Essen Health Care, a medical group in New York City, has a Center of Excellence for Pain with physical therapy, pain specialists, neurology and orthopedic specialists. It serves patients with acute and chronic issues in need of physical therapy.

In addition, it serves many elderly house call patients, due to pandemic restrictions, who have functionally deteriorated due to a lack of physical activity.

THE PROBLEM

Continuity and access to care for patients living with chronic diseases or going through cardiac and orthopedic rehabilitation are one of the most challenging areas in healthcare.

Difficulties include ensuring the quality of recovery, reducing readmission, increasing accessibility to therapy and increasing compliance with personalized treatment. This reduces the excessive costs involved for both the patient and the health system.

"As our offices have opened post-pandemic for full on-site care, there is a varying level of patient compliance to come in for on-site care," said Dr. Sumir Sahgal, founder and chief medical officer. "The concern includes potential exposure to COVID, cost of transportation and other priorities in a post-COVID era.

"We faced our own issues when it came to staffing shortages due to call outs from COVID exposure," he continued. "Post-exposure or with COVID, regardless of feeling well and able to work, physical therapists couldn't come to work since they posed a great risk to others. In addition, we had difficulty recruiting due to a small pool of available trained therapists."

PROPOSAL

Faced with these challenges, Essen Health Care turned to health IT vendor WizeCare's enterprise-wide virtual rehabilitation and remote monitoring technology.

WizeCare has developed technology for virtual physical therapy synchronized as well as unsynchronized with clinician time. It is powered by artificial intelligence, big data collection and analysis, computer vision, and machine learning.

"Our team spent a lot of time training but also guiding the patients. Even with clear goals, it took time and effort to get buy-in from all staff and clinicians."

Dr. Sumir Sahgal, Essen Health Care

"This is a full solution for all rehabilitation stakeholders including the patient, clinician, multidisciplinary rehabilitation team and payers," Sahgal explained. "It is helping patients reach their highest recovery potential, offering value-based care for payers, and reducing providers' need for care specialists in acute conditions.

"The vendor has developed a web and mobile app that delivers customized physical therapy video plans for patients to independently practice anytime, anywhere," he added. "These plans are controlled by the providers' PTs through the WizeCare Clinic web app, which also provides a communication interface between the patient and the clinician, including secure video and text chat."

The platform uses personalized, prerecorded videos as its treatment medium, and open architecture for mobile tracking technology that runs on consumer devices, able to deliver to each target patient population the optimal monitored path to recovery or maintenance.

It's designed to significantly improve patient compliance, thereby reducing the risks and costs associated with readmission into the hospital as well as reducing the risk of having recurrent health conditions. It also aims to enable clinicians to get a real-time, comprehensive and ongoing view of a patient's condition.

"The platform augments the rehabilitation experience by enabling patients to maintain a post-discharge rehabilitation training routine," Sahgal explained. "This allows them to move toward a behavioral change that can help them maintain a healthy lifestyle, significantly reduce their risk factors and prevent recurrent medical conditions.

"The platform enables clinicians to evaluate patients' movement patterns to reveal their core deficits and use the collected data to offer the highest potential intervention for chronic, acute/sub-acute, and post/pre-surgery patients," he added.

Benefits include precision diagnostics, clear treatment pathway, shorter and improved treatments, and early detection, he said.

MARKETPLACE

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MEETING THE CHALLENGE

The vendor's technology is being offered by Essen Health Care in a hybrid model at all PT centers. Patients who need physical therapy are referred to an Essen PT center.

"The first assessment is being done by a PT in-facility, following which the PT will prescribe the virtual platform to patients who are found as a good fit – clinical, high level of independence, with no cognitive impairments," Sahgal explained. "The front desk admin will sign the patient up and send an invitation to use the virtual service.

"A WizeCare representative on-site can assist with all things logistics and tech support," he continued. "The patient can download the mobile app to their iOS or Android mobile device or use the web app on their laptop or iPad. The PT builds a care plan for the patient out of a library of 1,000 exercises, and prescribes frequency."

The patient performs the practice independently while the technology provides real-time feedback on performance and tracks adherence and quality of performance to share with the PT. During that time, the patient can continue to meet with the PT on a video call alone or combine coming on-site and video sessions.

"During the video call, the PT can see the patient performing the exercise, while also monitoring the range of motion of the movement on an ongoing basis, which can help determine the improvement or difficulties in movement," Sahgal said. "The patient can communicate with the PT via app chat at any time and ask questions.

"The platform helps to reduce no-shows and cancellations – if a scheduled patient can't come to the facility, they are immediately offered to do a virtual session, thus increasing PT accessibility to them," he continued.

The platform analyzed patient performance via machine learning algorithms, leading to higher patient compliance, better outcomes and reduced costs, he added. The vendor uses AI for real-time analytics, diagnostics reports, decision support, ongoing assessment and care plan adjustment, vital patient data, and standardized care.

RESULTS

The most significant impact of the virtual physical therapy technology was enabling patients to perform their rehabilitation plan in a more accessible and affordable way, allowing them to gain a better clinical outcome, faster recovery time, and improved health and wellbeing, Sahgal reported.

Essen Health Care, he continued, saw success with:

1. Patient adherence to therapy. Some 70% of patients adhered to the care plan, in comparison with the standard 5% in-facility during the height of the pandemic.

2. Shortened rehabilitation period – a 20% reduction in the rehabilitation period. Patients need fewer sessions to reach their functional ability goals.

3. Better adherence with seniors. The most adherent patient group is 65 years old and above, enabling them access to care and taking down logistics barriers.

ADVICE FOR OTHERS

"Any technology in a healthcare setting is a disruptor, but channeled properly, it becomes an enabler," Sahgal advised. "Organizations need to prepare themselves for emergencies like a pandemic, and technology can provide value-based care with lower costs and better results. However, to choose and adopt new technology, an organization must do an internal assessment of people, process and place.

"Healthcare organizations have multiple needs across various divisions and patient groups," he continued. "They must decide where to implement. In our case, it was clear that virtual PT was needed at patient homes and needed to be available through multiple media, including phones and tablets, which most patients possessed."

Process is key to aligning adoption and enabling the clinicians as well as staff, he added. New technology will require constant tweaking as people and places create new scenarios, he said.

"Staff education, training and adoption is critical for success and most underestimated," he concluded. "Our team spent a lot of time training but also guiding the patients. Even with clear goals, it took time and effort to get buy-in from all staff and clinicians."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.