Remote Patient Monitoring for Hypertension Treatment
Dr. Rich (Medical Director, Internal Medicine Center, Erie County Medical Center) talks about remote patient monitoring for hypertension treatment. Dr. Rich explains why is hypertension such an important chronic medical condition and how remote monitoring work.
Featuring:
Learn more about Ellen P. Rich, M.D.
Ellen P. Rich, M.D.
Dr. Ellen Rich, Medical Director of the Internal Medicine Center has returned to her primary care roots on the ECMC Health Campus, serving as both a clinical and operational leader for the Center. A Clinical Associate Professor at the Jacobs School of Medicine & Biomedical Sciences, Dr. Rich has co-written articles about patient use of medical information and screening for mental illness in primary care clinics. She is certified by the Royal College of physicians as a medical educator.Learn more about Ellen P. Rich, M.D.
Transcription:
Joey Wahler (Host): Hypertension or high blood pressure is a chronic condition for many, and now medical personnel can monitor your blood pressure from their office while you are elsewhere. So we're discussing the benefits of remote patient monitoring for hypertension. This is True Care HealthCast, a podcast from Erie County Medical Center. Thanks for listening. I'm Joey Wahler, our guest, Dr. Ellen Rich, she's medical director at Erie County Medical Center's internal medicine center and associate professor of clinical medicine at the Jacobs School of Medicine and Biomedical Sciences. Dr. Rich, thanks for joining.
Dr Ellen Rich: Thank you for having me.
Joey Wahler (Host): So first, why is hypertension such an important chronic medical condition in the first place?
Dr Ellen Rich: So, first of all, it's very common. So we know a lot of people have it. And when there are chronic medical conditions that are common, we have a better chance of reducing the long term harms to a person, because we have a lot more information about how to help them. So hypertension is one of the risk factors for heart attack and stroke. And there's an incredible amount of evidence that by getting blood pressure into a individual's target goal blood pressure that we can reduce their risk of heart attack and stroke by anywhere from 30 to 50%, which is a highly effective, result. If we can do our job well.
Joey Wahler (Host): Wow. Sounds like it is. And so obviously if left undiagnosed or untreated high blood pressure can be dangerous?
Dr Ellen Rich: It's very dangerous, particularly because people. Experience symptoms from hypertension alone. People can have elevated blood pressure that's causing stress on their blood vessels and their heart and their kidney for many years, without even experiencing shortness of breath or a headache until it's far down the line in terms of having harmed their body. So, that's one of the reasons we want people to come to the doctor initially, to have their blood pressure checked by a healthcare professional. So that we can identify people who need their blood pressure treated.
Joey Wahler (Host): Gotcha. So let's get into this topic now. How exactly does a remote monitoring work?
Dr Ellen Rich: So in general, the idea is that a patient will check their blood pressures at home and that information will be transmitted to their doctor's office and followed remotely. In our particular case, we have purchased blood pressure cuffs that have been shown to be reliable. We give that to the patient along with education about how to check your blood pressure properly and when to check it. The blood pressure cuff then, transmits the information when the patient checks their blood pressure to an app on their phone, that then goes to a database.
And one of our nurse care managers monitors the database to look for any abnormalities, too high or too low blood pressures. And we're able to manage the blood pressures in between visits because we have regular information. And then we also have what we call virtual follow up visits to review how it's going with patients. And to have a healthcare professional, usually a physician, look at their blood pressure trends since they have started the program.
Joey Wahler (Host): And so to backtrack for a moment, you mentioned a monitoring cuff, and that goes on the wrist?
Dr Ellen Rich: It goes on the upper arm, so the cuffs that we use a person can manage with one hand. And then you hit a button and it's automatically fills up with pressure. Measures the blood pressure. And then there, is technology in the blood pressure cuff to transmit that number to the app on the patient's phone.
Joey Wahler (Host): And so there is still participation by the patient on the other end to initiate this?
