Boston Medical Center is a non-profit academic medical center and the largest safety net hospital in New England. It provides medical care for infants, children, adolescents and adults.
Dr. Christina Yarrington is chief of fetal medicine at Boston Medical Center. As head of the obstetrics department at the medical center, her focus is on ensuring the facility’s population has the resources needed to monitor patients at high risk for postpartum hypertension to reduce their risk. overall health in a way that doesn’t disrupt the crucial early days of a newborn. link at home.
PROBLEM
Postpartum hypertension is a leading cause of postpartum hospitalization and maternal morbidity, as it can lead to heart attacks and strokes, which makes blood pressure monitoring closely related. and being able to take advantage of the data from measuring blood pressure is important.
There are challenges in getting blood pressure data in a timely manner if dependent on a visiting nurse or if it is sometimes not possible to go to the clinic with an infant. The pandemic has magnified these challenges.
“Fortunately, we have already begun exploring remote patient monitoring solutions that integrate with our Epic EHR, which are easily accessible and require minimal patient effort,” noted Yarrington.
SUGGESTIONS
Boston Medical Center serves a community largely dependent on Medicaid to support access to health care. Reflecting the economic accessibility of patients, Yarrington and staff were looking for a remote patient monitoring system that could work without reliance on Wi-Fi, Bluetooth, or a personal cellular data plan. .
“Ultimately, we chose Rimidi because their clinical management platform integrates with a mobile-assisted connected blood pressure monitor, which means our patients only require wearing a cuff and pressing a single node and the data will come to us regardless of their Wi. – Fi, broadband, etc,” she explains.
“When you want to implement a remote monitoring program, it’s important that you pay attention to your unique patient experiences.”
Dr. Christina Yarrington, Boston Medical Center
“We’ve heard from many of our patients that telemedicine video views deplete their personal data plans, so the peace of mind that this part of their care is independent of the environment. The digital school has allowed them to participate,” she continued.
Data from blood pressure measurements taken from the cuff is transmitted directly to Rimidi, which is integrated with the Epic EHR, allowing clinicians to view blood pressure data within their existing workflow.
“The goal of implementing a remote patient monitoring solution is to give patients the tools they need to monitor their blood pressure at home while knowing their care team is looking for them and to know what they’re looking for. Catching any blood pressure out of range can lead to Yarrington’s interpretation.
She added: “We also hoped to be able to keep postpartum patients at home with their families and newborns, so we developed a new hypertension regimen remotely whenever possible. body.
MARKET
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CHALLENGE MIX ONLY
Patients at high risk for postpartum hypertension, such as those with hypertensive disorders of pregnancy, chronic hypertension, or hypertension during hospitalization for delivery, have their blood pressure measured. cell support and was instructed to measure blood pressure daily for six weeks postpartum.
They receive written instructions in English, Spanish and Haitian Creole (the three most common languages in the region) as well as a QR code that links to a video tutorial on how to monitor blood pressure at home with that language.
“Blood pressure results are transmitted to Rimidi’s secure web portal and combined with relevant, patient-specific clinical information is obtained from Epic,” says Yarrington. “This gives us the opportunity to see not only the individual’s blood pressure trends, which often inform next steps, but also the context of their hypertension in their overall cardiovascular health.
“For this program, Rimidi also set up configurable clinical decision support tags that will flag when a patient is missing a reading or when a reading falls outside a certain threshold.” she continued. “In addition, the system provides a discharge alert when a patient has been monitored for six weeks if their blood pressure seems good.”
The alerts were designed with the Boston Medical team in mind, she added, to improve triage, patient and provider communication, and clinical workflow.
“It’s not just data from Epic and the built-in sphygmomanometer, it’s an experience for clinicians; this technology launches and provides decision support in their Epic workflow.” , Yarrington explained.
“Overall, by setting up this program and using remote patient monitoring technology, we can intervene more quickly to prevent adverse outcomes,” she said. “Patients have said that through the program, they feel well cared for and that they feel like they have someone’s attention even after they’ve left the hospital.”
RESULT
Boston Medical recently published the results of its remote patient monitoring program in the Journal of the American Heart Association, Circulation.
Of the 1,000 patients followed up between April 2020 and September 2021, 98.7% submitted at least one blood pressure measurement, with an average of 17 unique measurements from those patients. registered individual for six weeks after birth. This has led to early detection and management of stroke risk.
TIPS FOR OTHER PEOPLE
“When implementing a remote monitoring program, it is important that you consider your unique patient experience,” advises Yarrington. “It’s not enough to just give a person a device – the amount of work they can do to deliver data, how they interact with it, and their particular digital environment will vary, and this are the key ingredients of success.
“The other half of the equation is making sure the solution integrates well with your existing EHR and clinical workflow,” she concludes. “Changing a workflow is always difficult, but take the time to properly train a handful of employees and make sure they’re comfortable with the new processes, and then disseminate it to those employees.” remaining, making new processes and procedures easier to implement.”
Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a publication of HIMSS Media.
