Renowned business author Jim Collins often points to the important role that passion plays when companies attempt to move beyond the status quo. The lesson wasn’t lost on clinicians at MultiCare Health System, a non-profit integrated healthcare system based in Tacoma, Wash.
After wanting to use video conferencing as part of a remote patient monitoring program, clinicians have watched their telehealth program take off. MultiCare launched its telehealth program well over a decade ago by providing home care patients, primarily those who suffer from heart conditions and chronic pulmonary obstructive disorder (COPD), with devices that could remotely monitor a variety of vital signs such as blood pressure, weight and oxygen saturation.
“It’s been really effective in allowing us to get our onsite visit utilization down,” said Lynnell Hornbeck, manager of home health at MultiCare. “And, we’ve also been able to get some good clinical outcomes.”
Recognizing the need to refresh and expand the services they provide to patients, the organization implemented new telemonitoring and video conferencing capabilities from Honeywell Life Care Solutions in 2015. The tablets collect and transmit biometric data wirelessly to Honeywell's remote patient monitoring software, providing a single consolidated view of patient information enabling care providers to make informed, data-driven decisions.
With the new technology in place, clinicians started to look at the program differently. Clinicians understood the importance of developing a strategy and establishing best practices for the team to fully optimize the new telehealth solution.
“We knew we had a good tool but we realized that we would have to develop a unique approach to make it work,” Hornbeck said. Extra effort was essential because many of the telehealth programs that she had researched seem to struggle to get results because leaders failed to actually define how to most effectively utilize the equipment.
To make the use of the new telehealth solutions more strategic at MultiCare, clinicians worked on finding ways to incorporate the technology into their workflow. Instead of randomly conducting video sessions with patients, clinicians came up with a plan to implement video visits with a group of identified patients. As such, the video visits became a part of the intended workflow, not merely a novel afterthought. In fact, after implementing this workflow change, MultiCare has gone from conducting just 20 video visits with patients per month to about 60 per month.
In addition to incorporating the telehealth visits into the nurses’ workflow, MultiCare also made a concerted effort to ensure that patients were comfortable with the technology. While the technology is easy to use, many older patients simply find the concept to be overwhelming. To address this concern, MultiCare initially conducts “hybrid” sessions with many patients. During these sessions, a nurse will visit the home and initiate the video session. The nurse will then leave the home as the patient continues the session with another remote caregiver who provides disease management education.
“It’s often overwhelming for many elderly patients to say, ‘Start a video visit.’ But if they see a nurse do it a time or two, they become more comfortable with it,” said Corissa Kilga, RN, a nurse who works in the telehealth program.
The nurses also looked for innovative and specific ways to use the video capabilities. As part of their impassioned embrace of the technology, they developed 19 applications including:
Interactive coaching sessions. Underuse of nebulizers is a significant problem among COPD patients. With the video technology in place, however, nurses realized that they could visually demonstrate how the equipment works to better ensure patient compliance. Showing patients how to use the equipment is just part of the nebulizer compliance push. The nurses also use the video capabilities to ensure that patients understand how important nebulizer treatment is to their wellbeing. To do so, the nurses visually show patients the difference in their oximeter readings immediately before and after they have used the device. “When patients actually see the effect that the treatment has on their breathing capacity they are much more motivated to perform the breathing exercises on their own,” said Kelly Gariando, RN, one of the nurses who works with the telehealth patients.
Virtual field trips. Just as teachers find that concepts sink in when students see things in person, the MultiCare nurses use videoconferencing to show patients how they are faring from a health perspective. To do so, nurses simply focus the video camera on screens in the healthcare organization’s electronic medical record. By doing this, patients become more engaged and better understand the connection between the doctor’s orders and their health status. Best of all, they are ultimately more motivated to take care of their own health. Nurses also leverage the technology to provide other virtual hands-on lessons using easy to understand references.
Grocery shopping lessons. Many home health patients struggle with food choices, which is an especially troubling concern for those suffering from chronic conditions that are easily exacerbated by diet. So, if nurses notice that a patient’s vital signs – weight and blood pressure, for example -- are trending in a negative direction, they might offer to go on a virtual grocery shopping expedition. The nurses will select a food item and go over the nutrition facts on the label with the patient using the video teleconferencing. Through this interaction, the nurses work with patients to discuss nutrition facts, serving size, sodium levels, and other dietary information.
Caring for the sickest patients. Doubutamine infusions, which are used with recovering heart patients, typically are administered in intensive care units, not on the regular hospital nursing floors. With the video functionality in place, MultiCare is able to send these patients home and monitor their infusions remotely. “These patients are very sick and many of them have a history of non-compliance,” Kilga said. “We conduct video visits with these patients every day. We often find that they are mismanaging their medication in a way that would put them back in the hospital.”
Minding medication matters. Nurses also leverage the video technology to increase the level of medication compliance. This proves to be especially helpful when patients are receiving “flexible” doses of a medication. “When we monitor patients for weight gain, those with a significant increase will be instructed to take an additional water pill and extra potassium. To ensure that they are taking the right dose, we have them put their pill bottles up to the camera so we can verify they have the correct medication, the correct dose, and we can provide instructions to take one or two of those pills right now, or this afternoon,” Kilga said.
The use of video has resulted in noticeable improvements in patient engagement, according to the MultiCare nurses’ observations. Many patients, for example, have come to appreciate the continuous monitoring offered through the telehealth initiative. “Before entering the telehealth program, one patient was overwhelmed because she had to go to so many different doctor’s appointments. But she expressed that she loves having the ability to meet with care providers and manage her health remotely through the video visits,” Gariando said.
With all of this enhanced engagement comes improved results. During 2014 the telemonitoring program focused primarily on patients with congestive heart failure as a primary or secondary diagnosis. In 2015 and 2016 the program expanded to include patients with a heart failure and/or COPD diagnosis. The program has continued to expand, growing from 765 patients in 2014 to 605 patients in just the first half of 2016. The 30-day readmission rate for patients with heart failure who participated in the telmonitoring program was 16 percent in 2014, 5.1 percent in 2015 and just 3 percent for the first half of 2016. This compares favorably with thirty day readmission rates for heart failure reported by the entire MultiCare Health System of 24 percent and 20 percent in 2014 and 2015, respectively.
These improvements have also resulted in reducing costs associated with hospital readmission. MultiCare estimates that in 2015 cost savings associated with hospital readmission avoidance from the remote patient monitoring program was $1.9 million.
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