Dr Ellen Rich: Yes. So patients need to participate in the program. So we ask them to check their blood pressure at least once a day, sometimes twice. And if they haven't been able to do that on a regular basis, we also are checking the database and we'll reach out to the patient to find out if there's any issues or concerns on their part. Trouble with the technology or loss of motivation, or misunderstanding so that we can make sure that we are following them appropriately. If they're in the program, we felt that they needed to be monitored more closely because they weren't achieving their blood pressure control goals, in the usual way.
Joey Wahler (Host): Gotcha. And so it's done how many times daily?
Dr Ellen Rich: Generally we're asking patients to do it once. There are some remote programs that have patients do it twice a day for a week and then take a week off. But we've opted for once a day.
Joey Wahler (Host): And so you mentioned some of the technology involved. There's an app that obviously is on a patient's phone. So for those that are more technologically challenged, even today, for those that may be older or out of the loop, what happens there?
Dr Ellen Rich: So we really try to ensure that people understand what is gonna be required to participate in this program. And the older population, many people have smartphones. So we actually have them come in with their smartphone. We download the app for them. We demonstrate how it works. And we also coach them on how to become engaged in a virtual visit, which usually requires, opening up a link either on a text message or on an email so that we can also have, the virtual visit component of our program, work to the best of its potential.
Joey Wahler (Host): So before. Go any further on some of the remaining specifics about this program, just as a doctor in general, we're talking about virtual visits to explain how the program works. We're talking about using an app on the phone for home monitoring. How much easier have things like this in recent years made your job?
Dr Ellen Rich: I don't think we utilized this technology very often prior to COVID. And C forced us all into a rapid cycle learning curve where we, reconsidered, how we could take care of people, even if we couldn't see them in person. And so we learned a lot. And one thing we learned is that, patients are usually available on their phone or on the computer when they say they are, it's a lot easier for them than coming into the taking a day off of work waiting too long in Buffalo. Sometimes snow gets in the way. So, our ability to see people regularly as we like to is improved with a virtual component. So I think in some ways it's made the job easier. The technology is a moving target.
Joey Wahler (Host): And obviously it's benefited patients as well. So you alluded earlier briefly to a remote monitoring team. What exactly do they do?
Dr Ellen Rich: So in our case, the team is really focused on, I would say three elements of the patient's care. One is, education. So nurses will, when the patients are enrolled in the program, spend 30 to 60 minutes, not just getting the technology straight, but going over. what does it mean to have high blood pressure? Why is it important? What the medications are expected to do? What can the patient do on their end? as far as diet and exercise, to try and improve their high blood pressure. The more they do, maybe the less medicine that they need. So that is one component of the team. And nursing plays a very big role in that.
The monitoring component is done by our management team, which is also a nursing team. And that team has learned to identify problems with blood pressure control, reach out to the patient first as the first line, before going to the physician and really investigating why things. The way that they are, for example, did you forget your medicine or did you have a particularly salty meal the day prior? Is there something going on in your life that's making you very stressed and so your blood pressure's up? And that team by contacting the patient when the blood pressure's too high.
They really educate the patient about what are the things that are making their chronic medical condition worse. And so that, again is a nursing role. I think those are the two, biggest members of the team in terms of interacting with the patients. And then of course, we have the physicians who when appropriate, we are making medication adjustments and reinforcing things about taking your medicine regularly, as well. So that is our team really.
Joey Wahler (Host): So aside from convenience, which is certainly a big benefit, would you say the main benefit of this remote program, Dr. Rich is the fact that it means someone else professionally is always minding the store here, so to speak when it comes to a patient's blood pressure?
Dr Ellen Rich: One of the reasons that we took on this very big initiative here is that there are a lot of studies that have looked at. Blood pressure monitoring in particular. And what they've found is that exactly. If someone's paying attention, and if your education about your medical condition has been reinforced by frequent contact, that patients are more likely to take their medications. They're more likely to stay engaged with their overall health, which means diet and exercise, and probably taking their other medicines.
