With eight hospital campuses across the New York metropolitan area and a large regional ambulatory footprint, Mount Sinai is committed to improving health equity and access to care. Its expertise in population health, along with its service to socioeconomically, demographically and culturally varied populations, means Mount Sinai is uniquely positioned to take on the challenge of delivering high-quality care to underserved people.

THE PROBLEM

"Our largest ambulatory cancer center is located in three immediately adjacent neighborhoods in Manhattan that represent a dramatic contrast in populations," said Dr. Cardinale Smith, chief quality officer for cancer at Mount Sinai.

"East Harlem is an area of high poverty and is predominantly Hispanic and Black. Central Harlem also has a high poverty rate and is predominantly Black and Hispanic," Smith continued. "A high proportion of residents in both Harlems live in public housing.

"In contrast, the Upper East Side is one of the wealthiest areas in the country and predominantly white," she added. "The healthcare disparities in the patients we care for were even more visible during the pandemic."

Like many health systems at the beginning of the pandemic, Mount Sinai experienced a drastic drop in cancer screenings and treatment. By April 2020, Mount Sinai's ambulatory and inpatient services department saw a 25% decrease in volume, indicating that patients were reluctant to come into a health facility.

It meant that many vulnerable patients were either not receiving or delaying cancer care, potentially putting their treatment plans off track. Despite an exponential increase in the number of telehealth visits by phone or video, Mount Sinai oncologists were limited by the information that patients could share without additional clinical information.

"To get started, patients just need to plug in the Home Hub into an outlet and all other monitoring devices are preconfigured and connected for the patient in the patient's preferred language."

Dr. Cardinale Smith, Mount Sinai

"Mount Sinai Oncology was looking for a solution that would improve physician/patient communication, enhance virtual care and eliminate barriers to delivering comprehensive care at home," Smith explained. "Mount Sinai selected vendor Current Health's remote patient monitoring solution to enhance its oncologists' ability to provide care to cancer patients within the comfort of their own home and supply patients the tools and infrastructure needed, including Internet connectivity."

Current Health's device and platform enabled oncologists to deliver cancer care remotely, Smith said, by:

• Decreasing readmissions by catching health deterioration early
• Enabling more comprehensive care outside of the cancer center
• Preventing potential patient exposure to infection by providing more care virtually
• Bridging the digital health divide as telehealth engagement continued to rise

"Additionally, a key consideration for Mount Sinai was the ability to provide equitable access to digital health solutions for all patients, including people of color and the elderly, who were less likely to use telehealth services due to accessibility, connectivity or tech literacy issues," Smith said.

PROPOSAL

Current Health enables patient care at home through a remote care management platform that provides health systems with the insight into patient health at home they need to intervene early and avoid patient hospitalization, Smith said.

"The platform centralizes health data from multiple sources, including Current Health's FDA-cleared continuous-monitoring wearable device, other peripheral remote patient monitoring devices, patient-reported surveys and the electronic health record," she noted.

The platform combines all the different data in a streamlined way as a decision-support tool for clinicians. Additionally, the platform provides video conferencing functionality to enable virtual intervention either from the health system itself, or through Current Health's 24/7 clinically staffed command center.

"Everything from the vital signs collected, patient education modules and clinical alarm configurations can be tailored to a specific clinical use-case, allowing for a single, enterprise solution to provide remote care," Smith said.

"To promote health equity, the vendor provides a preconfigured monitoring kit that includes everything a patient needs to get started, including Wi-Fi or cellular connectivity through its Home Hub and a tablet that walks patients through the setup process in multiple languages, and comes with built-in communication tools that allow patients to seamlessly communicate with their care team as needed," she added.

MARKETPLACE

There are numerous vendors of remote patient monitoring technologies on the health IT market today. Click here to read a special report on the RPM marketplace from Healthcare IT News.

MEETING THE CHALLENGE

Mount Sinai selected Current Health over other players in the space for several reasons: the small device, which captures several vitals, custom configurability, and ease of setup, Smith noted. The vendor also provided the device, as well as the cellular connectivity needed to make sure patients are continually monitored, she added.

"The vendor's next-generation device, which is not much bigger than an Oreo, discreetly attaches to a patient's upper arm and captures continuous vital sign data – such as respiration rate, oxygen saturation, mobility, pulse rate and axillary temperature – with ICU-level accuracy," Smith said.

"Additionally, the vendor's platform integrates with a wireless blood pressure cuff and an adhesive body temperature patch to capture additional vital signs that can help Mount Sinai identify deterioration in oncology patients," she added.

Cancer patients identified by their oncologists who would benefit from the RPM kit can either be sent home with a kit or have it delivered to their home after being trained by a care team member at the cancer center.

"To get started, patients just need to plug in the Home Hub into an outlet, and all other monitoring devices are preconfigured and connected for the patient in the patient's preferred language," Smith explained. "The tablet device walks the patient through a simple process to apply the wearable and ensure connectivity.

"In addition to wearing the device 24/7 for continuous monitoring, patients take daily blood pressure readings which are wirelessly transmitted to the dashboard and submit daily symptom questionnaires," she added. "The collected data is then transmitted back to the patient's care facility and, with actionable alarms, alerts clinicians if the data indicates any abnormalities or potential care issues."

The clinicians can then proactively intervene as needed – rather than relying on patients to determine when they may or may not need medical assistance – and determine if the issue can be managed remotely or if the patient needs to be brought into the hospital. Current Health integrates with Epic to allow Mount Sinai clinicians to receive alarms within their EHR as well as store vital sign data and notes about patient interactions.

RESULTS

Mount Sinai still is in the early stages of using this remote patient monitoring technology with its cancer patients and as yet does not have hard outcomes to report.

ADVICE FOR OTHERS

Remote patient monitoring is a novel technology that can be used in many different clinical settings, Smith said.

"There is an initial learning curve for both clinicians and patients to overcome, but there is a lot of potential to enhance the care we can provide outside of our facilities in a more convenient way," she concluded. "With the use of this technology, we can be more proactive and less reactionary in how we care for our patients. I hope the reimbursement landscape continues to support this model of care so it can continue to expand in a sustainable way."

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