How to Build a Remote Patient Monitoring Program

UPMC's five-year-old tablet-based program was initially only for patients with congestive heart failure, but is now in the process of expanding to as many as four other conditions, and is a valuable tool in preventing expensive and unnecessary hospitalizations.

This article first appeared in the January/February 2018 issue of HealthLeaders magazine.

Using it, patients answer questions daily about symptoms and medication adherence while the tablet receives data on vital signs from external devices such as blood pressure cuffs, which are transmitted to the call center.

Ramani says the average age of patients enrolled in remote monitoring is 72, so the system must be simple to use for older, less technologically savvy patients, like the 92-year-old who is using it with no problems, Ramani says.

"If you set it up right with large buttons, arrows, and a lot of white-glove assistance, you have great success," he says. "A fear for us was that the patients most likely to benefit would not be able to use it, but it hasn't played out that way."

Nurses telephone patients whose information triggers "red alerts," determined individually by the care team prior to deployment. In some cases, those alerts might entail adjusting medications or determining that a patient hasn't been getting the correct amount of medication.

Since inception, nurses have triaged more than 73,000 such alerts.

Given the costs, it's essential to effectively determine which patients would benefit from remote monitoring.

"Having kits for every patient is cost-prohibitive," says Ramani, so patients who have regular home healthcare aren't eligible, for example.

If there is patient reluctance to participate in the program, Lee mentions it comes from their anxiousness about being introduced to the technology while they are in the hospital.

It's difficult to learn while so much else is going on, says Lee, and they're preoccupied with going home.

But as they get more comfortable with the process, and they know a nurse is a phone call away, they generally feel positive about taking an active role in managing their health, Lee says.

"There are some patients who don't want to do this initially, but after they try it for a while, they don't want to give it up."