And the enhanced monitoring also, I think gives physicians some confidence in making medication changes. And what I mean by that is all of these data points. All of this information, gives us patterns that we feel like we can rely on. And so we're more likely to make a change that will benefit a patient between visits for example, and they don't have to wait as long for their medical problem to be controlled.
Joey Wahler (Host): And you led me with that into this, which is a question about how this can enhance a patient's care with specialists? I would imagine one key there is what you just mentioned, the fact that information, data that you're turning over to other doctors you can rely upon it because it's your info, right?
Dr Ellen Rich: Lot of our patients have complex medical conditions that often require more than one type of doctor. So as a specific example, we have a lot of patients with kidney disease and kidney problems who have a kidney doctor. And when we're co-managing or both caring for the patient, we have these data points. Sometimes the kidney doctor is actually the one who's managing the medicines more than we are. So we're partnering with them to give them that information so that they also can make more informed decisions, regarding changes for their patients.
Joey Wahler (Host): Understood. And so in summation here, doctor, what's your message overall for those listening that are considering remote monitoring for high blood pressure or at least, thinking about looking into it?
Dr Ellen Rich: We certainly talk to patients who are feeling a bit reluctant. And, I guess my message is one thing that we've learned here at ECMC so far in the several months that we've been doing this, a large percentage of the patients who've entered the program, their blood pressure is now under very good control. And they are feeling very satisfied that a problem that they would come to the office and the doctor would say, well, we're not where we need to be now is very well controlled. They have confidence in the blood pressures because we've given them a validated cuff.
We have confidence and they're engaged. And while it might feel, like a lot to take on. I think if patients give it a try, and have that feeling of accomplishment and satisfaction that this chronic medical condition is controlled that they'll be very happy with that.
Joey Wahler (Host): Indeed sounds very promising. Well, folks we trust you're now more familiar with remote monitoring for hypertension, Dr. Ellen Rich. Thanks so much.
Dr Ellen Rich: Thank you for having me.
Joey Wahler (Host): And to reach Erie County Medical Centers, internal medicine center, please do call 716-898-3152 again, 716-898-3152. Or visit ecmc.edu. Again, ecmc.edu. If you found this podcast helpful, please share it on your social media. And thanks again for listening to True Care HealthCast a podcast from Erie County Medical Center, hoping your health is good health. I'm Joey Wahler.
Joey Wahler (Host): Hypertension or high blood pressure is a chronic condition for many, and now medical personnel can monitor your blood pressure from their office while you are elsewhere. So we're discussing the benefits of remote patient monitoring for hypertension. This is True Care HealthCast, a podcast from Erie County Medical Center. Thanks for listening. I'm Joey Wahler, our guest, Dr. Ellen Rich, she's medical director at Erie County Medical Center's internal medicine center and associate professor of clinical medicine at the Jacobs School of Medicine and Biomedical Sciences. Dr. Rich, thanks for joining.
Dr Ellen Rich: Thank you for having me.
Joey Wahler (Host): So first, why is hypertension such an important chronic medical condition in the first place?
Dr Ellen Rich: So, first of all, it's very common. So we know a lot of people have it. And when there are chronic medical conditions that are common, we have a better chance of reducing the long term harms to a person, because we have a lot more information about how to help them. So hypertension is one of the risk factors for heart attack and stroke. And there's an incredible amount of evidence that by getting blood pressure into a individual's target goal blood pressure that we can reduce their risk of heart attack and stroke by anywhere from 30 to 50%, which is a highly effective, result. If we can do our job well.
Joey Wahler (Host): Wow. Sounds like it is. And so obviously if left undiagnosed or untreated high blood pressure can be dangerous?
