Even before COVID-19, Baptist Health, a health system based in Louisville, Kentucky, had a system-wide initiative to provide more patient-centric care, part of which included providing patient care on patients' terms.

THE PROBLEM

As a family medicine practitioner, Dr. Brett Oliver, chief medical information officer at Baptist Health, realized that patient health within the home is often a black box, and that better insight into what happens outside of Baptist Health facilities could help reduce readmissions and improve patient outcomes.

In his role as CMIO, he wanted to set up a program to transition care into the home and expand the health system's access and reach to patients where they wanted to receive care.

"While we already had some remote monitoring devices available to us, they lacked the ability to integrate into our larger program and thus weren't being utilized by our providers effectively," he noted. "At the beginning of 2019, I set out to find a more complete platform that had the ability to leverage artificial intelligence and machine learning to help us detect deterioration and enable intervention at scale."

PROPOSAL

That's when Oliver started talking with AI-powered remote patient monitoring technology vendor Current Health.

In late 2019, Baptist Health's home care team began piloting Current Health's remote care platform to manage CHF and COPD patients, with the goal of improving patient experience and quality of care by lowering the hospital readmission rate.

"We were about 10 weeks into the initial pilot when the pandemic started to sweep across the world," Oliver recalled. "We knew that a surge in COVID-19 hospitalizations could quickly overwhelm our existing bed capacity, resources and staffing.

"This, coupled with the uncertainty around disease progression leading to longer patient stays and more intensive monitoring, made us quickly pivot our strategy and use of Current Health's platform to monitor COVID-19 patients outside the four walls of the hospital to ensure safe care and recovery at home while maintaining bed capacity."

"The ability to set up alarms across multiple vital signs and adjust for individual patients is crucial for helping your care team understand when to act on alarms and gain a deeper understanding of their individual patients' conditions."

Dr. Brett Oliver, Baptist Health

The vendor's platform provides continuous monitoring of patient vitals, along with integration into a network of peripheral monitoring devices, so giving insight into a patient's health throughout the day.

"However, what's great about it is that it doesn't just mimic an ICU monitor or telemetry system," Oliver said. "It looks across trends in patient vital signs to help identify which patients are at risk for deterioration in a highly specific way. This 'intelligent monitoring' attracted me to pursue Current Health."

A key aspect of the platform, which Oliver was looking for in the first place, is the ability to set parameters between two or more different vital signs, such as oxygen saturation, respiratory rate and heart rate, to reduce the number of false positive alarms coming through the system. These alarms can be set for a cohort of patients and modified for the individual.

MARKETPLACE

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MEETING THE CHALLENGE

When the pandemic hit, Baptist Health quickly pivoted to use Current Health's remote healthcare platform to monitor COVID-19 patients outside of the hospital. As soon as these patients were stable, the health system gave them the option to transition recovery to the home.

"Current Health's monitoring kit came preconfigured with everything our patients needed, including WiFi or cellular connectivity through its Home Hub, a tablet, and a wearable device," Oliver explained. "Our care providers then walked patients through the setup process and instructed them to wear the device on their upper arm, which could then continuously capture their vital signs, including oxygen saturation, respiration rate, pulse rate, body temperature and mobility."

Using the remote patient monitoring platform, the Baptist Health home care team had access to a single clinical dashboard through which they could view the health status of all of their patients, ranked prioritized by condition. It also gave staff the ability to customize alarms for patients at the individual and population level to better identify when a patient was at risk of health deterioration.

"Current Health also provided first-line monitoring through their team of trained clinicians, enabling us to provide 24/7 patient support," Oliver noted. "Based on the nature of an alarm and our existing parameters, Current Health's team would either reach out to a patient to provide support via phone, if the patient's data indicated any abnormalities, or escalate the alarm to our home care team to provide early intervention."

The beginning of the pandemic had a steep learning curve for Baptist Health staff, who knew so little about the virus and how it interacts with its environment. Using the RPM platform gave them a unique advantage as they were able to collect more data about how COVID-19 progresses in patients and what key indicators they needed to watch out for to avoid rehospitalization.

RESULTS

Between March and November 2020, Baptist Health enrolled 270 COVID-19 patients into its remote care program. It monitored these patients continuously using the platform for an average of 12 days.

"With the ability to capture the broadest picture of our patients' health, our providers were able to deliver high-quality care to patients in their homes, while achieving zero hospital readmissions post-discharge – a remarkable achievement with a highly unpredictable disease," Olive stated.

"Not only did Current Health's remote healthcare solution allow us to extend our reach into the patient home, but it also provided comfort and security for both our patients and providers during an otherwise uncertain time."

ADVICE FOR OTHERS

"As telehealth and remote monitoring become more widely accepted, healthcare providers need a strategic partner to help grow and scale operations," Oliver advised. "Choosing an experienced remote monitoring provider can make the implementation process as simple and efficient as possible – with integration for things such as ordering and alerting – and have a hugely positive impact on clinicians' workflows, while also providing immediate cost benefits and improvements to patient care."

The combination of a single clinical dashboard paired with flexible configurations worked well for Baptist Health, allowing teams to align on shared goals and build integrated workflows, he added.

"Engaging providers early on in the selection and implementation process also can help enhance adoption and utilization rates for both patients and providers, which in turn grows buy-in for remote monitoring solutions and leads to better health outcomes," he said.

Another key consideration for selecting a remote patient monitoring system is flexibility, he said.

"This is especially important when you are first beginning to understand the population you're monitoring and configuring the right alarm parameters," he concluded. "The ability to set up alarms across multiple vital signs and adjust for individual patients is crucial for helping your care team understand when to act on alarms and gain a deeper understanding of their individual patients' conditions."

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