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The pandemic has led to an explosion in the use of remote care paradigms, from telehealth to remote patient monitoring and more. Many service providers have adopted these methods for the first time as a result of COVID-19.
But those at UVA Children’s Hospital have been in the lead in the trend and have used remote patient monitoring for nearly seven years under the supervision of pediatric cardiologist Dr. Geoffrey Fergales.
When he was brought to UVA Children’s one of his primary roles was to take over the home monitoring program that was being used among patients with congenital heart disease in children at high risk. At the time, the program was very rudimentary and consisted of patient caregivers who track directions manually on paper and call the hospital to participate, Fergales said. Moby Health News.
“We were responding to data, maybe when it was three to five days old already,” he said. “And for some kids, it might not have been dangerous – it could have been dangerous – but it wasn’t perfect. There were times when we could have intervened earlier and faster than we should have done otherwise.”
He soon realized that the standard of care they were providing inside the hospital did not last at the patient’s home.
“One of the things I had was the fact that the child’s risk profile does not change when he is in hospital, compared to when he actually goes home,” he said.
“What changes is what we do with them, and so I disliked the dichotomy of super-close monitoring of these children when they were inpatients, and then, when they came home, just to be like them.” “That transition didn’t make sense. It looks like this should have been more gradual.”
How did they do it
In the early stages of launching the remote patient monitoring program, Vergales says they faced typical logistical challenges such as setting the budget, how it works, and how to engage the necessary stakeholders.
“Logistically, there was a lot of heavy lifting, because you had to involve a large number of different people. We had to involve our EMR personnel, our data security personnel, all the doctors who would interact with it, the parents.”
But one of the benefits of working in pediatrics is that it’s a particularly executable community, according to Vergales.
“So I wouldn’t say it was easy, but we had an enthusiastic audience to get it done, and I was lucky that we at UVA got it. It wasn’t true in all of the centers where I was also helping to do it. Sometimes you get a lot of question” Why Need to do this? Will this be possible? And things like that. “
It was important to UVA children that the remote monitoring program would improve processes on both the patient and provider sides.
“We spent a lot of time thinking through the parts of the user interface, like how do people interact with their children every day? How do people interact with technology, and love writing tools every day? Which they don’t do. They interact with their phones every day.
We’ve also spent a long time on the back end, like, How can we make sure that the UI creates useful data in a report and style [so] We want to be able to interact with it [it] On a daily basis?”
With the help of a digital vendor, UVA Children’s launched its first remote patient monitoring platform in 2014. Initially, they sent patients home with an Ipad connected to the hospital’s electronic medical record so that it could seamlessly transfer patient data.
Two years after he was able to collect data in a manner similar to inpatient conditions, Virgales and his team began looking at other patient groups that could benefit from remote patient monitoring.
Ultimately, it spread to oncology, organ transplantation, cystic fibrosis, gastrointestinal disorders, malnutrition, and the neonatal intensive care unit. The software now also allows patients to use their own devices to share data.
According to Fergales, one of the biggest outcomes of the program was an increase in the rate of adherence. It allows a simpler and easier user experience on both sides.
In terms of concrete results, he says patient outcomes have also improved.
“When you look at a program that didn’t exist before, let’s take the NICU program. We get kids at home, on average, a week and a half before our appointment before that,” said Fergales.
“Once they were discharged from the hospital sooner, we also showed very significant reductions in emergency department visits and re-admissions. So we were able to find ways to get in on things before they get serious and communicate with the patient before they get serious.”
I look forward
Although UVA Children’s was able to make remote patient monitoring programs stand up to COVID-19, Vergales says the pandemic will only advance the field moving forward.
“I think we will witness more explosion of this, because the epidemic has already broken a lot of outdated rules and laws that were difficult for us to break and difficult for us to continue pushing limits,” he said.
Ultimately, with more progress, these capabilities will allow for better chronic condition management, greater patient participation, reduced use of specialist care, and better cost reimbursement, according to Vergales.
“That seems like the logical way medicine should move. We have all this capabilities and technology on the inpatient side. Why not find ways to engage it on the outpatient side?”
Vergales will present in a session titled “Transforming lives with remote monitoring of children” at the HIMSS21 Global Health Conference and Expo on August 10 from 11:30 am to 12:30 pm at Marco Polo 701 at the Venetian Resort in Las Vegas.
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