Renown Health Begins RPM Journey With Inpatient Program

The Nevada-based health system is looking to build its remote patient monitoring program slowly and steadily, using an innovative, wearable patch that captures relevant data.

While healthcare organizations often look at remote patient monitoring (RPM) as a means of caring for patients at home, Renown Health has launched a pilot project aimed at helping a rural hospital improve inpatient care.

And the Nevada health system's president and CEO sees this as the first step in a much larger journey toward integrated care no matter where the patient is located.

"This isn't just about monitoring a patient," says Anthony Slonim, MD, DPH, who has helmed Renown since 2014. "It's about system design. We have to be very thoughtful about how we approach [RPM], and make sure we have the infrastructure in place to support what we want to do."

Many healthcare organizations pivoted to telehealth during the pandemic to shift in-person services onto virtual platforms, and RPM programs soon followed that trajectory. The idea behind RPM is that a health system can track and care for patients in their home by capturing key data, such as vital signs, through either connected devices or by having the patient collect that data.

Anthony Slonim, MD, DPH, president and CEo of Renown Health. Photo courtesy Renown Health.

COVID-19 offered a good opportunity for health systems to test out that strategy, and many adopted the platform on the fly, launching a program with whatever they had at hand to care for infected patients at home and planning only for the short term. Others, though, look at RPM as a long-term project, capable of providing care management for many populations, from patients recently discharged from the hospital to those with ongoing chronic care needs.

For that strategy to work, however, it must be planned out carefully. And Slonim says he wants to take it one step at a time.

Starting Small and Scaling Up

Reno-based Renown Health, includes a trauma center, two acute care hospitals, a children's hospital, a rehabilitation hospital, a medical group, and a nonprofit insurance company, recently partnered with Denver-based BioIntelliSense to pilot its first RPM program in Renown South Meadows Medical Center. Patients admitted to the hospital are equipped with a wearable patch that captures vital signs and other biometric data.

That information is transmitted back to the Renown Transfer & Operations Center (RTOC), a state-of-the-art command center opened in August and equipped with roughly 30 large monitors. Slonim likens the new center to an air traffic control hub, monitoring patient rooms and other locations throughout the health system and allowing officials to keep track of rooms and the patients in them.

These command centers are becoming common in health systems across the country—Intermountain Health in Salt Lake City and Mercy Virtual in Kansas City feature them—as health systems look to gather the data coming in from technology platforms and connected devices in one place. From here, they can quickly determine which rooms are empty, in need of cleaning or ready for new patients; they can check on patients, answer patient requests, and monitor patient health.

Many of these rooms sit on a telemedicine platform that allows the health system to pull data from connected devices in the hospital room, tracking vital signs and other information. From that one room, care teams can monitor vital signs of patients throughout the hospital or health system, spotting trends that indicate a health concern and acting quickly.

This is the first step in Slonim's RPM strategy. And it begins with a small patch attached to the patient that monitors skin temperature, resting heart rate and respiratory rate, step, gait, sleep, activity levels, even infection-like symptoms that can support COVID-19 monitoring.

"This little half-dollar-sized device can revolutionize how we deliver care," he says.

Patients wear the patch during their hospital stay and can keep it on when they're discharged, allowing care teams to monitor them at home as well. That, of course, is a later phase of an RPM program that many healthcare organizations have already launched.

Pick the Right Signals From the Noise

But Renown is taking things slowly, starting inside the hospital. Slonim says he wants to get the framework down first, making sure that the program is tracking the right things and that his care teams are getting the information they need to improve outcomes.

"There's a lot of noise out there, and we have to pick the right signals from the noise," he says. By starting small and including all patients, his care teams have an opportunity to develop their own workflows and protocols, establishing guidelines that work for them and use the resources they have at hand. They'll map out what data is important for patients with specific health concerns, then determine how and when to shift from passive monitoring to a phone call or telehealth visit, and when in-person or emergency care is needed.

"Don't think of this as an isolated piece of equipment," Slonim says, fingering the patch he keeps on his desk at all times. "This is part of a much bigger series of programs."

To that end, Slonim's RPM strategy involves short, targeted pilot projects. The inpatient program will end at the end of this month, at which point they'll look to try out the program in the emergency department, as well as a rural location. Down the road they'll be launching pilot programs with skilled nursing facilities or assisted living complexes, and eventually they'll move this platform into the patient's home.

Slonim sees Renown Health as the ideal testbed for a long-term RPM strategy. The health system is in northern Nevada, a decidedly rural part of the country, covering a 100,000-square-mile area and serving roughly a million people as the only network between Salt Lake City and Sacramento. Healthcare here is local, and a trip to a specialist might take several hours. Care providers must have the resources at hand —physically or virtually—to provide patients with the care they need.

That formula has changed as well in recent years. Slonim, who was appointed by then-Nevada Governor Steve Sisolak in 2018 as a commissioner on the Patient Protection Commission, a statewide task force focused on improving healthcare access, affordability, and quality, wants to move beyond the episodic-based healthcare model to one that embraces population health and wellness. RPM fits that model by giving care providers the opportunity to collaborate with patients on their care, addressing needs as they come up, and promoting lifestyles and habits that improve overall health.

"We can't think of it as encounter-based care anymore," he says, "because it's a public health approach."

Looking Beyond Data Collection

It's also part of an integrated model of care, he adds, that encompasses "pre-acute care," or services delivered to people before they become sick enough to require a trip to the doctor's office, clinic, or hospital. RPM's one big selling point so far is that it can help health systems prevent hospitalizations, especially for preventable health issues, for which hospitals can be penalized.

Slonim also wants to ensure that all the pieces are in place for scalability and sustainability. While the potential for RPM is clear, the process must be tied into measurable improvements, be they reduced costs or better clinical outcomes. And it takes a while for RPM programs to gather that data and prove the premise.

That's also why the Centers for Medicare & Medicaid Services has been slow to recognize and offer reimbursement for RPM: the agency first offered CPT codes for "remote physiological monitoring" in 2019 and has only recently proposed additional codes for what it calls "remote therapeutic monitoring." Advocates expect the coverage will increase as health systems issue studies and reports on how their RPM programs have worked over a period of time.

Slonim sees his short, focused RPM pilots as ideal for gathering that data. And he's not interested in waiting for proof of value.

"At some point, I can sit and wait for CMS to make the change to deliver funding for me," he says. "Or I can go ahead and do all the right work and show them the value add."

So, this is just the first step on the journey, one that Slonim expects will expand up and out as his health system experiments with and finds new uses for the technology. These tiny, coin-sized patches, he says, will open new pathways to patient care, giving patients and their care providers more opportunities to connect and collaborate beyond the traditional visit to the doctor's office.