Remote Patient Monitoring (RPM) has advanced providers’ 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. Many clinicians recognize RPM has the potential to extend the resources of the care team by identifying the right group of patients who can be engaged in self-care activities and reduce the need for in-person, clinic-based care. To ensure the benefits of RPM are realized, practices may want to consider the five key strategies detailed here to increase the chances of program success.
1—Set program goals and objectives
At the outset, leadership should convene their clinical and operations teams to establish and document a set of specific goals and objectives to be achieved by the RPM program that are aligned to the organization’s strategy and current state. For example, provider groups who are participating in value-based contracting or alternative payment models may be considering RPM to attain better outcomes using fewer resources or existing care teams in a more efficient manner. Others may recognize RPM as a method to engage patients in self-care activities, targeting those who are close to realizing their goals for control of their condition and would benefit from joining a structured program to center them in realizing their health goals.
Community health needs assessments and the practice’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. Some of the most common chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease) are prime candidates to consider 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 allows a method to link organization objectives (better outcomes with current resources) to those being served. An example of this linkage: An organization setting up an RPM program for diabetics may want to define a goal to engage 50% of the practice’s adult diabetics, monitor their A1c levels bi-weekly for 12 months and achieve a 50% improvement in A1c control.
2—Establish an engaging program design
One of the challenges practices may encounter with RPM is communicating to potential program participants (patients) what the program is about, why they may be a good candidate to join and what benefits they may hope to achieve by participating. In developing the target participants for an initial program, several factors need to be considered: What health conditions, or perhaps care transitions (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 parameters inform a baseline of potential participants. From there, inclusion criteria need to be developed. Inclusion criteria are the characteristics or parameters set up to help decide who should be enrolled in the program and may consider age, diagnoses, risk score as well as an individual assessment of each patient’s ability or motivation to participate.
Accounting for limitations to 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. The practice may decide that with a dedicated coordinator and two part-time nurses, its ability to staff a program may be limited to a certain capped volume of patients. Similarly, it may want to focus on a sub-set of its patients where the practice has historically not met quality performance goals for process or outcome measures. As these determinations are made, the inclusion criteria become more focused. Other elements to figure out at this stage are the key performance indicators, outcome targets and other measures staff will be tasked with recording and tracking through the program to evaluate success.
3—Staff orientation and role clarity
With initial decisions around the focus of the program, candidates for enrollment and measures of success defined, the focus shifts to engaging staff and members of the care team in the details of the program and 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 think through all the little details, hand-offs, potential efficiencies and risks well 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 involved. A related benefit is this clarity of role and responsibility allows the evaluation of success, as well as identification of challenges and improvement opportunities.
4—Patient engagement and management
Outreach to patients who are good candidates for the RPM program, based on the previously developed inclusion criteria, provides the first opportunity to engage possible enrollees, share information about the goals of the program and why the practice or the patient’s provider believes they will benefit. While there are standard educational elements describing the program, how it will work, potential costs to patients, expectations etc., outreach efforts may take multiple rounds and use a combination of written materials, in-person discussions during a clinic visit, or telephone outreach to provide sufficient understanding and motivation for the patient to agree to enroll. Direct conversations with the patient’s provider or the designated RPM program enrolment staff will benefit from being tailored to reflect the personal circumstances, individual goals and anticipated benefits to patients. Enrollment of the patient into the program entails their registration in the technology solution that will be used for program management and the collection and review of device data. Selecting devices that can be used by patients in the program will likely be informed by a number of variables, including compatibility with the electronic health record or program platform, 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 and making device education, troubleshooting, repair and replacement easier.
In the program design and role clarity phases described earlier, program leaders would have outlined 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 are designated to manage patient education sessions might use a combination of online video instruction and in-person training to ensure participants are comfortable with how to use their device, how to initiate or upload data, and the expectations around frequency of when to take a reading. Depending on the nature of the patient’s clinical need and the devices they are using in the program to monitor their vitals, staff will also guide patients about what results to look out for which may indicate a problem or developing issue that needs to be brought to the attention of the practice.
Ongoing management of patients and review of their remote data continues in a cadence established in the program design, again aligned to the specific condition(s) 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 the clinical objectives for which the RPM program was introduced. While many participants in an RPM program would not likely “graduate,” the ability to advance patients into a model of self-care that doesn’t require ongoing clinician oversight and monitoring allows other patients to be added to the program over time without adding resources.
5—Program evaluation and extension
The fifth key to highlight for a successful RPM effort centers around performance assessment and evaluating the outcomes and impact of the program. As noted earlier, establishing key performance indicators up-front in the program design offers regular insight to clinical leaders and management on the day-to-day aspects of RPM. These day-to-day 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 (A1c level, BMI, blood oxygenation). Building upon these, practices will want to consider how to collect patient-reported outcomes regarding their experience with the program, their knowledge and confidence in self-management of their condition or their experience of care with the RPM program staff and clinical team. Similarly, using survey instruments or group discussions, soliciting input from staff as to their experience in the program and opportunities to adjust or refine how team members work together inform a parallel domain of learning and 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 upon data regarding the clinical progress of participants, combined with patient and provider/staff feedback, can help the practice determine the value and direction of future program expansion or to identify modifications to the scope of the current initiative.
As more people become aware of remote patient monitoring devices and their benefits, the pressure for practices to include them will only increase. By developing an intentional RPM program plan informed by these five keys to success, practices can undertake the important groundwork and planning needed to leverage patient self-care and technology in the pursuit of better care for all.
For more insights on the benefits of RPM, visit last month’s blog here.