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Partners HealthCare Center for Connected Health

Joseph Ternullo, JD, MPH, Kamal Jethwani, MD, MPH,

Susan Lane, RN, MBA, Khinlei Myint-U, MBA,

Robert Havasy, BS, MS Candidate, Michael Carter, BS,

and Joseph Kvedar, MD

Partners HealthCare Center for Connected Health, Boston,

Massachusetts.

AbstractThis article reviews the history, current status, and future plans of the

Partners HealthCare Center for Connected Health (the Center). Estab-

lished in 1995 by Harvard Medical School teaching hospitals, the

Center develops strategies to move healthcare from the hospital and

doctors office into the day-to-day lives of patients. It leverages infor-

mation technology to help manage chronic conditions, maintain health

and wellness, and improve adherence to prescribed regimen, patient

engagement, and clinical outcomes. Since inception, it has served over

30,000 patients. The Centers core functions include videoconference-

based real-time virtual visits, home vital sign monitoring, store-and-

forward online consultations, social media, mobile technology, and

other novel methods of providing careand enabling health and wellness

remotely and independently of traditional time and geographic con-

straints. It offers a wide range of services, programs, and research

activities. The Center comprises over 40 professionals with varioustechnical and professional skills. Internally within Partners Health-

Care, the role of the Center is to collaborate, guide, advise, and support

the experimentation with and the deployment and growth of connected

health technologies, programs, and services. Annually, the Center en-

gages in a deliberative planning process to guide its annual research

and operationalagenda. The Center enjoysa diversifiedrevenue stream.

Funding sources include institutional operating budget/research funds

from Partners HealthCare, public and private competitive grants and

contracts, philanthropic contributions, ad hoc funding arrangements,

and longer-term contractual arrangements with third parties.

Key words: videoconference-based real-time virtual visits, home

vital sign monitoring, store-and-forward online consultations, socialmedia, mobile technology, self-management

Overview

Established in 1995 by Harvard Medical School teaching

hospitals, the Center for Connected Health at Partners

HealthCare System (the Center) in Boston, MA, develops new

strategies to move healthcare from the hospital and doctors

offices into the day-to-day lives of patients. Anticipating the inevi-

table shift of the locus of care from the provider to the person, the

Center leverages information technologycell phones, sensors,

computers, networked devices, and simple remote monitoring tools

to help providers and patients manage chronic conditions, maintain

health and wellness, improve adherence to medical and lifestyle

regimen, and increase patient involvement in managing their health

and clinical outcomes. Since its inception in 1995, it has served over

30,000 patients. The Center evaluates new technologies and also

conducts feasibility studies and randomized controlled clinical trials.

Its efforts are guided by practical considerations, including an em-

phasis on what works and what does not. Its ultimate goal is to change

the way doctors and nurses deliver clinical services and to enable

patients to manage their own health. The Centers mission focuses on

education, community service, and clinical excellence. Among its

recurring educational activities is an annual 2-day meeting (http://

symposium.connected-health.org/). It attracts a global audience of

over 1,200 health professionals (from academia and community-based

practices), hospital and health plan administrators, researchers, large

employers, entrepreneurs, government policy makers, health tech-

nology business executives, investors, and media representatives. This

forum has been instrumental in forging relationships and collabora-

tion across a broad spectrum of gatekeepers in this community.

Priority Focus AreasThe Center has an enduring commitment to developing new and

nontraditional technology-based avenues to enhance access to care.These include videoconference-based real-time virtual visits, home

vital sign monitoring, store-and-forward online consultations, and

other methods for providing care and enabling health and wellness,

including social media and mobile technology.

In its early days, the Centers mission was limited to remote access

to specialty care. The objective was to serve as an institutional spe-

cialty resource for Partners HealthCare. Today, the Center has ex-

panded the scope of its activities to incorporate enabling healthcare

innovation and new methods of access.

