RPM 101: How Remote Patient Monitoring Saves Time, Money, and Lives

Parallax Health Sciences Chief Medical Officer, Dr. Bob Arnot, aka "Dr. Danger," joins CRF Health to discuss how Remote Patient Monitoring transforms healthcare in an increasingly digital world. 

For healthcare providers of all varieties, leveraging an RPM solution to virtually conduct patient visits, collect ongoing biometric data, and proactively analyze and treat at-risk patients has never been easier, more efficient, or effective. Listen to the webinar and learn about:

  • The Value of RPM for Patients, Payers, Providers, Clinicians, and Home Care Organizations
  • Applications Best-Suited for RPM
  • Standard Components of a Successful RPM Program
  • Recommendations for Getting Started and Implementing RPM

 

FULL TRANSCRIPT

MODERATOR

So welcome to today’s webinar, RPM 101 How Remote Patient Monitoring Saves Time, Money, and Lives. To kick things off with the presentation, we’re going to start with a poll. So the poll question is: What is your level of expertise with telehealth or remote patient monitoring? And here is the poll. So if you could just please select which answer best reflects your level of expertise and click Submit, we will see how our audience measures up today and take a quick poll there.

As you can see we have a couple of beginners and some intermediate and advanced people on the call, so that’s really great, we have a nice mix here. Very interesting to see. Today’s webinar agenda is on the screen and you can see that we’re going to be talking about key trends in healthcare, challenges for the current patient monitoring process, we’ll talk about RPMs, and what RPM is—remote patient monitoring, the definition. And some applications. And of course some benefits for all of the stakeholders and an overview of the typical components of the RPM solution. And then of course the recommendations for getting started.

We’re excited to have two presenters on today’s call. The first is Matt Weisensee. Matt comes to us as the VP of Sales for CRF Health. He is responsible for continued development and growth of the global organization. And he’s held senior leadership positions within the security, consulting, biotech, and investigative industries. He’s a graduate of San Diego State University and holds a degree in archaeology from the University of London.

Our co-presenter, a special guest, we’re very excited to have him here today, is Dr. Bob Arnot. And with that, I’m going to pass the presentation over to Matt. Matt will introduce Dr. Bob.

MATT WEISENSEE

Great. Thank you so much Jackie. Hi everyone. Good morning, good afternoon, good day for all of our international guests. I’m calling you today from sunny San Diego, California. I am really pleased to introduce our guest speaker today, Dr. Bob Arnot. He is an award-winning journalist, he’s an accomplished author, a physician, a humanitarian, and an athlete. I like to refer to him as the real most interesting man in the world. So without further ado I’m going to go through a little bit of his background and credentials. Graduate of Dartmouth Medical School. He’s the past physician of the US Ski Team, board member of Harvard Medical School, Board Olympic Physician, chief medical officer of many different organizations around the world including Parallax Health Sciences. And he is a humanitarian. He’s worked across the globe, reporting on medical conditions in places where there are crisis, war, famine, natural disaster. He’s also a founder of Lake Placid Sports Medicine, and he’s really a nice guy.

So I’m going to talk about some of his accomplishments, including his work in Syria, the US Committee on Refugees, Darfur Emergency Group. He’s going to share some really great stories about what he’s done for saving children, and work in Somalia. And we’re going to also shed a little light on some of his experiences, 13 publications to date, including a few bestsellers, number one New York Times bestseller, The Breast Cancer Prevention Diet. New publication, The Coffee Hunter. Just a very very broad range of material. And he’s best known for his television appearances, award-winning journalism, chief medical correspondent for CNN, NBC, featured in Vanity Fair, regular articles in Men’s Journal, and the prestigious duPont Columbia Award, as well as an Emmy award-winning journalist.

So without further ado, I’d like to introduce call sign Dr. Danger, Dr. Bob Arnot.

DR. BOB ARNOT

Hey Matt, thanks for a fabulous introduction there, and of course you’ve been just a wonderful teammate, as has CRF. You know, Matt is one of the few people I’ve met who is a true futurist. We were down at HIMSS a few weeks ago, and with all the leading healthcare technologists and telemedicine people in the world, and Matt just leads the pack, you know, for his insight and for his fantastic sort of technical knowhow.

