What do the Black Panthers have to do with remote patient monitoring for blood pressure in Seattle? As it turns out, quite a lot.
Country Doctor Community Health Centers in Seattle has bona fide radical roots. The Carolyn Downs Family Medical Center was created in 1970 by the
Black Panthers, an organization founded by Black Americans to combat police brutality, protest racist policies and protect their citizenry. The clinic, then called the Sidney Miller Free Medical Clinic after a fallen Black Panther activist, later changed its name as an homage to a Panther activist and mother who died young from cancer.
Meanwhile, the nearby Country Doctor Community Clinic was started by activists -- including volunteer doctors and medical residents opposed to the U.S. war in Vietnam -- as a way to support vulnerable community members in the Capitol Hill neighborhood. In 1988 the two clinics combined under the Country Doctor Community Health Centers umbrella. A federally qualified health center, it is the only Black Panther health clinic still operating in the country. The original founders wanted low-income residents to have the agency to make changes to improve their own lives and health care, and that ethos remains strong many decades on.
That brings us to the current day, where in the middle of an upheaval of a different kind—the pandemic—the clinic began pairing medical innovation with individual clients to help them improve an important health measure from the comfort and safety of their own homes. The clinic piloted a remote patient monitoring (RPM) program for patients with uncontrolled blood pressure, as part of CCI’s
Virtual Care Innovation Network.
Victories and tech challenges
Country Doctors’ goal was to have 25 individuals with hypertension signed up to track their own blood pressure readings by January 2022 and 50 patients in the pilot by June 2022. They now have more than 70 patients engaged in the program, according to Lorraine Hoover, director of quality, risk management, and programs at the clinic.
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The health centers is expanding telehealth to their patients who are unhoused or in supportive housing.[/caption]
But that doesn’t mean it was easy. One major challenge presented itself right away: The clinic had procured only medium blood pressure monitor cuffs. This was a misstep because many of the clinics’ patients with hypertension needed large or extra-large cuffs to participate, so it took longer for the health care team to find participants for the pilot. In addition, patients needed to be somewhat tech-savvy to join the program. Besides being able to use a smart phone, they had to be able to do basic trouble shooting with a Bluetooth device, Hoover says. Patients with iPhones needed to collect data via
iHealth, those with Android devices used blood pressure cuffs called
Qardio; both apps filter through a platform called
MyChart and upload to Epic, the clinics’ electronic health record (EHR).
The clinic also experienced some typical patient pushback: Some were hesitant to try something new, some were uncomfortable with the technology, or decided the process was too time-consuming or complicated. The program does demand a commitment on the part of the patient, so provider education and support is key, says Hoover, in getting patients on board with this program, which requires patients check their blood pressure 14 times in 28 days (just shy of 4 times a week).
Other obstacles: It was a challenge to include unhoused patients in the mix, since many do not have cell phones, access to the Internet, or the funds for data plans—something the clinic would like to tackle down the track. And on the provider side, Hoover said, ensuring that the clinic bills for this service and is appropriately
reimbursed also requires more attention. “In order to reimburse any nursing time spent managing and responding to the blood pressure results, the patient must check their blood pressure 14 times in a 28 day period,” Hoover explains. And as far as reimbursement goes, she says, “Manual tracking doesn’t work because HRSA [Health Resources and Services Administration] won’t give you credit for a blood pressure that’s written down; they don’t trust patients to write it down correctly.”
Patient self-monitoring: a new frontier
Remote patient blood pressure monitoring is an innovation that’s beginning to be embraced by CCI safety net health clinic partners. Some go the wireless tech route, while others try low-tech solutions opting for“unconnected,” BP self-monitoring via manual tracking.
Whichever path these clinics pilot, they realize early on that remote BP monitoring involves more than giving patients the tools for the task. With low-income populations typically less familiar with digital devices than the general public, they also need assistance on how to use the equipment. “The best would be cellular, which doesn’t require a cell phone at all: The cuff speaks directly with MyChart and therefore the clinic,” says Hoover.
Most CCI partner providers are still charting a path for sustained improvement in blood pressure control, writes
CCI president Sofi Bergkvist in a recent piece for our site on RPM. But it has the potential to make a big difference to many people who receive care via health clinics for vulnerable Americans, she notes. She shares some of the feedback around remote BP monitoring gleaned from clinic partners via a tool CCI uses called
rose, bud, and thorn.
ROSE: Patients appreciate how RPM saves them time and money by reducing the number of provider visits they need. Many say that they feel cared for, especially when there is a health coach to support them. Providers, for their part, receive rich data, which presents a more holistic picture of how their patient is doing over time.
BUD: Making RPM easy for patients still needs work. Connected devices show perhaps the most potential; a chip in the devices means patients don’t have to have connectivity. With everything integrated, there’s no need to synch readings with a smartphone app. Using GPS tracking for inventory control or to find patients for outreach can be helpful, but also raises privacy concerns.
THORN: Integration with electronic health records is a pain point, as is expanding remote patient monitoring from a pilot to an organization-wide practice. Finding a way to sustain RPM outside of a grant-supported program is also a concern.
(For other peer insights, see our partner-populated
virtual visit resource guide to remote patient monitoring which includes set-up tools such as a blood pressure monitoring instructional video, patient device agreements, and program participation forms, including an example from Country Doctor Community Health Centers. The guide also explores what
devices to procure, how to figure out
workflows for your care team,, and ways to help you
engage your patients.)
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From the Country Doctors' twitter feed[/caption]
Country Doctor Community Health Centers doesn’t yet have hard numbers on how well the pilot patients are doing – “the data is very hard to extract from our medical record,” says Hoover. However, she says that anecdotally, an impressive number of the cohort now have their blood pressure within a healthy range. Ideally, the clinic would like to roll out the program to all its patients struggling with blood pressure control, especially if the technology speaks directly to the chart and the clinic. “We’re always looking for ways for our patients to have a sense of empowerment over their own health,” says Hoover. “And this program is another tool we can use to help them have that control.”
Lessons Learned
Make sure providers have input on equipment procurement.
It was a mistake to only buy medium-size blood pressure cuffs for their patient population, says Hoover. If consulted in advance, a health care team member would have caught that oversight.
Consider technology solutions thoughtfully.
Bluetooth functionality may not be right for the demographic you serve. Meet your patients where they’re at when choosing digital devices and platforms for them to self-monitor their health.
Have patient engagement champions in place.
The right team members are key to “selling” the innovation to patients who may express reluctance to do things in a different, unfamiliar, or new way. Patient buy-in is critical to RPM success.
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The Virtual Care Innovation Network is a community health collaboration founded and funded by Kaiser Permanente in partnership with CCI, National Health Care for the Homeless Council, the primary care associations in each of the nine states in which Kaiser Permanente provides care, and regional associations in California. Its goal is to design or redesign virtual care models so they continue after the pandemic abates and beyond. VCIN seeks to solve some of the complex challenges associated with the implementation, improvement, and sustainability of virtual care, also commonly known as telehealth or telemedicine. 
