During the COVID-19 pandemic, many healthcare organizations ramped up their telehealth and remote monitoring programs.
At Providence, health system leaders recognized the need to prepare for a surge, and an important part of their plan was to keep hospital beds open for patients with severe viral illness. The organization, which operates hospitals in Alaska, Oregon, Montana, California, Washington, and Texas, developed a patient self-monitoring program for COVID-19 patients who are well enough to recover at home.
In the spring of 2020, Providence had used the remote monitoring platform for 700 COVID and non-COVID patients. As of Feb. 16, 2021, the health system had remotely monitored more than 16,000 patients.
Clinical leaders at the 51-hospital health system made several key strategic decisions to quickly scale up its virtual monitoring program to help keep hospital ICUs from being overwhelmed.
Quickly deploying digital tools
Providence treated patients located in Seattle, which was an epicenter at the beginning of the pandemic and had the first COVID-19 patient in the Pacific Northwest. Building an inventory of 5,000 thermometers and pulse oximeters early on gave Providence a headstart in ramping up its ability to distribute them during the health crisis to patients being monitored at home, according to Sherene Schlegel, executive director of telehealth clinical operations at Providence.
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When patients who test positive for COVID-19 are discharged from the emergency room or the inpatient environment, they go home with a thermometer and pulse oximeter, Schlegel said. Nurses then educate the patients on how to take their vital signs and make sure their thermometers and pulse oximeters are working.
“The majority of our admissions were a hands-on physical assessment for enrollment,” Schlegel told Fierce Healthcare. She added that before patients participate in remote monitoring, Providence wanted to verify that patients were well enough to stay out of the hospital.
“We didn't want to have someone coming to our COVID home monitoring program when they really weren't medically stable to be at home,” Schlegel said.
The program was deployed across more than 80 hospitals, urgent care and ambulatory settings in Washington, Montana, Alaska, Oregon, California and Texas.
Working with tech partners
For its remote monitoring platform, Providence is working with the digital health startups Twistle, which offers care automation and remote monitoring, and Xealth, a digital prescribing platform.
“We partnered with folks from Twistle to develop an automated process to be able to monitor patients at scale,” Schlegel said.
During the course of the pandemic, Providence ramped up the number of patients it could serve in the remote monitoring program from a nurse monitoring 15 to 20 patients in the first week to a nurse now tracking 85 to 100 patients per shift.
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“That was really key for us to be able to scale and help so many different hospitals and urgent care centers to help manage some of the COVID patients,” Schlegel said.
Using Twistle, patients send text messages three times a day to share their vital signs. Nurses can send a link to video chat with the patient and use an online dashboard to monitor vitals collected from pulse oximeters and thermometers.
“There's a scoring mechanism with each one of these answers that then populates it into a red, yellow or green,” Schlegel explained. If patients are scored a red or yellow, that means a nurse is holding a video call with a patient and they may require a higher level of care, she said.
Patients marked with a severe condition, for example, may have a respiratory rate greater than 30 or an oxygen saturation of 88% or less, Schlegel said.
Geisinger Health System offers a similar remote monitoring program that uses an oximeter and thermometer to let patients send data to care providers.
The Twistle program lets patients self-monitor symptoms and providers can keep track of positive or presumptive COVID-19 cases.
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Making it simple for patients and providers
At Providence, the remote monitoring program has an 87% compliance rate from patients, meaning they respond to the text messages from nurses. The health system credits the compliance to the fact that patients don’t have to download an app or log in to a portal.
Patients also find the technology easy to use, providing a net promoter score of 70, which is considered a high score for healthcare technology and patient communication solutions, Providence executive said.
The Twistle remote monitoring program also integrates with Epic’s electronic health record (EHR) software which helps providers’ workflow.
“[Xealth] allowed us to streamline the registration to Twistle by automating the digital care activity from Epic, our EMR, into Twistle,” Schlegel said. “That also saved us an immense amount of time and optimized our workflows for our nurses.”
Providence plans to continue the COVID-19 remote monitoring program through the end of the public health emergency and then “sunset it,” Schlegel said. However, the health system plans to continue with virtual monitoring in a different form.
“It's worked very well during the public health emergency and allowed us to get up and running and quickly see a large number of patients,” she said. “But for traditional remote patient monitoring, we're going to be working on different models, different platforms to be able to meet the needs of the chronic care conditions for patient monitoring.”