MaineGeneral Health in Augusta had high, rising readmission rates for congestive heart failure. In January 2020, the organization launched a remote patient monitoring pilot, working with vendor Health Recovery Solutions to monitor CHF patients after discharge from the hospital.

THE PROBLEM

Upon discharge, patients often need support to understand their symptoms and warning signs after returning home. Remote patient monitoring allows patients to monitor their blood pressure, weight, oxygen saturation, symptoms and medication adherence in real time at home with a dedicated registered nurse who actively outreaches to patients as needed.

During the pilot, MaineGeneral Health learned it takes more clinical time to monitor and follow up with patients. Because of this, it hired a full-time employee to monitor the patient panel. As the program grew to more than 100 patients, the organization expanded to allowing referrals for patients with any chronic condition or COVID-19 and hired additional clinical staff.

"When COVID-19 hit, patients avoided coming into the office, when possible," said Laura Mrazik, telehealth coordinator at MaineGeneral Health. "Patients needed a mechanism to connect with their primary care providers for chronic or acute care needs when virtual care was appropriate.

"We shifted priority to identifying a user-friendly solution for our outpatient practices to deploy virtual visits," she continued. "Patients with COVID-19 symptoms were able to stay out of the office for their routine chronic condition follow-ups without exposing patients or staff."

PROPOSAL

MaineGeneral already had selected the RPM vendor prior to COVID-19. However, the pandemic exacerbated the need, especially as patients began delaying care.

"Patients are educated while in the hospital on the opportunity to monitor," Mrazik explained. "Once discharged, a care team member visits their home and sets up the unit for them; this includes a data-enabled tablet, programmed only for the vendor's application, as well as Bluetooth-connected heart-rate monitor, pulse oximeter and scale.

"In May and June 2022, MaineGeneral has achieved a CMS-CHF readmission rate of 0%, compared with 20% and 26.7% in the same months the prior year. Additionally, the overall CHF readmission rate has hit 0% in four of the last nine months.

Laura Mrazik, MaineGeneral Health

"Units are programmed with disease-specific survey questions to flag high-risk symptoms and set with daily reminder alerts to take medications and record vital signs," she added. "Early interventions by RNs on staff have resulted in avoiding readmissions through timely medication adjustments, identifying a pacemaker's dead battery, discovering a patient's need to be on hypertension medication, and more."

In an effort to find a video technology that was easy for patients to use, MaineGeneral ended up with HIPAA-compliant Zoom as the video conferencing component for virtual care in outpatient settings. The organization implemented virtual visits across all primary care, integrated behavioral health and pediatric behavioral health service lines.

"This funding also purchased tablets for patients in the hospital who were unable to visit with their families due to the new no-visitor policies," Mrazik said. "We deployed Zoom-enabled tablets so patients could connect with family and friends during an inpatient stay.

"In an effort to resolve for the need to limit patient exposure and connect with patients virtually, MaineGeneral planned workflows, purchased equipment, improved processes, and expanded telehealth services in remote patient monitoring and virtual visits in the outpatient setting," she added.

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MEETING THE CHALLENGE

For remote patient monitoring, as patients record their data, it is transmitted in real time to a central care team. If an issue is identified, the team can provide immediate support through video conferencing with the patient, education, or consulting the patient's primary or specialty care provider to determine if clinical intervention (medication change, for example) is necessary.

MaineGeneral Health monitors patients for an average of 90 days before they graduate from the program. The vast majority of patients are 61 to 90 years old.

"The program has grown from an active caseload of 25, up to monitoring 225 patients at a time," Mrazik noted. "MaineGeneral started with 50 units for CHF patients only and evolved to keeping 300 units in rotation to monitor patients with any chronic condition or COVID-19.

"Care teams refer patients from an inpatient stay, home care or their outpatient practice," she continued. "We primarily monitor patients with CHF, with COPD, hypertension, pneumonia and COVID-19 as other most frequently seen diagnoses," she continued.

A grant from the FCC allowed MaineGeneral to invest in staff time to grow its active patient census while maintaining the program's integrity. The organization integrated Health Recovery Solutions with Homecare's electronic health record system so home care can actively see vitals, notes and interventions.

"We deployed 500 Zoom licenses across care settings, including primary care practices, integrated behavioral health practitioners and our pediatric behavioral health specialty practice," Mrazik stated. "Patients connect with their care team virtually, when appropriate for chronic or acute care needs, by joining a visit scheduled through MaineGeneral's Zoom license. We have integrated Zoom with Stratus to ensure patients have on-demand access to interpreter services during a virtual visit."

RESULTS

While MaineGeneral monitors patients with any chronic condition, most patients in the program have CHF. In parallel to the program's RPM growth, the organization standardized CHF education and post-discharge follow-up to support the readmission reduction efforts, including granting outpatient care managers access to Health Recovery Solutions as they follow patients for 30 days post-discharge.

"In May and June 2022, MaineGeneral has achieved a CMS-CHF readmission rate of 0%, compared with 20% and 26.7% in the same months the prior year," Mrazik reported. "Additionally, the overall CHF readmission rate has hit 0% in four of the last nine months."

With patient experience at the forefront of the organization's decision-making, it has seen the impact quality clinical personnel and a strong vendor relationship has on a telehealth program, she added.

"MaineGeneral's adherence rates to taking vitals – blood pressure, weight, O2 saturation – has consistently maintained an average higher than the vendor's book of business," she continued. "MaineGeneral RNs monitor the vendor's clinician portal, which stratifies patients who have taken their vitals already by normal or out-of-range readings, and those who have not yet recorded for the day.

"The RNs call patients daily if they have not recorded yet," she said. "Another downstream effect of staff and technology synergy has been high patient satisfaction scores. Overall, MaineGeneral's most recent RPM satisfaction rates show 90% of RPM patients are satisfied or very satisfied with the impact of the program and their ability to become an active participant in their health."

USING FCC AWARD FUNDS

MaineGeneral Health was awarded $603,315 to equip providers with all-in-one workstations capable of video conferencing and remote patient monitoring devices to perform virtual visits and reduce exposure.

"We were leasing RPM equipment, which includes the patient data-connected tablet and Bluetooth-enabled peripherals including blood pressure cuff, scale and pulse oximeter," Mrazik explained. "The FCC funds purchased remote patient monitoring units and covered one-year licensing fees for 200 units, which allowed MaineGeneral to expand our programs rapidly.

"We plan to continue growing the RPM program to reach an active census of 300 patients," she continued. "MaineGeneral has been able to invest dollars in the clinical personnel to grow this service, setting up units in patient homes and monitoring patient vitals and following up as needed."

The Zoom licenses and IT equipment for virtual visits (all-in-one desktop PCs and web cameras) expanded the telehealth services. This FCC funding was an integral part of expanding a sustainable telehealth program at MaineGeneral as the organization continues to refine processes, incorporate new integrations and expand services to meet the needs of the community and care teams, she concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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