Heart failure care without borders: Medly paves way for new model of care

By Jessica Fifield, eHealth Innovation & Healthcare Human Factors

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Heart failure is the most rapidly rising cardiovascular disease in Canada, affecting more than 1 million people nationally, and with more than 50,000 new diagnoses annually. A complex chronic condition, people living with heart failure face symptoms of shortness of breath, swelling in the lower limbs, and fatigue, as well as frequent flare-ups often leading to hospital admission. The journey that follows heart failure diagnosis is undeniably challenging and, for many, life-altering.

Heart failure management requires patients to take an active role in their care by maintaining a low-sodium diet, restricting fluids and taking their medication as prescribed. Guideline directed care is a cornerstone of therapy. A major challenge in care is the lack of access to heart failure specialists. Currently, Canadian clinics are facing high patient volumes that cannot be supported with traditional patient visits alone.

Within the heart failure clinic at Peter Munk Cardiac Centre (PMCC), one program is helping pave the way to transform how care is delivered for heart failure patients and reduce the burden on the health system, and most importantly the patients themselves.

Canada-first telemonitoring technology

Medly, a heart failure management program, developed by the teams at UHN’s eHealth Innovation, PMCC and the Ted Rogers Centre for Heart Research, is a first of its kind in Ontario and Canada. Medly is unlike traditional telemonitoring programs with its use of the Medly management algorithm, developed by heart failure clinicians to rapidly assess and triage patients, and the creation of a new role in the heart failure care delivery model: a Medly coordinator role.

Mary O’Sullivan, a registered nurse and Medly coordinator at PMCC, currently manages nearly 300 heart failure patients, a patient volume not typical of such a role. For Mary, her patient load is made possible and has the potential to grow with the support of the Medly Program.

“I am able to connect and give nursing care to patients across the province each day,” Mary says. “Medly provides a platform for such a unique nurse-patient relationship. It allows me to gain insight into how their heart failure management fits into their daily lives and enables me to interact with patients in their own environment and develop long-term relationships with them. This personal element enhances the way that I assess, triage and provide education for these patients.”

The Medly Program allows Mary to assess, support, and provide education for her patients in real time wherever they are located. These patients use the Medly smartphone app to record their daily weight, blood pressure, heart rate and symptoms. These measurements are analyzed instantly via the Medly management algorithm. If the algorithm determines that a patient’s clinical status is deteriorating, an actionable feedback message is sent to the patient, and Mary is alerted through the Medly clinician dashboard. When alerts are received, Mary assesses the patient’s clinical need and can escalate to the patient’s cardiologist who then provides higher-level clinical expertise. Through this alert escalation process, more patients are able to access their heart failure specialist at the right time.

An invaluable opportunity

Dr. Heather Ross explains Medly with patient at PMCC

To one of Medly’s clinical champions, Division Head of Cardiology at PMCC Dr. Heather Ross, the addition of Mary’s role to the Peter Munk Cardiac Clinic has proved to be invaluable. “Mary has allowed us to realize the promise of Medly, specifically being able to scale a remote monitoring intervention to a large population at reasonable cost,” says Dr. Ross, who is also a scientific lead at the Ted Rogers Centre.

In a perfect world, Mary’s role and technologies like Medly would already be infused and easily deployed across the healthcare system. Product owner at eHealth Innovation, Mala Dorai believes the program is unparalleled to any other heart failure management solution she has come across.

“The rapidly rising burden of heart failure requires us to think outside the box. We at eHealth Innovation are doing just that. We designed the Medly program with a team of engineers, researchers and human factors experts who understand the needs of heart failure patients, and consulting heart failure specialists with the practical clinical knowledge and processes of Canada’s leading cardiac care centre.

This is why I believe Medly is the kind of specialized yet scalable solution capable of addressing this critical need.”

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Image at top: Mary O’Sullivan with patient explore the Medly Program