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.

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.  

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.

Pros and Cons of Kits

Sending equipment kits home with patients versus completing individual in-home installments has proven to be a successful and effective model.  Since switching to kit installations, the COTN team is able to utilize their time more efficiently.  This method ensures that in the future, as enrollment rises, they will be able to accommodate larger numbers of patients, keeping up on readings and ensuring adequate communication with patients and providers.

The only drawback to this strategy thus far is a decrease in the level of personal connection between the COTN team and the patients whose health they monitor.  Meeting the patients in their home environment provided an opportunity for the team to get to know the patients better and learn more about their lifestyle.  Though still more efficient, it is now sometimes necessary to spend a little more time examining patient charts, or speaking on the phone with patients in order to create a clear picture of what is happening for them health-wise, the effectiveness of their medications, and what habits or activities may contribute to the state of their health.

The COTN program RNCC states that since switching to the kit method, the level of care provided to patients remains comprehensive, though the level of personal connection is not the same.