[04:54]

So this first picture you see here is coming out of a place called Rocket Alley Afghanistan, and they call it that because the US forces out there are rocketed nearly every single night. Now this is maybe 5-6:00 in the morning, and we look out the back of the airplane, and we’re getting shot at by the Taliban. The next picture here you can see the tail gunner shooting back out of the airplane. And again, ferocious fire there. We have an Apache helicopter trying to cover for us. The tail gunner turns around to me and says, Bob would you like to take the last few shots. The next picture shows the US Marine Corps Operation Iraqi Freedom. I’m there on the righthand side. Our chief there is Mad Dog Mertha. I worked with two great generals during that year out there. Mad Dog Mattis, who’s now the Secretary of Defence, and Johnny Kelly who is now the Secretary of Homeland Security. In fact one morning I was doing mede-vac all night long and I run into this young officer in the morning, he says, you were great on Don Imus’s show this morning. And Don Imus, I don’t know if you remember him or not, he said, Bob I understand the Marines are getting pushed back out there and it might be six months until they get to Baghdad. And I turned around and I said, who’d you hear that from? And he says, well you know, CNN, BBC. And I said, those guys, they’re about 70 miles behind us with the cooks and supply guys. These Marines are gonna be in Baghdad within six days, which fortunately we were. So there’s a great team out there. I looked out at this young Marine’s insignia rank, it was a star, and he was Johnny Kelly who is now the head of Homeland Security. And the next slide here you can see that I’m with a wonderful young lieutenant colonel from the 82nd Airborne and this is a raid inside Baghdad where US armed forces were putting their lives at risk every single day. On the following slide, you ask the question, so how does a mild-mannered country doctor roam around Iraq without getting killed. And the difference here of course is you know, Custer’s last stand on the left side with no intelligence at all, and on the righthand side we have what’s called Blue Force Tracker.

Now, on the next slide you’ll see what’s really kind of the core point of my talk, and that is, you know, lots of people talk about sensors. They have a heart rate monitor, they have something that measures pulmonary, FEV1, or heart rate or whatever. Well you know, from the physician side, you really want to look at what we would call and integrated picture. An integrated picture of the patient, in the case of physicians of course. Well, Blue Force Tracker, you don’t have these in the US Army or US Marine Corps troops out there saying ah, you know, I’ve got this great infrared sensor. No, they say, I have this airplane overhead called Joint Stars and it is taking radar satellite pictures, delay satellite pictures, optical satellite, infrared, UIVs, recon halos, just a massive amount of data that’s all being integrated into one battlefield picture that finally allows these soldiers of course to be able to protect themselves and to win.

Now a little closer to home, on the next slide here we’re going to see the difference between success and failure in terms of international humanitarian efforts. The Rwandan genocide on the lefthand side and the war in Southern Sudan on the lefthand side. In the following picture you’re going to see a picture of myself, I’m in that light blue shirt, and we are right on the border between Rwanda and the Congo. And this is the kind of security it took to get around. You can see we had mortar man, machine gun man, camera man, and whatnot. It was pretty a pretty dicey time and pretty dangerous to get around.

The following slide we can see our group after the Haitian earthquake. We have a wonderful group called Artists for Peace and Justice, and in the picture with me you see Demi Moore and Susan Sarandon, Paul Haggis the founder, Sean Penn. Almost every night after the earthquake I’d get a call from Sean, he said, Bob I got this kid. I’d go, Sean what’s his diagnosis. We’d go through it. I’d call the head of Homeland Security at home, we’d get clearance for them to fly him to Fort Lauderdale and we’d get another kid out. What was so interesting about this is that, as tragic as the earthquake was, there were children such as I remember one 15-year-old boy, he had an aortic stenosis. And he would not have survived in Haiti, because he never would have had surgery. But because he had lost all of his medicines, went into congestive heart failure during the earthquake, I evacuated him with Sean one night, we got him into Fort Lauderdale, they stabilized him over the course of the week, replaced his aortic valve, and now he has a wonderful future in front of us.

Our group has put together the first ever sort of free high school in Haiti. Also during the earthquake, I took a Google Health Key in there, we took many many people from Google and hooked them up with the 82nd Airborne, International Medical Corps, Save the Children, the Haitian government, University of Miami, so that they were able to create a whole catastrophic health package, which is now available for free to international humanitarian community members.

[09:53]

Now on the following slide, you’ll see a picture of myself during the Rwandan genocide. We had 2500 bodies by the side of the road, just a terrible event as you can imagine. And with the cholera epidemic out there, one day I was walking along with a camera man taking a picture of this little boy that appeared to be dead. His nostrils moved, the sound man said, I think he’s alive. I gave him a little water. He was. I took him back to a Doctors Without Borders camp, they said, we have nobody to care for him. I said I’m a doctor, can I care for him. I gave him oral rehydration salts. In about 3 hours he was kicking and back to life. I took him down to a French military camp, where there was a French nurse there, and I said, can you take care of this boy, and with tears in her eyes she said, yes we will take care of your baby, which they did.

