HIMSS22: Dr. Nirav Shah of NorthShore University HealthSystem on Continuous RPM

HEALTHTECH: How has remote patient monitoring evolved?

SHAH: There have been a few periods of rapid growth in telehealth and remote patient monitoring. The initial remote monitoring occurred with the advent of telephones, when a physician could do a remote consultation. The second phase grew out of the federal government’s interest in monitoring the care of astronauts in space. In this phase, there were improvements in the ability to collect physiological data remotely in the form of electrocardiograms and blood pressure cuffs.

It wasn’t until the internet age when remote monitoring really took off, and we were able to transmit large quantities of data. In this phase, we are still talking about point measurements for remote monitoring, such as readings from blood pressure cuffs, weight scales and glucose monitors. It wasn’t really until the ability to have smaller and cheaper microchips, implantable devices and machine learning when we were able to conduct and make sense of continuous remote monitoring with large volumes of physiological data.

HEALTHTECH: What was the planning process like to launch the continuous RPM program at NorthShore? Which stakeholders were initially involved? What adjustments did you make along the way?

SHAH: When we initially started, we were attempting to predict the risk of complication after surgery. At the time, we were in the midst of a change in how NorthShore conducted perioperative care and anesthesia, and so the length of stay was in flux and rapidly decreasing. Essentially, the historical data was no longer a valid representation of the current postsurgical experience, limiting our predictive ability.

We realized that we needed to start monitoring patients on discharge to understand the risk of developing postoperative complications. As we were thinking about solving this, we took the approach that we wanted to be broad and scalable so that we could leverage this technology not only for surgical use cases but also for different high-risk medical use cases, such as heart failure and chronic obstructive pulmonary disease (COPD).

We built a multidisciplinary stakeholder group that included clinicians from diverse specialties and IT specialists to think about the clinical, analytics, security and device aspects of a remote monitoring solution. We performed a market evaluation and landed on a local startup, physIQ, which is a device-agnostic analytics company with a strong skill set in developing the machine learning algorithms to help make sense of high-volume continuous data.

We started our remote monitoring program via the research pathway by building out clinical trials to understand the feasibility and preliminary efficacy of continuous remote monitoring attached to a cascading and escalating clinical workflow.

The field of continuous remote monitoring is in its infancy. There are adjustments that we make every day within the constraints of our clinical trials. This is not an area where there’s robust literature that allows us to mimic best practices, so we have been a very nimble, agile and adaptable group. This work is a learning process in how best to implement this novel technology.

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HEALTHTECH: Did you have any tech considerations for security, user friendliness, data capture and storage, etc.?

SHAH: When we were looking for a partner, we were looking at this from the standpoint of a clinical provider. We were very interested in a scalable solution that could be used for different patient populations. Second, we were interested in a remote monitoring platform where there was evidence in the literature that the marketed solution could actually identify physiological perturbation with enough time to intervene. Finally, we were interested in a platform that was easy to use and had demonstrated usability in patients who are not typically considered savvy with technology.

That’s what led us to our current vendor partner, physIQ. In terms of security, storage and data capture, we relied on our health IT partners who were part of this process to vet these aspects.

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HEALTHTECH: What are some next steps or plans?

SHAH: Having already deployed continuous remote patient monitoring on heart failure, colorectal surgery and COVID-19 populations, we are now building a pathway for hip fracture patients and COPD patients. We’re also planning to develop use cases for stroke and pneumonia. As we learn more about how to deploy this across different use cases, the hope is that we can publish our findings and eventually expand into quality improvement so that we can impact patients on a larger scale.

HEALTHTECH: As patient expectations change, how do you see RPM programs addressing them? What does that mean for traditional healthcare providers, and how can they adjust?

SHAH: A lot of patients are looking for convenient, engaging, seamless, on-demand care. RPM is a way to give patients and providers the technology to connect when issues are being identified by the patient or by the patient’s physiology. It’s really a patient-centric technology that aims to prevent costly utilization and is well suited to value-based care models.

Most traditional healthcare providers are in a fee-for-service model, where acute care is generally what our systems are set up to handle. Generally, if a patient has an issue on the ambulatory side, the common answer is to go to the emergency room. This is a health system–centric model.

Developing structures and processes that allow for efficient care that is part of the physician or nurse workflow will enable healthcare providers to adjust to this changing environment and to changing patient expectations. Using these types of technologies can help separate the signal from the noise, because for continuous remote patient monitoring and remote patient monitoring in general, there are a lot of alerts and a lot of noise that can come with it. Ensuring that the pathway is as seamless and as efficient as possible will allow healthcare and healthcare providers in general to adjust to this patient-centric future.

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HEALTHTECH: What can attendees expect to learn from your HIMSS presentation?

SHAH: There are a few things that we would like to convey to our attendees. First, how do you develop a remote monitoring program? Specifically, we’ll discuss how we got our program started and the key considerations to start one at another health system.

Second, we are interested in conveying that this is not just a technical problem, but that it involves looking at this from the sociotechnical framework. Specifically, you’ll hear how to marry technology with the culture of your clinical providers and the health system.

With some of these talks, it can be at a 10,000-foot vantage point that leaves attendees wanting more specifics and results. So, we will be presenting some of the results from our soft launch and testing period, where we actually evaluated this in heart failure patients.

Finally, we’ll speak to the difference between remote monitoring and continuous remote monitoring, as there are key differences that allow for more unique opportunities to identify and impact patient care.

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