Leaving her internist’s office at the Ochsner Center for Primary Care and Wellness in New Orleans, the elderly patient stops by the O Bar in the lobby.
This bar won’t serve her an alcoholic beverage. Nor a smoothie, nor a latte. She might, however, walk away with a new Fitbit on her wrist or a weight loss coaching app downloaded into her smartphone. The O Bar is a brightly lit tech support station sleekly appointed with stainless-steel stools, counter-mounted iPads and wall-mounted video displays. It’s modeled after the Genius Bar in Apple stores.
At the O Bar (O for Ochsner, of course), there’s a technician on duty to advise the patient on how best to fill the prescription that bears the doctor’s signature. He’s checked off two mobile computer apps appropriate to her health situation (from eight categories: nutrition, fitness, women’s health, oncology, diabetes, medication, smoking cessation and general health). He’s also recommended she consider outfitting herself with a chic, wrist-worn activity-tracking device (from a preprinted prescription list that also includes a Bluetooth-enabled blood glucose monitor, a wireless weight scale or a wireless blood pressure monitor).
The devices are on sale at the O Bar at a discount, which is also available to the public. Most of the mobile apps are free. A few may cost a buck or two. The technician will help set up everything — even to this particular patient’s technophobic satisfaction — before she leaves.
If her doctor had enrolled her in Ochsner’s hypertension program trial, she might have received an Apple Watch — priced at about $250 retail — gratis (about which more later).
Ochsner Health System stands at the forefront of hospital systems worldwide in adopting mobile apps and wearable technology to cement patients’ engagement in overseeing their own health. Indeed, the legend at the bottom of every O Bar prescription slip quotes Benjamin Franklin: “Tell me and I forget, teach me and I may remember, involve me and I learn.”
According to a survey earlier this year of some 8,000 health care consumers in seven nations, fully one in three patients now uses a health app linked to a mobile phone or a tablet computer. One in five wears a monitoring device like an Apple Watch, a Fitbit or a Jawbone. Those percentages leave a lot of room for growth, but they’ve more than doubled in just the last two years.
The study, by Nielsen for Accenture Consulting, found that three of four consumers believe wearable technology will help them stay engaged in a healthy lifestyle or adhere to a treatment protocol. So do an overwhelming number of physicians — 85 percent. What’s more, the surveyors reported that 78 percent of health care consumers are willing to wear such technology and about the same percentage already do. Almost 275 million wearable electronic devices are projected to be sold worldwide this year.
A mere 10 percent of patients expressed reservations about sharing mobile-generated data with doctors, and only 13 percent had a problem with giving it to nurses. They were much warier when it came to letting employers kibitz on the data, though. At that, 31 percent balked. And twice as many were hesitant to let their health plans have a look: 63 percent were opposed.
Of health-related apps and devices in current use, according to the Accenture survey, 59 percent address fitness, 52 percent deal with healthy diet and nutrition habits, 36 percent help patients navigate symptoms, 28 percent are patient-provider access portals, 25 percent track health conditions, 12 percent are for medication management, and 10 percent assist in chronic condition or disease management.
O Bars — there are now three scattered among Ochsner’s 13 owned, managed or affiliated hospitals, with a fourth about to open — are the inspiration of Richard Milani, M.D., the system’s vice chief of cardiology. He also serves as its chief clinical transformation officer.
“Most innovation used to occur within health care systems,” Milani says in explanation of his second job title and purview. “Now, in Silicon Valley, there are a million startups working on digital health care applications. A [hospital] system needs someone focused on the quality and safety of things that may be beneficial on the delivery side.”
Excited by the potential of health-promoting apps and wearables to “positively influence patient behavior,” Milani says, he saw a need to help people sort through the proliferating options.
“There are about 110,000 apps out there,” he notes. “Probably half don’t offer a lot of value. Some are easy to use. Some are hard. We believe it’s the responsibility of the delivery system to say to a patient: ‘Let us do some of this work for you. Look, we think this one would be valuable to you. People who’ve tried it find it easy to use, and they like it. This is an avenue for you to get more involved in your own well-being.’ A lot of apps and wearables do a very good job.”
