At Deaconess Health, early efforts to apply telehealth to home monitoring were slow and clunky, particularly in the manual collection of data, so that the effort put into the program outweighed what little results they were getting. Roughly three years ago, administrators at the Indiana-based health system decided to narrow their focus. “This wasn’t going to work unless we found the right patient,” says Amanda Bohleber, MD, the health system’s chief transformation officer. “This was really about finding the right patient who would benefit from this and using the right tools.”
Bohleber and Allison Flowers, RN, Deaconess Health’s telehealth clinical manager, replaced the legacy RPM platform with Vivify technology and integrated with the health system’s Epic EMR platform. They used a tool within Epic to evaluate patients based on their readmission risk, then created a new RPM program targeting those with chronic conditions like COPD and congestive heart failure who had at least a 20 percent chance of returning to the hospital after being discharged. Therein lies the challenge for health systems who’ve jumped onto the RPM bandwagon over the past year to handle patients affected by COVID-19. Many have found that telemedicine and mHealth tools are great for tracking patients at home and giving providers insight into how to manage their care from a distance.
The 20 percent readmission rate is a key number. For health systems like Deaconess, that’s a costly percentage of patients coming back for care, affecting not only the quality of life for those patients but the hospital’s bottom line. Telehealth and RPM programs that push care out of the hospital and into the home need to attack those statistics, changing the outcomes at home. But in many cases the effort put into the platform isn’t equaling the results at the other end, and the health system isn’t seeing a significant decrease in cost, an improvement in caregiver workloads or an uptick in clinical outcomes. They’re shifting care around, not improving it.
READ MORE: New Coalition to Push Telehealth, RPM as a Mainstay for Home Care “The patient has to be sick enough to benefit from this program,” says Bohleber.
“They’re getting care when they need it, and at home,” says Flowers. “They like knowing that someone is always watching out for them … and along the way we’re giving them education (and access to other resources) that helps them to manage their own disease.” For Bohleber and Flowers, the goal was to not only create a program to manage care at home, but to use it on patients who were spending a significant amount of time receiving care, costing the health system a lot of time and effort and reducing their enjoyment of life. The program would, first and foremost, allow these patients to receive care at home, where they would be more comfortable, while allowing providers to track key benchmarks and observe daily activities that directly affect care management.
While designing an RPM platform that caters specifically to patient with certain chronic conditions – in this case COPD and CHF – Bohleber and Flowers also had to make sure that process was comfortable for the care providers, beginning with the nurses who would be checking up on patients every day and gathering the data from the platform. On this end, nurses manage care from one dashboard, receiving alerts whenever the data indicates a patient in need of help. The technology itself is simple. The health system has 50 kits for the program, containing wireless mHealth devices that track patient vitals and a tablet that allows patient and provider to connect via virtual visit whenever necessary to collaborate on care. What goes into that kit is dependent upon the type of patient being treated, so it’s important that the health system choose the right devices and platform that meets specific needs. READ MORE: Telehealth, RPM Programs Can Benefit Greatly From a Nurse’s Perspective
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