Now, in the next slide you can see Southern Sudan, you've read a lot about it in the news recently, terrible civil war down here. And this is another sort of example of sensors. So if you see on the next slide here, they are the simplest of sensors that are used with these children every day out there, they might measure heart rate, how fast they’re breathing, temperature as examples. The following slide you can see healthcare team out there. And you would wonder what difference it would make to be able to record these measurements. Well the following slide you can see satellite picture. We teamed up with Google. Google had satellite capabilities, and we were able then to integrate the on-the-ground picture with what was happening with an individual child. So in the following slide, you can see a closeup of the camp here where that young child was, and an even closer-up picture we can see that the village had been bombed. So with this satellite picture, once we see that for instance, fevers are lasting longer than five or six days, we would say to ourselves, are the antimalarials not working? Are they not getting the antimalarials? If women weren’t making breast milk, how are they missing in terms of their nutrition. And we’d be able to quickly react. So instead of reacting, you know, six months or a year later after you’ve had hundreds of thousands of deaths, because of on-the-ground telemetry and, most importantly, integration into a platform, we get that kind of picture.

Now on the following page you see a very unfortunate accident with American Airlines on the lefthand side, on the righthand side you see the kind of minute to minute monitoring that we have on airplanes. Now I’m a pilot, in fact I’ll be flying in a couple minutes from here in Northern Vermont down to North Carolina. And the following slide you can see an aircraft here, and it’s not a matter of saying gee I’ve got a great sensor on one of my blades. You have an overall picture of the engines and fuel supply, every piece of the aircraft that is going back to base and of course to compile it, so you have a completely integrated picture. And again, it’s really why aviation is so safe today is you have that second-to-second management.

On the following slide it’s a very simple sort of example, you have a vehicle manager. You know, if you have onboard sensors there, again, you’re less likely to end up stranded as these poor women are on the side of the road and much more likely to understand what happens. Following slide, here you can see failure in the Olympic Games, so people, you know, obviously distraught after years of training. On the righthand side you see myself here in the world championship race. I’m going to show you the next picture here, the following slide you can see the beginning of the race, where it gets up to 25 foot swells, 37-knot winds they got across the most single dangerous passage in the whole world. A gruelling gruelling race that takes me seven and a half hours. On the following slide you can see that I’m measuring my heart rate, my pace, this is all real time. And I succeed because we have these kinds of real time measurements.

So on the following slide, we have the summary point here, and it’s this. In our current healthcare system, we have episodic crisis-driven care, where we lurch from sort of one illness or one episode to the other, as opposed to continuous wellness. And the heart of continuous wellness is, again, the physician and the practice manager have a real time overview of everything, so the patient’s electronic medical record of all the different sensors all integrated together.

So on the next slide you can see how telemetry has worked with real world problems in terms of managing airplane health, managing vehicle health, managing athletes, saving humanitarian lives, saving our US military on the ground.

And finally my last slide for now until we come back that is, you know, telemetry saves money, lives, and time. Saves US troops. Saves young children in humanitarian disasters, which are ongoing right now in Syria and the Congo and in Southern Sudan and Somalia. Keeps planes in the air. Keeps cars on the road. Keeps athletes winning medals. And again, we’ve let patients lurch from crisis to crisis and we have these phenomenal tools. So you know, my experience working with this wonderful team, with Richard and Matt and Larry at CRF, who I really think are the leaders in terms of telemedicine, is that we’re really putting together this integrated picture that the physician can see of the patient so that you are able to stop that patient lurching from crisis to crisis and illness to illness and ER visit to ER visit to the ability to really intervene and maintain what I would call continuous wellness.

[15:12]

So Matt, again thanks for that wonderful introduction. Again, you know, as we hear you in the next part, keep in mind that Matt is one of those few individuals that is a true futurist who is bringing us the future today with his team at CRF. Matt.

MATT WEISENSEE

Well, thanks a lot, Bob, I didn’t expect that. And what a great introduction to remote monitoring, how telemetry does save time, money, and lives.

And the first topic of today’s webinar is key trends in healthcare. I’m sure all of you are aware that there’s a variety of different things happening today, primarily the shift from fee for service to value-based care. So with new MACRA laws and changes in Medicare and Medicaid throughout the nation, people are moving from fee for service to an at-risk, and what I like to call an at-reward, model. We’ve all realized that there’s a benefit of RPM, and we’re going to go through some of those in depth today. But we all know it all comes down to improving care, reducing the cost, mitigating the risk, knowing that the landscape is changing, the Internet of Things has changed how we deliver care, how support decisions are made, and also the fact that there is a rising cost and a real epidemic in readmission into hospitals. So the idea today—and you’ll hear it a lot—you’ll hear about convergence and alignment, but it’s all about population health management, looking at the population holistically and trying to predict and mitigate that risk by collecting, transmitting, and analyzing data. So the science and art of preventing disease, prolonging life, and promoting health is by using this technology. And I’m going to go into a few of the challenges as well.