Not only have those on offer at the O Bar been vetted by Milani and his colleagues, there’s what he describes jocularly as “a genius, somebody tech savvy and good with people” behind the counter — “an enabler” — to guide patients or passers-by through the selection. Using a touch-screen tablet, patients can “play with” apps before choosing among them.
“The key value [for the patient] is that it doesn’t matter how technologically savvy you are. There’s somebody there to help you,” he says. “The value [for us] is greater patient engagement, better outcomes and better health in the long run. Which is what we’re here for.”
Fill this prescription
All of the devices carried at the O Bar are Apple HealthKit-enabled, Milani says. That means that if the patient has agreed, data generated by the devices can be fed directly into his or her Epic electronic health record.
“That’s the beauty for us,” Milani says. “We only have to deal with one [HIPAA-compliant] portal rather than gazillions.”
Starting two years ago with a weight reduction program to prevent readmissions for congestive heart failure, and expanded last year to include blood pressure and heart rate control for hypertension, patients have been asked to fill out a detailed digital questionnaire on a tablet computer. Respondents appear to be more candid when using a tablet than in face-to-face interviews, Milani suggests. Ochsner physicians then run the answers through algorithms that help them construct personalized care plans and suggest appropriate decision-support tools tailored to each patient.
As a reminder of the resource mobile technology represents for modifying unhealthy behaviors — “lifestyle changes do work, and sometimes they’re more important than medication," Milani asserts” — Ochsner has given each doctor a desk “prescription” pad enumerating the categories of apps and devices available through the O Bar. The doctor checks off the family of tools most likely to suit the patient’s needs, and the patient takes the prescription to the O Bar, where the “genius” advises and dispenses.
The system has caught on, and enthusiastic feedback has brought even skeptical physicians on board, Milani reports. “Sometimes, it’s actually the patient teaching the doctor,” he says.
The O Bar is an “integral part of our digital hypertension program,” Milani says. Patients who fail to keep their blood pressure under control are guided through the download and use of apps that sync to their EHR, and the patient’s numbers on a dashboard are closely monitored by care providers to determine when intervention is warranted.
Participants receive regular motivational text messages and can view their results, progress and risk profile through their patient portal app, along with tips on reducing their risk. Each month, a hard copy summary report is mailed to patients so families can be brought into the loop.
A subset of patients are given Apple Watches in a trial to determine whether wrist-top medication and physical activity reminders, for example — two apps for the device Milani is keen on — are effective in helping patients achieve their blood pressure goals. Outcomes are being compared with those of patients in the program who do not use the watches.
Results so far look promising, Milani says. “I don’t want to say it’s a done deal yet, but I can tell you it’s trending in that direction. I can’t wait to declare victory. But we need more data.”
Setting up, stocking and staffing O Bars and the hypertension program impose significant costs to Ochsner, Milani acknowledges, “These aren’t meant to be profit centers,” he says. “We discount as much as we can. We’re a nonprofit, and, honestly, if we could come close to breaking even, we’d pop the Champagne. The return for us, I think, will be in better outcomes.”
Meanwhile, he notes, “we’re busy trying to get our stuff together” to convince health insurers that paying for mobile devices will be offset by savings in hospitalizations. “I’d think they’d really like this sort of thing,” Milani says.
To hospital consultant Munzoor Shaikh, of West Monroe Partners in Chicago, Ochsner is taking advantage of a huge opportunity that most hospitals have yet to appreciate. For high-risk patients with chronic diseases, he notes, especially those in capitated populations, providing mobile apps and wearable lifestyle tracking devices tied into a medical record — rather than relying on self-reporting — gives vigilant clinicians a firmer platform for in-time, money-saving intervention. And it creates a true partnership between the patient and the medical team.
“Everybody talks about patient engagement, but few are looking at provider engagement,” Shaikh says. “Digital is the medium to make that happen.”
David Ollier Weber is a principal of The Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily.