For RPM Success, Workflows are Key

With a steady increase in chronic diseases, Remote Physiological Monitoring (RPM) provides clinicians with a great, non-invasive tool to not only keep track of patients key vital signs, but also use the monitoring to increase patients’ participation in their care.

The continual monitoring allows for more timely interventions (such as medication changes) and opportunities for just-in-time education (e.g., a visit to a Chinese Buffet leads to an increase in weight through fluid retention).

RPM Success is Not About Technology

But RPM, like almost all of telehealth, is not about the technology. Sure, we need monitoring devices (such as a blood pressure cuff, scale, pulse ox, glucometer, etc.) that easily collect and transmit the physiological data as well as some data display and patient management system (here’s a diagram of an RPM system).

But nowadays secure, reliable, user-friendly technology is almost a given (though some solutions that rely on Bluetooth are prone to more frequent need for support).?

The key to success from a clinical perspective (i.e., maintaining or improving the patient’s health) though hinges on properly defined workflows that define the protocols for all phases of the service.

The Patient’s Journey

From beginning to end, for each patient, the RPM service comprises 5 stages:

1. Identification
2. Enrollment
3. Equipment Setup
4. Monitoring & Management
5. Unenrollment

In the Identification stage patients are screened and qualified for the service. In addition to criteria such as the type of chronic disease and the number of comorbidities, other aspects include an assessment of the patient’s cognitive abilities, their digital health literacy, connectivity at home, and insurance eligibility.

The Enrollment stage handles the onboarding and orientation of the patient and on the clinical side also includes the establishing of the specific monitoring requirements and target ranges.

During the Equipment Setup stage the devices are configured for and assigned to the patient and then installed in the patient’s home, followed by test transmissions to ensure the proper workings of all components.

At the heart of the RPM is the Monitoring and Management phase which entails the periodic monitoring (typically daily during normal clinic hours) of the status of the data collection and the level of the physiological data within the clinician-defined boundaries. This stage includes multiple processes to ensure patient’s participation in the program and to allow for clinical interventions by the clinician (such as medication changes). During this stage clinicians will also review historical data in preparation for visits with the patient, to identify trends or address the patient’s level of participation.

The Unenrollment phase occurs when patients no longer need or want to participate in the RPM program. For some programs (e.g., 30-day or 60-day post-discharge monitoring) this phase includes the retrieval of the devices which, after cleaning and calibration, could be redeployed.?

The Key Players

It is important to note that a number of people are involved in making RPM a success for each patient. Here are most of the typical “players” that participate in one or more of the phases:

• Patient - front and center is obviously the patient, whose engagement is key for participation. The value of RPM is the periodic collection of data vs. sporadic single data points. It is thus key to truly enroll the patients in the participation to ensure their active engagement.
• Caregivers - typically family members involved in supporting the patient who may bring a better level of digital literacy to assist with the reliable and periodic collection of the physiological data.
• Clinician - the “prescribing” physician or advanced practice provider that decided on the patient’s participation in the RPM service. Involved in identifying and enrolling the patient, executing clinical interventions driven by the collected data to improve the patient’s health, and using the data to inform their care and care plan.
• Home Installer - this optional, but highly beneficial role (to minimize challenges with the equipment setup) can be filled by a number of people, such as Community Health Workers, Home Health staff, or EMTs.
• Monitoring Nurse - the member of the clinical team (typically a nurse) that scans the received data at least daily, reaches out to the patient to ensure participation and provide just-in-time education. The monitoring nurse will also escalate to the clinician when the patient’s physiological data falls outside of the desired range, to the clinician can intervene (e.g., with changes in medication).

Typical Escalation Protocols

At the core of the RPM service’s “Monitoring & Management” phase are multiple processes that are periodically activated, depending on the patient’s participation and the patient’s transmitted data.

Here are a few of the most common scenarios:

No data received - in this scenario the monitoring nurse reaches out to the patient to ensure that there are no technical problems preventing the collection and transmission of the data. This is also an opportunity to encourage the patient in the periodic participation.

Technical Support - when the patient’s equipment is not working properly technical support staff or the home installer may talk to or visit the patient to reconfigure and reconnect the monitoring devices.

Data slightly out of range - in this scenario, typically the monitoring nurse will inquire about the status of the medication. Did they take their medication as prescribed? Are there questions about the medication? Is potentially a refill needed??

Data outside the prescribed limits - when one or more of the measurements of the patient’s physiological data exceeds the clinician-established limits, the monitoring nurse can escalate the patient to the clinician to conduct a clinical evaluation of the situation and determine the best course of care.

Poor patient participation - if the collection and transmission of data by the patient is consistently missing or too sporadic, a call or virtual visit with the clinician is typically the best way to re-engage the patient.

For Telehealth Success, Workflows are Key

Efficient and effective healthcare is the result of well-defined and well-understood workflows to coordinate the work between the various parties involved in the delivery of care.

It is crucial to meticulously document the various steps involved and to systematically review for each step of each process what “alternate scenarios” are likely to occur which then further have to be defined.?

In our work with clients, we first define the Happy Day Scenario (what should happen 80% of the time) before we go through each step to brainstorm what could be different or what could happen to change the flow — so we can pre-define the correct and appropriate response to whatever happened.

Training by the vendor on the RPM monitoring platform is necessary, but definitely not sufficient to ensure a successful RPM service, as this just represents the tip of the iceberg of workflows that each organization has to define to make RPM a success.

Do you want to pick Christian’s brain about launching or optimizing your organization’s RPM services? Then schedule a brief call to explore the options.

To receive articles like these in your Inbox every week, you can subscribe to Christian’s Telehealth Tuesday Newsletter.

Have you attended Telehealth T-Time: A Community for Telehealth Enthusiasts yet? This monthly, FREE event always features networking opportunities and three presentations by fellow telehealth experts. Check it out!

Christian Milaster and his team launch, expand, and grow Telehealth Programs for rural health centers, behavioral health agencies, health systems, schools, and libraries. Christian is the Founder and CEO of Ingenium Digital Health Advisors where his team and consortium of experts partner with healthcare leaders to enable the delivery of extraordinary care by accelerating the adoption of digital health innovation.

To explore how we can help your organization solve your challenges, contact Christian by phone or text at 657-464-3648, via email, or video chat.