We dedicated programmatic and technical support, including EMR integration, to create a seamless patient and provider experience. Clinical and operational champions collaborated to design an effective program that worked for both staff and patients. Each pilot measured engagement, enrollment, and patient satisfaction to determine near-term operational success. We were testing the ability to get data, incorporate it in the EHR, and make it work for our organization.

Each pilot took a different approach to enrolling patients. For the hypertension pilot, the pharmacist and their medical assistants would reach out to patients for enrollment. Our intention for oncology was to layer on the enrollment workflow at the point of care. But it was difficult for nurses to identify patient eligibility in real time. Instead, they had to review eligibility data after the appointment, and then message or call patients to enroll them. For orthopedics, surgery schedulers introduced the RPM program instead of doctors, which caused challenges building patient trust and confidence in the technology. We believe enrollment rates are higher when clinicians engage patients directly.

Our strategic evaluation included technical, operational, and financial requirements. We first collected program constraints from the relevant business and clinical leaders to understand their nonnegotiables for a product. We then conducted market research and gathered information from external health system collaborators. With this information in hand, we ran two rounds of vendor demos with 13 potential best-in-class partners, selecting a vendor with the highest ratings against criteria.

As part of our technical and operational assessment, we included a value chain analysis. We identified the typical RPM journey and the associated activity that must happen. For example, the patient joins the program. While they must be enrolled, we also need to be able to identify them for enrollment.

We tested analytic capabilities, scalability to plug in new devices and add new pathways, security standards, EMR integration, device logistics, and sustainability of the companies. And although we didn’t bill in the pilots, we did test the ability to bill.

Sustainability was a big consideration for us, especially with the current RPM vendor landscape. We didn’t want to choose a start-up that didn’t have staying power and would shutter or be acquired in the near future. Operational readiness on the vendor end was also very important to us. We asked for references for systems they worked with, as we understand there is a big difference between vendors operating small pilots and broad implementation at a large health system.

Our goal was to integrate the RPM journey into the clinical workflow. To achieve this, we embedded multiple patient touchpoints as needed within our RPM journey.

As we mentioned earlier, each pilot had distinct markers around engagement, enrollment, and patient satisfaction. Our hypertension pilot defined engagement with the vendor as patients submitting vitals on a recurring basis of two times a week.

Our oncology pilot saw a lot of success. Engagement was defined as patient completion of surveys. Patient satisfaction rates were good, but provider satisfaction was mixed. We found that nurses engaged with the program more than oncologists.

Orthopedics was our least successful pilot, but we learned a lot. Patient engagement was measured by completion of electronic patient-reported-outcome (ePRO) questionnaires. In orthopedics, it is not yet standard practice for clinicians to use data from these surveys at the point of care. And the ePROs were not incorporated in day-to-day patient care. Because of this, patients felt their data was not being used or examined, which led to drop off in engagement.

• Hypertension: 65 patients enrolled, 81% of those patients engaged, patient net promoter score (NPS): 68, provider NPS: 100.
• Oncology: 73 patients enrolled, 62% of those patients engaged, 93% “good” or “excellent” patient satisfaction, 50% of physicians see value in RPM for measuring patient outcomes.
• Orthopedics: 47 patients enrolled, 56% of those patients engaged, patient NPS: 20.

The overarching lesson we learned was that in-home remote patient monitoring minimizes shortcomings of episodic care and provides visibility into condition management between visits, which allows for timely intervention. We had four process-specific lessons we learned, which were:

1. Sufficient lead time is needed for program design and analytics. It took a few months for the RPM product team to align all the cross-functional stakeholders on the foundational design. But once we had alignment, it took about six months from the day we set up our product team to our first patient. We expected the process to move more quickly, but the added time allowed us to ensure we picked the right vendor and the correct internal capabilities.

2. Patient recruitment improved when the program was positioned as standard of care. At the start, patients were unsure about the RPM technology, but they became more receptive when their care team positioned the program as a standard of care. We learned that operational readiness for RPM requires more resources and effort compared to other digital health technologies. Additionally, the way RPM is implemented significantly influences patient recruitment and engagement.

3. Clinician bandwidth can cause barriers. Embedding program enrollment into existing operations was more challenging than we expected due to the necessary clinician bandwidth for both identifying the right patient and setting aside time to talk to them. This work was additive for our entire care team (despite what some RPM vendors claim).

4. Patient engagement rates are driven by clinical staff. We initially thought physicians would be the primary drivers of RPM adoption, but we found that our nursing teams drive RPM engagement. Our nurses monitored escalations and triaged patients. We found that engagement rates dropped off in programs when patients didn’t hear back on their data submissions, so our nurses participated in patient touchpoints to maintain and grow engagement.

We’re continuing to build our foundational RPM capabilities for the shift of care into the home by designing the program as a standard of care. To do this, we have a multidisciplinary governance to prevent roadblocks. We’re also creating a dedicated RPM workforce that can:

• Create an environment that permits rapid evaluation and development of new measures.
• Evaluate near-term impact of RPM programs on quality outcome measures (30-day readmissions, preventable hospitalizations, preventable ED visits).
• Assess vendors for operational readiness.
• Advance RPM to the next use case based on operational readiness, size of impact, and business viability.

Like we’ve heard from others, organizational alignment is necessary for a successful RPM program. One lesson from Stanford Health Care’s work is that pilots will be productive as long as the organization sets a vision before launch. Pilots should be used tactically to identify strengths and weaknesses before deploying a full-scale RPM program. By taking this approach, pilots can save an organization time and money. This idea of productive failure allowed Stanford Health Care to learn as much as possible in a short amount of time, and they can now apply those lessons to their broader RPM strategy.

Other organizations can tactically deploy pilot programs. But an organization should establish clear start and end dates to ensure their pilots are able to move to an enterprise-wide solution. After the pilots conclude, organizations can apply lessons learned to future RPM deployments as part of a long-term strategy.