Among the Centers current priorities is to facilitate an orderly

shift in the locus of care from traditional settings to the patients

environment by facilitating wellness through self-management tools

that encourage individuals to take an active and engaged role in theirhealth and wellness. These tools include targeted education and

feedback that encourage healthy lifestyle and are applied in several

chronic conditions, including obesity, hypertension, and diabetes.

Range of ServicesRESEARCH

The Centers research team tries to focus on identifying innova-

tive ways to address challenging problems in healthcare delivery. Its

research portfolio includes feasibility pilots, one-arm trials with

DOI: 10.1089/tmj.2012.0294 M A R Y A N N L I E B E R T , I N C . V O L . 1 9 N O . 5 M A Y 2 0 1 3 TELEMEDICINE and e-HEALTH 363

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matched control samples, and randomized controlled trials. Some

projects are commissioned and funded internally at the Center or

through interdepartmental collaborations with Partners HealthCare

System and affiliated colleagues. Others are funded through com-

petitive governmental and industry-sponsored grant and contract

applications. A selected sampling of current and past projects1 in-cludes smartphone apps that incorporate the use of sensors and be-

havior feedback, promoting lifestyle modifications in individuals

with chronic diseases, such as:

. text messaging, empowering patients with chronic illness to

increase physical activity2

. in-home sensors and algorithm-driven feedback, preventing

falls in home-bound populations

. improving medication adherence via a device placed in a per-

sons home

. deploying social media tools to improve follow-up and reduce

exacerbations in teens with asthma3

. building a predictive model using behavioral characteristics tostratify patients with heart failure by risk of re-admission

. a user-friendly Web-based return on investment tool, demon-

strating the cost savings of remote telemonitoring in patients

with congestive heart failure.

This research program constitutes an essential component of the

Center.

ADVISORY

Since its inception, the Center has met with numerous technology

developers, contracted with several of them, with a consistent focus

on prudent investment in technology, one that has the maximal ef-

fect on quality of care and health outcomes. The Center works with

providers, payers, not-for-profits organizations, technologists, en-

trepreneurs, and innovators in the following advisory ways:

. Assisting in the design, development, and evaluation of con-

nected health programs tailored to specific conditions, specific

populations, and specific settings. Representative examples

include advising on videoconferencing-based virtual visits,

e-visits, customized text-messaging programs for clinical use,

provider-to-provider telemedicine case consultations, and re-

mote monitoring of various medical conditions.

. Use of the Centers proprietary Technical Evaluation Meth-

odologies for evaluating connected health tools (devices and

solutions) and mobile applications (apps)

. Convening patients, clinical end-users, and other experts toprovide feedback and insights on proposed connected health

products and services

. Convening 2-hour, intensive, fast-paced engagements known

as red team reviews. These are geared towards start-ups that

are developing innovative and disruptive solutions to deliver

care. Proposed solutions are presented to the Center. It, in turn,

provides immediate clinical, research, business, technical, and

customer engagement/support feedback. A venture capitalist

also participate each red team review.

PROGRAMS

The Center has ongoing programs in heart failure, hypertension

diabetes, and other chronic conditions, as well as online second

opinion program and enhanced medical education and training ac

tivities that have been integrated across the Partners HealthCare

network. Some of these programs are highlighted below:

. Diabetes Connect and Blood Pressure Connect. These program

offer patients and their care providers a way to keep track o

their blood sugar and blood pressure readings, respectively,4,

and to collaborate on a care plan between office visits. Almost

1,000 patients in the Partners HealthCare System have been

enrolled by their providers into these programs.

. Connected Cardiac Care. This is a home telemonitoring and

education program for patients with heart failure who are a

risk for hospitalization. The program involves daily vital sign

monitoring and uses just in time education and care coordi-

nation to keep patients at home.

. Partners online specialty consultations. This program offerpatients and their treating physicians worldwide online access

to leading specialists at Massachusetts General Hospital, Brig-

ham and Womens Hospital, and Dana-Farber/Partners Cance

Care. In the majority of cases, the specialist consultant would

offer an alternative diagnosis, treatment plan, or treatmen

options.6 The service is offered as a benefit to members o

employees of interested employers, payers, and benefit man

agement organizations.

