Program Update 5/5/2016

Active enrolled participants continue to increase. The enrollment is around 60 with additional referrals waiting to be contacted. Becky is processing through referrals and enrollments efficiently to get patients on board and interested in the program.

While the interface is being worked on the team continues to use the new workflow. This has meant extra work for Becky, but it has been effective. The interface is currently in testing. The team is working to ensure that when this release occurs the interface will work in production for the different scenarios along with the transfer of alerts/data between the two applications.  A go live date will be determined in the near future.

Program Update

Program Update (4.21.2016)

Active patient enrollment is at 56 patients with 3 additional enrollments going on this week, and an additional 5 referrals to follow up on. The team is seeing good clinical outcomes for the patients and the ability to use the data gathered by the remote patient monitoring products has been very useful in caring and education patients.

Some of the equipment is aging. This grant began with some purchased and some “in kind” equipment that was already used by RCCHC. With the program being in the 3rd year it is to be expected that some of the equipment may no longer work. The Mosaic team is going through inventory to provide the exact peripherals where they may need replacement. Overall there isn’t a standard set in industry for how frequently the equipment should be replaced. It is policy however that all equipment is re-tested multiple times upon refurbishment to ensure it is accurate and working.

Program Update (4.7.2016)

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.

The team has been managing the patients using the Epic – Ideal Life interface. The interface allows the patients to be tracked through Epic. The nurse is currently verifying that all of the data and alerts are transferring accurately for each patient; but in the future she will work out of the same portal managing encounters for the patients with the providers in Epic. This will reduce the RN’s time and increase communication and actions to be taken by the patients’ clinical care team.

Already they are observing physician involvement increasing because it is something they are accustomed to, responding to Epic encounters. The RNs supporting RPM are busy with the transition, but even with the transition activities they are encouraged to have more time working with the patients in the near future.

Another benefit gained by the interface going live is discharging patients who were not actively participating in the program. The current status has 50 active patients and 6 referrals pending with 2 scheduled for enrollment. Becky will be back out promoting the program after it is confirmed that the interface is fully functioning as intended, and we project the number of active patients will increase.

Program Update (3.10.2016)

Currently the active patients being monitored is around 60. There are typically a couple discharges and a couple new referrals every week. This has been steady activity and manageable while the team has also gone live with the Ideal Life – EPIC interface. Becky does have 4 outstanding referrals that are being scheduled which continues to demonstrate the organizations belief in the program.

The OCHIN interface between Ideal Life and Epic has gone live in March. Becky is excited about the time-saving potential this will provide her and the per diem RN’s supporting the patients in the long-run. Currently they continue to work through a few challenges to ensure first and foremost that all of the data in Ideal Life is accurately accounted for in Epic. Becky and Brandon continue to work together to identify any outstanding challenges and in most instances the interface is working as planned. The newly enrolled patients will be up for about a week and the summary reports will be generated in Epic. Becky is excited to see how that will occur.

Even though there have been a couple of open tickets established, the interface is in production, the team is excited and encouraged by how it is working so far. The team will continue to validate data in both Ideal Life and Epic for the near future to ensure data accuracy. It won’t be long before the team is fully transitioned over.

Program Update (2.25.2016)

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

Program Update (12.3.15)

The relaunch occurred as planned.  New referrals opened up on 12/1/15 as expected.  

Becky was at all clinic sites on Tuesday and spent time with nurses and ensured the equipment was ready to go.  Already there have been two new referrals and two more discharges.  Active patient count is 45 with one more patient in for enrollment today.  This is exciting and shows that the clean-up activities were necessary and the retraining of clinicians allows the relaunch to work.  The RN coordinators at the different clinics are excited.  There are new education materials and a new RN process to allow a decision to be made for potential patients.  One goal since the launch is to define nicer handouts, tips for the patients.  Currently they are in review by the Medical Director and in English but the goal of language translation is not far behind.  These documents are a work in progress to ensure they are useful and accurate.

Program Update (11.19.15)

Ongoing patient clean-up remains the focus as planned.  Currently there are 48 active patients.

Becky has been at the two other Mosaic clinics and talked with the nurses and trained them as some are new.  This training will prepare for the re-launch of referrals on December 1.  The goal is for Becky to spend Tuesdays at Madras, Thursdays at Redmond while still being based at the Prineville Clinic.  This change will allow her to support clinician questions immediately and ensure inventory at the clinics is available.  

Jessica continues to focus on inventory and equipment recovery.

Program Update (11.5.15)

As the team continues to clean things up in preparation for relaunch of referrals we are currently at 61 patients.  There were 5 discharges last week – patients were stable and providers agreed to discharge them as recommended. 

The team is organizing kits to get them together to allow for the enrollment of new patients beginning in December 2015.  Everyone is fine with the numbers going down to get exactly which patients should be on the program enrolled and supported while inventory is managed to allow the team to take on more patients in a month.

The presentation at the Oregon Rural Health conference received good feedback and questions. There were about 70 people in attendance and a lively discussion, questions and feedback occurred.  One of the St. Charles administrators was in attendance at the conference – and she will be present on Wednesday when the team meets with St. Charles to discuss potential opportunities.  

Program Update (10.8.15)

As of today there are 69 actively enrolled patients.  The per diem RN’s are supporting alerts while Becky catches up with two week reports for each patient and prepares to meet with the providers with program changes and to relaunch the RPM program.

Program Update (09/24/15)

The RN open position has been filled and Becky will fill the role full-time on 10/5/15.  As part of this transition she is performing RPM activities.  The focus is on discharging patients who are not actively participating and obtaining unused equipment.  There have been a couple of referrals that have been processed but right now the focus is on “clean-up” before doing a relaunch.

Couple patients enrolled right now through the interface and we are receiving alerts within the in basket.  One little challenge but as of this afternoon we will be ready to go with training within the clinics.  Go live date October 26, 2015.  Target is enrolling all patients into Epic so they are ready to go on the go live date.

Program Update 8/27/15

The program is now in a stage of transition with resources.  A position has been posted to include re-defining the RN position differently to account for supervision of a matrixed clinical administrative assistant.   At the same time the Mosaic per diem RN’s will support the program.  For the time being, referrals are being suspended to allow the current staff to focus on the current active program patients.  A nurse outline for training will be worked through so the new resource is able to assume this role.

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.