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.

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.

 

 

 

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.

In the Spotlight

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

Equipment Retrieval Challenge

With enrollment numbers on the rise, it is increasingly important that Telehealth equipment be returned promptly when one’s participation in the program ends.  Although patients are given explicit instructions to do so, the equipment is not always returned.

In an attempt to encourage timely return of the equipment, the COTN coordinators at the Prineville Clinic are keeping a list of patients with items checked out.  There are notes in two areas of these patients’ charts in EPIC, viewable by the front and back office staff at the clinics.  Reminder notes are also attached to upcoming appointment notices.  The COTN staff has also sent out letters and made regular phone calls to patients, requesting them to return the equipment.

COTN’s RNCC has recently created a new letter, which will inform the patients of the cost of the equipment, which they will be responsible for if it is not returned.  The next step, if all of the above steps have failed, will be to send an invoice to the patients, billing them for the cost of the equipment.

Balancing Equipment and Demand

In general, patients enrolled in Telehealth participate in remote patient monitoring for a standard three months.  This amount of time has been found to be effective in determining whether a patient will benefit from further monitoring.  However, not all patients show much progress in the initial three months.  After this time period has passed, it is up to the provider to extend the referral, requesting for further remote patient monitoring. Some patients participating in the Central Oregon Telehealth Network (COTN) have been enrolled for nearly a year, and depending on specific health issues and provider concerns, this may be necessary.

For patients who are not ready or willing to make lifestyle changes, continuing to monitor their health from afar may not be helpful to their care.  Due to a potential increase in demand for equipment, especially with new sites being added to the COTN, it may be necessary to distribute limited equipment to new patients who may use the feedback from their daily readings to proactively take charge of their health.

While this balance of equipment with patient demand is an issue to be aware of, it is a challenge that program administrators believe will balance itself out as they continue working with providers to ensure that patients involved in remote monitoring are benefiting from the program.  

Patient Interview, Sep. 10, 2014

A 69-year-old patient reports that her experience with Telehealth has been “an eye opener,” helping her to be more accountable for her own health.  The patient has been on the program for eleven months.  It is difficult for her and her spouse to get to the hospital due to the remoteness of their home and the unwieldy road leading to and from it.  The task is insurmountable during Central Oregon’s severe winter storms - twelve-foot drifts of snow have been known to isolate their home from thoroughfares for up to three months at a time.

The patient has experienced multiple health complications, and has recently undergone a successful gastric bypass.   Telehealth has helped her to feel more at ease being active following the procedure.  During hot summer months, the pulse oximeter helps her to know if she needs to wear an oxygen pack while working outdoors.  She states that she “feel[s] more secure knowing that my blood pressure is not going out of whack, if my oxygen level is good or bad.”  Further, the patient has become more prudent regarding her diet, knowing that loading up on salty foods will be reflected in her readings. 

While her experience with Telehealth has been very positive overall, she has had trouble with the equipment.  At times, she takes her blood pressure two to three times before receiving a reading.  When her pulse oximeter failed to read accurately, she was unable to receive a new one in a timely manner due to incline weather.  Despite equipment hassles, she is hopeful that she will continue to benefit from Telehealth, and is grateful for the relationships that she has cultivated via the program - “it’s good to know that I am in reach of medical care.”      

New Site Troubleshooting - Telehealth Equipment Kits

            The Fall 2014 Telehealth rollout to Mosaic Medical’s Redmond Clinics brings a fresh wave of challenges, but the solutions to each issue are being executed in tandem by the team in Prineville.   

            Mosaic Prineville’s two resident Telehealth managers have been solely in charge of enrolling patients in Ideal Life, educating patients on equipment use, installing the equipment in patient homes, and monitoring and forwarding transmitted readings for all enrollees.  It is anticipated that Redmond’s rollout will add 25-50 new patients to their caseload.  With a 30 minute drive separating the clinics, plus many more miles to the rural homes of patients, it is logistically impossible that the RN Care Coordinator and Team Care Assistant could continue to provide equal and quality care to existing and new patients in both cities given the current process.  Each home installation may take up to 2 hours, leaving no one at the clinic to check on alerts for current patients and complete other obligations.  Sending one employee out for an installation could place that team member at risk of harm, and is still less efficient than possible.