The challenges today, of course limited access to care in rural areas. You know, the United States in general has a lot of open spaces. And there’s not enough doctors, there’s too many patients. The reality is that we need to create a better mousetrap. We need to manage this risk by using technology to collect the data, analyze it, send it into our own existing clinical systems, prioritize the patient population, and focus on the most needy and where we can move the needle. We know the statistics, the 80-20 rule, that 80% of the costs are attributed to 20% of the patient population. So with these new challenges we need new ideas. And with the integration to care coordination plans and being able to monitor people real time remotely from anywhere in the world, we do see the cost of expensive ER visits, overcrowding of waiting rooms, and ultimately driving more positive health outcomes.

So another quick poll.

MODERATOR

Thanks Matt. We’re curious if anybody currently has a remote patient monitoring program in place. So please, again, select your answer and hit Submit. So we have some people that do and some people that don’t. Looks like it’s pretty split even.

So Matt I’ll pass that back to you, if you have any other comments about that.

MATT WEISENSEE

Great. It sounds like we have a lot of advanced people on the call. Oh, 50-50, that’s excellent. I’m surprised because the statistics today show that only about 7 or 8 percent of the US population has a telehealth strategy. And I know that it’s rapidly evolving, and they expect by 2022 to be at 70%. So congratulations to you all that are already underway with a digital strategy. And for the rest of you, it’s really great to know that you’re on this call and you are interested in learning more about RPM and telemetry.

[19:48]

So what is telehealth and remote monitoring? It’s a really broad industry. It really is a part of telehealth. Remote patient monitoring is all about telemedicine, delivering health-related services, data, and information via mobile devices and telecommunication technology. There’s many modalities—video conferencing and virtual visits of course, used in behavioural health. Using store-and-forward type of telemedicine to share imaging, X-rays, and EMR data between different systems. And mobile health, now the the influx of health and wellness apps. And I call it the age of consumerism, the patient now acting as a consumer. They go online, they look at Yelp to gauge the effectiveness of their physician. They look at reviews of their insurance carriers, they go out and purchase and make health decisions online and using mobile technology. And then that leads us to remote patient monitoring.

The definition of it by the Center of Connected Health Policy is that it’s the use of “digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location for assessment and recommendations.” That’s a pretty long sentence but it really hits it on the head. In a nutshell, it’s about collecting vital signs and patient data, could be from respiratory to lab data, weight, blood pressure, glucose levels, cardiac output, etc. There is about 50 different combinations of remote monitoring today, and there are many ways to collect, transmit, analyze, and deliver that healthcare using the technology.

So how do you apply it? Well, you’re probably aware of the main one—chronic care management. That is the real biggest low hanging fruit. About 80% or more of all healthcare spend in the United States is attributed to chronic care management. But the real quick easy ways to move the needle to improve healthcare, reduce cost and risk, is to reduce readmission. The penalties are staggering, I’ll share some of the data with you in a second. But there also is a use for this in home health, hospice, assisted living, just doing wellness and health self-management programs. It’s used in psychiatry. It’s used for post-episodic care, after cardiac events, diagnostic monitoring, and for rehabilitation and post-surgical. So there’s a lot of different ways to use remote monitoring. And I’m sure all of you have other ways that you’re using it today, since we have over 50% of you already implementing remote patient monitoring and telehealth strategies in your organizations. And we would love to hear about those. If any of you would like to send us a note—doesn’t necessarily have to be a question—we’ll include that in this list, so it will help the general audience.

And then what are the benefits? Well the answer to that is, there are three main ones, but inside of each of these buckets there’s about 20 different applications that can help save time, money, and lives. It saves money by adopting this holistic approach to managed care that provides better services while simultaneously reducing costs. Remote monitoring can prevent readmission, shorten hospital stays, improve staff efficiencies. That’s obvious. But improving care. Clinicians can make practical care adjustments, they can manage patients by exception, and not being overwhelmed by mass amounts of data, because there is now workflow and rules engines built into monitoring, there is the analytics dashboards, predictive modelling, that will help drive positive outcomes by only providing the data that’s necessary, the actionable data needed to make decisions there on the spot. And it also supports care delivery via proactive home monitoring, continuous biometric data collection, and also integration with different types of communications systems. As you’re aware, most of these systems today have an integrated alerting, alarming, and integrated text and email system. And of course now, with the onset of digital video, we can now do telemedicine and virtual visits on the spot.

[25:00]

And then the ultimate goal: increased satisfaction, patient and customer. Every stakeholder can improve their satisfaction. Less time waiting in the waiting room. You know, it’s easy to use, it improves engagement, it actually ironically brings the patient and the clinician closer together. They see each other more often, they talk to each other, they interact in the new form of media that everyone is accustomed to today, which is cell phones and video chatting. So it increases the care, gives patients the freedom and flexibility to actively participate in their own health.

