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May 05, 2024

Wearables, remote patient monitoring & the future of chronic care management with Richard Milani, MD

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

Current capabilities of remote monitoring, using wearable technology for chronic disease management and future opportunities for practices with Richard Milani, MD, chief clinical transformation officer at Ochsner Health. AMA Chief Experience Officer Todd Unger hosts.

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Unger: Hello and welcome to the AMA Update podcast and video series. Today, we're talking about the latest trends in remote patient monitoring and how the use of this technology has continued to grow following the pandemic. I'm joined today by Dr. Richard Milani, the chief clinical transformation officer at Ochsner Health in New Orleans. I'm Todd Unger, the AMA's chief experience officer in Chicago. Welcome back, Dr. Milani. How are you doing?

Dr. Milani: I'm great. Thanks for having me back, Todd.

Unger: Well, Ochsner has been one of the leaders in remote monitoring. Believe it or not, we talked to you two years ago about how you were using it with COVID patients. And since then, the technology has continued to grow in terms of your usage. Let's just start with a quick overview of the ways that Ochsner is currently using remote monitoring.

Dr. Milani: Well, we actually started in 2015. And we have programs in various chronic disease states like hypertension, diabetes, COPD, even dyslipidemia. And then we've since grown new programs in falls. And we can talk about falls a little bit, fall prevention in the elderly and even in elderly seniors that live alone. We have a product called Connected Home, which we can discuss as well.

Unger: So out of all the different ways that you're using remote monitoring now, what do you think are some of the biggest improvements that you've seen with patients that would not have been possible without the use of this approach in technology?

Dr. Milani: Well, there are several examples I could give you. I'll go back to the fall situation. So we actually have the ability to monitor gait using iPhone technology and, moreover, using Apple Watch. We have a personal emergency response system. So using that, we can detect people who are at risk for falls.

And then we have a completely virtual program that they go through to actually reduce falls. And we can track their progress through this passive monitoring just when they go out for a normal walk. So there's lots of little subtleties that we can do in terms of collecting information and responding to information by virtue of these type of technologies.

Unger: Tell me, how does that actually work? You said you get some kind of signal that there's a problem with gait. And then you have a virtual program to help correct that. What's that look like?

Dr. Milani: So we can identify using artificial intelligence populations that are at risk for falls. So just as a way of background very quickly, falls is the third leading cost of care in people 65 and above in the United States, so about 28% of them fall every year. It is a leading reason for hospitalization due to trauma in that age group. And it's also the leading traumatic cause of death in that age group. 99% of hip fractures, for instance, are due to falls.

So falls are a big problem. And there's not a lot of real programs that actually address that specifically in order to reduce it. So, one, we can identify high-risk populations. Two, through monitoring of gait, we can actually see that someone is getting worse or getting better based on the interventions that we're employing. So, again, identifying risk groups and using technology through remote means to look at populations, we can see who's doing what and who's getting better and where we need to focus more attention.

Unger: And what a great use of AI, a topic we've been talking a lot about lately. Dr. Milani, Ochsner was also an early adopter of remote monitoring. But I want to take a look at the future. In five years based on the kind of early results that you're seeing, what are the programs that you think most health systems should have in place?

Dr. Milani: Well, I think the most important thing is for systems to be thinking about creating an infrastructure. Because I think where things are going is going to be more and more passive monitoring of groups that will then pop up. In other words, I'm passively monitoring a group of individuals or a population. And now all of a sudden, a signal arises. And then as a health system, you'd want to respond to that signal.

For instance, we have the ability to passively monitor blood pressure. So that already exists today. There's actually a product. This is one right here as an example that's going through the FDA now.

Imagine now that it's sort of built into say your Apple Watch or your Google Fit, and it identifies you as now having high blood pressure. You didn't even know it. That would pop up in our system and say, hey, let's get you managed, let's get you treated.

So I think what's going to happen over time is that as technologies continue to be more improved, our abilities to identify populations with a problem are going to be real. And we're going to not have to wait on them to figure it out. We should be able to help figure it out for them and respond in the moment.

So I think what systems ought to be doing is saying, "OK, we know that this is a lot of data. How can I capture this information and get through it in a way that doesn't burden the system but yet takes care of people that I'm responsible for?"

Unger: Let me ask you a little bit more about that. Because when we talk about this topic, I'm always amazed because of, what you talked about, is infrastructure. And there are so many aspects to that. There's the physical infrastructure, the equipment, the technology, the systems, and the teams to be able to pull this off. When you think about building out that infrastructure and that kind of organization to do that, what do you advise other health systems and particularly maybe smaller ones as they kind of try to start up a program like that?

Dr. Milani: Yeah, I think that the good news is that you need a platform. I mean, I shouldn't say that's the good news. Let's look at the requirements. The requirements are a platform. You have to have some way of capturing this information and then doing something with it on the back end. So either you're going to go out and either create a platform or buy one. Or the good news, what I was getting to, is that now the EMR vendors are starting to be able to provide that infrastructure.

So if you're on say Epic as an example, they're adding more and more features to be able to collect a lot of this information in the background so that if you want to be able to start doing things with it and then collating that information, you can. So I think, again, as practices want to progress, it can be expensive to try and create your own platform, but you can take advantage of the EMRs hopefully over the next few years to be able to do that for you.

Unger: I have one last question for you. Another area where Ochsner has been very hard at work and a real leader is in the area of physician wellness and addressing issues around physician burnout. So I'm curious because the work that's been going on there has been going on simultaneously with the work that you're doing with remote monitoring. Do you see a potential connection between remote monitoring and burnout? The technology gives physicians so much wealth of data on their patients. But how do you see them coming together to combat what is really a significant problem right now?

Dr. Milani: Yeah, I think it actually is going to take the burn out away. And the reason I say that is that we don't have to rely on physicians to do all this stuff. In other words, you can create protocols. You can use the existing guidelines. You can have a dedicated team. That team can consist of health care personnel that are not physicians. And now you're unloading the physician from a lot of work not adding to it.

Again, these protocols have to be designed by doctors and things like that to make sure that they're safe and appropriate and following the current science, which is doable. But now that day-to-day work can be taken off of their plate, and they can do the things that only they can do in the office or in any virtual fashion.

Unger: That sounds like the subject of a future discussion for the two of us. I can't wait to talk to you about that more. Dr. Milani, thanks so much for joining us today.

And that's it for today's episode. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks again for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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