            To troubleshoot this issue, Telehealth equipment kits have been created by the RNCC and TCA, containing different combinations of equipment that could be ordered by Redmond providers.  These kits streamline the process and allow the patient to take responsibility for home installation.  In the provider’s office, patients may be given a demonstration of how to use the equipment, just as had previously taken place in home.  Instructions for installation, and phone number from troubleshooting are included with the equipment to guide the patient once they arrive at home.  To date, ten Prineville patients have been sent with kits from their providers, and have experienced no difficulties in getting the equipment set up, with readings successfully transmitting back to the clinic. 

            It is anticipated that this standardized process can be duplicated at the Redmond clinics.  Once a provider makes a referral, the Medical Assistant will bring the appropriate kit to the patient.  The MA will ensure that the Remote Monitoring Consent Waiver and Release is retrieved from the kit, stamped with the patient’s Medical Record Number, filled out by the patient, and faxed to the Prineville clinic, so that the RNCC and TCA can enroll the patient in Ideal Life.  Further, this communication will enable the Prineville team to contact the patient, answering any further questions about the program, completing any troubleshooting, and provide any additional education if necessary.  One concern from the Redmond clinic was that explaining the equipment to the patient might consume an excessive amount of MA time – the clearly articulated instructions included in the kits should eliminate this issue.

           

             

Patient Interview, Aug. 26th, 2014

            A 65-year-old male was referred to Telehealth for weight and blood pressure monitoring.  The patient refused a remote weight scale, but willingly accepted a kit containing a blood pressure cuff and transmitter pod.  Since July 25^th, the patient has consistently transmitted blood pressure readings to the Mosaic Medical Prineville Clinic, performing checks up to five times per day.  He is confident that he will complete the three months of monitoring initially ordered by his provider, and looks forward to the possibility of continuing use of the Telehealth equipment past the scheduled discharge date.

            When questioned regarding his intention to remain in the program, the patient stated: “I like it because I can keep track of my blood pressure instead of having to worry about it.  I don’t have to find some place to go check it.”  The patient explained that prior to enrolling in Telehealth, he would seek out places to check his blood pressure, making extra visits to his provider, or driving to a pharmacy.  This posed an inconvenience, as he lives in a remote area.  Having just begun a new medication, he was increasingly concerned about keeping track of his blood pressure - Telehealth allows him to do so conveniently.  The patient has traveled with his equipment, independently trying different locations for transmitter placement when in a new area to ensure that the readings are sent.    

            The patient’s only concern about the program is leaving for extended hunting trips, when he will be unable to plug in the transmitter cell pod.  Such a concern may be addressed by suggesting that a patient continue to monitor their blood pressure under such circumstances, even if they are not transmitted to the clinic.  Telehealth has enabled this patient to monitor his own blood pressure regardless of his location, encouraging him to experience greater self-efficacy regarding the management of his health.

           

Patient Referral

During a recent installation, a patient inquired as to whether their spouse could use the blood pressure cuff newly installed in their home to monitor his own blood pressure.

Although the answer was no, this is one example of a positive referral being made by a program participant due to their own involvement with and enthusiasm regarding the possibilities of remote monitoring.  It has not yet been determined whether this patient's spouse will be recommended for the program by their PCP, but this demonstrates the value that some patients place on being able to monitor their health independently.

Transmission Difficulties

The new equipment that has replaced older PODs has been a step forward in remote patient monitoring in the region.  However, equipment challenges persist.  The most recent encounter involved an installation in a home with a roof made of metal.  It seemed that the metal roofing of the home, which extended into the eaves, caused difficulties with the PODs ability to relay a signal.  Some patience combined with patient flexibility aided in testing the POD in different locations around the home, resulting, eventually, in a successful transmission.  This issue could be potentially troublesome due to the unanticipated amount of extra time that the installation took.