Ochsner Execs Describe Digital Medicine Transformation

Louisiana-based Ochsner Health continues to make progress on applying digital health tools to chronic disease management. The health system’s starting point was a realization that the current approach to chronic disease “is so broken that the only way you're going to have a real impact on it is a redesign, not to try to fix the current system,” said Richard Milani, M.D., chief clinical transformation officer. “So that's exactly the approach we took.” The first step, he added, was to get more data.

Ochsner owns or manages 40 hospitals across Louisiana. It has more than 2,000 employed providers and many more community providers. It has about 35,000 employees.

Milani, who is also vice chairman of Ochsner’s Department of Cardiology, was speaking during a recent webinar put on by EHR vendor Epic. He was joined by Laura Wilt, system vice president and chief information officer at Ochsner. Before joining Ochsner in 2013, she worked for Epic’s Implementation Services team.

They both described the growth of digital medicine teams at Ochsner working on both patient-facing and clinician-facing applications. Milani said patients with hypertension are outfitted with a Bluetooth-enabled digital cuff. They can take their blood pressure and it goes through Apple’s HealthKit, directly into Epic.

The digital health team created custom dashboards within Epic. “If I open up a medical record, I typically have to go to a variety of different places to assemble the information I need, whether it be labs, or imaging, or my previous notes to make a decision,” he said. “But if I'm dealing with a specific disease state, I can assemble all that information in advance, so that if I open up a custom dashboard, I have it all right there in front of me. It saves me time and it prevents me from making mistakes, because now I've got all the information correctly in front of me and we can add decision support to know exactly how to handle that.”

Ochsner created a digital team made up of a pharmacist combined with a health coach trained in behavior science and the science of behavior change. “We ask that patients take their blood pressure no less than once a week,” Milani explained. “If not, they get a reminder in an automatic text. Now we have plenty of data coming in, and we have a team that's trained in behavior science, as well as a team that can actually change the medicines and do all the necessary therapy according to the guidelines. Physicians enroll patients with a single click within Epic into the system. They get a MyChart message that says Dr. Smith just asked you to join the program.”

This work began in 2015, and Ochsner has published several papers on their work. “We have seven years of data now. We are getting two- to three-fold better control rates and standard of care, and it's sustainable,” Milani said. “We have net promoter scores of about 87.5, so it's extraordinarily well received among patients. The only complaint I ever got from patients is: ‘what took you so long to figure this out to do this this way?’”

He added that they have recently shown that they have reduced the cost of care. “The quadruple aim has been fulfilled,” Milani said. “We're actually taking a burden off of providers by managing this for them if they choose, providing it at a better level of service and convenience for patients with a better experience; we're getting better outcomes and reducing the costs all at the same time — several hundreds of dollars per member per month in terms of reductions in diabetes costs and hypertension costs. We have these programs now in COPD, lipids, hypertension and diabetes. We also have a program in pregnancy.”

The pregnancy program, Connected MOM, came about, he said, in response to these clinical questions:

• How can we have a more continuous connection with pregnant women during the nine months of their pregnancy and postdelivery?

• How can we provide just-in-time education at various time points throughout pregnancy?

• How can we monitor weight and blood pressure during the pregnancy, so that if there was a problem, we would catch it sooner than their next visit? And if it wasn't a problem, we can avoid having to have certain visits.

“We have data that shows that we're identifying gestational hypertension that would have eventually been found, but we are finding it sooner,” he said. “We are actually reducing pre-term delivery as a result of having this program.”

Wilt said part of her IT team is specifically focused on digital patient experience. “We built a team that tries to help support the existing digital medicine program and develop future things. One of the teams we added in the last two years focuses on patient technical experience as part of the digital experience team. They're the ones who are answering calls or chats from patients who may be having trouble technically, if they're doing a video visit, for instance. We actually have a support team, almost like a help desk, but for our patients as part of that group.

In 2014, Ochsner also launched what it calls the “O Bar” concept based on the Apple Genius Bar, but focused solely on health tech. Ochsner employees help people with devices and apps. They can help people who are not tech-savvy get set up with an FDA-approved blood pressure cuff or glucometer. “We have opened the door to a whole world of potential benefits to people who otherwise would not have entered by virtue of having this ‘genius’ who's willing to sit there with you and show you how to take a blood pressure,” Milani said.

Wilt said all this data that is gathered for care teams using digital tools is available to other providers in Epic. They use Epic registries and Epic social determinants of health tools to store all of this data. “While we're gathering it from different places, it really is coming into those places,” she said. “Then we're using some custom logic and algorithms to determine how to present that data to the care team and to the doctors as well. We've talked a lot about the centralized care team that works this on a day-to-day basis. But if that same patient goes into the emergency department, or just has a regular follow up visit with their primary care or another doctor, they're able to see all this information. So while we have a centralized view for the care team that we've been talking about, it's really consistent with the rest of the record.”