Partners HealthCare is teaming up with one of the state's largest employers in an experiment to see whether they can improve employees' health and, ideally, reduce medical costs by monitoring workers' high blood pressure over the Internet.
A computer program will analyze their results and provide automated feedback and advice weekly on a secure website; researchers will e-mail or call employees whose readings climb particularly high. They will be compared with 200 employees in a control group, to see if electronic monitoring and feedback lead to lower blood pressure.
The blood pressure initiative is part of a major investment in telemedicine by Partners, the largest healthcare provider in Massachusetts and the parent company of Massachusetts General and Brigham and Women's hospitals. In January, the organization decided to double its investment in this field to $6 million over four years, to pay for telemedicine programs for diabetes, emphysema, and depression, as well as the blood pressure trial.
The study with EMC is the first time Partners has joined with a large employer on a telemedicine initiative and will be the organization's largest clinical trial of digital healthcare.
Hospital executives believe that a growing number of patients with chronic conditions or who live in remote locations will be monitored and treated by doctors who receive data about their illness electronically and consult via live video transmissions. In some cases, the technology allows more frequent contact and faster intervention than an in-person visit.
A growing number of hospitals are investing in telemedicine, including the Cleveland Clinic, where patients can get second opinions online. UMass Memorial Health Care in Worcester has partnered with a private company to establish an eICU, in which doctors at a central location monitor patients electronically in intensive care units at various hospitals. Mass. General physicians read brain scans over the Internet and consult over live video hookups with community hospitals treating stroke patients. Partners monitors about 80 congestive heart failure patients at home, with their weight and blood pressure readings transmitted to nurses electronically.
The blood pressure study is scheduled to begin next month. EMC executives, who say they have cut medical costs through other innovative programs, said they want to use EMC's influence as a large company to spread technologies that improve people's health.
The partnership grew out of a conversation about three years ago at a dinner party, when Dr. Thomas Lee, head of Partners' physicians group, sat next to EMC's Jack Mollen, now executive vice president for human resources.
Lee said that while millions of Americans have hypertension, the leading cause of strokes and one of the most important risk factors for heart attacks, one-third of those people consistently lowered their blood pressure into the normal range. "The other two-thirds are either not taking their pills, haven't been diagnosed, or are not going back to the doctor to have it checked," he said.
In the study, researchers will test whether frequent feedback to those being monitored will succeed in getting employees to do more to control their hypertension. Full-time employees between the ages of 30 and 65 who have been diagnosed with hypertension or prehypertension qualify.
Two hundred employees will get blood pressure cuffs that will automatically send readings to Partners through a wireless device attached to their phones. The employees must agree to take their blood pressure at least twice a week and to log onto a secure website at least once a week to see graphs of their blood pressure over time and receive feedback. That may include advice such as: "All of your recent readings have been high. Many people need more than one medication to get the best results for controlling their hypertension. You and your doctor need to keep working to find the best combination for you."
Two hundred other employees will receive educational materials on controlling high blood pressure. People in both groups will continue seeing their regular doctors. After six months, Partners will compare the two groups to see whether more of the employees in the monitored group lowered their blood pressure.
Lee said that patients who take their own blood pressure and then report it to their doctors tend to "put an optimistic spin" on it, so the automatic transmission of readings will improve accuracy. And patients' blood pressure levels during office visits are often higher than their normal blood pressure, making in-office monitoring challenging, he said.
"The model of people going to the doctor to find out what their blood pressure is and the doctor responding to that, that is clearly not the right model," he said. "Even when they come to the doctor for their one reading, it might just be bad that day, or the patient might be scared.
"Blood pressure jumps around all the time." Lee said. "You can easily be misled. To me, the ideal is to get more data."
EMC executives said they don't know what percentage of their 31,000 employees worldwide have high blood pressure; the company has 8,600 Massachusetts employees.
At EMC, healthcare costs soared 12 to 15 percent a year during the early 2000s. Executives consolidated insurers to get better deals and slightly raised workers' copayments for doctor and emergency room visits.
But the company also adopted more innovative programs to help employees improve their health in the belief that doing so would rein in costs.
Workers were given personal health records "to heighten awareness of the true cost of healthcare," said Delia Vetter, EMC's senior director of benefits and programs.
Employees' individual records include data on how much the company and the employee have spent on that person's medical care, personalized messages about preventing heart attacks and other illnesses the employee is at risk for, reminders to have mammograms and prostate cancer screenings, and alerts about dangerous drug interactions.
The company also enrolled 7,000 employees in a diet program and said that 130 with hypertension, diabetes, and high cholesterol who closely followed the regimen reduced medical costs for themselves and the company by about $700 each in the first year.
Overall, health care costs at EMC are growing about 7 percent annually, compared with about 10 percent statewide.
"Hypertension is the beginning of something that could be very catastrophic if it's not managed properly, and the majority of folks who have it are not managing it adequately," Vetter said.
"If they're managing their blood pressure," she said, "we're not going to see a $400,000 claim several years from now for open-heart surgery."