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How Houston Methodist is scaling inpatient RPM across its hospitals
The health system considered several factors to successfully deploy and scale BioIntelliSense’s RPM tool, which has helped improve patient and clinician experience.
Remote patient monitoring (RPM) enables healthcare providers to track patient data remotely between clinic visits, bolstering outpatient care, such as remote chronic disease management. However, outpatient care isn’t the only area where RPM has made a difference. Some health systems, like Houston Methodist, are deploying RPM tools inside its hospitals to ease inpatient monitoring burdens.
Research shows that healthcare executives see the value in RPM. One 2023 survey revealed that 73 percent of healthcare executives said their organizations’ RPM programs have yielded a positive return on investment (ROI). The survey, which polled 141 healthcare executives, also shows that 46 percent of respondents expected to increase their RPM budget in 2024, and another 46 percent expected to maintain their current budget.
For Houston Methodist, RPM has become integral to their inpatient care workflows. In April, the system announced that it had scaled BioIntelliSense’s continuous patient monitoring solution across its eight hospitals.
“We saw an opportunity to innovate how we do vitals in the hospital,” said Sarah Pletcher, MD, vice president and executive medical director of strategic innovation at Houston Methodist, in an interview with mHealthIntelligence. “And we really wanted to implement a strategy that would allow central monitoring.”
The health system has been using the RPM solution for about a year, and while it has provided numerous patient care benefits, health system leaders had to consider several factors, including clinician buy-in and the right technology partner, to ensure a successful implementation.
UTILIZING RPM IN THE INPATIENT SETTING
Houston Methodist rolled out BioIntelliSense’s RPM tool through four initial pilots in its flagship hospital. According to Pletcher, seeing the benefits of the electronic intensive care unit (eICU) for critically ill patients encouraged health system leaders to consider a similar option for lower-acuity med-surg units.
Enter the Food and Drug Administration-cleared BioButton multiparameter wearable device. It is wireless and adheres to the patient’s upper left chest, passively capturing up to 1,440 sets of vital sign measurements per patient daily, said James Mault, MD, founder and CEO of BioIntelliSense.
The device captures multiple vital signs, including heart rate at rest, respiratory rate at rest, skin temperature, and contextual biometric measurements like activity level, sleep tracking, and gait analysis. The collected data undergoes algorithmic-based analytics, with insights transmitted to a dashboard for clinicians.
“The BioButton continuous patient monitoring solution is not just about gathering data — it's about managing data by exception and generating actionable clinical insights to facilitate better, safer patient care,” he said in an interview with mHealthIntelligence.
Every patient admitted to Houston Methodist through the emergency department (ED) gets a BioButton device. Pletcher explained that a central monitoring team can view vitals measurements for all 2,600 patients across the health system hourly. They are focused on catching early signs of deterioration and supporting the bedside staff as they address clinical issues.
“Once we began actively monitoring patients, we were seeing these great catches that the team was able to identify because they went from having data only every four hours to minute-level data on the patients and having, especially with respiratory rate, more objective, accurate data to work with,” Pletcher said.
These catches help keep patients from experiencing adverse outcomes and reduce the need for higher acuity care in the ICU, she added.
Not only does the device allow clinicians to intervene quickly when a patient deteriorates, but it also enables clinicians to identify stable patients who may be candidates for earlier hospital discharge with home-based monitoring, Mault noted.
Further, the device can help enhance patient satisfaction in the inpatient setting, an essential metric for hospitals in an increasingly patient-centric landscape.
“The transformational shift from manual spot check monitoring four-to-six times per day to continuous minute-level vital sign measurement improves the patient experience with fewer interruptions of sleep to help facilitate healing,” Mault said.
Additionally, by alleviating the burden of checking in on patients every few hours, the solution gives time back to clinicians.
“It’s been tremendous for the patients getting more sleep, [and] for the bedside team, getting more time back and having peace of mind that we're watching the patients with them,” Pletcher said.
IMPLEMENTATION CONSIDERATIONS
To deploy the BioButtion wearable device effectively in its initial pilots at its flagship hospital, leaders first focused on change management.
Pletcher noted that using the device resulted in a significant change in workflow for the clinical teams. Leaders had to help the teams understand the new partnership between the central team monitoring the patients, and communication was critical for this.
“You can never communicate enough,” she said. “I think one thing that is helpful to us is we often start with a group of units for piloting new things. And it's a good cross section of lots of different types of patient populations. But what's nice is that the teams in those units are familiar with adopting new things, and then they help us as we're then moving out to other units to be able to say, from the real-life bedside perspective, ‘This is great. Here's how it works. Don't worry. You guys will learn how to put it on really quickly.’ So, they become our ambassadors.”
Effective change management also requires comprehensive education on the technology. The health system created videos to help the clinical teams and patients understand the device.
With clinicians, Pletcher and her team also focused on helping them understand the science and the validation strength behind the device.
“We partnered with nursing education; we partnered with the informatics teams,” she said. “We did a lot of open houses and demos, and we'd host some of our community hospitals to come and see the units that were some of the first to go live.”
Mault echoed Pletcher, adding that clinical teams must understand and trust the data collected and insights gleaned.
“Generating real-world evidence and proof points — case studies, best practice sharing, testimonials, publications — helps hospital customers develop business cases and operational models to grow and scale inpatient and at-home monitoring programs,” he said.
Selecting the right technology partner is another important factor in a successful implementation. Pletcher explained that they started by defining what they wanted: a medical-grade device with multiple parameters that was easy to wear.
“I can't emphasize enough the importance of shopping and doing your homework and picking the technology, really digging in to understand the extent of FDA validation studies,” Pletcher said.
Pletcher also wore dozens of devices to determine the difference in utilization from a patient experience perspective. The health system finally selected the BioButton device, partly because it was thin and easy to wear.
“It just sticks with the sticker right on the patient's chest,” she said. “So what's great about that is because it's so small, and it's very snugly stuck onto the chest, patients can sleep in any position. If they're able to get up and take a shower, they don't have to take the button off. So, it's very convenient and doesn't bother them to wear it in just about any sleeping position.”
Once the technology partner has been selected, healthcare provider organizations must ensure the technology has the intended impact. According to Pletcher, Houston Methodist assessed the technology and its effects in phases, deciding early that it would halt deployment if the technology did not meet expectations and accelerate the implementation if it did.
“And it was by far the latter…we saw that value very early on, and it really led us to push ourselves to speed up the implementation process,” she said. “We got faster and better at the onboarding education rollout so that we were able to get this program to all of our hospitals as early as we could.”
RPM performed via healthcare wearables has the potential to transform an age-old aspect of inpatient care, making patient care more seamless and reducing burdens on patients and their caregivers. According to Pletcher, this ultimately drove the decision to scale the technology systemwide within a year of the pilots.
“Our goals are lofty,” she said. “We want to give the patient a better experience. We want the patients to be even safer. We want to give time back to the bedside team that they can really devote to being at the top of their license and delivering that hands-on care to the patients when needed. And all of those things result in better performance for the health system.”