And the stats I mentioned. This one is the most alarming. Seventy-four percent of all readmissions were considered avoidable. Talk about an opportunity when 87% of the healthcare spend is on chronic care management and nearly a quarter of all Medicare heart failure patients were readmitted. And that’s the most expensive indication there is. So just by tackling that, and Dr. Bob Arnot will give us a couple of great use case examples here, one on asthma, COPD, as well as I’m going to share some information on some diabetes studies that we’ve done. And then maybe talk at the end about other things like AFib and just general health and wellness proactive healthcare management.

These numbers are alarming. You know, 2600, that’s about a fourth of all the hospitals in the country, were penalized for readmission, $3.2 trillion of our national health expenditure. That’s second only to guns and bombs. Chronic disease is the largest opportunity for us to tackle. As I mentioned, 86% of our entire healthcare spend—and we’re already short 9000 physicians, and we’re going to be closer to 30 in the next five years. So I think it’s time to think about how we deliver healthcare.

And the benefits for all stakeholders—patients, providers, and payers—are immense. And I’m going to just shed light on a few of the ones I could fit in this value wheel. From the obvious one, better access to care, everyone can have a kid in their home, they can reduce the burden of having to go to the hospital. They improve their own quality of life by proactively managing their own health. They have a very integrated care circle network included in their remote monitoring plan. They can be connected to their doctor, to their family members, to their insurance carrier, and their pharmacist all from the push of one button, instead of having to drive all around town and pick up their films and deliver the to their doctors. The old way of doing business is gone. The reduction in the transportation costs is a big one. They can stay at home longer instead of going back to the hospital. And there’s different support programs, educational materials, care plans, that can be integrated into remote monitoring, which helps empower them to manage their own health, change their behaviour.

And I have a personal story there. I used one of our devices in our remote monitoring kit about two months ago. I was preparing for the HIMSS conference. And I felt a tightness in my chest, shortness of breath, and I took my remote monitoring kit off my desk and self administered an ECG. I was alerted by the monitoring platform, our CareMax program, that I had AFib. I immediately contacted a coworker, they rushed me to the emergency room, and I was diagnosed with pulmonary hypertension. I’m probably violating HIPAA concerns right now, but I’m so glad that I had this technology available. Otherwise I might have just blown it off as heartburn or anxiety. But it made me change my diet, my behaviour, I go to the gym twice a week, I eat yogurt and fibre, and I’ve never felt better. So it’s all about this prolonged independence, being able to manage yourself and live a better life.

[29:46]

So benefits of RPM for providers specifically. There is a lot of them. And I only could fit this many on the slide. So I always think it’s always about risk stratification. I’ll start near the bottom. It could be a new revenue stream for a provider, because there are many different alternative payment methods, reimbursement models, there are ways to generate revenue by using the technology to see more patients, to be more efficient. And every state has its own unique Medicaid laws, which can drive new revenue in many different was for physicians, home care agencies, for PVMs. Even EMR companies, they’re getting more patients in their system, they’re collecting more data. And everyone’s working together in concert to create an overall benefit. It’s looking at the big picture so people can make health decisions. And there are also obvious things like continuity of care, better quality of care. The more that you test, the more knowledge you have, the more power it is, and the better you will be, it’s just common sense. But as Dr. Bob Arnot said, the early intervention supports the preventative healthcare initiative in this country. The sooner you know, the more likely that you’re going to survive that chronic illness. And it also just creates this efficient patient engagement where everyone’s working together and everyone understands the risk and reward of their own health.

So for payers, there’s a lot of them. Reducing cost and mitigating risk, improving quality scores—HIDA scores, you know of course—which dictate reimbursement models, are very important. It creates more accountability between patients and providers. Now they have a record, real time, of how often they have administered care, how the patient is complying and adhering to their plan. And seeing if there’s a direct correlation between the remote patient monitoring program and the actual claims and healthcare spend for the organization. And with this move from fee for service to value-based medicine, we’re all at risk here. I mean our own health, the financial viability of our organizations, our own healthcare system, and of course the overall health of our nation and our individual country. So we’ve seen a trend now in payers as being some of the biggest buyers of remote patient monitoring because ultimately they’re the one’s writing the cheques, and they want to reduce those costs and mitigate those risks. And it also creates satisfaction and loyalty. The more you are caring for your customer—it’s about engagement, you know. In a previous life I worked for the Gallup organization in human capital management strategy, and we called it human sigma. It’s the same thing in a customer relationship at a casino or a hotel or a store. The better you take care of your employees, the better they feel, the better they take care of their patients, and the better they serve the population, which ultimately creates this synergy which allows everyone to prosper. So I think this is a really great benefit for everyone.

