One of my favorite times at work is when I am in a meeting and it feels like we’re in a sandbox, where everyone realizes they want to build toward the same thing and starts creating it together. Despite our different needs, there’s plenty of space to collaborate, get inspired by each other, and watch the sandbox take on a new shape. That is what I thought of when I recently listened to a discussion by members of CCI’s Tech Hubs.
George Lee, the chief innovation officer at Asian Health Services, shared how he is working toward improved blood pressure control with remote patient monitoring (RPM). His providers started with patients who did not speak English, had not used telehealth in the past, and had uncontrolled blood pressure. Since then, the providers have expanded remote patient monitoring to all their care sites and now offer it in 15 languages, including Lao, Burmese, Mandarin, Cantonese, French, Vietnamese, ASL, Tagalog and Khmer.
Remote patient monitoring is still relatively new among our partners, and most providers are still charting a path for sustained improvement in blood pressure control. But because it has the potential to make a big difference to so many underserved people, I’ll share some of the Tech Hub meeting’s main takeaways through a feedback tool we use at CCI called rose, bud, and thorn.
Rose – what is working well
Many patients say they want to use remote patient monitoring when offered a chance to try it. “We had an acceptance rate of about 70 percent,” said Dr. Lee. He also learned that patients were more likely to say “yes” if asked directly by their healthcare provider who called to say, “Hey, your blood pressure is a little bit high and we have this program where I can monitor you; we can make adjustments right away, and my health coaches will be calling you.” People want that connection with their provider.
Patients appreciate how RPM saves them time and money by reducing the number of trips to see their provider. Many say that they feel cared for, especially when there is a health coach to support them. Providers, for their part, get unusually rich data, which provides a more holistic picture of how the patient is doing over time. This moves the dialogue from, say, a 30-minute annual check-in with a provider to ongoing blood pressure readings that trigger regular conversations with health coaches and the primary care provider.
What I am the most excited to hear is how blood pressure control is improving in these programs.
Bud – what is evolving and has potential
Providers are still learning how to make remote patient monitoring work smoothly and integrate it in their clinical workflow across care sites.
Making it easy for patients is also something that needs more work. Connected devices show perhaps the most potential, because a chip in the devices means patients don’t have to have connectivity: Everything is integrated, so there’s no need to synch readings with a smartphone application. However, there’s still uncertainly about how to cover subscription costs outside of grants. In addition, using GPS tracking for inventory control or to find the patients for outreach can be helpful, but it raises privacy concerns. “I was a bit surprised to hear how many patients were concerned when they learnt that the RPM devices could be tracked with GPS,” said one of the Hub members who runs one of the largest programs for remote patient monitoring. “It is something we should be aware of.”
Thorn – what is hard
Challenges abound in terms of connectivity and ease of use for patients: 22 out of 25 organizations working on remote patient monitoring as part of our Virtual Care Innovation Network say that connectivity and digital barriers can be difficult.
Integration with electronic health records is another pain point, as is expanding remote patient monitoring from a pilot to an organization-wide commitment. Finding a way to sustain RPM outside of a grant-supported program is also a concern. Value-based care may allow more room to offer remote patient monitoring, but many organizations are not there yet.
We have collected some resources from our partners that may be valuable if you are planning to introduce remote patient monitoring. Among other things, they can help you explore what devices to procure, figure out workflows for your care team, plan how to distribute devices and patient consent forms, or help you engage your patients. You might also be inspired by a story in which CCI clinic participants combined remote patient monitoring with a mobile van service.
Why do I think remote patient monitoring is important? Many people have a hard time making regular checkups for chronic diseases. In my own case, while I can make it to see my healthcare providers, I feel comfort knowing that they have access to my blood pressure readings from my home. The readings at home are different from the few times I go to see my provider in person. At one point I had a spike in my blood pressure over a 10-day period, and she asked me to see her. I have never felt so reassured and cared for by the healthcare system.
I am wishing you a long and lovely Labor Day weekend.
Sofi
Sofi Bergkvist
President, Center for Care Innovations
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