Dr Ellen Rich: It's very dangerous, particularly because people. Experience symptoms from hypertension alone. People can have elevated blood pressure that's causing stress on their blood vessels and their heart and their kidney for many years, without even experiencing shortness of breath or a headache until it's far down the line in terms of having harmed their body. So, that's one of the reasons we want people to come to the doctor initially, to have their blood pressure checked by a healthcare professional. So that we can identify people who need their blood pressure treated.
Joey Wahler (Host): Gotcha. So let's get into this topic now. How exactly does a remote monitoring work?
Dr Ellen Rich: So in general, the idea is that a patient will check their blood pressures at home and that information will be transmitted to their doctor's office and followed remotely. In our particular case, we have purchased blood pressure cuffs that have been shown to be reliable. We give that to the patient along with education about how to check your blood pressure properly and when to check it. The blood pressure cuff then, transmits the information when the patient checks their blood pressure to an app on their phone, that then goes to a database.
And one of our nurse care managers monitors the database to look for any abnormalities, too high or too low blood pressures. And we're able to manage the blood pressures in between visits because we have regular information. And then we also have what we call virtual follow up visits to review how it's going with patients. And to have a healthcare professional, usually a physician, look at their blood pressure trends since they have started the program.
Joey Wahler (Host): And so to backtrack for a moment, you mentioned a monitoring cuff, and that goes on the wrist?
Dr Ellen Rich: It goes on the upper arm, so the cuffs that we use a person can manage with one hand. And then you hit a button and it's automatically fills up with pressure. Measures the blood pressure. And then there, is technology in the blood pressure cuff to transmit that number to the app on the patient's phone.
Joey Wahler (Host): And so there is still participation by the patient on the other end to initiate this?
Dr Ellen Rich: Yes. So patients need to participate in the program. So we ask them to check their blood pressure at least once a day, sometimes twice. And if they haven't been able to do that on a regular basis, we also are checking the database and we'll reach out to the patient to find out if there's any issues or concerns on their part. Trouble with the technology or loss of motivation, or misunderstanding so that we can make sure that we are following them appropriately. If they're in the program, we felt that they needed to be monitored more closely because they weren't achieving their blood pressure control goals, in the usual way.
Joey Wahler (Host): Gotcha. And so it's done how many times daily?
Dr Ellen Rich: Generally we're asking patients to do it once. There are some remote programs that have patients do it twice a day for a week and then take a week off. But we've opted for once a day.
Joey Wahler (Host): And so you mentioned some of the technology involved. There's an app that obviously is on a patient's phone. So for those that are more technologically challenged, even today, for those that may be older or out of the loop, what happens there?
Dr Ellen Rich: So we really try to ensure that people understand what is gonna be required to participate in this program. And the older population, many people have smartphones. So we actually have them come in with their smartphone. We download the app for them. We demonstrate how it works. And we also coach them on how to become engaged in a virtual visit, which usually requires, opening up a link either on a text message or on an email so that we can also have, the virtual visit component of our program, work to the best of its potential.
Joey Wahler (Host): So before. Go any further on some of the remaining specifics about this program, just as a doctor in general, we're talking about virtual visits to explain how the program works. We're talking about using an app on the phone for home monitoring. How much easier have things like this in recent years made your job?
Dr Ellen Rich: I don't think we utilized this technology very often prior to COVID. And C forced us all into a rapid cycle learning curve where we, reconsidered, how we could take care of people, even if we couldn't see them in person. And so we learned a lot. And one thing we learned is that, patients are usually available on their phone or on the computer when they say they are, it's a lot easier for them than coming into the taking a day off of work waiting too long in Buffalo. Sometimes snow gets in the way. So, our ability to see people regularly as we like to is improved with a virtual component. So I think in some ways it's made the job easier. The technology is a moving target.
Joey Wahler (Host): And obviously it's benefited patients as well. So you alluded earlier briefly to a remote monitoring team. What exactly do they do?
