Remote monitoring is one of the most promising ways technology can potentially improve patient care while also improving efficiencies related to costs and time. At Visiting Nurses Association (VNA) Rockford in Rockford, IL, health system professionals have implemented a program using remote monitoring technology to efficiently track and monitor patients in the Heart & Vascular program who suffer from congestive heart failure (CHF). Recently David Taylor, supervisor of telehealth services at VNA Rockford, shared his insights on the opportunities and potential of remote monitoring technologies.
By Scott Westcott, Contributing Writer
By deploying remote monitoring technology to patients with congestive heart failure, VNA Rockford has cut its hospital readmissions by nearly one-third.
Remote monitoring is one of the most promising ways technology can potentially improve patient care while also improving efficiencies related to costs and time. At Visiting Nurses Association (VNA) Rockford in Rockford, IL, health system professionals have implemented a program using remote monitoring technology to efficiently track and monitor patients in the Heart & Vascular program who suffer from congestive heart failure (CHF). Recently David Taylor, supervisor of telehealth services at VNA Rockford, shared his insights on the opportunities and potential of remote monitoring technologies.
Q: Why did you target CHF patients for this application? What was your overall objective?
A: We had two major goals at VNA in response to the new CMS reimbursement structure — first, to reduce overall readmissions to Rockford Memorial Hospital, and second, to avoid and reduce penalties based on those readmissions. CHF patients were one of the three patient groups identified by CMS as being high-risk for readmission following discharge, so we decided to work with that population.
Q: Describe the RPM (remote patient monitoring) solution — what technologies are involved and how are candidates identified?
A: The RPM solution uses Honeywell HomMed’s Genesis DM Pro and Genesis Touch monitoring devices, which reside with the patients in their homes, in conjunction with Honeywell HomMed’s LifeStream software, which VNA Rockford telehealth nurses utilize to monitor their patient populations on the back end. Data collected from patients includes vital signs that are measured and reported daily (i.e., weight, blood pressure, heart rate, and blood oxygen levels), in addition to responses from predetermined questions such as “Are you having more difficulty breathing today than on a normal day?” or “Are your ankles swollen today?” These questions are designed to determine overall patient health related to CHF patients. Data is communicated to physicians only if a patient exhibits signs of slipping outside the parameters that designate stable health. Patients are entered into the Heart & Vascular program following discharge from the hospital if they meet three criteria: They are diagnosed with CHF, they are discharged under the care of a cardiologist, and they do not meet Medicare or insurance guidelines for homecare.
Q: How do VNA staff and hospital cardiologists institute protocols and standards for RPM services for each patient?
A: We designate the standard RPM parameters based on industry best-practice standards or in some cases, even more stringent guidelines. That said, we also customize some of our parameters based on the observance of trends in the data collected from our patients. For example, if we have consistently noted that a patient has a low heart rate from a prescribed medication, we will adjust data ranges on our side in order to accommodate what their “normal” is.
Q: How did you cost-justify the solution given the reimbursement issues that surround RPM and other telehealth solutions?
A: We justify the expense through the demonstrated cost avoidance our program is able to achieve — within our agency as well as in the greater hospital. And our program is continuing to grow based on those results. In addition, and perhaps most importantly, RPM services are the right thing to do for our patients.
Q: In what ways did VNA nurses and Rockford cardiologists intervene with the patients (in an effort to keep them out of the hospital) based on the data they received from the RPM solution?
A: Through early recognition of potential complications based on patient data points, we have been able to provide early intervention such as a change in patient medications without a visit to the doctor or in other instances, a visit to the physician’s office without a trip to the emergency room.
Q: What results have you seen from the solution to date?
A: In 2012, prior to the implementation of the Heart & Vascular program, the readmission rate for Rockford Memorial Hospital was 25 percent. Following the launch of the program, overall readmission rates dropped to 17 percent, and in 2014, year-to-date readmission rates are holding steady at 15 percent.
While the Heart & Vascular program played a significant part in reducing the overall hospital readmission rates, we were also able to measure successful results within our program participants — with readmission rates of 10 percent for all-cause readmissions and about 4 percent for those related to CHF complications.
Q: What impact has the program had on patients?
A: Our patients have reported increased levels of independence and an awareness of their condition that gives them the ability to control their disease — instead of the other way around. The program also has provided our patients’ families with peace of mind, knowing their loved ones are being consistently monitored. In addition, the positive health improvements impact their greater communities and employers, as patients have been able to be more participative within those environments.
Q: What’s next for the program? Are you targeting additional patient populations/other chronic diseases?
A: Yes, we are currently expanding our program within other high-risk populations of patients, such as those at higher risk of readmission due to multiple comorbidities. And we are confident we will be able to achieve the same level of success within those patient populations.