Providence, a 52-hospital health system headquartered in Renton, Washington, sees digital innovation as a critical means to overcome industry-wide challenges and transform care delivery to improve improve the community it serves.
Many of the digital health and virtual care systems under development, as well as those pursued over the years, aim to address three macro challenges facing the health care industry. facing: workforce shortages and burnout; hotel capacity and throughput; and fragmentation of care or patient access.
Expanded medical system Remote patient monitoring aims to directly address these two issues.
PROBLEM
“Scheduling in-person appointments with primary care providers as often as needed to follow Appropriate monitoring and follow-up can be a real challenge for patients with chronic diseases.” “RPM provides a viable solution to improve patient care and outcomes, promote team-based care, and maintain a neutral workload for PCPs and care teams.
She continued: “It significantly eases the patient journey by extending our clinical team directly into the home, improving the quality of care we provide to patients with chronic while simplifying the patient experience.” “RPM has been a game changer for both our caregivers and patients, and our work with [RPM vendor] Cadence is a great example of how our commitment to embracing this virtual approach to care has resulted in better patient outcomes.”
PROPOSE
For large-scale adoption, Providence has done it a population health approach and considering how many patients might qualify for this type of program, the clinical benefits, increased access, and the ability to care for patients in a better way .
“What we found is that there is a lot of interest in RPM from both the caregiver and patient perspectives, so this is a huge opportunity to widely deploy this technology,” said Cunningham. “For years, we tested RPM in smaller pilots but never scaled it up for a variety of reasons.
“With technology, it is very important to develop simple and easy tools that do not burn out physicians but instead reduce the administrative burden and make the care delivery process efficient and more energetic.”
Dr. Kenneth W. Kooser, Providence Medical Group Family Medicine-Lacey
“When we connected with Cadence, we saw an opportunity to deploy RPM across our entire footprint,” she added. “Together, we were able to identify a location where we could prove the concept, demonstrate success, and socialize it internally to scale.”
When it began this work, Providence had four fundamental goals: increase patient engagement, strengthen patient-provider relationships, improve quality of care, and ultimately transition delivering care from reactive to proactive.
“We knew this would improve clinical outcomes and reduce overall medical costs for patients – and we were right,” Cunningham noted.
“Since then, the program has helped us ensure the safety of chronically ill patients at home to achieve our goal of The fifth aim of healthcare improvement: Improve the patient experience by tailoring treatments and interventions to patient data; Addressing population health issues through the provision of proactive, preventative care; reduce costs by connecting patients to the most appropriate care intervention and reducing avoidable hospitalizations; improve provider well-being by expanding their reach through virtual care teams; and provide equitable care by reaching all patients, regardless of their ability to seek in-person treatment.”
MEETING THE CHALLENGE
At Providence, patients with congestive heart failure, hypertension and/or type 2 diabetes are provided with devices that allow Cadence’s virtual care team to proactively monitor the patient’s condition at home.
“If there is a concern, the Cadence team will reach out to the patient to assess their health status, manage their medications, and if necessary, connect them with a clinician at Providence,” said Dr. Kenneth W. to hopefully avoid a trip to the emergency room.” Kooser, a family medicine physician at Providence Family Medicine-Lacey Medical Group in Lacey, Washington.
“This team-based approach allows for additional touchpoints with chronic disease patients in the comfort of their homes, between patient visits,” he continued. “Cadence services are accessible 24/7 and help triage urgent, urgent and non-urgent issues, helping to reduce the burden on Providence’s clinicians.”
For team-based care to be successful, he added, it’s important to establish mutually agreed upon clinical guidelines so that everyone on the care team is pulling in the same direction.
“For example, with remote monitoring, it means we have to put clear and effective clinical instructions in front of the patient, so everyone on the patient care team understands,” he explains. when and how to intervene if necessary. “We regularly review and update these clinical guidelines with the latest evidence-based practices.
“We then communicate these new guidelines to everyone in the patient population in an effort to standardize care and ensure every patient receives the best care across the board,” he continued. clinical exposure”.
