At-Home Monitoring Creates Virtual Hospital for UCI Health
Outside of its hospital and clinic walls and at the height of the pandemic, University of California Irvine Health (UCI Health) began caring for patients in their homes with technology, diagnostic devices, and a drive to deliver a better patient experience. The public health care system and academic medical center, which operates a 459-bed acute care hospital serving a region of nearly four million people in Orange County, went beyond providing patients with the ability to talk with clinicians via phone and video at home or work and took it to the next level of telehealth: remote patient monitoring.
Under this program, UCI Health patients with such conditions as COVID-19, pneumonia, or chronic obstructive pulmonary disease who are improving can sometimes leave the hospital early if their vitals and symptoms are monitored continuously as they recover at home. Susanna Rustad, UCI Health’s chief procurement officer and executive director of virtual care, and Khurram Mir, senior program manager, spoke with me recently about the ins and outs of this program and their plans to expand this work and establish full-fledged hospital care at home. Such a hospital would provide remote patient monitoring, around-the-clock care, visits by clinicians and care teams, and delivery of medications and meals. This interview was condensed and edited for clarity.
Q: Why did you start this remote patient monitoring program?
Rustad: We ventured into building a spectrum of care using digital health in response to COVID-19 and given the capacity crisis. The capacity crisis wasn’t new, it was exacerbated during the pandemic. The demand for acute care is high, we’re seeing aging and senior populations that on average have more diverse needs, and our hospital has been at capacity and constrained for years. We have a new medical center complex that is in progress. However, as with any large-scale construction project, all this takes years of planning and building. Our new hospital footprint is predicated on 25% care-at-home assumptions as part of the model.
You can imagine how unpleasant it is if you’re a patient, and you need care, and you end up in a hallway in our emergency department and not being able to get into an actual bed. This is why we want to be able to create capacity and do it in a really sustainable way. And the advent of all this technology makes it possible to continuously and remotely monitor patients at home and around the clock. With remote patient monitoring, we can provide care to a population of patients in the hospital who are lesser acuity if we’re able to shift them to their homes where they’re comfortable, where they heal really well, where they’re surrounded by their caregivers and the support system that they’re accustomed to. Patients are also starting to really seek out on-demand technologies and wearables. This is what patients want as well.
Q: From the patient’s perspective, how does your remote patient monitoring program work?
Rustad: If a patient is improving in the hospital and their physician determines the patient meets the program’s inclusion criteria, could benefit from the program, and it is safe for them to go home to complete their treatment or recovery, then the physician presents the remote patient monitoring program to them as a care plan offering. Upon consent to participate in the program, the care team enrolls the patient. A nurse ensures the patient understands the program and provides them with all of the tools and technology — biometric devices, tablet, smartphone. The nurse ensures they have a good understanding of the technology and walks them through the process.
When vitals are taken, they are automatically uploaded into our artificial intelligence platform. The monitoring dashboard with advanced triaging functionality enables the 24/7 care team to focus on the patient’s status and needs. And if at any time the patient has a question, they can contact their care team via text, video chats, or a phone call.
Q: How have patients you’ve offered the remote patient monitoring program to responded?
Mir: We have received a lot of positive feedback that patients are really happy with the program, really love that they can be monitored around the clock. They are compliant and they complete their daily check-ins and questionnaires. They are very happy to have care providers and health coaches to talk to and connect with, as well as having that extra dimension of support and technology for 30 days of the program.
But there are a few patients that it seems as though our program does not work as well in regard to their adoption, such as not wearing the technology, or adherence to regularly scheduled programmatic activities. We are using this as an opportunity to learn from our patients and providers.
Q: How else did the pandemic impact providing care to patients at home?
Rustad: The pandemic was the X factor in changing the perspectives of providers and patients in how they could give and receive care. In addition, regulatory and policy barriers were relaxed, allowing innovative care models to come to the forefront, take root, and lay a foundation for the future of care at home. Reimbursement barriers were also removed during the pandemic to encourage health systems to implement technology-enabled solutions.