. Mobile health. Using technology already in most patients

hands, the mobile health initiatives provide personalized, in-

teractive, multilanguage education, and reminders to divers

patient populations. At-risk patients in urban community

health centers are receiving messages for a healthy pregnancyfrom their obstetrical team and midwives. Pregnant patient

about to deliver at the Brigham and Womens Hospital will be

getting ready for discharge at 32 weeks with targeted edu-

cational information. Appointment reminders, supportive

messaging, and educational content are provided to larg

populations of patients to help keep them connected and en

gaged as they go about their daily lives.

. Collaborative media services. Since the Centers inception, this

team has provided videoconferencing and streaming media

services that facilitate clinical interactions and teaching and

learning for clinicians and patients worldwide. The Center

technical expertise includes podcasting and Web conferencing

streaming media hosting, and cross-platform video on demand

Role of Connected Health at PartnersHealthCare System

The Center is a division within the Information Systems Depart-

ment of Partners HealthCare. Partners HealthCare is a not-for-profit

integrated healthcare system in Boston. Founded in 1994 by Brigham

and Womens Hospital and Massachusetts General Hospital, Partner

HealthCare includes community and specialty hospitals, a physician

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network, community health centers, homecare,

and other health-related services. With ap-

proximately 60,000 employeesincluding

physicians, nurses, scientists, and caregivers

Partners is the largest private employer in

Massachusetts. The Partners institutionsmaintain a total research budget of more than

$1.4 billion.

The Center has a current staff of 45 em-

ployees. It is situated at the Partners corporate

level and is a strategic and priority area of

interest for Partners in helping to fulfill its

mission of teaching, patient care, research, and

community service.

The Center serves as an enterprise-wide

knowledge repository and center of connected

health activities and works extensively with

other service areas throughout Partners. These

include community health centers, Partners

HealthCare at Home, departments of psychia-

try, dermatology, neurology, medicine, and

surgery, Partners International, and Partners

Community Health.

The Beacon Hill Telemedicine initiative is an example of an in-

ternal collaboration at Partners HealthCare that has created a con-

venient avenue of access to care for patients. This initiative, one of

the Centers Virtual Visit programs, was developed in collaboration

with The Beacon Hill primary care clinical practice at Massachusetts

General Hospital. It uses videoconferencing technology to alleviate

the burdenof travelto an urban centerfor follow-up appointments. It

is secured by a Web application called BlueJeans (Fig. 1). Patients areable to interact with their Boston-based care team at the Beacon Hill

practice directly from their own homes in suburban Greater Boston

using their home computers.

ImpactThe Center currently provides connected health services through

its chronic care management programs, as follows:

. Connected Cardiac Care. This program, currently in its 7th year

of operation and developed and operated in conjunction with

Partners HealthCare at Home, serves approximately 400 con-

gestive heart failure patients per year. Over the years, the pro-

gram has demonstrated a 50% reduction in re-admission rates,translating to about $1 million in savings for the system. In

addition, the program has demonstrated high rates of satisfac-

tion with both providers and patients. In a recent survey with

cardiologists and other referring physicians, a greater than 90%

satisfaction rate of the program in its current form was reported.

Similarly, more than 90% physicians reported that they would

recommend the program to others. The Centers current work on

this program involves efforts to improve efficiency by triaging

patients into subprograms of different intensities, based on

disease severity. The Center is also considering the feasibility of

expanding the program to other cardiac diseases such as post-

myocardial infarction, atrial fibrillation, etc.

. Diabetes Connect. This program has served almost 1,000

patients with type 2 diabetes. Patients are expected to upload

their blood glucose readings and view their trends online. The

Center found that hemoglobin A1c was reduced by almost 1.5

% among active patients and 0.8% among the inactive, within 1year of starting on the program.4 These results have led to a

focus on patient and provider engagement and to operations to

reduce effort and ability of patients and providers to improve

adoption and engagement.