“With technology, it’s also important to develop simple and easy applications. tools that do not burn out physicians but instead reduce administrative burdens and make care delivery more efficient and energizing.”
In the case of remote monitoring, he added, the value to patients is clear: Patients have peace of mind knowing someone is monitoring their health consistently.
“What is less discussed is how RPM can improve work-life balance and reduce the burden on clinicians,” he notes. “For us, the important aspect is ensuring EHR integration is available from the start to our clinicians. With EHR integration, all patient information is available in real time.” real time for clinicians.
“They can easily identify patients who would benefit from remote monitoring, based on personalized eligibility criteria established by our clinical team, and then easy ordering for patients in the EHR.” “We also prioritized innovative features, such as a sophisticated alert system and patient communications platform, to make RPM seamless and easy to use for clinicians, staff and patients. core.”
For example, the majority of these alerts are effectively resolved by the RPM team without referral to a primary care provider, he added.
“In fact, less than 1% of alerts require referral to the Providence care team,” he reports. “This results in fewer phone calls and texts to the clinic. This means we can also catch potential patient problems in real time instead of having to wait for the patient to come in for a check-up.” according to the traditional calendar, then their health condition may worsen.
“Not to mention, with remote monitoring data available, clinicians can make better use of in-person visits with patients and reduce the need for more frequent visits that might otherwise be avoided,” he said. due to everyday concerns”.
RESULT
Providence’s remote patient monitoring program went live in the summer of 2022 with two pilot programs in Washington state. Since then, the health system has seen high growth and adoption.
“We measure key metrics including utilization, retention, patient and provider satisfaction, and Providence PCP progression, along with other metrics,” explains Cunningham. clinical outcomes such as blood pressure, proportion of patients following instructions, etc.
To date, she reports, Providence exists more than 1,500 patients are currently enrolled in this model of care, and “we expect this number to reach 5,000 to 8,000 by the end of 2024.”
Meanwhile, 88% are measuring vitals daily and 77% are still enrolled in the program after six months.
Cadence is reducing the workload for providers and its clinical care teams, while successfully managing and triaging patient alerts: Only 0.6% of remote encounters are delivered Providence clinicians.
The clinical results for patients with hypertension and type 2 diabetes were even more remarkable: Patients who started with a systolic blood pressure >160 achieved an average systolic blood pressure reduction of 21 mmHg by week 12th (in other words, a 12.55% reduction in systolic blood pressure at week 12); and patients with blood sugar readings above 183 mg/dL had a 16.75% reduction in blood sugar by week 12.
After a successful year, Providence is now partnering with RPM in Washington, Montana and California, and is giving the green light to expand the program to Alaska this year.
ADVICE TO OTHERS
At the highest level, Providence prioritizes executive alignment at the start of any major partnership or large-scale initiative, Cunningham noted.
“Choose your technology projects intentionally, with strategic KPIs and an implementation plan behind them,” she advises. “Make sure they align with your health system’s key goals and help solve your biggest challenges.
“This is very effective in determining whether our approach is effective,” she continued. “Be serious about bringing stakeholders together, reviewing and making sure you’re on the right track to either keep moving forward or not.”
She added that piloting and developing a proof of concept is key.
“We are a firm believer in piloting technology programs before scaling them more widely across the health system,” she explains. “That said, we don’t want to engage in perpetual experiments, so we always plan a ‘scale pilot’ approach to any solution we show.
“For remote patient monitoring programs, it is important to ensure the communication flow works correctly between patients, physicians, and your partners,” she continued. “Ensuring incoming data is managed properly – where is it going, who is looking at it, whether it creates additional burden along the way, who processes this information, are important questions.” important to ask.”
And finally, Providence recommends developing a “tiger team” to scale, ensuring someone with expertise in change management and workflow redesign is on the team.
She concludes: “Implementing a program like this is just the beginning – the real scaling is when the rubber meets the road and you need a team internally, across departments, that can promote and encourage adoption at every touchpoint.”
“Assigning project managers to different parts of the organization, including clinical influencers, operations support and IT as well as marketing and communications professionals, is critical to the success of the program.”
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