Update

Becky and Jessica have been drafting out a guide for inventory management.  Specifically, like the status given equipment in its different return state and what happens when the equipment leaves Mosaic’s possession along with where equipment is in the inventory workflow.  The inventory management workflow will be placed into Mosaic’s workflow in the coming weeks to increase their oversight and insight into controlling the inventory 

Current enrollment is around 70 patients.  There is more equipment out than what we are receiving readings for so Aimee is going to follow-up to determine whether or not these patients graduated the program.  There has also been some conversation surrounding reading compliance to determine if there may be a better way to motivate the patients.

Lots of continued discussion surrounding changed to program delivery once integration has occurred.  Such items include whether or not data collection will change.  There has been additional conversations regarding the benefits and efficiency of having RCCHC patients use of Remote Monitoring Kiosk to take vitals at time of clinic check-in.  Initially the RCCHC would implement this process then perhaps send a kiosk to Mosaic for use if it proves sustainable and efficient.  Target would be spring 2016.

Challenges

There are still ongoing challenges regarding resource and workload management.  There will be another per diem nurse joining the team in September.  After OCHIN interface is fully integrated, Aimee will be working on refining the resource needs list.

Successes

Aimee has been making visits to the two newest sites, Redmond and Madras, based partly on feedback provided during an informal team interview.  We have a newly trained RNCC in Redmond who is fully onboard and excited about the program. We have a .3 employee who is assisting with the equipment cleaning and reset.  This is a great benefit.

Building and testing OCHIN interface is progressing.  We are looking to enroll active patient information into the system for testing purposes on or about 8/17/15.

Opportunities

Andy Eck is continuing to pursue opportunities available to expand the program.  Specifically targeting the St. Charles Medical system.  Andy has provided items to the executive for consideration and will be following-up once we have a better handle on the training manual, ideal life interface, etc.

While both Prineville and Madras demographics reflect similar percentages of patients aged 60-69, Redmond's data reflects the highest percentage in the 50-59 age range.  

All three site demographics reflect the ethnic diversity of the patients support by each clinic.  Notably the Non-Hispanic/White population is the majority in all three; however, Madras' patient population is largely Spanish speaking in nature.

Update

As of June 18, we had 78 active participants with a total of 90 units in the field.  We will be looking into the discrepancies.  We are still looking into the Glucometer enabler issue presented previously. the Glucometers are less cumbersome for the patients and may be more efficient than enablers due to the communication issues presented. Due to these factors, it is likely data collection will be more consistent if supported by the Glucometers.  Currently we are also working on completing drafts of procedure manuals focusing on the remote RN support.  This would provide a guide for any nurse to step into the support function with ease as well as provide information for other locations that are interested in starting a similar program. 

Successes

Andy Eck is still working closely with St. Charles Medical System to explore expansion of the program.  Networking through this channel and the recent regional meetings has made state level agencies more aware of what is happening in their own "back yard", so to speak.  Wonderful awareness!

Challenges

OCHIN interface still in process; completion target dates have come an gone.  Resources at our end are needed to support testing, yet as of June 18 there is no definite test date confirmed. We still don't have a committed resource to back-up our Regional RN, Aimee Priest.  While we did finish training a per diem nurse, this resource may not be sufficient to cover all needs.  

Challenges

Glucometer enablers are not transmitting as of 5/21/2015; troubleshooting by customer service was attempted.  However, the only truly effective resolution was providing new glucometer.

Successes

80 patients enrolled in the program as of 6/4/2015 and referrals are increasing!  Andy is meeting with ancillary Service Director for medical clinics to determine whether or not the RPM program can be expanded in year three to St. Charles Medical.  

Thanks to  Aimee, all non-compliant patients and their providers have been contacted.  The patients have either come into compliance (actively participating) or the equipment has been recovered.

Celebrations!!

New per diem nurse has been trained by Aimee; this will assist with workload overflow and vacation coverage. 

The Prineville clinic sits in Crook county, population as of 2013 is 20,815. The town of Prineville has a population of 9,223.  

The Madras clinic sits in Jefferson County, population as of 2013 is 21,145.  The town of Madras has a population of 6,363.

The Redmond clinic sits in Deschutes county, population as of 2013 is 165,954.  The city of Redmond has a population of 27,427.

 

 

 

OPPORTUNITIES

Andy Eck (Regional Director of Operations, Prineville) is making progress in coordinating with the CCO board regarding expansion of the RPM program outside Mosaic during year three. 

 

SUCCESSES

Andy Eck  (Regional Director of Operations, Prineville) has been asked to attend the upcoming Oregon Health Authority conference in June.   This governing body for Medicare want to know more details about our program, so Andy will give a mini presentation and lead a forum regarding the program.  The networking that this conference, the one in Seattle recently and others is wonderful. 

 

CHALLENGES

OHCHIN interface software testing and implementation continues to be a challenge.  Reports from developers do not coincide with actions noted those involved in launch at sites.  This translates into continued inefficiencies based on the need to maintain records in two seperate EMR systems. 

