Remote Patient Monitoring (RPM) - Enabling New Models of Care

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Remote Patient Monitoring (RPM) - Enabling New Models of Care in the Patient’s Home

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Remote Patient Monitoring (RPM) - Enabling New Models of Care

  1. 1. Enabling New Models of Care in the Patient’s Home Tuesday, 15 December 2009 Margaret Scott OAM, Nursing Director, Hunter Nursing Anthony Fanning, RPM Program Director, Healthe
  2. 2. Agenda <ul><li>Who we are </li></ul><ul><li>Trial Background </li></ul><ul><li>Aims and Objectives of the Trial </li></ul><ul><li>Background Research </li></ul><ul><li>Trial Framework </li></ul><ul><li>Program and Evaluation Process </li></ul><ul><li>Learnings so far </li></ul><ul><li>Questions </li></ul>
  3. 3. Who we are – Healthe Group <ul><li>International health and wellness organisation </li></ul><ul><li>Formed in 2002 </li></ul><ul><ul><li>Healthe Care – 12 private hospitals in Australia </li></ul></ul><ul><ul><li>Healthe Work – Occupational Health Consultants </li></ul></ul><ul><ul><li>Healthe Home – Community Nursing and Home Care including Hunter Nursing </li></ul></ul><ul><ul><li>Healthe Tech – Innovative Technology and Device Solutions </li></ul></ul>
  4. 4. Who we are – Hunter Nursing <ul><li>Mobile community nursing staff </li></ul><ul><li>Community based service delivery </li></ul>
  5. 5. Trial Background <ul><li>Healthe Care, Hunter Nursing and Intel Digital Health Group </li></ul><ul><li>Small scale trial - CHF and COPD </li></ul><ul><li>Using the Intel® Health Guide and Intel® Health Care Management Suite </li></ul><ul><li>Community Care Environment </li></ul><ul><li>Significant planning, training of staff and assessment of the project guidelines was conducted </li></ul><ul><li>Trial commenced in November 2009 </li></ul><ul><li>Specific KPIs identified to determine outcomes </li></ul>
  6. 6. Trial Framework
  7. 7. Key Aims and Objectives of the Trial <ul><li>Obtain conclusive validation </li></ul><ul><ul><li>Cost savings </li></ul></ul><ul><ul><ul><li>Reduce hospital re-admissions </li></ul></ul></ul><ul><ul><ul><li>Reduce GP visits </li></ul></ul></ul><ul><ul><ul><li>Reduce Community Nursing visits </li></ul></ul></ul><ul><ul><ul><li>Better utilisation of scarce nursing staff </li></ul></ul></ul><ul><ul><li>ROI & Feasibility of RPM service offering </li></ul></ul><ul><ul><ul><li>Patient participation in self-management </li></ul></ul></ul><ul><ul><ul><li>Technology solution </li></ul></ul></ul>Remote Patient Monitoring
  8. 8. Telehealth Business Drivers & Benchmarks
  9. 9. Benchmarking – eg Home Visit Rate
  10. 10. Evidence-based Approach & Analysis of 56 Studies
  11. 11. ROI Modelling & Business Case
  12. 12. Study Design Consent Patients for CHF and COPD Arms <ul><li>Healthe / Intel POC Study </li></ul><ul><li>25 pt CHF and 25 pt COPD study </li></ul><ul><li>Retrospective matched control group </li></ul><ul><li>Primary Outcome is Cost Savings </li></ul><ul><li>Multiple sites in Healthe hospital network </li></ul>CHF Intervention Group 25 pts COPD Intervention Group 25 pts Deploy HGS to Patients Monitor patients with HGS for 6 month time period Evaluate Healthe Claims Data for 12 + 6 month period for both intervention groups Deploy HGS to Patients Monitor patients with HGS for 6 month time period Retrospective analysis of two matched cohorts as control groups. Evaluate Healthe Claims Data for 18 month period for both control groups Report out cost savings found in intervention group and calculate Return on Investment (ROI)
  13. 13. Approach and Feedback Loop Data Aggregation / Standardisation Risk Profiling Stratification Targeting Recruitment Engagement Outcome Measurement Monitoring
  14. 14. Stratification & Patient Cohort Selection <ul><li>Solution overview – participants, technology, process </li></ul>Remote Patient Monitoring
  15. 15. Longitudinal Baseline Data (12 months) Remote Patient Monitoring
  16. 16. Inclusion and Exclusion Criteria <ul><li>Have been diagnosed with heart failure </li></ul><ul><li>Live in an area which provides broadband services </li></ul><ul><li>Are physically and mentally capable to complete the monitoring process or have a caregiver capable of assisting in the use of the Intel® Health Guide </li></ul><ul><li>Willing and able to sign an informed consent to participate in this evaluation for a duration of 180 days minimum </li></ul><ul><li>The patient requires monitoring interventions only rather than hands on care interventions </li></ul><ul><li>Have a life expectancy of less than six months </li></ul><ul><li>Live in a nursing home or other multi-member assisted living facility </li></ul><ul><li>Intend to be away from their home for >2 weeks during the 180 day monitoring period </li></ul><ul><li>Sustained periods of memory loss and other forms of dementia </li></ul><ul><li>Are unable to read and understand English </li></ul><ul><li>Patients with impaired eyesight and hearing </li></ul><ul><li>Patients with dementia </li></ul><ul><li>Wound care as a predominant interaction </li></ul><ul><li>Personal Care </li></ul><ul><li>Any technical intervention </li></ul><ul><li>Patient refused to participate </li></ul><ul><li>Substance abuse </li></ul><ul><li>LVEF </li></ul><ul><li>Patient moved </li></ul><ul><li>Patient institutionalized </li></ul><ul><li>History of noncompliance </li></ul><ul><li>No telephone line </li></ul><ul><li>NYHA class I </li></ul><ul><li>Enrolled in other CC project </li></ul><ul><li>Patient died prior to enrollment </li></ul>
