Shannon McAllister, assistant vice president of virtual care at WVU Medicine
Photo: WVU Medicine
Remote patient monitoring programs are not one size fits all. This is something Shannon McAllister has learned from experience.
"When we started our remote patient monitoring journey, we used a fully centralized team that was responsible for the patient from enrollment to receiving alerts and communicating with practices and patients," said McAllister, assistant VP of population health and telemedicine and assistant VP of virtual care at WVU Medicine, part of the Morgantown-based West Virginia University Health System.
"The largest challenge this came with was scalability issues," she said. "We originally chose it because otherwise it would be difficult for individual practices to take on the management of an additional program."
But at WVU – which is a member of the American Telemedicine Association Center of Digital Excellence, also known as ATA CODE – virtual care leaders "quickly realized that centralized nursing models present significant scalability challenges spanning operational, technical and human factors," McAllister said.
"In a centralized system, a finite number of nurses in a single location are responsible for managing data and alerts for patients across a wide geographic area," she added.
But this creates a critical bottleneck as the patient population grows – the nurse-to-patient ratio quickly becomes unsustainable.
"Furthermore, managing and addressing localized variations in healthcare delivery and patient needs from a single hub is cumbersome," McAllister explained. "The model ultimately limits the growth of the RPM program.
"So we chose to implement a hybrid approach with much greater electronic health record integration to better scale the system," she continued. "With the new approach, all services are initiated locally – primary care physician office, hospital, etc. The pieces that are still maintained centrally are those that are universal, such as consent, onboarding and information-gathering for any alerts."
Clinical decisions remain local
The pieces maintained locally are the ordering and patient selection, and any clinic interventions based on alerts responded to centrally. This allowed for clinical decisions to all remain with the providers, such as the PCPs, managing patients. But the initial response and gathering of information is handled centrally.
"This allows the central team to be much more efficient and effective as their tasks are in limited scope – not all-encompassing – and the providers still have all information they need to make clinical decisions," McAllister said. "And the clinical decisions are theirs, not those of a centralized team that may not know the patient as well as their individual provider.
"Previously, we were only live with three provider groups," she continued. "This new, hybrid process allows for widespread growth, and we now are live in all of our hundreds of primary care offices and are spreading to specialty practices now as well. This has been a game-changer in making this service available for all patients. Additionally, we are serving many more patients – 500% growth over the centralized approach."
The model is not the only positive change. WVU Medicine also integrated significantly more with the EHR, which allows seamless communication and documentation between the local and centralized teams while all members of the care team can see all patient information easily.
"We have also used the integration to automate billing, which previously was a manual process," McAllister reported. "All of these things help foster the growth of the program. The integration and finding the sweet spot between local and centralized resources ensure this is a meaningful program for providers, patients and the care team supporting both."
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