Kentucky Cardiology in Lexington was finding it difficult to monitor the blood pressure of patients at home and feel comfortable it was getting accurate numbers.

The staff would ask a patient if they had a way to take their blood pressure at home, and they would say yes. Staff then would provide the patient a blood pressure log (a paper form) and request they take their blood pressure two times a day.

THE PROBLEM

"We ran into difficulties with this because the patients would either forget to take their blood pressure, decide it was too much to track or simply decide they weren't going to do it," said Dr. Avi Eres, a physician at Kentucky Cardiology.

"At their follow-up visit, the patient would have no log to show the provider, or they would have multiple pieces of paper with no dates or times. Therefore, it was difficult for the provider to make a sound judgement on how to adequately diagnose the patient's hypertension or hypotension."

PROPOSAL

While doing some research, Eres came across remote patient monitoring technology company Optimize Health online and requested a demo. Optimize Health explained its program in detail, showed Eres exactly how it would look in real time and let him ask all the questions he had.

"For our practice, we knew we had an older patient base, and we would need something that would be easy for our patients to use," he explained. "We wanted to evaluate our patients' progress with blood pressure monitoring and be able to react in a timely manner to the patients' questions or concerns with their blood pressure.

"Also, I needed to make sure we would own the devices and be able to store them at our office, as well as not have to pay another company to manage our patient base."

Once he had completed the demo and had his questions answered, Eres decided to move forward with Optimize Health.

"We started with 50 RPM devices, and within a month we had purchased another 150 devices. We currently have 300 devices."

Dr. Avi Eres, Kentucky Cardiology

"I liked that patients didn't have to record their blood pressure numbers on a sheet of paper," he said. "I liked that the patients would have multiple ways to communicate with us, and that the vendor offered the training we needed to make the program successful."

MARKETPLACE

There are many vendors of connected health and remote patient monitoring technologies on the health IT market today. Healthcare IT News published a special report on these types of technologies, with a comprehensive list of vendors with details. Click here to read the special report.

MEETING THE CHALLENGE

After Kentucky Cardiology signed up with Optimize Health and received its first 50 blood pressure monitoring devices, it determined which patients would benefit from the program by using its chronic-care-management application from vendor Chronic Care IQ.

Medical assistants ran a report of all the patients who had hypertension. From there staff reviewed the patients to determine who would benefit using the remote patient monitoring to track their blood pressure.

"If the patient had an upcoming visit with their provider, we would go ahead and prepare everything for their visit," Eres said. "We consulted with the provider the day of the patient's visit to make them aware of who we thought would be a good candidate for the RPM program.

"Once the provider saw the patient, the medical assistant would meet with the patient to review the documentation and show the patient how to take their first blood pressure reading by using the steps outlined on the cuff," he continued. "The important thing to stress to the patient was that we needed a reading for 16 days."

After the patient was enrolled, staff would start monitoring the patients' readings with the Optimize Health software. Medical assistants would call the patients if they saw a higher-than-normal reading, or no readings in a few days. They would walk the patients through how to do the reading again and remind the patients again that the staff needed 16 days of readings.

RESULTS

When Kentucky Cardiology started the remote patient monitoring program, it did not imagine the program would take off the way it did.

"We started with 50 RPM devices, and within a month we had purchased another 150 devices. We currently have 300 devices," Eres noted. "In the first two months, we increased our patient enrollment by 75%. By the third month we increased our patient enrollment by 83%. We had one provider for whom we had to limit the number of devices he could have daily to ensure we had enough for the other provider and patients we had already pinpointed.

"Through identifying the patients who would be a good candidate for remote patient monitoring, we have been able to successfully reach 86% in patient engagement, which means that out of 200 patients enrolled we are interacting with 172 patients for 20 minutes or more every month," he continued. "

This has helped patients build relationships with our office personnel and makes them feel valued as a patient."

In one case, Kentucky Cardiology had a patient who was at risk of stroke due to her blood pressure. Since being in the remote patient monitoring program, her blood pressure has been brought under control because staff have been able to monitor her in real time and adjust her medications as needed.

"She is living a fuller life without the stress of potentially having a stroke," said Eres. 

"We have several patients who have been able to reduce their medications due to monitoring their blood pressure and communicating with them on ways to lower their blood pressure through diet. These patients are grateful as they feel better and appreciate that their doctor's office took the time to listen and work with them."

ADVICE FOR OTHERS

For a practice that is looking into a remote patient monitoring program, Eres suggests the following prior to starting any program:

• Determine what your patient base is and how you want to enroll them into the program.
• Determine whether you have adequate staff to onboard patients to make the program successful.
• Identify what the billing looks like.

"When we started the program, we jumped in with both feet and figured it out as we went," Eres recalled. "Initially we were enrolling so many patients that every medical assistant and manager was involved. We knew the patient base we were targeting, as we already had a chronic care management program.

"However, we did not have enough staff to enroll the patients, much less follow up in a timely manner to ensure the patient was doing their daily readings or if they had any questions," he concluded. "This took us a few months to manage effectively."

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