Dr. Lucienne Ide, Atlanta native and founder of cloud-based chronic disease management platform Rimidi, already wasn’t proud of where Georgia ranked among other states in terms of mothers surviving childbirth.
“Last I checked, you were more likely to die having a baby in Georgia than in Iraq,” Dr. Ide says. “Georgia has consistently been at the bottom of the list in terms of maternal mortality. It is abysmal; it is embarrassing.”
It’s true; the numbers are grim. According to Ide, the main cause of the morbidity has been cardiovascular issues — post-partum hemorrhaging and strokes. Now COVID-19 has added new concerns.
Healthcare providers may be able to identify mothers with high-risk pregnancies, but that doesn’t always equate to how many of them will have a stroke. The normal solution is to have those mothers come back to their doctor to have their blood pressure checked to measure who is getting better and who isn’t. But that’s a tougher ask right now, with continuing challenges like public transportation during the coronavirus shutdown.
“Layer on top of that something like a pandemic,” Ide says. “Now you just had a baby, a newborn, who you’re terrified is gonna get COVID, or you’re gonna get COVID and give it to the baby. The last place you wanna go is back to your doctor’s office or into the healthcare system, where your chances of exposure are higher. But if we don’t keep monitoring your blood pressure, you have risk.”
According to the latest numbers from the CDC, there were 3,788,235 births in the U.S. in 2018. On average, 6 to 8 percent were considered “high-risk pregnancies,” requiring frequent monitoring and treatment, meaning frequent visits to their physicians. Yet around 30 percent of Boston Medical Center pregnancy patients have hypertensive complications such as chronic or gestational hypertension, or preeclampsia.
“Women who have gestational hypertension or preeclampsia are considered ‘high-risk’ during and after pregnancies, and can benefit from close monitoring,” said Christina Yarrington, OBGYN and director of labor and delivery at Boston Medical Center, in a statement.
“In the midst of the COVID-19 pandemic, adding the capability to remotely monitor blood pressure in these patients is especially pressing, as we are trying to limit their exposure to healthcare settings.”
A recently announced partnership between Rimidi, the company Ide founded in 2011, and Boston Medical Center, gives her a new sense of hope that there will be improvements.
Based in Atlanta, Rimidi is a cloud-based software platform that helps doctors provide better connected care to patients with chronic conditions such as diabetes, fatty liver disease and heart failure. The software integrates with existing electronic health records (EHRs) to offer specific approaches to treatment for certain individuals, based on patient-generated data, best practice guidelines and clinical information.
The remote-monitoring partnership program with Boston Medical Center is up and running, with around 60 patients currently being monitored. The hospital will use Rimidi’s cardiovascular disease platform view, which combines relevant EHR data with patient-generated blood pressure data from a cellular-connected blood pressure cuff, to allow physicians to turn real-time information into actionable data for better outcomes.
Ide says the doctors at Boston Medical Center needed a quick solution, and wanted to cut through bureaucracy and get to work immediately, so they called. “They said, ‘Look, I can’t wait. My patients are gonna stroke out at home. We need to have this up and running in about a week,’” Ide says they told her.
“And I appreciate that passion and laser-focus,” she said. “I can do something about it. I can get technology into their hands, I can watch that data, and I can know who we need to worry about and intervene with. That’s really what got this kicked off.”
Ide says Boston Medical Center is “the Grady of Boston,” comparing it to the Atlanta hospital which serves as a safety net for citywide healthcare, particularly for families on Medicaid. She says it’s a big deal for some women just to get to the hospital. By sending devices that transmit data back to hospitals, Rimidi relieves mothers of the burden of visiting in person.
“Why are we asking this woman to get in the cab, Uber, take public transportation, find a babysitter, take the baby with them… None of that makes any sense, when we can literally put a blood pressure cuff in an envelope, mail it to their house and then we’re connected. And if they don’t text, we shoot ‘em a text message. If they test and there’s a problem, we pick up the phone and call ‘em. It’s not super-high-tech.”
Ide says technology like Rimidi should be more of the norm than an exception when it comes to healthcare, but widespread adoption of virtual models like telemedicine have been blocked for financial reasons. The “unfortunate truth about healthcare,” she says, is that much of the industry operates in ways that make less sense for doctors and nurses (from systems and workflows to appointment bookings and on-site visits), and make more sense for how they get paid.
“It solves a problem right now during COVID, but the truth is, why are we asking these women to do that anytime?”
Since the pandemic, the Centers for Medicaid & Medicare Services (CMS) and the U.S. Department of Health & Human Services (HHS) have temporarily waived many regulatory barriers to virtual healthcare. At least for now, more doctors are being paid to remotely monitor patients.
Ide says it is working well, and is already leading to conversations with “a big system here in Georgia” who now wants to collaborate with Boston Medical Center to find better data in order to identify the different contributors to maternal mortality. And she hopes the public will notice improvements enough to demand more virtual services going forward.
“To keep this going, there’s gonna be enormous pressure, because all of us as consumers are gonna say, ‘Hey, I liked that — being able to text message or Facetime my doctor.’ And the doctors are gonna say, ‘I liked that too! I had happier patients and I could provide timelier care; they didn’t have to wait eight weeks to get an appointment.’”
Ide says she’s been working with an advocacy group in Washington, D.C., to gather anecdotes and push to tell the patient-level story.
“Let’s capture what a difference this made for this new mom, from having the support without the stress, to the aggregate data of like, did we make an impact on outcomes? Did we save some lives by doing this?
“It’s gonna take bundling all of that up, going back to the regulators, and looking at what good we did during this period. Don’t reverse it. Let’s make this permanent.”