With changing times, more and more hospitals and health systems have reverted to a system where patient’s health is being monitored at home to prevent them from visiting their physician office or hospitals emergency departments.
It’s not only as a measure of safety, but also as an aspect of financial saving that minimises patient encounters. Through a remote monitoring program, hospitals can avoid Medicare penalties that result from excessive readmissions, it also facilitates achieving population health goals, as defined in the healthcare reform law and most accountable agreements..
The three most important health systems that have been running successful monitoring programs, and have most graciously shared their best practices for other providers to adapt are mentioned below.
Partners HealthCare
Partners HealthCare through ‘The Center for Connected Health’ in Boston administers the technology-enabled care coordination programs. It tests the clinical benefits, implementing new initiatives, and determining the potential return on investment of best programs that are initiated through the system.
According to Joseph Kvedar, MD, the centers founder and director, they have dedicated 50 people to move care out of the physician’s office or hospital to make it a continuous function in the patient’s life.
Connected Cardiac Care, which is a heart failure telemonitoring program, and which was launched in 2003 through a partnership with the system’s home health service Partners HealthCare at Home is one of the center’s most successful programs. In order to remotely monitor the patient’s vitals, the program entails delivering monitoring equipment to the patients home, which includes a scale and blood pressure cuff, this enables to remotely monitor the vitals of the patients daily. Every morning, the patients answer a series of questions related to their health, daily habits, and wellbeing. During the successful run of the program, 250 patients were being monitored by four nurses.
An intervention becomes necessary if the patient’s vitals are found to be unusual or if no data has been forthcoming from the patient, the telemonitoring nurse calls the patient to determine his wellbeing. In order to comply with the daily monitoring routine, a phone call is a powerful stimulus for the patient, according to Dr. Kvedar, knowing that they are being monitored, builds up a relationship of care, which is essential for the success of the program, he explains.
He further observed that there was a 50 percent drop in all-cause readmissions, which had a significant impact on patient mortality. In the process of implementing the program on a large scale, Partners at HealthCare at Home are managing it , while Dr. Kvedar and his team are currently working towards setting up similar programs for diabetes and hypertension patients.
While many sceptics may have a different opinion on the efficacy of telehealth and remote patient monitoring, consistent success is being observed in the programs at the Centre for Connected Health, according to Dr. Kvedar, who observed that the good success they achieved was because the patients became well-acquainted with their doctor, who was involved, and watching their information.
Although there was financial temptation to outsource a program like this, noted Dr. Kvedar, who realised that by doing so, the clinical-patient relationship would be undercut by the hospital, which would be detrimental to the success of a remote monitoring program. he further observed that these programs are taken seriously by the patients, when the doctor is involved and the program becomes a part of their comprehensive care plan, it makes a big difference, he noted.
Dr. Kvedar also feels that besides keeping the remote monitoring program in-house, the nurse-to-patient ratio must also be lowered. The ratio best suited they found was 80 to 100 patients per dedicated telemonitoring nurse for patients with acute illnesses, he observed. According to him, the nurses should have a close working relationship with the patients’ primary and referring doctors, he explained, it’s not a good practice to see a patient experiencing trouble, and there’s nothing they can do about it, he concluded.
Essentia Health
Way back in 1998, the Minn – based Essentia Health started a remote monitoring program for heart failure patients at Duluth. The heart failure programs until then were associated with transplant programs. Linda Wick, NP, RN, the program manager stated that they were mainly focused on transplant population, and not on the overall heart failure population. The program had begun with one physician, one nurse practitioner, and one registered nurse, and since then it has expanded to include 14 nurse practitioners, and 14 registered nurses that work across seven sites. In all, 2,300 patients currently receive treatment through the program.
The momentum for the program when it began, was the low adherence of patients’ to medication guidelines among heart failure patients. The medical adherence according to Ms.Wick was 20 percent for heart patients across the country, adding that it now stood at 50 to 70 percent in the general heart failure population, she noted.
