Clinical integration has many facets, each required to ensure success: collaborative leadership, aligned incentives and stakeholder support, realistic clinical programs (actionable data and metrics, management, protocols), technology infrastructure that is neutral to EMR or vendor choice.

This presentation outlining practical experiences from implementing real-world programs with clinical integration as a focus was given to the National Institute for Healthcare Leadership Forum held in Phoenix Arizona on October 19th, 2017.

Lv N, Xiao L, Simmons ML, Rosas LG, Chan A, Entwistle M

J Med Internet Res 2017;19(9):e311

Background: EMPOWER-H (Engaging and Motivating Patients Online With Enhanced Resources-Hypertension) is a personalized-care model facilitating engagement in hypertension self-management utilizing an interactive Web-based disease management system integrated with the electronic health record. The model is designed to support timely patient-provider interaction by incorporating decision support technology to individualize care and provide personalized feedback for patients with chronic disease. Central to this process were patient-generated health data, including blood pressure (BP), weight, and lifestyle behaviors, which were uploaded using a smartphone.

Objective: The aim of this study was to evaluate the program among patients within primary care already under management for hypertension and with uncontrolled BP.

Methods: Using a 6-month pre-post design, outcome measures included office-measured and home-monitored BP, office-measured weight, intervention contacts, diet, physical activity, smoking, knowledge, and health-related quality of life.

Results: At 6 months, 55.9% of participants (N=149) achieved office BP goals (<140/90 mm Hg; P<.001) and 86.0% achieved clinically meaningful reduction in office BP (reduction in systolic BP [SBP] =5 mm Hg or diastolic BP [DBP] =3 mm Hg). At baseline, 25.2% of participants met home BP goals (<135/85 mm Hg), and this percentage significantly increased to 71.4% (P<.001) at 6 months. EMPOWER-H also significantly reduced both office and home SBP and DBP, decreased office-measured weight and consumption of high-salt and high-fat foods (all P<.005), and increased intake of fruit and vegetables, minutes of aerobic exercise, and hypertension knowledge (all P<.05). Patients with higher home BP upload frequencies had significantly higher odds of achieving home BP goals. Patients receiving more total intervention, behavioral, pharmaceutical contacts had significantly lower odds of achieving home BP goals but higher improvements in office BP (all P<.05).

Conclusions: EMPOWER-H significantly improved participants’ office-measured and home-monitored BP, weight, and lifestyle behaviors, suggesting that technologically enabled BP home-monitoring, with structured use of patient-generated health data and a personalized care-plan facilitating patient engagement, can support effective clinical management. The experience gained in this study provides support for the feasibility and value of using carefully managed patient-generated health data in the day-to-day clinical management of patients with chronic conditions. A large-scale, real-world study to evaluate sustained effectiveness, cost-effectiveness, and scalability is warranted.

This is a YouTube video from a keynote presentation given at TiEcon 2014 - Healthcare 2025; "Disruptive changes to the way healthcare is practiced".

This paper, published by HL7 New Zealand, provides a personal view of highlights from the Health Information Management Systems Society Conference (HIMSS) 2017, which took place in Orlando Florida February 19-23, 2017.