How to find the right remote mix

Chronic heart failure (CHF) patients are nearly perfect candidates for remote patient monitoring. They have multiple clinical factors that can affect their post-hospital recovery, are at risk for exacerbation after discharge and have some of the highest readmission rates in healthcare.

That's why so many organizations are using CHF patients in pilot testing of remote health programs. Texas Health Resources (THC) is among them. The system has lowered readmission rates for these at-risk patients by 27 percent or more, CIO Edward Marx (pictured) told FierceMobileHealthcare.

The trials have been an unqualified success: Both patients and physicians are responding well to the technology, clinical research director Tamara Plant said. The 24-hospital health system is seeking federal funding to expand the program to other chronic conditions, such as diabetes and hypertension, Marx noted.

The trial set-up
THC provides CHF patients with packets that include vital-sign monitors, iPads and an EHR-driven app that integrates the patient's data with his or her electronic medical record. Each package has a wireless scale and pulse oximeter. The test group also gets a blood pressure cuff.

Using the devices, patients' collect their vitals and transmit them to a caregiver portal via the tablet. They also answer a short series of questions once a day, entering information about their sleep patterns, whether they've had trouble breathing, if they've experienced any swelling and if they've been taking their medications, for example. If an answer falls outside of set parameters, it triggers an alert for the central nurse, who contacts patients to determine if they need intervention, Plant explained.

Once complete, the biometric data and patient answers are transmitted to Texas Health's electronic health record system and becomes part of the patient's record, CMIO Ferdinand Velasco (pictured) said. "Physicians can log in and see trends right in the patient's record."

If a patient is readmitted, his or her vital trends are in their chart for their primary care physician, emergency room doctors and other clinicians, Plant added.

The EHR connection has been key to the program's success, but setting it up wasn't easy, Velasco noted.

It "took a lot of effort on our part to tie that in."

The program has cost about $24,000 since it was launched in April 2011. That includes the cost of the technology and packets, plus salaries, travel and other expenses.

And the results? THR has dropped its readmission rates for CHF patients from nearly 14 percent to about 10 percent, Marx said.

The next steps
THR is setting its sights on expanding the program to other diseases or conditions and technologies. Most interesting are "wearable technologies" that could allow patients to be monitored continuously, "not just in the home," Velasco said.

A few more tips from the THR pilot:

Tailor your questions: Don't overwhelm patients with dozens of questions, no matter how relevant they might seem, Plant warned. The CHF pilot settled on five to seven questions that are absolutely key to managing heart failure--weight, sleep patterns, breathing and swelling, for example. There are plenty of other questions researchers would like to ask, but through trial and error they've found patients won't complete much more than seven questions per day.

Watch the scale: Without a doubt, the scale has been the most valuable piece of equipment for identifying CHF patients in danger of an exacerbation, Plant said. The system allows clinicians to set alerts not only for the usual daily increase of three pounds but also for a daily increase of 3 percent, or a weekly increase that may be more gradual but just as important, she noted.

"The scale is our number one indicator that tells us what we want to know. It simply gives us the most information on these patients," Plant said.

Invest in a big screen: The program started out with iPads that have 5-inch screens, but Plant encouraged other hospitals to push for the biggest screen size they can afford. "In the next go-round, we would go for the bigger screen size so patients can watch videos on how to use the equipment, educational material, etc., a little easier," she said.

Recruit patients: Originally, the pilot program required physicians to refer patients for the study, Plant noted. With its success, however, researchers now actively search the EHR database, seeking patients who might be good candidates. In most cases, physicians are open to enrolling their patients, Plant said. In fact, one physician reluctantly allowed his worst CHF patient into the program, at the researchers' request, and was stunned to see the patient have his longest period out of the hospital--the entire 90 days on the study protocol, she added.

For more:
- download FierceMobileHealthcare's free eBook, Telehealth Monitoring & Mobile Tech.

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