Novel Remote Patient Monitoring System Improves Key Outcomes

Abstract

Introduction Remote Patient Monitoring (PRM) has recently been discouraged given overall neutral results of telehealth interventions. Nevertheless, many HF programs rely on some form of RPM, including our own program at HealthEast, Fairview where a vendor supplied external RPM system had been used for many years with favorable clinical outcomes and cost of care reductions; however, the RPM was costly, had limiting reporting, and minimal capacity for customization. As a result, an analogous RPM, MyHealthTracker (MHT) was created and piloted in 2017 using Epic, MyChart, and telephony capabilities. Methods An Epic database was used to identify HF patients taking an oral diuretic. Qualifying patients were enrolled, tracked, and provided protocol driven care administered by Population Health Beta Implementation Nurses. Care included adjustment of diuretics, laboratory testing, and clinic visits. Baseline data including hospitalizations, related 30 Day Readmissions, and ED visits were extracted from the years 2016-2017. The same data set was extracted for the enrollment year (2018). The data were partitioned into six month segments over that three year time span according to date of admission to the hospital or ED. Results A total of 128 patients met criteria and were enrolled in the pilot totaling 8602 patient days post enrollment in Q1 and 2 of 2018 and 17,999 patient days post enrollment in 2018 Q3-4. Seasonal variations were adjusted for comparing like quarters pre and post enrollment. Post-enrollment reductions in hospitalization, 30 Day Readmissions, and ED visits were evident. Post enrollment hospitalizations were reduced by 33% compared to prior period. Similarly, 30 Day Readmissions were reduced by 75% and ER visits were reduced by 52%. Based on a typical total cost of care of $13,000/admission and $2,300/ED visit, a projected $310,400 cost was avoided including previous vendor cost. Conclusions Despite inconsistent evidence to support the use of RPM, HF programs continue to utilize them, often at an operational expense with variable outcomes. An internally developed RPM system, MHT, allows for more robust reporting, can be modified without vendor costs, and scaled to support healthcare systems. Further, MHT has demonstrated reductions in hospitalizations, 30 Day Readmissions, and ED visits with projected cost savings exceeding $2400/patient enrolled. This RPM is in use and will be augmented with ongoing data collection, including stratifying patients based on HF stage or class, mortality, diuretic dosage, renal function, and variance reports.