  17. 17. End to end system Remote Patient Monitoring Secure Data Centre Intel® Health Guide Weight Scale Pulse Oximeter Blood Pressure Monitor Clinical Information Databases Intel® Health Care Management Suite Monitoring Tools Patient End User Clinician Clinician
  18. 18. Intel® Health Guide Deployment <ul><li>50 Intel® Health Guides to be deployed to patients </li></ul>
  19. 19. Vital Signs Monitoring and Peripherals <ul><li>Remote monitoring of: Blood Pressure, Weight, Pulse Oximetry with certified peripherals </li></ul>
  20. 20. Intel® Health Guide Connectivity
  21. 21. Monitoring Centre and Staffing Clinical Monitoring by Registered Nurse or Clinical Nurse Specialist <ul><li>Receive data </li></ul><ul><li>Manage protocols </li></ul><ul><li>Manage exceptions </li></ul><ul><li>Report data </li></ul>
  22. 22. Care Protocols and Personalised Care Plans COPD sample protocol
  23. 24. Community Nursing and Patient Interaction
  24. 25. Intel® Health Care Management Suite
  25. 26. Video Conferencing and Connectivity
  26. 27. Video Conference usage information (from actual project in the US) – RAW DATA Number of Care Managers (CM) = 3 Number of Patients = 16 with 12 using VC
  27. 28. Video Conference usage information (from actual project in the US) – RAW DATA
  28. 29. Video Conference usage information (from actual project in the US) – RAW DATA
  29. 30. Learnings so far
  30. 31. Program and Evaluation Process Reduced number of face-to-face community visits between patients and healthcare clinicians Alert intervention summary Reduced number of hospital bed days Alert types and frequency Reduced emergency room visits Video Conferencing interventions Reduced re-hospitalisation rates (all cause) Video Conferencing satisfaction of patients. Video Conferencing frequency Claims data IHGS patient satisfaction score IHGS clinician satisfaction score ROI PQOL pre/post Patient adherence to vital signs monitoring and daily sessions. Cost Effectiveness Patient Utilisation Financial / Clinical
  31. 32. Learnings so far - Financial <ul><li>Reduced re-hospitalisation rates (all cause) = reduced number of hospital bed days </li></ul><ul><li>Reduced presentations to emergency ward </li></ul><ul><li>Reduced number of face-to-face community visits between patients and healthcare clinicians </li></ul><ul><ul><li>Weekly -> Fortnightly </li></ul></ul><ul><ul><li>Fortnightly -> Monthly </li></ul></ul>To date there have been no re-hospitalisations of patients in the trial
  32. 33. Learnings so far - Utilisation <ul><li>Clinician satisfaction </li></ul><ul><li>Video Conferencing capacity </li></ul><ul><li>Flexibility in Personalised Care Planning </li></ul><ul><li>Alert types and frequency </li></ul><ul><li>Alert intervention summary </li></ul><ul><li>Patient adherence to vital signs monitoring and daily sessions. </li></ul>
  33. 34. Learnings so far – Patient Adherence Early signs of positive patient compliance and participation
  34. 35. Learnings so far - Patients <ul><li>Increased feelings of support </li></ul><ul><li>Reduced anxiety </li></ul><ul><li>Increased access to nurse </li></ul><ul><li>Increased access to education and information </li></ul><ul><li>Increased ability to manage self care </li></ul><ul><li>Early recognition of potential problem before crisis occurs </li></ul>
  35. 36. Learnings so far - Carer <ul><li>Increased support for the carer </li></ul><ul><li>Increased support in providing care to patient </li></ul><ul><li>Reduced worry / anxiety </li></ul><ul><li>Increased access to nurse, especially via video conferencing </li></ul><ul><li>Increased information / education about the disease and its management </li></ul>
  36. 37. Learnings so far – Nurse <ul><li>Clinical Staff Satisfaction </li></ul><ul><ul><li>Access to new skill sets </li></ul></ul><ul><ul><li>Access to alternate work environment </li></ul></ul><ul><li>Increased access to current data </li></ul><ul><li>Ability to transfer current data to GP in a more timely manner </li></ul><ul><li>Ability to monitor a larger number of patients </li></ul><ul><li>IHG and management suite offers increased functionality and flexibility in care planning </li></ul>
  37. 38. Learnings so far - Organisation <ul><li>Increased flexibility and appropriateness in roster allocations to patients </li></ul><ul><li>Increased non face-to-face contact with high dependency chronic disease patients </li></ul><ul><li>Decreased home visits for monitoring </li></ul><ul><ul><li>Weekly -> Fortnightly </li></ul></ul><ul><ul><li>Fortnightly -> Monthly </li></ul></ul>Early signs of improved Nurse-Patient ratio
  38. 39. Thank you & Questions

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