Comparatively, through Essentia’s remote monitoring program, which facilitates close remote monitoring of patients’ habits and follow-up contact from nurses, the medication adherence rate rose to 98 percent. This has resulted in an increased adherence, leading to an average overall readmission rate of 5 to 10 percent, across the organization’s seven sites.
Through a special scale used among patients’ their vitals are sent to nurses in Duluth directly, resulting in the readmission rate dropping further to 2 percent.
Also being an accountable care organization, Essentia aligns well with the population health and care coordination goals of the ACO, reaping the benefits of the remote monitoring program. Despite the program created in the fee-for-service world, telemonitoring has helped the hospital save money. Ms. Wick asserted that looking at the cost of caring for the population even before the ACO, the hospital still incurred cost despite people’s condition not being managed.
Highlighting the importance of allowing strong patient-nurse relationships to develop, Ms. Wick recommends other hospitals that are looking to begin a telemonitoring program to adapt this policy. Further emphasizing that programs utilizing skilled nurses help people stay away from hospitals. Advocating the view that even patients that are on right medications have other issues, such as unaffordability of medication, or personal issues for which they are struggling, or seem to be depressed. Experienced nurses can figure that out and intervene, referring the patient to appropriate treatment, preventing the condition from escalating further, according to Ms.Wick.
She also recommends that patients’ should be made aware of who to reach out to, in case they notice a problem themselves. Explaining that often patients’ are told about the symptoms for which they should call, but they are not notified who they need to call. Ms.Wick noted that primary care physicians are difficult to reach, and calling the hospital front desk staff that discharged the patient to reach out quickly to the referring physician may not be possible. Pointing out that often patients’ want to do the right thing making the call, she noted that the hospitals do not give them the requisite tools.
Centura Health
The Colo based Centura Health at Home started its remote patient monitoring program at Englewood almost nine years ago, helping patients suffering from chronic diseases manage their condition at home, without the need to be hospitalized or visit the emergency room. Erin Denholm, senior vice president of clinical transformation at Centura explained that they’ve learnt a great deal from the experience they gained ever since they started the operations. It has allowed them to refine and tweak the program, and has gotten them best results.
Under the program, high risk patients’ receive monitoring equipment in their homes that allow them to record their vital signs.The information is then remotely uploaded to a health station located at the Centura hospital through a basic telephone line connection. It is done once everyday, with the nurse tracking the reports for any red flags. Any readings falling outside the parameters are reported by the nurse to a physician, who decides on the best course of treatment.
Over 3,200 patients were included in the program last year, most of whom were hospitalised for congestive heart failure earlier. According to Ms. Denholm, the readmission rate for congestive heart failure dropped to 1.7 percent, with an all-cause readmission rate of 7.3 percent. This bettered the national average of a 24 percent all-cause readmission rate of congestive heart failure patients.
Ms. Denholm elaborated that the remote patient monitoring program at Centura greatly helps with in-the-moment management preventing the downward spiraling condition of frail or elderly patients in the ER swiftly. The remote monitoring according to her, arrests the deteriorating conditions of the patients quickly, restoring the optimum level of wellness in them.
The patient population experiences an additional benefit of the program , which is an improved socialization and reduced anxiety. Ms. Denholm explained that seniors get a feel of belonging, as if someone is looking out for them. It is also comforting for them to know that a nurse will be in touch with them, if their vitals show any abnormality, reducing their anxiety and the associated physiological symptoms which manifest through anxiety. She observed that some patients become so attached to their monitors, it gives them a feeling of security.
Ms. Denholm advises other hospitals that are looking to implement a similar program to involve all stakeholders early, in order to ensure their engagement. Getting the hospital board, administration, and physicians on-board in the initial stages helps accelerate the adoption and implementation of a remote monitoring program, she asserts.
In addition, Ms.Denholm recommends observing extreme care while selecting monitoring equipment from a vendor, making sure that it achieves the program’s parameters. She explains that during the process of equipment selection, a proactive approach should be adopted, keeping questions handy, so that a best fit for the program is chosen.
Emphasizing, Ms. Denholm states that telehealth or telemonitoring may hold different definitions to different vendors, a clear communication of needs should be presented to the vendor, for the remote monitoring program to take-off