. Blood Pressure Connect. Blood Pressure Connect aims at en-

abling patients to maintain their blood pressure levels through a

Web-based program. Overall, systolic pressure decreased by

6 mm Hg (95% confidence interval, 48 mm Hg; p< 0.0001).

The effect was most pronounced in those with baseline blood

pressure over 160 mm Hg (25 mm Hg; 95% confidence interval,

1832 mm Hg; p

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The Center has evaluated the impact of simplifying technology on

clinical outcomes, operational efficiency, and rates of adoption. A

small clinical pilot compared the use of wireless mobile technol-

ogy with landline connections. It revealed that patients measured

themselves more frequently when given wireless technology (me-

dian, 0.66 versus 0.20; p=0.013). These patients also uploaded theirreadings sooner (within 4 days versus 7 days; p=0.017) and more

frequently (median, 0.46 versus 0.1; p= 0.0001).7 As a result, the

Center is gradually incorporating wireless mobile technologies

wherever appropriate and triaging the most difficult patients to these

technologies.

Business Model and SustainabilitySince itsinception, theCenter hasengaged in a planning process to

guide its annual research and operational agendas. Strategic goals

and departmental priorities are established for the year, and a longer-

term vision is set for the ensuing 35 years. All of the Centers ac-

tivities, whether contemplated, in process, or ongoing, must advance

the Centers mission in teaching, patient care, research, or community

service. The strategic roadmap is reviewed regularly, and progress is

monitored on an ongoing basis. Modifications are made upon the

consent of the Centers management team.

From a financial perspective, the Centers guiding principle has

been to strive toward a diversified revenue stream. To meet this ob-

jective and avoid a concentrated revenue source risk, the Center has

sought to cast a wide operational and relationship net and deliver

value and attract support from a broad cross-section of stakeholders,

as described below.

Several of the Centers programs are supported via internal insti-

tutional funds. These programs are considered important tools to aid

Partners in achieving better population health and chronic illnessmanagement. In addition to institutional funding, which accounts,

variously, for approximately 3340% of the Centers annual oper-

ating costs, the Center has been the recipient of public and private

competitive grants and contracts, philanthropic giving, ad hoc

funding arrangements, and other, longer-term contractual arrange-

ments, of both the annual retainer and pay-as-you-go, fee-for-

service nature. Several of its third-party contractual relationships are

long term, 10 years or more in duration.

The Centerhas enjoyed long-term loyalty andcommitment among

its staff. This represented an operational asset that has aided the

Centerin its business planning andoperationalgrowth. In addition to

its staff, the Center has relied upon several consultants and the advice

and support of senior leadership within Partners HealthCare, physi-cian, nursing, and allied health clinical champions, and third-party

governmental, academic, and industrial supporters. The Center has

maintained an active presence and involvement in various trade

associations and professional societies. This has added to the con-

tinuous learning environment and an ever-growing network of

contacts and collaborators.

All of the Centers activities are categorized among the following

six business units: (1) research, (2) connected health initiatives, (3)

collaborative media, (4) public events and policy, (5) advisory ser-

vices, and (6) online consultations. For each business unit, the goal i

service excellence and break-even operations. Within each busines

unit, for all activities project plans and project management meth-

odologies are in place. Financial results are reported monthly and

reviewed carefully among the management team.

FutureThe current generation of Connected Health programs at Partners

HealthCare is poised to grow throughout the enterprise. The Center

will serve primarily as an innovation incubator. As its programs

mature and are ready for deployment at scale throughout Partners

the Center will develop a rigorous approach to assure successfu

deployment. Two anticipated examples of this phenomenon are a

follows:

. The Centers remote monitoring data repository, which allows

for vital signs gathered remotely to be easily incorporated into

our information technology infrastructure, will soon be con-

nected to the electronic record. This will enable Partners clini-

cians to view the data in the electronic record. Similarly

patients will be able to access their remote monitoring data via

the Partners patient portal. As these changes occur, any vestige

of innovation/experimentation associated with the platform

will have ended, and full-scale integration into mainstream

enterprise-wide information technology service will result. This

will promote care coordination and enable, for example, remote

monitoring of heart failure patients.