Dr Ellen Rich: So in our case, the team is really focused on, I would say three elements of the patient's care. One is, education. So nurses will, when the patients are enrolled in the program, spend 30 to 60 minutes, not just getting the technology straight, but going over. what does it mean to have high blood pressure? Why is it important? What the medications are expected to do? What can the patient do on their end? as far as diet and exercise, to try and improve their high blood pressure. The more they do, maybe the less medicine that they need. So that is one component of the team. And nursing plays a very big role in that.
The monitoring component is done by our management team, which is also a nursing team. And that team has learned to identify problems with blood pressure control, reach out to the patient first as the first line, before going to the physician and really investigating why things. The way that they are, for example, did you forget your medicine or did you have a particularly salty meal the day prior? Is there something going on in your life that's making you very stressed and so your blood pressure's up? And that team by contacting the patient when the blood pressure's too high.
They really educate the patient about what are the things that are making their chronic medical condition worse. And so that, again is a nursing role. I think those are the two, biggest members of the team in terms of interacting with the patients. And then of course, we have the physicians who when appropriate, we are making medication adjustments and reinforcing things about taking your medicine regularly, as well. So that is our team really.
Joey Wahler (Host): So aside from convenience, which is certainly a big benefit, would you say the main benefit of this remote program, Dr. Rich is the fact that it means someone else professionally is always minding the store here, so to speak when it comes to a patient's blood pressure?
Dr Ellen Rich: One of the reasons that we took on this very big initiative here is that there are a lot of studies that have looked at. Blood pressure monitoring in particular. And what they've found is that exactly. If someone's paying attention, and if your education about your medical condition has been reinforced by frequent contact, that patients are more likely to take their medications. They're more likely to stay engaged with their overall health, which means diet and exercise, and probably taking their other medicines.
And the enhanced monitoring also, I think gives physicians some confidence in making medication changes. And what I mean by that is all of these data points. All of this information, gives us patterns that we feel like we can rely on. And so we're more likely to make a change that will benefit a patient between visits for example, and they don't have to wait as long for their medical problem to be controlled.
Joey Wahler (Host): And you led me with that into this, which is a question about how this can enhance a patient's care with specialists? I would imagine one key there is what you just mentioned, the fact that information, data that you're turning over to other doctors you can rely upon it because it's your info, right?
Dr Ellen Rich: Lot of our patients have complex medical conditions that often require more than one type of doctor. So as a specific example, we have a lot of patients with kidney disease and kidney problems who have a kidney doctor. And when we're co-managing or both caring for the patient, we have these data points. Sometimes the kidney doctor is actually the one who's managing the medicines more than we are. So we're partnering with them to give them that information so that they also can make more informed decisions, regarding changes for their patients.
Joey Wahler (Host): Understood. And so in summation here, doctor, what's your message overall for those listening that are considering remote monitoring for high blood pressure or at least, thinking about looking into it?
Dr Ellen Rich: We certainly talk to patients who are feeling a bit reluctant. And, I guess my message is one thing that we've learned here at ECMC so far in the several months that we've been doing this, a large percentage of the patients who've entered the program, their blood pressure is now under very good control. And they are feeling very satisfied that a problem that they would come to the office and the doctor would say, well, we're not where we need to be now is very well controlled. They have confidence in the blood pressures because we've given them a validated cuff.
We have confidence and they're engaged. And while it might feel, like a lot to take on. I think if patients give it a try, and have that feeling of accomplishment and satisfaction that this chronic medical condition is controlled that they'll be very happy with that.
Joey Wahler (Host): Indeed sounds very promising. Well, folks we trust you're now more familiar with remote monitoring for hypertension, Dr. Ellen Rich. Thanks so much.
Dr Ellen Rich: Thank you for having me.
Joey Wahler (Host): And to reach Erie County Medical Centers, internal medicine center, please do call 716-898-3152 again, 716-898-3152. Or visit ecmc.edu. Again, ecmc.edu. If you found this podcast helpful, please share it on your social media. And thanks again for listening to True Care HealthCast a podcast from Erie County Medical Center, hoping your health is good health. I'm Joey Wahler.