Clinical leaders at the Tacoma, Wash.-based MultiCare Health System, a six-hospital integrated healthcare delivery system, have been utilizing remote monitoring and telehealth technologies for more than a decade, with a focus on improving outcomes and reducing readmissions among patients with chronic conditions. As digital health technologies have advanced from basic vital-sign data collection, to Bluetooth-enabled mobile platforms and video interfaces, the MultiCare team has been able to expand its telehealth program, and is seeing significant results with reducing readmission rates.
Lynnell Hornbeck, home health manager at MultiCare, says the health system initiated its telehealth program more than a decade ago, primarily focusing on heart failure patients, and working with Honeywell Life Care Solutions, a Brookfield, Wis.-based telehealth software vendor.
“At the time, there were reasons to start remote monitoring and telehealth, and one of the reasons was to look at alternative ways to deliver care rather than in-home visits. For home health, the reimbursement model had changed and was more of a capitated or bundled payment-type approach, rather than per visit, particularly for nursing visits,” Hornbeck says. “But another large reason was from an outcome perspective; there was some information coming out about the benefits of telemonitoring with improving outcomes and reducing readmissions. It was early back then, 15 years ago, and with our initial project, the equipment we used was older technology; it wasn’t wireless, it had the basic vital sign capacity, and there was no video or face-to-face capability with that equipment.”
Fast-forward to today, and MultiCare’s Telehealth Chronic Disease Management program for Home Health patients has grown from 10 remote monitors to 100, and has expanded to include patients with pulmonary conditions, mostly chronic pulmonary obstructive disorder (COPD), as well as pneumonia, in addition to the heart disease patients. MultiCare continues to work with Honeywell and leverages the vendor’s telemonitoring and video conferencing capabilities through its LifeStream 5.2 telehealth software.
With a census of 80-90 patients per registered nurse, patients participating in the program report their blood pressure, respirations, weight and oximetry on a daily basis using a tablet, called the Honeywell Genesis Touch, and this tablet transmits the biometrics to Honeywell’s LifeStream Management Suite.
The software alerts the nurse to abnormal values, resulting in a staff intervention, Hornbeck says. This may include medication education, enactment of physician ordered action plan, or coordinating patient appointments with providers. Interventions are provided telephonically or via video visit.
Hornbeck reports that the telehealth program for home health patients has helped to reduce 30-day readmissions rates for heart failure and COPD patients. “That’s our key metric, our readmission rate. Year-to-date data, 30-day readmission rates for heart failure patients is 4 percent, and 30-day readmissions for COPD patients is 2 percent. So, it’s very successful,” she says, adding, “What I would highlight, in particular with COPD patients, is a lot of articles and literature for tele-monitoring have not been supportive of the use of it for COPD patients. With our program, we use a lot of medical protocols, and with addition of the video and the engagement and the unique interventions, we feel it’s been quite successful. We’re proud of the fact that we’ve been able to use this with that COPD population as well.”
Kelly Gariando, R.N., telehealth registered nurse at MultiCare, says that the remote monitoring technology is a valuable tool, but the technology alone doesn’t achieve those results. “We have about 80 to 90 patients active at any one time, and our monthly interventions to achieve that is over 700 interventions. So, it is a lot of work; it is not just the vitals coming in, and then, once in a while, we call patients. There’s a lot of calls and a lot of coordinating with physicians and reviewing physicians’ notes after a patient sees a doctor. We’re on Epic, so we can see the physicians’ notes, and then we call the patient and say, ‘I see you saw the doctor and your meds were changed, did you pick up your antibiotics or your medications?’ It’s a very interactive type of monitoring. And, I would say a full 50 percent of the time those patients needed those follow ups for a variety of reasons, such as they had not yet picked up their medications or they left the doctor’s office with questions about the meds and didn’t understand why the doctor was changing things, and didn’t want to ask.”
Hornbeck adds, “When we speak to others about this program, we really emphasize that a tool is wonderful but if you just put it in the home and don’t have any protocols around it, if you don’t have the intensive tools that have been developed, along with the willingness to respond and be proactive and have the clinical aspect of it, all of that is very important. It is all of that together that makes this program successful.”
The Engagement Piece
Many clinical leaders at hospitals and health systems talk about “high-tech, high-touch,” and that concept seems to be driving the success of the remote monitoring program for MultiCare’s home health patients. Hornbeck says implementing the video interface capability as part of the remote monitoring program as an alternative to nurses conducting at-home visits has been a critical factor. “The video aspect of it is, from an engagement perspective, is huge,” she says.