. The Centers online consultation software will be offered en-

terprise-wide at Partners as a white label service for depart

ments or clinicians wishing to expand their online capabilities

either as a convenient and augmented service offering to theircurrent patient pallet or as an organized, efficient, and proven

pathway to channel random and ad hoc consultation request

that currently come via phone, fax, e-mail, and word of mouth

As Connected Health programs move to scale, the Centers work

will expand in multiple ways. Patient and provider demographics

quality and cost pressures, new payment models, an increasingly

mobile lifestyle, and learning from other industries suggest an in-

evitable quest toward a distributed care mode in which the locus o

care shifts away from the provider setting to the community. The

Center will focus on three keys critical for future development:

1. The ability to use connected health and other data to micro-

segment the patient/consumer population and offer themhighly specific messaging tailored to their specific need

and intended to motivate improved health and increased

engagement

2. The ability to automate various care processes using software

agents, robots, and targeted messaging

3. The ability to use the phenotypic data generated via connected

health programs to compare with increasingly highly defined

genotypic data, allowing refined approaches to diagnosis and

therapy.

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Among those who have dedicated their careers to this field,

questions that are often asked include:

. What are we missing?

. How can we move faster?

.

Are there policy considerations that we arent dealing with butshould?

. What other groups can we enlist as colleagues and help move

the field forward together?

These are questions of success, confidence, and good will. As our

nation facesvexing healthcare challenges of cost, quality, and access,

we are bound to consider connected health, e-health, mobile health,

telemedicine, etc., in its search for solutions.

Disclosure StatementAll authors derived salary through their employment at Partners

HealthCares Center forConnected Health. Foreach of the authors, no

other competing financial interest exists.

R E F E R E N C E S

1. Proteus Biomedical, Inc. Proteus Sustained Behavior Change Study.ClinicalTrials.gov Identifier: NCT01503008. 2011. Available at http://clinicaltrials.gov/ct2/show/record/NCT01503008 (last accessed September2012).

2. Massachusetts General Hospital, Center for Connected Health, PartnersHealthcare. Text to Move (TTM) Study. ClinicalTrials.gov Identifier:NCT01569243. 2012. Available at http://clinicaltrials.gov/ct2/show/study/NCT01569243 (last accessed September 6, 2012).

3. Massachusetts General Hospital, Center for Connected Health, PartnersHealthcare. Implementation of ACT through Facebook for Teenagers withAsthma. ClinicalTrials.gov Identifier: NCT01675921. 2012. Available at http://clinicaltrials.gov/ct2/show/study/NCT01675921 (last accessed September 6,2012).

4. Ling E, Mohammed M, Kvedar J, Jethwani K. Diabetes Connected health

evaluation [poster presentation abstract eP3]. Telemed J E Health 2012;18:A-128.

5. Agboola S, Myint-U K, Kvedar J, Jethwani K. Home blood pressuremonitoring program improves management of hypertension [poster sessionI abstract 118]. Circ Cardiovasc Qual Outcomes 2012;5:A118.

6. Mullangi S, Kvedar J, Jethwani K. Online specialty consultations in patient care:An alternative model of health care delivery. Poster session presented at the2012 Scientific Advisory Committee Symposium, Boston, MA, April 18, 2012.

7. Agboola S, Myint-U K, Kvedar J, Jethwani K. The impact of using mobile-enableddevices on patient engagement in a blood pressure remote monitoring program[poster session II abstract 221]. Circ Cardiovasc Qual Outcomes2012;5:A221.

Address correspondence to:Joseph Ternullo, JD, MPH

Partners HealthCare Center for Connected Health

25 New Chardon Street, Suite 400D

Boston, MA 02114

E-mail: jternullo@partners.org

Received: November 20, 2012

Accepted: November 21, 2012

PARTNERS HEALTHCARE CENTER FOR CONNECTED HEALTH

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