Community Health Systems sees growth in remote patient monitoring

When Community Health Systems began developing its remote patient monitoring program, Dr. Lynn Simon says the organization moved intentionally, which has been a key in the program’s success.

Simon is president of healthcare innovation and chief medical officer of CHS, the for-profit system based in Tennessee that operates 71 hospitals and more than 1,000 sites of care in 15 states.

Like many health systems, CHS wanted to launch remote patient monitoring to help track patients with chronic conditions and spot problems before they became more serious. CHS partnered with Cadence, a remote patient monitoring provider which employs its own clinical team to support health systems in monitoring patients.

CHS tapped Cadence to work with the health system’s primary care physicians to track patients. So far, CHS is remotely monitoring patients with hypertension, diabetes and heart failure.

“We started off just with a couple of clinics, just trying to prove proof of concept and getting the workflows right. But then it expanded relatively quickly, from clinic to clinic,” Simon says.

Since announcing the partnership with Cadence two years ago, CHS has now enrolled more than 10,000 patients in its remote patient monitoring program.

In an interview with Chief Healthcare Executive®, Simon talks about the development of the program, getting buy-in from physicians, and outlines some of the keys to success.

At times, rolling out a new initiative can lead to sleepless nights, Simon says, but she hasn’t lost sleep due to the remote patient monitoring program.

“It's really been well received sort of all around,” she says. “So it's been easy on our providers. The patients love it, they really feel engaged … they feel like their doctor is more engaged in their care. And that's always a good thing.” (See part of our conversation with Lynn Simon in this video. The story continues below.)

Building the program

When CHS began developing its remote patient monitoring program, Simon explains that one factor was imperative: It had to be manageable for clinicians.

Even before selecting a partner and deploying technology, she says, “We were really very specific about making sure that it wasn't going to put more burden on our providers and on our clinic staff.”

“Some of the physicians had used remote patient monitoring in the past, but they were just getting inundated with data and messages, and it was just too burdensome for them,” Simon adds.

Working with Cadence, doctors can see updates on their patients in the electronic medical record system, but they aren’t bombarded with alerts, she says.

“I think that was the one thing that was very deliberate is to make sure we could help extend the reach and the expertise of our clinicians, but not burden them with more inbox messages,” Simon says.

When CHS began testing the remote patient monitoring program, the health system chose the doctors carefully.

“We piloted with physicians who are really interested in it, and wanted to make it work,” Simon explains.

As doctors began seeing success with the remote patient monitoring program, others wanted to come on board.

“If you have 100 patients on it, people are going, ‘Oh, that's nice,’” Simon recalls. “But when you start to have thousands of patients on the system, and then you have doctors talking about how well it's working for them, we have patient testimonials about how well it's working for them … we saw great momentum once we started to get more and more patients being monitored.”

• Read more: How Boston Medical Center used remote patient monitoring to track vulnerable patients

Getting buy-in

With the program, Cadence identifies patients that could be good candidates for remote patient monitoring. CHS’ doctors decide which patients are most appropriate for monitoring. CHS physicians will encourage patients to participate, and ultimately, patients make the call.

Patients typically spend about 30 minutes each month talking with Cadence’s clinicians. Only a handful of alerts generally go to the patient’s primary physician.

As CHS sought to expand the program, the system had educational calls as they rolled it out in different markets.

But CHS had teams that would meet with the clinicians in each new market to talk with providers and answer questions. Some of those included the CHS doctors who launched the initial remote patient monitoring programs.

“We had providers in our first markets talk to doctors in the upcoming markets about how well it's working for them, gave them an opportunity to reach out and talk to docs, to see how it's working,” Simon says.

The doctor-to-doctor conversations, along with encouraging data on the early success in participation, “really made a difference,” Simon says.

“That's always better to hear from a colleague how well it's working than, you know, me trying to sell it,” she says.

“Quite frankly, I've done very little selling of the program,” Simon says. “It's really been market to market and provider to provider.”

As CHS expands remote patient monitoring in new markets, the system begins with a few doctors at the outset.

“So you get a few docs in the market, they start to use and start seeing results and then they're talking among themselves, and then the word will spread,” Simon says. “So yes, it's really been nice with the sort of self-adoption among the providers themselves.”

Looking ahead

Simon has high hopes for the continued expansion of the remote patient monitoring program at CHS. She says it’s possible that the program could grow to 20,000 or 25,000 patients by the end of the year. She also says it’s possible the program could expand into specialty care.

She’s encouraged by the high number of patients that are regularly using the remote monitoring devices.

Simon also notes that the program is not necessarily leading to a drop in office visits, but she notes that some of the patients in remote monitoring typically need more visits.

“We're really not seeing a huge reduction in the visits that people are having,” Simon says. “We're just seeing more monitoring and more engagement. If the patient isn't doing well, they may have to come to the clinic more, but we may not have known that before.”

Advice for other systems

For health systems looking to build remote patient monitoring programs, Simon says it’s important to move deliberately. Health systems need to define their goals.

“Be really intentional about what metrics you want to achieve,” she says. “What are you trying to achieve?”

It’s also important to think about the workflows involved with a remote patient monitoring program.

“We all know that our providers and our caregivers are so burdened,” Simon says.

Whether a health system chooses to find a partner or build their program on their own, it’s vital to “create a process that actually takes the burden off the provider,” she says.

“I think that's probably a big part of our adoption,” she says. “They're not getting a million messages, the office isn't getting a million phone calls. And we're not making it harder for them to provide care, we're making it easier for them to provide care.”

Simon also says that health systems should think about the patients they want to monitor, and they should realize some of those patients don’t regularly see doctors.

She says that CHS saw that more clearly as the program expanded.

“The patients that really might need to be on the monitoring are not the ones that are going to come in every day,” Simon says. “They may be the ones that are not coming in.”

As the program evolved, CHS examined the characteristics of patients that may be amenable to remote monitoring, regardless of whether they were being seen regularly.

“Once we started doing that, we started to get much more traction,” Simon says.