Ochsner’s “O Bar” Opens Up the Path to Improved Outcomes in Chronic Disease

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Modeled after the Apple Genius Bar, these consumer-oriented digital health hubs help patients take steps towards more comprehensive health tracking.  

Lisinopril 20 mg once a day, an iPhone app, and a bluetooth blood pressure cuff might be the next prescription coming from primary care doctors at Ochsner Health System in Louisiana. That’s thanks in part to a new initiative called “O Bar”. Modeled after Apple’s Genius Bars, each O Bar features a helpful technology specialist and an array of smartphone-connected blood pressure cuffs, glucose monitors, scales, apps and Fitbits to help patients manage chronic diseases like CHF, hypertension and diabetes – with a modern twist.

Patients at the O Bar learn about managing their disease, and link their new devices to their smartphones. Apps and settings are configured so that they’ll beam information back to Ochsner, where care coordinators and clinical pharmacists will assess progress using CHF, hypertension and diabetes guidelines, and fine-tune their drug regimens accordingly.

Dr. Richard Milani, a cardiologist and Chief Clinical Transformation officer for Ochsner Health System, spearheaded the project in an effort to improve chronic disease management, which accounts for so many emergency department visits, re-visits, hospitalizations and deaths.
While sleek and modern, the O Bars themselves are not revolutionary – they are just an eye-catching front-end of a sophisticated operation. On the back end, based on patient data feeds, Ochsner has developed proprietary tools in their EHR to regularly report on those at risk. Patients whose blood sugars fall outside parameters, or CHF patients who are not sending new data from their wifi scales, are highlighted. Ochsner mingles those updates with background information on their patients, from medical risk factors to health literacy. Even details about transportation capabilities and disposable income make it into the risk analysis. It’s all weighted and plugged into a calculation of who is most at risk, and who needs the most attention.

Every day, the Ochsner Digital Medicine team reviews the data feeds and reaches out to patients most at risk. Is there a technical issue blocking the flow of data? Is there a quick fix to explain why a patient’s numbers are off? Care managers can help with prescriptions, transportation to clinics, and other things that may keep a chronically ill person off-balance. Health coaches can motivate, answer questions and assess progress on nutrition and fitness. And Ochsner’s clinical pharmacists can adjust medication dosing to help keep blood sugars, blood pressure and edema in check.

With these traditionally non-adherent patients transmitting data and getting special attention, Ochsner Health said compliance with care management goals rises from 50% to 66% in just the first 30 days after an O Bar visit. Re-admissions in CHF patients sent home with wifi scales are down 44%, and improvements in diabetes and blood pressure control among patients have also been observed.

The O Bar, for all its preliminary successes, is losing money overall because of operating costs, but Ochsner thinks it’s well worth it considering the benefit to their patients and wider community. And then there’s the monies associated with meeting benchmarks and realizing incentive payments for keeping patients healthy and reducing exacerbations of chronic disease. Regardless, patients using the O Bar can save money, because Ochsner negotiates with manufacturers; an app-controlled connected blood-pressure cuff sells for $40 at the O Bar, but at Best Buy or on Amazon it’d retail for $135.

Any hospital system willing to set aside a space in a clinic, staff it with a few friendly technicians and showcase an array of validated apps and devices can start a similar program. The biggest challenge will be developing the infrastructure to collect and process information from the apps and devices – and make sense of it. Coaching, managing and adjusting regimens based on data and risk – it’s those algorithms and practices that help Ochsner keep patients adherent and out of the hospital.

ABOUT THE AUTHORS

Editor At Large
A specialist in emergency medicine informatics at Mount Sinai in Manhattan, Dr. Genes is EPM's resident tech guru. He practices emergency medicine at Mount Sinai Hospital but can be found sharing his wit and wisdom all over the web.

SUB-EDITOR
Dr. Lacocque is an emergency medicine resident at Midwestern University in Chicago and serves as the EMS Section Editor for EM Resident Magazine, EMRA’s official publication.

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