Remote Patient Monitoring: A New Recipe For Success

Compiled by Amanda Griffith, Contributing Writer

CHRISTUS Health realizes a marked decrease in hospital readmissions and significant cost savings with RPM pilot.

A new report by Berg Insight estimates the total remote patient monitoring (RPM) market at $5.85 billion as of 2013, including revenues from medical monitoring devices, mHealth connectivity solutions, care delivery platforms, and monitoring services. Results found that mHealth connectivity solutions alone will account for 40 percent of total revenues in 2018, up from just 23.3 percent in 2013.

Using patients’ own mobile devices as health hubs has thus far not proven a viable option for RPM, so alternatives driven by hospitals have begun to take center stage. Incentives from payers and insurance companies, national health systems that support remote monitoring, and a shift to performance-based payment models have helped increase the rate of adoption.

Dr. Luke Webster, VP and chief medical information officer at CHRISTUS Health, oversees the health informatics department for his organization and is responsible for leveraging the use of clinical tools to improve the quality and efficiency of patient care across the entire health system.

Here he describes how CHRISTUS Health uses the AT&T Remote Patient Monitoring platform powered by Vivify Health to care for patients with complex conditions, in the comfort of their own homes. Specifically, he shares the results of a pilot by CHRISTUS St. Michael Health System in the Texarkana region.

Q. What drivers led CHRISTUS to explore RPM? When did you begin this initiative?

A: In August 2010, CHRISTUS St. Michael Health System launched a care transition intervention program to assist in the reduction of hospital readmissions of high-risk patients diagnosed with specific chronic illnesses (i.e., congestive heart failure, coronary artery disease, hypertension, diabetes, myocardial infarction, pneumonia, and chronic obstructive pulmonary disease). These diagnoses have been attributed to a high number of complications and high readmission rates within 30 days of a patient’s initial discharge.

Our care transition nurses began to conduct home visits to these patients, but because of the remote population area, some had to travel as far as 50 to 60 miles to reach their patients. This meant some care transition nurses spent approximately 500 hours per year away from the hospital, time they could have spent treating current patients and identifying new enrollees.

AT&T and VIVIFY Health approached us in 2012 with an opportunity to address these limitations through its RPM solution.

Q. What was your initial application of the technology? Why did you choose to start where you did?

A: The RPM solution is a home-based monitoring system that helps to engage patients and family members in their own care, while seamlessly involving healthcare providers through integration with their clinical information systems. Wireless connectivity through Bluetooth technology sends data from personal health devices (e.g., tablets, weight scales, blood pressure cuffs, pulse oximeters) at the patient’s home to a monitoring station within the clinical unit of the hospital. This is all done in a highly secure manner.

The RPM solution would replace the initial home visit and would hopefully result in both increased interaction with patients throughout the transition period and increased program enrollment since care transition nurses would spend less time away from the hospital.

In the early stages of the pilot, this replacement of home visits resulted in significant concern among our nurses who feared it was too necessary to eliminate. We asked them to try it, though, and ultimately, they found they could see more patients because they weren’t traveling. They also found that patients at home were very engaged, if not more so, because they could still “visit” with their nurses, just via video chat. Eventually they resoundingly agreed that the home visit wasn’t necessary for a great number of patients, and they felt comfortable with the solution taking the place of those visits.

Q. Please describe the components and logistics of the solution implemented at CHRISTUS.

A: This particular program, part of an institutional review board (IRB) study, identified patients who were hospitalized with an episode of decompensated congestive heart failure. The care team identified those who might be appropriate for remote patient monitoring, and then the care transition nurse, during the hospital stay, conducted an evaluation. If deemed appropriate, the care nurse would bring the RPM kit to the patient’s room to teach the patient how to use the tablet and operate the software. The kit, consisting of a tablet computer and the Bluetooth-enabled devices, goes home with the patient at discharge. Once home, the patient sets up the weight scale, pulse oximeter, blood pressure cuff, and tablet computer, as instructed.

The RPM kit is the hub for every patient being monitored. Updates and data values are filtered, with nurses alerted to any critical values that require quick assistance. The next action could be anything from prompting the patient to call their primary care provider or, in critical situations, making a call to 911 or directing the patient to be seen in the emergency department.

The software runs continuously, so it prompts patients throughout the day with customized reminders and compliance alerts from the care transition nurse. That’s important because we noticed that patients are more engaged at home with the use of this tool because they are prompted repeatedly to take action. We’ve found that those patients managed at home have had much better overall outcomes. In addition, the patients who participated in the pilot felt more connected to their caregivers in a way that transformed, for many, how they felt care was being delivered.

Q. What results have you seen from your application of RPM technology?

A: We experienced a significant ROI with the RPM pilot, including a decrease in average inpatient admissions from 1.31 to 0.25 postprogram in the congestive heart failure patient population. We also benefited from a decrease in the average cost of care for that patient population by a huge amount, from $14,229 to $1,626. Allowing for the subsidy we received from AT&T, in addition to the equipment vendor, the average return on our investment was $2.46 for each dollar spent during the pilot.

We also measured patient satisfaction. Ninety-five percent of the 45 patients within the initial pilot study told us they were enormously satisfied, and 89 percent have answered the same as we’ve expanded our program. Post pilot, from Dec. 12, 2013 to May 31, 2014, 61 additional patients have participated in RPM, bringing to 140 the total number we have engaged in this type of care transition management.

Furthermore, we’ve received resoundingly positive comments as patients have become engaged in ways like never before. They feel they are healthier and talk a lot about a greater connection to the care team at the hospital. The software monitors their health at home, but they know that at the touch of a button they can still talk to their nurses. Someone’s always watching over them, in a way that’s very different from past experiences without a remote monitoring system.

Q. How does CHRISTUS plan to expand its use of the technology going forward? What other applications are under way?

A: We now monitor patients with additional conditions, including severe pulmonary disease and difficult-to-treat diabetes. We’ve also expanded use in our Corpus Christi region through a rural clinic with a very high disease burden, and in San Antonio, additional implementation plans are under way.

Texas allows for reimbursement of remote monitoring for certain chronic conditions — hypertension and diabetes, among others — so use of RPM also helps with reimbursement with patients who are covered by Medicaid.

We’ve also proposed to our internal HR department the use of RPM tools within our employee population of 30,000 so we can improve outcomes and decrease employee events enterprisewide.

The other piece of the plan is to work with payors to try to help them understand the value these tools provide, in particular within the commercial market, so they reimburse us for keeping patients healthy.