Leon Medical Centers serves Medicare patients in South Florida. The center also is the only HIMSS Stage 7 Outpatient Medical Care Institution in Miami-Dade County. The healthcare organization drives toward a standard of care that focuses on personalized patient-physician relationships and quality-driven medical care. (HIMSS is the parent organization of Healthcare IT News.)

THE PROBLEM

One of Leon's main areas of focus is diabetes treatment and care, as the population in the Miami-Dade area has a high incidence of type 2 diabetes. This chronic condition requires continuous care, and Leon needed a way to ensure continuous care that would work within its existing clinical workflow and align with its mission of providing personalized patient care.

"Leon Medical Centers has always been a leader in patient care using available technology to improve our patients' health," said Lourdes Dapena, director of pharmacy services. "When COVID-19 started, we had already implemented this program that became extremely useful to be able to continuously monitor glucose levels in high-risk patients with type 2 diabetes remotely."

PROPOSAL

With a focus on patient-centric care and an understanding there is no one-size-fits-all approach to diabetes management, Leon Medical Centers was looking for a platform that would enable more personalized interventions for its highest risk T2D patients.

Leon was attracted to the Rimidi platform for four key reasons, Dapena explained:

The platform integrates directly with Leon's Hyperspace Epic EHR, providing clinicians the ability to see a more holistic view of their patients' status within their existing workflow.

The platform is integrated with Smart Meter iGlucose, a cellular-enabled glucometer. This cellular-enabled technology allows for an out-of-the-box set-up for the patient, with no complicated syncing, pairing or smartphone requirement. Once set up, the data from iGlucose flows directly into Rimidi's platform in near-real time.

The platform pulls in relevant data from the Epic EHR and stratifies patients who are at the highest risk, enabling a focused approach to remote monitoring from the start.

"Look for third-party apps that already are integrated with your EHR through SMART on FHIR, so clinicians don't have to login to multiple platforms and the IT staff doesn't have to be burdened with frequent product updates."

Lourdes Dapena, Leon Medical Centers

The platform technology includes a highly configurable clinical decision support engine, which can alert clinicians when a glucose reading is missing or readings are concerning – either from the individual patient level, or in a filterable patient population list.

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MEETING THE CHALLENGE

At the beginning of 2020, Leon Medical Centers defined a patient cohort, in this case, any patient with an A1c greater than 9%, uploaded their information into the Rimidi/Smart Meter technology solution and enrolled them in remote patient monitoring, with the goal of reducing their A1c.

"When patients enrolled in either their in-person clinic appointments or virtually, they were given a SmartMeter iGlucose cellular-enabled glucometer and instructed by their doctor how often to take their blood-glucose reading." Dapena said. "The data from iGlucose was then able to flow directly into the Rimidi platform, where it was curated alongside relevant clinical data from the EHR."

RESULTS

To date, approximately 225 high-risk patients have been enrolled to be remotely monitored by Leon clinicians. Now, 84% of those patients have been able to get their A1cs below 9%, a key indicator of better diabetes control.

The average number of blood-glucose readings per assigned device per month is 28, indicating high levels of patient engagement.

ADVICE FOR OTHERS

Dapena advised her peers that there are three key features to look for in this kind of solution.

"It should support multiple chronic disease states," she said. "While Leon started remote patient monitoring with just glucometers for patients with T2D, it's important to note that many of these patients have multiple, comorbid conditions like obesity, heart failure, hypertension and fatty liver disease.

"A solution that supports multiple use-cases enables more personalized, holistic patient care. As you search for solutions, look for one that will support clinicians or clinical staff in managing comorbid chronic conditions side-by-side."

Second, it should create a continuous feedback loop, she suggested.

"It's important to look for platforms that provide data in real or near-real time to the clinical staff so they can provide timely interventions and communication with the patient," she said. "Look for solutions that enable patient-provider communication."

And finally, the technology should integrate with a healthcare organization's EHR, she said.

"Even better than being able to transmit data in near-real time to the care team and communicate remotely with the patient is being able to do it within your existing EHR workflow," she concluded. "Look for third-party apps that already are integrated with your EHR through SMART on FHIR, so clinicians don't have to login to multiple platforms and the IT staff doesn't have to be burdened with frequent product updates."

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