How to Integrate Remote Patient Monitoring Across Cancer Care Settings

Traditional Cancer Care

Kwiatkowsky sets the scene by explaining that routine monitoring for cancer patients is limited at best. “Traditionally, cancer care has been largely episodic,” he told PharmaNewsIntelligence. “That means that providers treat patients, see them in the office or cancer center, and then they go home to recover from treatment.”

Kwiatkowsky noted that patients spend nearly all their recovery time away from the care team. “The healthcare industry used to think that the trouble, symptoms, and issues they had were unnecessary suffering. And later, we understood it also led to unnecessary ER visits and hospitalizations and, in turn, costs,” he stated.

According to a study published in Nature, 3.7–4.2% of all ER visits are due to cancer-related incidences. Additionally, nearly 30% of all patients with solid tumors undergoing chemotherapy have at least one ER visit.

Kwiatkowsky shared that trends have proven that early interventions addressing the symptoms and issues that arise during cancer treatment help prevent ER visits, facilitate treatment retention, and improve overall survival. The goal of Canopy’s ePRO-based monitoring platform is to encourage addressing these issues early on.

“This is not so much about a survey, but more about eliciting the patient's symptoms and issues and then supporting them in a timely fashion so that they can feel better, do better, persist on treatment longer, and not have emergencies,” said Kwiatkowsky.

Basics of the ePRO-Based Monitoring Platform

PharmaNewsIntelligence asked Kwiatkowsky to describe the aspects of the platform and the intended use for its features. Kwiatkowsky prefaced his explanation by clarifying that changing how providers and healthcare systems address these issues is far from a simple process.

“Generally speaking, it is hard to do this in the real world because it's not easy to change the way medicine is practiced,” noted Kwiatkowsky. While providers are doing their best, he remarks that there have been limited resources for monitoring cancer patients early on. Until recently, the technology was unavailable. Even when the technology became available, there were no supporting financial benefits to incentivize healthcare facilities to adopt these monitoring methods.

Triaging and Retention

One of the most important uses of remote patient monitoring is to engage patients and address any concerns as they arise simultaneously. Kwiatkowsky states, “Canopy helps providers engage the patients and elicit their issues. Then it helps providers triage those issues.”

This tool allows patients to submit their concerns. At this point, the platform categorizes and prioritizes the issues and sends it to the providers. Rather than having multiple incoming phone calls, nurses, medical assistants, and other healthcare professionals can sift through patient concerns and prioritize reaching out and addressing more critical issues. “The platform supports the nurse’s decision-making and the workload of the nurse, and we help capture reimbursement for this to make the business case possible,” added Kwiatkowsky.

He also revealed that “Canopy’s ePRO-based monitoring platform enables the practice to monitor patients between visits by engaging them. The engagement rates are incredible: over 80% enrollment, 90% patient engagement at six months, and so on.”

Remote Patient Monitoring Across All Settings

After hearing the basics of the platform, PharmaNewsIntelligence asked Kwiatkowsky to explain what evidence is available to support the use of this platform.

Concerns About Replicating Results

Kwiatkowsky shared that early studies stated that overall survival improved by 20% when remote patient monitoring was implemented. However, many healthcare professionals were critical of these results, claiming that these statistics wouldn’t be upheld in more rural settings. “The biggest criticisms that people had about that study were basically ‘My patients won’t do it. Old patients won't do it. Rural patients won't do it — they don't have smartphones, and so on,” he reiterated. “The second biggest criticism was ‘this can't work at a real practice. This is just for Sloan Kettering and other academic institutions.’”

Evidence to Support Remote Patient Monitoring Across All Settings

Kwiatkowsky shared that the recent study intended to prove these claims wrong and show that this technology can work in all communities. “Canopy purposefully chose Arkansas as a site to run this study to show this can be done, and it can be done in the real world, in community oncology, and patients would engage, and the providers will be able to support them,” he added.

In the study published in the Journal of Clinical Oncology, researchers implemented the ePRO-based monitoring platform in a community clinic in Arkansas. Of all the patients approached, 923 were enrolled. At three months, retention was 94%. At six months, it was 88%, and at nine months, it was 73%.

“Once the patients were enrolled, the research team monitored them. We saw how long they stayed on, how many issues they reported, which kind of issues, what percent of those issues converted into a phone call with a nurse, how many of those phone calls converted into an acute visit at the practice, and so on,” noted Kwiatkowsky.

The study results allowed researchers to pull meaningful clinical data on remote patient monitoring in community cancer settings. Kwiatkowsky stated, “the results demonstrated that patients were both enrolled at a high rate and engaged at a high rate and that the practice was able to handle the inbound. Regarding the world impact, we showed that only 6% of the reports required intervention from a physician.”

Incentivizing Providers

One of the most significant issues with integrating new technologies and tools is getting providers and healthcare facilities to adopt them. “This is one of the largest, the most meaningful challenges. It's not a secret that changing physician behavior is tough, and providers are overwhelmed and burdened. Beyond that, it’s not just about changing physician behavior, but changing how cancer care is practiced,” said Kwiatkowsky.

Rather than uprooting the current procedures that oncologists and other cancer care professionals use to address concerns, Kwiatkowsky and his team aimed to integrate remote patient monitoring tools into existing practices.

Enrollment

“Canopy tries to integrate as much as possible into existing workflows and make those better so that we don't need to change the world and reinvent everything,” he said. “For instance, every cancer center today has a chemo class when patients start treatment. We try to get providers to enroll the patients at that opportunity.”

Kwiatkowsky shares that patients are already receiving a lot of terrifying information on their symptoms during this time. A remote patient monitoring tool that allows patients to communicate with healthcare professionals may provide additional comfort and security to patients.

Procedure

In addition to making enrollment easy for patients and providers, Kwiatkowsky attributes some of the success of this platform to its ability to streamline care for doctors, nurses, and administrative staff.

“Canopy offers them decision support, and instead of them getting phone calls, notes, emails, and messages, we bring all those phone calls into a dashboard together with patients who've reported through the app,” reiterated Kwiatkowsky. “We take the acute ones and put them on the top. Then we support the nurse and their workflow and decision-making.”

Beyond streamlining enrollment and clinical care procedures, Kwiatkowsky shared that they have included features in the platform that can capture reimbursement, implement payment models, and conduct other tasks to ease billing.

“Plugging into all these existing workflows has been extremely helpful. With that momentum, physicians, although they didn't have to directly intervene or be direct users of the platform, have become very engaged with the nurses around what patients are reporting and have become advocates of enrolling patients, and have become engaged with us,” concluded Kwiatkowsky.

Looking ahead, it is no doubt that remote patient monitoring will continue to grow. With that in mind, researchers, developers, and other industry leaders should consider developing platforms that build on or enhance existing workflow to boost provider and patient engagement and patient outcomes.