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. 2021 Oct;12(5):1161-1173.
doi: 10.1055/s-0041-1740480. Epub 2021 Dec 29.

Continuous Remote Patient Monitoring: Evaluation of the Heart Failure Cascade Soft Launch

Wei Ning Chi  1 , Courtney Reamer  2 , Robert Gordon  2 , Nitasha Sarswat  2   3 , Charu Gupta  2 , Emily White VanGompel  4   5 , Julie Dayiantis  6 , Melissa Morton-Jost  6 , Urmila Ravichandran  7 , Karen Larimer  8 , David Victorson  9 , John Erwin  2   3 , Lakshmi Halasyamani  4   5 , Anthony Solomonides  1 , Rema Padman  10 , Nirav S Shah  2   3
Affiliations

Continuous Remote Patient Monitoring: Evaluation of the Heart Failure Cascade Soft Launch

Wei Ning Chi et al. Appl Clin Inform. 2021 Oct.

Abstract

Objective: We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol.

Methods: This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021. Patients were provided with non-invasive wearable biosensors that continuously collect ambulatory physiological data, and a study phone that collects patient-reported outcomes. The physiological data are analyzed by machine learning algorithms, potentially identifying physiological perturbation in HF patients. Alerts from this algorithm may be cascaded with other patient status data to inform home health nurses' (HHNs') management via a structured protocol. HHNs review the monitoring platform daily. If the patient's status meets specific criteria, HHNs perform assessments and escalate patient cases to the HF team for further guidance on early intervention.

Results: We enrolled five patients into the soft launch. Four participants adhered to study activities. Two out of five patients were readmitted, one due to HF, one due to infection. Observed miscommunication and protocol gaps were noted for protocol amendment. The study team adopted an organizational development method from change management theory to reconfigure the study protocol.

Conclusion: We sought to automate the monitoring aspects of post-discharge care by aligning a new technology that generates streaming data from a wearable device with a complex, multi-provider workflow into a novel protocol using iterative design, implementation, and evaluation methods to monitor post-discharge HF patients. CRPM with structured escalation and telemonitoring protocol shows potential to maintain patients in their home environment and reduce HF-related readmissions. Our results suggest that further education to engage and empower frontline workers using advanced technology is essential to scale up the approach.

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Conflict of interest statement

The study devices, monitoring platform, and tech support are non-financial support by physIQ. K.L. is an employee of physIQ. All other authors do not have any conflict of interest. K.L. reports employment and equity from physIQ, during the conduct of the study; other from physIQ, outside the submitted work. N.S.S. reports non-financial support from physIQ, during the conduct of the study. J.E. reports and I serve on the ACCMedAxiom Board of Trustees. This is the for-profit arm of the ACC. While I have no direct relationships with vendors, the Board approves partnerships with vendors. U.R. is funded by the Daniel F. and Ada L. Rice Foundation. The foundation is not involved in the research design, implementation, or production of the manuscript in any way. Therefore, there is no conflict of interest. W.N.C. is funded by the Daniel F. and Ada L. Rice Foundation. The foundation is not involved in the research study design, implementation, or production of the manuscript in any way. Therefore, there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Continuous remote patient monitoring solution.
Fig. 2
Fig. 2
Soft launch workflow. IV, intravenous; LE, lower extremity; MCI, multivariate charge index; MD, medical doctor; NP, nurse practicer; PND, paroxysmal nocturnal dyspnea; RN, registered nurse; SOB, shortness of breath.
Fig. 3
Fig. 3
Patient journey.
See this image and copyright information in PMC

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