And the big question is, how does it work. A lot of you understand it already. And Dr. Bob, if you feel like interjecting at any time during the second slide here, I’m going to talk about basic telemedicine. So various sensors, they could be implantable, wearable, wireless, wired, in the home, that are in a remote location from their clinician. They’re transmitting through Bluetooth, Wifi, GSM, wire connections, direct to the cloud, an IoT. And inside of the health cloud, there will be a platform that exists that aggregates the data, and it integrates back into other systems like labs and imaging centers, EMRs, EHRs, health information exchanges, various apps. And then that data is pushed and visualized in various portals—dashboards, mobile apps. And then, where does that data go? Well, back into the cloud to be shared with all of these latest technologies and in particular the predictive modelling, artificial intelligence, machine learning, and social media interactions between health data and these other clouds within the cloud.

Bob, would you like to talk a little bit about that, about precision health?

[34:53]

DR. BOB ARNOT

Yeah, Matt, I mean that’s a great introduction to it. You know, let’s take your case as an example, of atrial fibrillation. You know, meeting with some very senior cardiologists and talking to them about telehealth, their big complaint is, you know, it’s just a sensor. And you know, you put together so well with your team there at CRF is this integrated picture. So with atrial fibrillation as an example, you know, we as doctors want to know, is it a real episode. And so because you’re taking that trace right there real time, we can look at it and verify it’s a real episode. We want to know what your symptoms are and we also want to know what medications you may have failed.

Now, the most interesting thing here, Matt, is that when all of this does go back up into the health cloud and you then compare with outcomes data and practice data, what it really allows us to do is to practice much better medicine. So as we’re accumulating hundreds of thousands of patients like you with atrial fibrillation, we’re able to say look, your record shows that you had 15 episodes of atrial fibrillation, you’ve only had it about six months, you’ve failed on these drugs, you’re a candidate for ablation. And this is an amazing therapy where they are able to go in with a cryoballoon and basically put it in the pulmonary veins and basically ablate the atrial fibrillation. So in many cases, it’s just never a problem again. So what I love about this is look, the patient has an ability to see this, so you Matt can see the sign on a dashboard, right there on your iPhone or on your iPad or on your computer easily. It’s giving you real-time information, it’s going to someone to monitor it, so if the doctor doesn’t have an opportunity to look at it, we know that it’s atrial fibrillation, and that’s fed back. But the most important thing I hear, you know, from physician offices—and I visit them a lot—and from care practices, is look, we want something that works with what we have. It has to work with Cerner or Epic or whatever our EMR is. We want to be able to image, get our images and our apps and our labs, it all has to come into one picture. So this gives us this continual measuring, but the dream here is that as all of this is then integrated in the cloud, we are able to help doctors and patients make much better decisions in terms of how we take care of patients, and that of course means lives saved, and dollars saved.

You know, I always talk about two bottom lines in medicine, you have a bottom line measured in dollars and cents, and you have a bottom line measured in lives saved, and you know, with this wonderful precision medicine system you put together with your team at CRF there, you really have the very best of both worlds.

MATT WEISENSEE

Thanks Bob. And I know that you have a personal interest in the next study. And we’re going to let you talk a little bit about it.

DR. BOB ARNOT

Sure. You know, as you indicated Matt, there are lots of different interesting applications. You know, I’ve gone through PubMed, I’ve been able to talk to doctors and large healthcare systems, and we have for instance a very good rheumatologist using it. He’s using it for autism in remote parts of California. A dentist with special cameras can use this remotely to look for cavities. You’re gonna talk a little bit about diabetes, diabetes and pregnancy. Fantastic of course in cardiology. United Healthcare now has thousands of these monitors out, looking at patients with congestive heart failure to make certain that they aren’t readmitted to hospital, because of course that’s one of the biggest cost drivers in American medicine. You of course have what I would call hospital-to-hospital and doctor-to-patient. Hospital-to-hospital, I was just down to Dartmouth the other day, where they have a stroke telehealth unit so that a senior neurologist at Dartmouth can share images, view an examination of a patient in a remote setting. We’re beginning to use these now in terms of helping in places like Syria to be able to bring expert medical information and judgement really, to help there. I was also down at the Department of Psychiatry at Harvard Medical School just last week, and they're finding that telepsychiatry has a very robust usage there that patients are much more likely to use it, it’s very convenient for the physician, and of course it’s tremendously important for the patient as well. But to get back to your case again, you know, the doctor doesn’t want to do what we call shadow telehealth, you know, where they get an EKG that you’ve taken a picture of or something that you have on some app. It’s got to go into the EMR, it’s got to be integrated.

So now let’s take a look at asthma. This is a disease that I have. It’s one of the top ten drivers of healthcare costs. $56 billion spent a year, and the drug cost for an asthmatic, $3,259 a year. You know, we hear so much about obesity and heart disease and diabetes. Asthma is really sort of this sleeper disease.

