The pandemic led to an explosion in the use of remote models of care, from telehealth to remote patient monitoring and more. Many providers have adopted these modalities for the first time as a result of COVID-19.

But those at UVA Children’s Hospital were ahead of the trend and have utilized remote patient monitoring for about seven years under the guidance of pediatric cardiologist Dr. Jeffrey Vergales.

When he was brought on at UVA Children’s one of his primary roles was to take over the home monitoring program that was being used among high-risk pediatric congenital heart disease patients. At the time, the program was pretty rudimentary and consisted of the patient’s caregivers manually keeping track of trends on paper and calling into the hospital to share, Vergales told MobiHealthNews.

“We were responding to data, probably when it was three to five days out of date already,” he said. “And for some kids, that maybe wasn’t dangerous – it could’ve been dangerous – but it wasn’t ideal. There were times we could’ve probably intervened earlier and sooner than we otherwise should have.”

He quickly realized that the level of care they were providing within the hospital wasn’t continuing into the patient’s home.

“One of the epiphanies that I had was the fact that the kid’s risk profile doesn’t change when they’re in the hospital, compared to them when they actually go home,” he said.

“What changes is what we do with them, and so I did not like the dichotomy of super-careful close watching of these kids when they were inpatients, and then, when they would go home, just to be like ‘have at it.’ That transition didn’t make sense. It seemed like that should’ve been more gradual.”

HOW THEY DID IT

In the early phases of getting the remote patient monitoring program onboard, Vergales says they faced the typical logistic challenges such as figuring out the budget, how it would operate, and how to get the necessary stakeholders involved.

“Logistically there was a lot of heavy lifting, because you have to engage a ton of different people. We had to engage our EMR folks, our data security folks, all the clinicians that were going to be interacting with it, and the parents,” he said.

But one benefit of working in pediatrics is it’s a particularly actionable population, according to Vergales.

“So I wouldn’t say it was easy, but we did have a motivated population to get it done, and I just was lucky that at UVA we had that. That’s not been true at all centers that I’ve also been helping out to do this. Sometimes you kind of get a lot of ‘Why do we need to do this? Is that going to be possible?’ and things like that.”

It was important for UVA Children’s that the remote monitoring program would improve the processes on both the patient and provider sides.

“We spent a lot of time kind of in the weeds thinking through user interface pieces, like how do people interact with their child every day? How do people interact with technology, and like writing utensils every day? Which is, they don’t. They interact with their phone every day,” he said.

“We also spent a lot of time on the back end, like, how can we make sure that the user interface generates meaningful data in a report and fashion that [so] we want to be able to interact with [it] on a daily basis?”

With the help of a digital vendor, UVA Children’s rolled out its first remote patient monitoring platform in 2014. At first, they sent patients home with an Ipad that was connected to the hospital’s electronic medical record so it could seamlessly transfer patient data.

A couple of years into being able to collect data in a way similar to an inpatient setting, Vergales and his team began looking into other patient populations that could benefit from remote patient monitoring.

Eventually, it spread to oncology, organ transplants, cystic fibrosis, gastrointestinal disorders, malnutrition and the NICU. The program also now allows patients to use their own devices to share data.

OUTCOMES

One of the biggest results from the program was skyrocketing adherence, according to Vergales. It allows for a simpler and easier user experience on both sides.

As far as tangible outcomes, he says that patient outcomes have also improved.

“When you look at a program that otherwise didn’t exist before, so let’s take the NICU program. We get kids home, on average, a week-and-a-half earlier than we did prior to this,” Vergales said.

“And once you get them out of the hospital sooner, we’ve also demonstrated far, far significant reductions in ED visits and readmissions. And so we’ve been able to find ways to interject on things before they become serious and connect with the patient before they become serious. “

LOOKING AHEAD

Although UVA Children’s was able to get their remote patient monitoring programs standing before COVID-19, Vergales says that the pandemic will only advance the field moving forward.

“I think we’re going to see more of an explosion of this, because the pandemic did break down a lot of antiquated rules and laws that were hard for us to navigate through and hard for us to continue to push the boundaries of,” he said.

Eventually, with more advancements, these capabilities will allow for better chronic condition management, higher patient engagement, a reduction of tertiary-care utilization and better reimbursement, according to Vergales.

“This just seems like the logical way that medicine should be moving. We have all of these capabilities and technology on the inpatient side. Why shouldn’t we find ways to engage it on the outpatient side?”

Vergales will be presenting at the session titled “Transforming Lives With Pediatric Remote Monitoring” at the HIMSS21 Global Health Conference & Exhibition on Aug. 10 from 11:30 a.m. to 12:30 p.m. in Marco Polo 701 at The Venetian Resort in Las Vegas. 

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