16.8 mmHg, while average diastolic blood pressure (DBP) decreased from 88.7 +/- 9.7 to 76.2 +/- 12.6; positive patient satisfaction

Though these numerous aforementioned studies (and others going back to 2006) show positive clinical outcomes and cost savings, the market is still nascent.  In fact, a December 2015 report by Chilmark Research stated the current customers of remote patient monitoring programs are primarily payers, and that it will take a few years of expanding risk/value-based contracts for broad adoption to occur across the provider market.

Emerging Standards in PGHD

The related technology marketplace for sensors and gateways is also evolving.  IEEE Standards Association has established standards to ensure a baseline quality of function and interoperability for many personal health devices. Most serious connected health companies strive to build devices compliant with the IEEE  11073 standards, as the FDA has also recognized them.  The Continua Alliance, now part of the Personal Connected Health Alliance (in partnership with HIMSS), works closely with the IEEE standards to further establish interoperability certification for devices.  Such certification means that integration of a Continua-certified device with a gateway/hub has been reduced from months to weeks, but we still have a way to go before we reach plug-and-play compatibility.

Many vendors seek to solve this by either building their own proprietary devices and integrating with their own hub/gateway, or building a pre-integrated ecosystem of devices from multiple companies, in order to provide a readily-usable system for customers.  The market evolution is at the point where some companies believe there is still an opportunity to establish themselves as the standard, if they can gain enough market share.  This goes for fitness devices, as well as some health devices, where it is more common for them to provide an API to their cloud of data (representing their system), than an API to their device.  Companies that focus on purely making one or more devices, and not selling systems, do recognize it is in their best interest to build to the Continua standard, so that they can be more easily integrated into a wide variety of device ecosystems (and sell more devices).

Adopting and using these technologies in a provider organization can be relatively straightforward as a pilot program (as shown in the studies), but it can then be a challenge to consider subsequent scaling and volume use across the enterprise.  As time progresses, it is anticipated that in parallel to the technology becoming more standards-based, the patient onboarding, workflow and integration into EHRs will become more standardized, which will lower the barriers to entry for many more providers to offer these programs to their patients.   

These programs enhance care quality, improve the patient experience and lower per-capital healthcare costs – what’s not to love about the end-game?  But to get there, providers should start playing now, and building their knowledge base around the use of personal health devices.

Keywords: 
PGHD, health outcomes, standards