Anu Banerjee, Chief Quality and Innovation Officer, Arnot Health
In the United States, one of every three adults has hypertension, a condition created when the force of the blood pumping through your arteries is too high. Hypertension is often referred to as a “silent killer” because it usually is not associated with symptoms. According to the Center for Disease Control and Prevention, hypertension is the lead cause for all cardiovascular complication and chronic kidney disease. Only 47% of people being treated for hypertension have it under control. Diabetes is when the pancreas does not make enough insulin and cause elevated levels of glucose in the blood. In the United States, 29.1 million or 9.3 percent of people have diabetes. In 2010, diabetes was the seventh leading cause of death among Americans and is associated with many debilitating complications: Heart attack, stroke, blindness, kidney disease and amputations. The prevalence of hypertension in patients with diabetes is 71 percent. In diabetes, complications are more severe for those who have a poor control. Hence, daily monitoring blood sugar and blood pressure is essential in these two conditions.
"Advances in Technology allow clinical operation in the management hypertension and diabetes synchronous with customers’ needs"
Fluctuation in pulse, blood pressure and blood sugar is normal. However, increase in the range and frequency of fluctuation is associated with adverse health effect. Hence, it is the cumulative effect of abnormal blood pressure and blood sugar over time that is associated with complication. Collection of aggregate information in these conditions this way is more reliable and accurate. Therefore, it will be useful to collect continuous information on blood sugar and blood pressure to detect its cumulative burden in these two conditions. Consistent with this logic most patients’ with diabetes are encouraged self-monitoring and this principle also applies in the management of blood pressure in and pulse. Essential in these two setting is to direct intervention based on changes seen in aggregate data set.
Repeated measurements taken over extended periods indicate true burden of blood pressure unlike, single determination taken every 3-4 months in clinical practice. Currently, decision made in hypertension is based on one or two readings taken randomly. Literature supports home blood pressure is superior. Average of several blood pressure readings at short intervals is similar to hemoglobin A1c measurement a bio-marker, used in assessment of diabetes control during preceding several months.
Technology based access to blood pressure and blood sugar is reassuring to customers’ when one is under supervision and interventions are associated with risks. Technical measures required in monitoring blood pressure are easy to teach and monitoring devices are inexpensive. This is similar to self monitoring blood sugar at home. Diabetes has been the ideal model for clinical management and its effectiveness is accepted among elderly because it permits greater level of confidence. In health care delivery operation pledging surveillance to be vigilant to concern in real-time is reinforcement to accept plan of care.
Modeling data is critical to care givers. Devices designed to generate information in these two common conditions will assist quick review on level of control scale plan of treatment and achieved goals with precision. Difficulties in achieving goals require effective and systematic dialogue on contextual issues. Such interaction is not practical in our existing electronic medical recordings.
Thematic analysis of atomic data and Meta data along with linear integration of HBP and treatment would make this a model for meaningful use. A similar scheme to integrate data related to diabetes management is needed where; interaction is much more intense to achieve a steady state. Furthermore, HBP data with linear flow, if methodically aggregated with due validation, into a matrix format along with parallel flow of integrated information on changes in treatment, these two data sets organized in this scheme, will be more valuable for interpretation and critical review.
Advances in Technology allow clinical operation in the management hypertension and diabetes synchronous with customers’ needs. Besides, in hypertension, it holds promise to refine clinical care that is qualitatively more efficient.
CheckMyVitals, a Telemedicine solution for monitoring blood pressure and blood sugar was built on the theory of bench-marking scheme that was based on day to day operational experience in the management of diabetes and hypertension. Core issues prioritized from patient’s perspective included; operational ease, reliability, cost and, adaptive to routine personal household device, regular operation associated with composite health and economic benefits. Provider’s perspective: Gain in information of superior quality and enable both quantitative and qualitative service delivery unobtrusive to workflow. These issues became formative and summative guiding principle in the design feature during development.
Expansion of this theme from individual to population level information can help to detect susceptible segments in population to develop prevention strategy. Technology enables proactive care plan in a patient centered manner.
Technology has the ability to design public health a key terminal, to focus and integrate nutritional and exercise in the management of chronic diseases conditions like hypertension, diabetes, obesity and other cardiovascular risk related issues. Checkmyvitals is in its early stages to assemble longitudinal quantitative nutritional and exercise values in the EMR.
Mhealth operational design with utility features that supports end users has the potential to make significant change in health care delivery. It has the potential to render higher quality for diverse population group at minimal cost.