 

Check it out!

I found an organization called Telehealth Alliance of Oregon on the web and, while their website does not specifically talk about what we are doing, it does highlight how telemedicine is being implemented in our state.  Additionally, it has a blog area with articles and topics that might be of interest to those  visiting our site.  Check it out!

http://www.ortelehealth.org/content/who-tao

MOSAIC MEDICAL IN THE NEWS!

 Exciting news article published in our local paper; follow the link to see!

          On the job: Community health worker |

 Specialized outreach worker reduces barriers to care

http://www.bendbulletin.com/health/3004536-151/on-the-job-community-health-worker#

More NRTRC Annual Conference Notes

In addition to the presentation by our team going extremely well, there were many attendees discussing what role telehealth can and does play in behavioral health. It was encouraging to realize how long the concept of telehealth has been in practice and to see how its grown as technological advances have grown to support it. There are some thoughts on how this might implemented into our current program; early stages as of yet, but certainly something to look into.

 

FUTURE GROWTH

We continue to investigate partnering with the larger care organizations in our area to see where this program might fit to support their patients. Identifying the population and how to tap into is remains a high priority. The idea behind it always being continuity of care, patient engagement and supporting patients in a way that will encourage their engagement.

Observations

What are the staffing needs for a program like this? Based on best practices to date, this largely depends upon the number of patients brought onto the program at one time. The ideal manageable number for our locations and patient population 1 RN for every 75-100 patients. Ideally during the first year of implementation there should be at least one fulltime employee dedicated to the program then once it is in place 1 RN with 1 Per Diem Nurse seems to be sufficient.

Surveys Results: Prior to Implementation and One Year Later

Based on results of the survey given to staff prior to training and launch of the program, the majority of respondents viewed the project positively. Once training was accomplished, there was an 8.5% increase in the overall excitement of site personnel with a correlating decrease in responses that leaned toward a "wait and see attitude".

Prior to training and launch of program there was a wide range of concerns; however, the majority dealt with how the program would affect each individual's job responsibilities, the technological support for the remoteness of patients and patient compliance. During the past year these areas have become more clearly defined. Most notably the technology used at first wasn't sufficient to ensure continuous monitoring. This area is one of the most critical and will vary greatly depending on population specific demographics; cell tower vs land line vs VOIP. Understanding patient and site technology capabilities prio to launch could ensure a smoother implementation.

Additional comments provided during the survey addressed the tech issues with suggestions including options that would allow patients to view results and offer healthcare support literature which might encourgage patients to better engage in their care.

Efficiency issues were also mentioned such as ensuring there is a streamlined interface between the Healthcare Records Management System (Epic) and the software used by RNs to input program information (Ideal Life). This would decrease the burden of recordkeeping placed on personnel.

Ongoing Challenge

 Still tracking down a few kits; getting patients to return these in a timely manner continues be a challenge which requires creative solutions.

NRTRC Conference Overview: Innovation Through Collaboration

 The annual NRTRC conference was held in Seattle March 30 - April 1.  The purpose of the conference was to bring providers together, increase their knowledge and utilization of telemedicine. Mosaic Medical's own Aimee Priest and Andy Eck were invited to present.  This was a great opportunity for Mosaic Medical to engage in the larger telehealth community.     

 

During the presentation, our team discussed the positive impact of remote monitoring and chronic care management for Community Health Centers and patients.  Additionally, they discussed the evidence based practices that enhance short-term remote patient monitoring interventions, compliance, care team efficiency and significant healthcare savings.   The presentation highlighted program strengths such as how it better engages patients in their own healthcare.  It also give providers additional tools to care for some of the most vulnerable population within a proactive approach to health management.  The forum allowed us to share the following program statistics:
 Our largest age group populations are within the 50-59 and 60-69 year ranges

 59.43% of all patients have at least two diagnoses
  (Hypertension and Diabetes most prevalent)

 76% (161) of all patients successfully completed or remain on the program   

 There has been a 5.2 point reduction in systolic BP; a 3.4 point reduction in diastolic BP

 Diabetics on average saw an A1C improvement of .33 after six-month participation

 A 7.4% increase between pre-program PAM scores and post-program PAM Scores 

Catching Up: Successes and Celebrations!

Patient participation grew from 67 patients in early December to 85 patients in mid-March for a total of 220-225 since the start of the program. Interpreters needed for certain demographics, this continues to be successfully managed as of December 18, 2014.

New per diem nurse hired for rural clinics to assist as back-up when primary RN is unavailable. This will ensure program continuity and reduce workload on primary RN. We continue to look for opportunities to support the local healthcare community as well as provide patients in rural areas with the monitoring care they need. To this end, we are researching possible partnerships with healthcare providers outside the Mosaic Medical arena.

 

In the Spotlight

Really nice story about the Roanoke Chowan Program can be found here...and with some amazing quality pictures!