[39:48]

Now let’s take a look at the next slide, you know, I think it’s the most interesting one. And what it shows is, look at the lack of commitment to medication usage. You know, we always teach asthmatic patients that it’s not just a matter of using rescue medications, but this is an inflammatory disease where you want to be using inhaled steroids as a way of calming down the basic inflammation. Well look at this, this circle on the righthand side. Fifty-four percent of adults and 78% of children are not committed to using their medications properly. Now, look at the rest of this. You know, of all the different illnesses, you know, one could argue that with diabetes as an example, you might be able to improve someone’s blood sugar levels chronically but it might not translate into dollars saved, one would hope so. But for insurers, you know, insurers really want to know that within a six-month period, their investment is going to save them money. Well, in the next six months, you’re going to have asthmatics that sort of go wildly out of control, they’re going to be visiting the emergency room, they’re going to be hospitalized, they’re going to take urgent care visits. And look at the numbers here, spectacular numbers in terms of many of the sudden visits they have to make.

Now let’s take a look at this next slide here, Matt. What this shows us is that way that asthma is treated today. You’re in the emergency room, you go home, and you are lost to care. No one knows what’s happening to you. You know on a day to day basis there’s nobody that’s monitoring you, you could be getting worse day by day and you end up in the emergency room. Then you go back home again. No one’s monitoring you, we don’t know whether you have a fever or we don’t know what your forced expiratory volume is, which of course tells us in a one-second reading whether or not you can push the air out fast enough. You end up in the ICU, you end up in the hospital. Again, tremendous risk to the patient. You have many thousands of deaths every year. And of course tremendous cost to the system.

Now, on the next slide, we have what I would call a very sort of good sense of how telemedicine works here. Now, with your CRF system this really isn’t available any place else as an overall platform. On a daily basis we’re able to measure FEV1, and for those of you who aren’t pulmonary experts, you basically take a very deep breath, you blow it out, as quickly as you can into one of these meters, and you see how fast you’re able to push air out. Now, on the lefthand side, on Monday morning, someone’s able to push out a lot of air. But as you can see, as the week goes on there’s less and less air that’s being pushed out. We’re also doing oxygen saturation, so as we get to a week out, we can see that oxygen saturation is starting to fall. Most interestingly, we’re also able to measure inhalations, so on your inhaler, there’s a little device now, that CRF has, and every time you click it, that’s uploaded. And this is all automatic, there’s nothing that the patient has to do. You will have a device in your home or a pad that then uploads this, it goes to your little dashboard for instance, on your iPhone, it goes to your physician. And now you’re able to see that you’re using more and more of these rescue medications. Now, the more you use, the higher your risk of sudden death. And it also shows how poorly managed you are. So now, look at these three lines, and we can see that FEV1 is dropping, oxygen saturation is dropping, the patient desperately is taking more and more rescue medications, and they are headed to the emergency room, to hospitalizations, and even worse. And so this package again is set up so that the consumer is able to watch it on a real time basis. The physician’s practice is watching this. And with this, we’re trying to prove—and I’m quite certain we can—that we’re saving real dollars and we’re also saving human lives. So you know, it’s just a really great example of how this is all integrated together.

Now I’m going to send this back to you, Matt. Again, wonderful applications. We’re looking for instance at post event, where we have a new device. It’s a 12-lead EKG that a patient can manage themselves. I’ve used it, so has Matt. It’s a wonderful application, because should you not have the lead on properly, there’s a little red button that tells you how to correct it. And with this, if you have someone who’s home after a heart attack or after bypass surgery or angioplasty, you can measure then whether or not their chest pain is just due to the procedure itself—for instance chest pain after bypass surgery, maybe a cracked rib—versus something that’s more dangerous. So a  wonderful application.

I’m going to give this back to you Matt, to talk a little bit about your outcomes that are improving with diabetes, which of course is one of the very biggest drivers in terms of health costs in the US, and around the world, increasingly.

[44:28]

MATT WEISENSEE

Sure, thanks a lot Bob. Yeah, diabetes is a sweet spot for us, pardon the pun. We started off as an organization about a decade ago. We invented the first wireless glucometer. And we built a portal to transmit data to the patient and the caregiver and the clinician. And then we soon realized there’s comorbid events and we had multiple other indications with our diabetic population. So we expanded to weight loss, treating obesity, then hypertension. So we integrated a variety of other devices. And today we have about 50 devices and 50 different integrated platforms inside of our health cloud. But this study was one of the first ones we did in Baja Mexico in Tijuana, using our MyGlucoHealth glucometer, where we were able to improve diabetic care by using mobile technology. We had wired and wireless gluometers, and we uploaded the data to a care team. It was in a very large group study with Qualcomm and Scripps and a few others, and we did constant monitoring. And it improved the capacity for clinicians to see more patients. Ultimately, similar type of results. It improved glycemic control, quality of life improvements, the knowledge of their illness. It reduced A1c levels in half, which is substantial. And it just improved clinical support by providing all this rich real-time data to the entire team. And now the study is pushing Phase III, expanding throughout Baja, and we’ve got some other great connections throughout Mexico and expanding into Latin America. If you’re not aware, diabetes is the single largest pandemic in the world, about 30% of the entire global population suffers from type 1, 2, or is in pre-diabetes. And there is a big opportunity for all of us, using this technology, to help change lives and help improve healthcare.

