Remote Monitoring Boosts Chronic Illness Care

Remote monitoring services are enabling Sisters of Mercy Health System clinicians to offer care to chronically ill home-based patients sooner, as well as track the conditions of seriously ill or injured hospital patients located miles away.

Sisters of Mercy Health System, based in St. Louis, is the ninth largest Catholic healthcare system in the United States, operating 26 hospitals, as well as outpatient centers, clinics, and other care facilities in seven states.

About three years ago, Sisters of Mercy began rolling out a remote monitoring system based on technology provided by TIBCO. To date, Sisters of Mercy is providing real-time, remote monitoring services to patients in nine of its largest hospitals, plus two non-Mercy hospitals.

Mercy is also using the remote monitoring capabilities afforded by TIBCO to help identify early signs of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) among home-based and soon-to-be-discharged hospital patients who are in danger of developing either of the two incurable, chronic, and potentially life-threatening conditions.

The monitoring allows physicians and other clinicians -- at the hospital, in their offices, or elsewhere -- to remotely track the condition of intensive care unit and emergency department patients at nine Mercy hospitals, as well as patients in two-non Mercy hospitals located in rural communities where there are shortages of key healthcare professionals, such as critical care workers.

In tracking of patients for COPD and CHF, data from Mercy hospitals and ambulatory care facilities is remotely monitored.

Eventually, all 26 Mercy hospitals are expected to be part of the remote monitoring, and the architecture has the potential to offer remote monitoring services to many more non-Mercy hospitals, said John Conroy, Sisters of Mercy executive director of application development.

"Our architecture allows us to bring up the non-Mercy hospitals as a software-as-a-service," he said. The services being offered can assist in tracking the condition of patients, including those in healthcare facilities facing a shortage of clinical expertise, such as critical care specialists, and also hospitals lacking an integrated electronic medical record, which makes it harder for clinicians to quickly assess key patient information.

Mercy's hospitals use an EPIC electronic medical record (EMR) system that's run centrally at Mercy's flagship hospital, St. John's Mercy Medical Center in St. Louis.

Using TIBCO, St. John's Mercy collects data from an array of disparate systems used at the nine large hospitals, including medical monitoring equipment from a variety of vendors, such as Philips Visicu and Siemens, said Conroy.

Data from these decentralized and disparate systems include vital signs; lab results; pharmacy data; admission/transfer and discharge information; and flow sheets.

TIBCO ActiveMatrix BusinessWorks takes messages from the medical monitoring equipment, transforms them into XML, and publishes them to the TIBCO enterprise message service (EMS), the backbone of Mercy's mission-critical systems. Clinicians can read vital signs in real time beamed from each of the system's acute-care facilities that are connected to the network.

The TIBCO publish-and-subscribe messaging system replaced Sisters of Mercy's previous point-to-point architecture. In the new environment, a published message is transformed into a common information model and made immediately available to systems downstream, including Mercy's EMR.

The advantages include data quality and velocity, as well as volume, said TIBCO. With TIBCO automating many of the system's manual interfaces, Sisters of Mercy captures about five million clinical events every day.

A full-time team at St. John's Mercy hospital, which has 1,100 beds, is assigned to monitor the remote patients' systems.

With "a flip of a switch," a remote hospital can send admissions information, test results, and other medical studies to any other of the facilities in the group or the to the central monitoring location for consult, Conroy said.

Data from the array of decentralized systems also gets integrated into Mercy's centralized the EPIC EMR. This allows patients' attending physicians, as well as primary care physicians to remotely access this information via the EPIC EMR. The doctors also receive alerts if any patients' readings are out of range.

"In a quarter of a second, if a blood pressure goes up or skin temperature changes, it's detected," said Conroy.

For non-Mercy hospitals, clinicians can also view integrated patient data, rather than having to access multiple systems for readings on patient's lab work, vital signs and other key data important in monitoring the condition of patients, he said.

The remote monitoring is also helping Sisters of Mercy identify about 200 patients monthly who are exhibiting signs of COPD and CHF. This allows home-care nurses and the patients' doctors to provide earlier intervention treatments to patients, before their conditions worsen, said Conroy.

Through the collection of data, including updates to admissions and discharge info, symptoms and diagnoses codes, TIBCO is helping Sisters of Mercy identify patients that are showing signs of COPD or CHF. If these patients are hospitalized, they can be enrolled sooner in intervention programs upon discharge. Patients who are receiving care at outpatient facilities and who are exhibiting signs of COPD or CHF are identified.

"If a patient is going to the ambulatory care facility for a yearly exam, but is complaining shortness of breath or sleeplessness, the monitoring will pick it up," he said. "It's about quality of care and patient safety," he said.

The non-profit organization is offering the remote services to non-Mercy hospitals "not to make a profit but to help others," he said.