Investment in Digital Therapeutics Like Medly Can Reduce Strain On Hospitals In Ontario
The use of digital solutions like Medly can save money and lives down the road
DISCLAIMER — This article was a class assignment I did during grad school. The assignment was to write a policy briefing note to the provincial Ministry of Health about how to leverage technology to improve outcomes for a specific disease condition in the province. I specifically focused on Heart Failure patients.
PURPOSE
To request operational funding from the Ontario Ministry of Health for scaling ‘Medly’ across hospitals province-wide. Medly is a smartphone-based app used for remote patient monitoring (RPM) and was developed by eHealth Innovation at the University Health Network (UHN) in Toronto¹.
This app empowers patients to self-monitor heart failure (HF) symptoms and connect virtually with their care team as needed¹. Medly is ISO 13485 certified and classified as a Class II medical device by Health Canada for its decision support capabilities². A cardiologist needs to prescribe the use of Medly to a heart failure patient before they can access the tool².
OPTIONS
- Maintain the current standard of care for HF where most of the clinical care, including routine follow-up care for relatively stable patients, is traditionally offered in person.
- Provide funding to scale the Medly tool to healthcare institutions across the province that serve HF patients.
- Provide grants to enable hospital-community-academic partnerships whereby research centers at academic institutions will gather evidence as the solution is deployed provincially.
KEY CONSIDERATIONS
With Option 1, maintaining the status quo is riskier than committing to a meaningful change. For context, HF is the fastest-growing cardiovascular disease in Canada with more than 50,000 new diagnoses each year¹.
Continuing with the current standard of care for HF means most eligible patients will be deprived of access to a powerful RPM technology like Medly that has the potential to make their lives easier. The downstream effects are clear and worsen every day in the form of higher hospital costs, more strain on a short supply of healthcare providers, and worse patient outcomes³.
With Option 2, the barrier to implementation is that there is limited evidence to do a large-scale deployment³. However, there is a growing body of evidence from pilot studies to demonstrate Medly’s efficacy²:
- Improved patient-reported outcomes related to satisfaction and quality of life².
- The app is user-friendly enough for older adults over 70 years of age to use the platform. Users reported more than an 80% adherence rate with the Medly platform².
- High probability (90%) of being cost-effective, especially in patients with advanced HF due to a reduction in HF-related hospital readmissions by 50 percent².
- As a digital therapeutic, Medly is scaling evidence-based clinical care and making it accessible to hundreds of patients currently⁵.
The Medly algorithm makes it possible for a single nurse to manage a patient caseload of 350 patients at a time². Fewer than 1% of the clinical alerts are critical. Most alerts can be self-managed by patients².
In other words, it is alleviating the pressure on providers by extending their reach to a patient when and where they need it. This approach also frees up providers’ capacity to focus on more high-risk patients who truly need in-person care⁵.
With Option 3, the start-up costs and time commitment are high but the long-term success of the project hinges on establishing research partnerships.
An arm’s length and independent team of researchers can guide implementation using evidence and develop best practices for what a successful RPM deployment for HF patients looks like. This can solidify Ontario’s position as a leader in Canada and internationally for innovation in medical research and commercialization.
RECOMMENDATION
Option 2 is recommended with the condition that Option 3 be implemented as part of a long-term strategy to ensure the sustainability of this initiative.
It is important to note the net negative vs net positive impact of this initiative will depend on how it is implemented.
Successful implementation depends on leveraging high-quality evidence. Without ongoing applied research, we cannot generate this evidence. That’s why we need academic partnerships to critically evaluate implementation efforts and highlight blind spots (double-loop learning) so we can course-correct our actions according to the latest data.
CONCLUSION AND NEXT STEPS
HF’s prevalence is reaching epidemic proportions and is compounded by a rapidly aging population and an acute shortage of healthcare workers in Canada⁶.
We need a solution that is going to stretch government dollars and optimize for the quadruple aim of 1) improving patient and caregiver experience, 2) improving the health of populations, 3) reducing per capita cost of healthcare, and 4) improving provider satisfaction².
RPM has great potential to meet these criteria. The good news is that Ontario already has an existing RPM tool in the form of Medly. RPM is a one-to-many model of care that is going to redefine how healthcare is delivered⁵.
If we scale this solution province-wide, it can impact a population of close to a million patients living with heart failure. That’s why operationalizing Medly across hospitals in the province is a critical funding need.
BACKGROUND
Heart failure happens when the human heart is unable to pump adequate blood to meet the body’s needs¹. More than half a million Canadians have an HF diagnosis, and the disease burden is projected to increase⁷. HF has a high mortality rate of 30% within the first year of diagnosis⁷.
Among all patient groups, HF patients have the highest hospital readmission rate within 30 days⁷. Yet, 40% of these readmissions are avoidable⁷. Unnecessary readmissions impose high healthcare costs. In the case of HF, the cost is $2.8 billion per year and represents the third most common reason for hospitalization⁷. Hospital readmissions for HF can be prevented by improving the transition of care from the point of hospital discharge to the patient going home⁷.
RPM technology like Medly can improve HF management by giving patients the ability to stay on top of their health when they measure their daily vitals and symptoms⁷. These measurements are transmitted via Bluetooth to the Medly app⁷. The app algorithm personalizes self-care messages to the patient based on their readings and reported symptoms⁷. If there are signs of clinical deterioration, the app alerts the health provider responsible for the patient’s care⁷.
Clinicians can access patient information in real-time, including historical data and trends on a secure Web dashboard⁷. The provider can then guide the patient remotely when possible, so they don’t have to visit the hospital⁷.
REFERENCES
1. Integrating heart failure care from hospital to home. [Internet]. Medly. [cited 2022Oct21]. Available from: https://medly.ca/
2. Pham Q, Cafazzo J. Developing Digital Therapeutics: The University Health Network Experience. Journal of Commercial Biotechnology. 2022;27(1).
3. Gheorghiu B, Ratchford F. Scaling up the use of remote patient monitoring in Canada. Stud Health Technol Inform. 2015 Jan 1;209:23–6.
4. Boodoo C, Zhang Q, Ross HJ, Alba AC, Laporte A, Seto E. Evaluation of a heart failure telemonitoring program through a microsimulation model: cost-utility analysis. Journal of medical Internet research. 2020 Oct 6;22(10):e18917.
5. Makin S. The emerging world of Digital Therapeutics [Internet]. Nature News. Nature Publishing Group; 2019 [cited 2022Oct21]. Available from: https://www.nature.com/articles/d41586-019-02873-1
6. Oulton JA. The global nursing shortage: an overview of issues and actions. Policy, Politics, & Nursing Practice. 2006 Aug;7(3_suppl):34S-9S
7. Seto E, Ross H, Tibbles A, Wong S, Ware P, Etchells E, Kobulnik J, Chibber T, Poon S. A mobile phone–based telemonitoring program for heart failure patients after an incidence of acute decompensation (Medly-AID): protocol for a randomized controlled trial. JMIR research protocols. 2020 Jan 22;9(1):e15753.