So I know we only have about ten minutes left, so I want to go through the last couple slides.

How do you choose a partner. There are many reasons to consider. I would say that the three biggest ones are, is this platform interoperable, does it work with other systems. Can you scale this system to meet your own needs as you grow. You might start off with 50 or 100 patients in your program, but if you move it into your entire population, so you can collect all that quantitative and qualitative data, so you can stratify your patient populations and mitigate risk, you need to understand that everyone needs to be on the platform. So is it secure. How much does it cost. I always answer that with, actually nothing. Because before you even receive your first invoice in a telemedicine program, if you choose the right type of technology partner, you should already receive ROI, soft and hard. There are many ways to start using this technology tomorrow. And of course, how easy is it to use, which affects adoption. Is it engaging. And is there actionable intelligence. Is there data that you can use to drive important decisions. So these are some of the main ones.

And recommendations. These are just a few of my personal ones. Ask yourself the question, what is our digital health strategy as an organization. You know, assess what your current care coordination plans are, your telemedicine and population health strategy. You know, seek executive sponsorship and align it with the strategy. If everyone doesn’t buy in, then it’s not going to work. It’s got to be top-down. And set goals. Don’t think that you can take on the entire population at once. Start off with 50 or 100 patients. You know, what’s important to you, is it about population health, is it about just reducing readmission, is it about reimbursement optimization. You should understand those things, and there’s lots of resources available, and I’ll be more than happy to share some of those with you if you send me a note. And engage the patient and the provider. Create a roadmap where you can implement one step at a time. Communicate it effectively, not only with your own organization, but with the patients, providers, the payers. Let everyone know what your goal is, and then manage it, and improve. And those are the things I would recommend most.

So this is just a picture of our solution—integrated devices, an integrated platform. And if anyone is interested, I’ll let you know afterwards. What is the future? You know, it’s a great question. And I think Bob and I have a few ideas we’d love to share with you.

[50:05]

DR. BOB ARNOT

Well you’re welcome, Matt. Great great presentation. You really have earned your reputation as a futurist today, just a tremendous vision of where all this is going and how important telehealth is to the future of medicine, cost savings, and of course to dramatically improve patient care. Well done.

MATT WEISENSEE

Well thanks, Bob. And if you have any other comments, remarks, talking about all of the possibilities of remote monitoring, please share them with the group now. I’ve seen some of your work and your spreadsheets and your dashboards and your vision and the strategy to create this type of program for many organizations. And I can tell you in this group that the list goes off the page with all of the different variations and kit configurations and different implementation strategies that are available to treat and tackle these conditions to reduce the cost of healthcare for healthcare for chronic disease management. Bob?

DR. BOB ARNOT

Well thanks Matt. You know, I’ve been involved in technology really since the very beginning of my career. I ran a sports medicine laboratory for athletes. And you know, we were able to go from last in the world to first in a number of different sports through the use of this kind of sports medicine. As an example, we were able to use 3D motion sensors that are programmed with MIT to look at how people ski jumped. And we noticed that our jumpers flexed at the knees too slowly. We can prove that, and they quite quickly improved. With our cross country ski races, just looking at heart rate and pace we found that many of them were going way to fast up hills. We redid their heart rates and you know, we began to win medals on a World Cup level. So I’ve seen this for many many years, obviously at an elite level in terms of world class athletes. Out with Save the Children, the International Medical Corps, wonderful organizations out in South Sudan and different parts of Africa. So I know from firsthand experience how wonderful this is, and it’s really the ability to make this highly affordable and to integrate this that is making such a big difference and why CRF has been such a wonderful partner to us.

Again, just to summarize at the end here, you know, think again of that poor child sitting there in Southern Sudan or a US soldier sitting out there in the middle of Syria, and how the integrated picture really sort of saves their lives. Well it’s this integrated picture, you know, CRF has I believe 50 different FDA Class II devices, so it has the most devices, it has the best overall customized integration, and I’m just very very excited about working with such a great organization, and with Matt Weisensee, a true futurist and great friend a tremendous presenter.

MATT WEISENSEE

Thank you Bob. So thanks everyone. I do have a couple really great questions here.

[Q&A SECTION STARTS AT 52:56]

 

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