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Photo: Renown Regional Medical Center

Renown Regional Medical Center in Reno, Nevada, faced many challenges with telemedicine and the ability to scale quickly as the COVID-19 pandemic grew in force last year and the organization had to close its outpatient offices for elective services.

Some of these challenges included technology for providers available at scale, a platform to deliver care in a user-friendly fashion, licensure for these tools, state licensure, and expanding quality care to patients amidst the capacity and staffing challenges that all health systems were facing across the country.

New challenges caused by speed

Bandwidth was a concern as many organizations were diving into virtual care and scaling very quickly. And that led to new challenges such as security of virtual meetings and on-camera etiquette training. 

Overall, the big challenge was gaining the ability to ensure high-quality care was delivered in a timely and accessible fashion for patients to allow them to get the right care at the right time while limiting exposure to COVID-19.

“In order to address these care challenges, we implemented a few different solutions to create the right capacity and seamless care for patients with high-quality virtually,” said Mitchell Fong, bad taste in mouth while taking clarithromycin director of telehealth at Renown Regional Medical Center. 

“The initial implementation was a deployment of a Teladoc COVID-19 screening portal to see patients with COVID-19 symptoms to triage and coordinate testing at appropriate locations.

“At that time, all patients would need a COVID screening with a provider in order to be eligible for a COVID test at the time when testing was limited,” he continued. “This was a tremendous tool used to prevent unnecessary exposure but work in alignment with the county to prioritize resources efficiently as a community-wide response.”

“We had no program for RPM available pre-COVID, and now we have seen more than 500 patients with COVID-19 and COPD via remote monitoring with a high patient satisfaction rate.”

Mitchell Fong, Renown Regional Medical Center

Around the same time, Renown Regional also launched Zoom embedded within its electronic health record to provide a tool for all of its providers to deliver virtual care. 

This service created licensure for all providers across the health system and all service lines to use the technology for direct-to-consumer virtual visits, patient-family visits in the inpatient setting, and virtual triaging outside of the ED in a tent used to screen patients with COVID-19 symptoms for appropriate exposure mitigation.

Remote patient monitoring

“The final tool that was used as a response was a continuous remote patient monitoring tool that was implemented with a focus on using the continuous pulse oximetry monitoring in partnership with Masimo,” Fong explained. 

“This tool is called Masimo Safety Net and allows for minute-by-minute pulse oximetry readings across a few vital signs – pulse rate, respiratory rate, oxygen saturation and temperature – to allow quality monitoring for patients.

“COVID-19 and COPD patients were monitored with this tool post-discharge to ensure the patients would get to a full recovery, or that any exacerbations were responded to in the moment to deliver timely care and support in the moment using virtual visits, in partnership with community paramedics, to provide enhanced support as necessary,” he added.

For the RPM tool, the initial capacity challenge was so bad on the community that Renown Regional staff had to create an alternate care site by converting two floors in a parking garage into a 1,400-bed hospital for COVID-19 patients. Fortunately, the organization only needed to open the first floor, a 700-bed capacity.

“With this, we were seeing huge capacity challenges from facility and clinical resources as our nurses and providers were severely overwhelmed,” Fong recalled. 

“The ability to centralize monitoring with smart alerts as well as continue to discharge patients sooner, with oxygen support, but have virtual providers and technology to manage the care remotely, allowed us to create capacity for those most acute patients to have prioritized care.

“These tools have helped us address the initial wave of COVID-19, but have also set us up to successfully build capacity and access to care outside of our brick-and-mortar locations for the future,” he continued. “We are now building a hybrid care system to create synergy between in-person and virtual services to allow patients to have more preference on the delivery of care in a quality fashion.”

Preventing readmissions

In the future, the various technologies will allow staff to better monitor patients to prevent readmissions while teaching these patients to best control their conditions, he added.

“Virtual visits will be a great enhancement to build on the personal interactions between the patient and the health system and create an opportunity to expedite the right care at the right time and right place,” Fong stated. “The future potential is limitless, and we look forward to how these tools can create the framework for a health system that can bring care to the patient.

“One example of the technology is remote patient monitoring using Masimo Safety Net,” he continued. “This was initially used only for COVID-19 patients as they were getting ready to be discharged from the acute setting and in the alternate care site. We would set patients up with the device the day before or morning of discharge and educate the patient on the tool while validating the tool was paired to the patient mobile device and sending data to the cloud-based clinician portal.”

After this connection was successful, the patient would be discharged with the device and multiple batteries sent with the patient in their discharge packet with the written information to support the patients at home. Virtual visits were then scheduled for these patients for the next seven to 10 days so the patient would have their routine visits with a provider to manage and monitor their recovery.

Monitoring patients with virtual visits

“Finally, the patient was set up with a DME vendor to ensure oxygen was delivered to the patient upon their return home,” Fong explained. “Patients would be monitored until they were deemed ready for discharge through virtual visits from the provider, and a six-minute walk test – or comparable test – would be completed remotely using the passive monitoring technology in combination with a virtual visit.

“For this service, Masimo Safety Net was not integrated with any other systems, but our care team would respond to alerts within our EHR,” he added. “In the future, we look to integrate this platform within our EHR.”

The overall success of this program was strong as Renown Regional expanded its capacity and ability to manage as many patients as it could to meet the overwhelming demand.

“Patient satisfaction scores scored in the 90s and we saw readmissions and ED return rates to be similar to what we expect for COVID-19 patients with oxygen support,” Fong said. “The opportunity is we were able to be extremely proactive in care for these patients and support these patients prior to needing to be readmitted to the facility by proactive alert response and coordination of care in the moment.

“As we then worked to expand this to the COPD population, we have seen a reduction in readmission rates in the small pilot we have conducted thus far,” he added.

Hard results achieved

Renown Regional has seen 1,500% growth in virtual services across all services including primary care, urgent care, specialty care and remote monitoring encounters compared with the pre-COVID volume.

“We have seen that stabilize around 1,000% of our pre-COVID volume, but the ability to meet that volume has demonstrated the access we have been able to create virtually while supporting the community to stay remote and at a distance,” Fong said.

“Another metric is the overall volume and success for remote monitoring,” he continued. “We had no program for RPM available pre-COVID, and now we have seen more than 500 patients with COVID-19 and COPD via remote monitoring with a high patient satisfaction rate. Further, in the small sample size for COPD, we have seen a reduction in readmission rate that has continued to trend toward reduction over a six-month timeframe.”

Using FCC funds

Last year, Renown Health Foundation for Renown Regional Medical Center was awarded $977,720 by the FCC telehealth grant program for a virtual screening system, remote patient monitoring equipment, laptop computers, tablets and telehealth equipment to limit COVID-19 exposure by using telemedicine in the acute, transitional care and ambulatory settings, to implement a COVID-19 virtual screening portal to treat patients from home, and to deploy a telehealth intensive care unit to deliver high-quality care to COVID-19 patients.

“The FCC telehealth funds were exhausted with the aforementioned services and technology used in the alternate care site in alignment with those services,” Fong said. “FCC funds were used for the Teladoc COVID screening portal, Zoom for all of our providers, Masimo Safety Net implementation and devices, and finally for hardware to allow our providers to deliver virtual care effectively.”

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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