5 key steps to establishing a remote patient monitoring program

Planning is critical for organizations that want to reap the potential benefits of initiatives that extend care to patients in their homes.

Many clinicians recognize that remote patient monitoring has the potential to extend the resources of the care team by identifying patients who can benefit most by engaging in self-care activities, reducing the need for in-person, clinic-based care.

Remote patient monitoring (RPM) gives providers enhanced ability to track and manage patients in nontraditional settings by using digital technologies to collect and transmit data from the patient to their provider team for monitoring, assessment or recommendations.

As more people become aware of remote patient monitoring devices and their benefits, the pressure for healthcare organizations to include them will only increase. By developing an intentional, well-designed RPM program plan, healthcare organizations can undertake the important groundwork and planning needed to leverage patient self-care and technology in the pursuit of better care for all.

To ensure healthcare organizations fully realize the benefits of RPM, they may want to consider five key strategies to increase the chances of program success.

1. Set program goals and objectives

At the outset, leadership should convene clinical and operations teams to establish and document specific goals and objectives for an RPM program – these should be aligned to the organization’s strategy and current state.

For example, provider groups that are participating in value-based contracting or alternative payment models may be considering RPM to attain better outcomes using fewer resources or to increase the efficiency of existing care teams. Other organizations may see RPM as a way to engage patients in self-care activities, targeting those patients who are close to realizing their goals for control of their condition and would benefit from joining a structured program to help them attain their health goals.  

Assessments of community health needs and the organization’s own experience in dealing with its patient population will help inform which conditions or diseases are prevalent and represent a significant burden of illness in its community. Patients with some of the most common chronic conditions – such as diabetes, hypertension, chronic obstructive pulmonary disease, among others – are prime candidates for RPM, as they are frequently experienced, require regular monitoring of signs and symptoms to identify exacerbation or improvement and are tracked by clinical indicators that can easily be measured in nonclinical environments.

Creating specific program goals associated with the target population is one way to link organization objectives – better outcomes with current resources – to those being served. For example, an organization setting up an RPM program for diabetics may want to define a goal to engage 50 percent of the practice’s adult diabetics, monitor their A1c levels bi-weekly for 12 months and achieve a 50 percent improvement in A1c control.

2. Establish an engaging program design

Healthcare organizations may encounter challenges communicating to potential program participants what the RPM program is about, why they may be good candidates to participate and what benefits they may hope to achieve by joining.

In developing the target participants for an initial program, several factors need to be considered:

  • What health conditions or even care transitions (for example, 90 days post-discharge) can we best impact?
  • What clinical resources are available to manage chronic conditions and lead this program?
  • What are the strategic goals of our program, and how do they inform who we should target for participation?

These factors can help identify potential participants. From there, the organization needs to develop inclusion criteria, which are the characteristics or parameters that help decide who should be enrolled in the program. These factors can include age, diagnoses, risk score as well as an individual assessment of each patient’s ability or motivation to participate.

Accounting for limitations in the size and scale of the program is just as important for success, recognizing staffing resources, the complexity of the enrollees and the time commitment required for program oversight, monitoring, documentation and reporting. For example, a practice with a dedicated coordinator and two part-time nurses may decide that its ability to staff a program may be limited to a certain capped volume of patients. Similarly, it may want to focus on a subset of its patients where the practice has historically not met quality performance goals.

As these determinations are made, the inclusion criteria become more focused. Other elements to determine include the key performance indicators, outcome targets and other measures staff will be tasked with recording and tracking to evaluate success.

3. Orient and clarify roles for staff

Next, the focus shifts to engaging staff and members of the care team in program details and delineating what their roles and responsibilities will be. A clearly stated model of care should account for each step of the RPM process, identifying the specific tasks and interactions between team members, patients, devices and technology.

A tool to consider as the team maps out these roles and actions is a RACI matrix, an acronym standing for Responsible, Accountable, Consulted and Informed.  By applying a structured model to each step of the RPM program, the team can visualize all details, hand-offs, potential efficiencies and risks in advance of launching the program.

Using a RACI construct also brings clarity and transparency to each team member and facilitates a level of confidence and awareness for everyone. This clarity of role and responsibility enables the evaluation of success, and identification of challenges and improvement opportunities.

4. Set a mechanism to engage and manage patients

Outreach to potential patients for the RPM program, based on inclusion criteria, enables engagement of possible enrollees, sharing with them information about the goals of the program and why the provider believes they will benefit.

There are several standard educational elements about an RPM program, including how it will work, potential costs to patients, expectations and more. Outreach efforts may take multiple rounds and use a combination of written materials, in-person discussions during visits, or telephone outreach to provide sufficient understanding and motivation for patients to enroll.

Healthcare organizations can tailor direct conversations to every patient to reflect their personal circumstances, individual goals and anticipated benefits. Patient enrollment requires their registration in the technology solution that will be used for program management, and the collection and review of device data.

Device selection for participating patients will vary depending on several variables, including compatibility with the electronic health record systems or program platform, as well as device features, availability, ease of use and cost. Organizations will want to determine in advance the devices around which they will standardize their program, limiting the selection to those that fit their needs, also bearing in mind the ease of device education, troubleshooting, repair and replacement.

In program design and role clarification phases, program leaders should outline and set specific intervals for when device data (whether auto-read or patient-initiated) will be uploaded to the technology platform/EHR for review and monitoring. These regular readings and data uploads will continue throughout the program.

Staff who manage patient education sessions may use a combination of online video instruction and in-person training to ensure participants are comfortable with how to use their devices, how to initiate or upload data, and the expectations for how frequently to take readings.  Depending on the nature of the patient’s clinical need and the devices they are using, staff can inform patients about what results may indicate a problem or developing issue that they should bring to the attention of the organization.

Ongoing management of patients and review of their remote data continues in a cadence established in the program design, aligned to the specific conditions and goals set for the patient. The patient’s RPM program should account for graduation criteria — the clinical indicators that show the stabilization, reduction of symptoms or other factors that would uniquely demonstrate the patient has accomplished intended clinical objectives. While many participants in an RPM program are not likely to “graduate,” the ability to advance patients into a model of self-care that doesn’t require ongoing clinician oversight and monitoring would enable other patients to be added to the program over time without adding resources.

5. Evaluate and extend the program

A successful RPM effort must include performance assessment, evaluating the outcomes and impact of the program.

Establishing key performance indicators in designing the program can give clinical leaders and management insights on the day-to-day aspects of RPM. These measures might track the percent of eligible patients who agree to enroll, the frequency and compliance of patients with uploading data per their program goals, or individual patient level measures of clinical relevance, such as A1c levels, BMI or blood oxygenation.

In addition, organizations will want to collect patient-reported reflection on their experience with the program, their knowledge and confidence in self-management of their conditions and their experience of care with the RPM program staff and clinical team. Similarly, using survey instruments or group discussions, soliciting input from staff on their experience in the program and opportunities to adjust or refine how team members work together can support potential refinement.

Understanding what is going well and what may need revisiting supports a cycle of continuous quality improvement and empowers those directly engaged in the program to share their knowledge and insight. Collecting and acting on data regarding the clinical progress of participants, combined with patient and provider/staff feedback, can help the organization determine the value and direction of future program expansion or to identify modifications to the scope of the current initiative.

Graham Brown is a principal and senior vice president with NextGen Advisors focused on transforming care with provider organizations. This article originally appeared on the NextGen Healthcare website.

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