Q: How many patients are participating in the remote patient monitoring program? When did it start?
Mir: We launched remote patient monitoring in January 2021 with 70 COVID-19 patients. Our primary focus was to decompress our inpatient units and reduce the lengths of hospital stay. The program then matured into reducing readmissions. We have now expanded to include patients with pneumonia and chronic obstructive pulmonary disease (COPD), so we’ve served over 150 patients. We are also exploring chronic heart failure and ob/gyn use cases.
Q: Can UCI Health patients receive acute-level hospital care at home today?
Rustad: In addition to our previously approved remote patient monitoring program, we’ve built out a high-touch, high-quality, virtual inpatient acute hospital, and we are working with the California Department of Public Health to secure state-level approval for that program. We are approved for acute-level hospital-at-home care at the federal level.
Q: Can you tell me about a patient who struggled with the remote monitoring tools and technology and how it was resolved?
Rustad: Recently, we had a COVID-19 patient who was discharged from the hospital and enrolled in our remote patient monitoring program. While at home, the patient contacted our 24/7 nurse command center and indicated she was having trouble operating her equipment and wanted to return to the hospital. Our case management team took proactive measures to dispatch our mobile urgent care unit, and they were able to arrive at the patient’s house within 90 minutes. They completed education on the use of equipment, the care plan, and medication reconciliation. They also conducted a home assessment, which includes a social determinants of health evaluation.
Q: Given the digital divide, how are you ensuring health access for all patients in the remote patient monitoring program?
Rustad: All patients deserve health equity and inclusion. As such, all patients who are eligible for the program are accepted regardless of their insurance status, including the uninsured. And if the patient isn’t comfortable with the technology, we ask, “Do you have someone who lives with you who is?” So many times, their emergency contact or their caretaker or relative is the one who also receives training. A lot of seniors have participated in this program.
Q: What about patients who don’t have Wi-Fi access?
Mir: To address potential gaps in coverage and minimize digital divide issues, we provide patients the technology, which includes a smart device that comes with a cellular connection to get online and connect with the 24/7 care team.
Q: What outcomes and results are you seeing with remote patient monitoring?
Rustad: We are experiencing great results. Early outcomes data indicate a reduction in length of stay and readmission rate. Patients feel empowered regarding their health conditions with the level of interaction they receive from care providers at home.
Q: How does this program advance UCI Health’s mission?
Rustad: Our mission is to discover, teach, and heal. Our vision includes transforming health care by building this spectrum of care that is now possible and desired in the home. We believe we are transforming health care by building an expanded and safer ecosystem and improving quality in an efficient manner, which is a foundational piece for existing and future value-based care. We believe we are capable of redefining health care and creating health care without boundaries, which meets the patient where they are and improves access to services.
Q: What’s been the reaction to the remote patient monitoring and upcoming hospital-at-home programs internally?
Rustad: Providers and patients have embraced the idea of remote patient monitoring. We have seen an increase in our patient enrollments and have served over 150 patients. We’ve assembled multidisciplinary teams from the department of medicine, nursing, pharmacy, and case management that really believe in the cause and aspiration of our hospital-at-home endeavor.
Q: What advice would you give another large hospital system that’s interested in providing care at home to patients?
Rustad: A bit of practical advice would be that the tools, technology, and platform can be installed with relative ease compared to the heavy lift of clinical process engineering and the operationalization of a new frontier. Organizations should seek to invest in dedicated resourcing versus attempting to leverage existing resources if they desire to accelerate results and be able to scale.
This article was adapted from one first published by the California Association of Public Hospitals and Health Systems (CAPH) on February 28, 2022, and it is reproduced with permission of CAPH and the author. Copyright © 2022, all rights reserved.
This is one of a series of CAPH blog articles funded by the California Health Care Foundation.