How Cleveland Clinic is advancing RPM in its hospitals

Remote patient monitoring technologies, which give clinicians real-time insights into patient health, enhance healthcare outcomes in myriad ways. One of the most popular use cases for the technologies is supporting patient care between clinic visits. However, some health systems are also using RPM within the hospital to enhance care at the bedside.

Cleveland Clinic is one such health system using RPM technologies to enable timely interventions and boost positive patient outcomes. The provider organization recently struck a partnership with Masimo to update its current remote monitoring tools in various inpatient units, including the tele-intensive care unit (ICU).

RPM use has skyrocketed in the last five years, spurred by the CMS adding 10 Current Procedural Terminology (CPT) codes related to RPM services and the COVID-19 pandemic. One estimate revealed that RPM claim volume increased by 1,294% from January 2019 to November 2022.

Research has highlighted RPM's efficacy in enhancing inpatient care. A 2022 study showed that RPM can help alert clinicians to patients at risk of deterioration. The study included 217 patients, 24 of whom experienced clinical deterioration. Wearable RPM devices were able to detect clinical deterioration 29 to 40 hours faster than standard monitoring methods.

Cleveland Clinic was no stranger to RPM and its benefits before the new partnership with Masimo.

"Remote patient monitoring is something we've been doing for a while at the Cleveland Clinic in various forms and settings," said Chiedozie Udeh, MD, medical director of ICU operations at Cleveland Clinic, in an interview. "We have central telemetry, we have a teleICU, we have a number of other solutions, services or programs that we engage in for caring for patients."

The new partnership aims to enhance the health system's existing hospital-based RPM services and promote the development of new RPM initiatives. In establishing the partnership, Cleveland Clinic took several steps to ensure smooth technology and workflow integration, focusing on change management.

Factors driving tech partner selection

Though Cleveland Clinic has had success with its home-grown RPM solutions, leaders identified areas for improvement that were only possible with the technical expertise of a third-party vendor.

We don't want to be alerted when something has gone wrong; we want to catch it even before it starts going wrong ... We don't want to find out when it's raining. We want to know before the rain starts. We don't want to find out when the hurricane has hit. We want to know when it's forming out in the ocean.

"As we've continued to grow as a system, we thought it would be helpful and useful to get us to that next level to collaborate with an expert technical partner in terms of developing medical devices and solutions," said Udeh. "And we can combine that with our clinical expertise to improve our outcomes even more than we have."

She noted that the health system selected Masimo after a "long and careful search." The health system was looking for a partner with extensive technical expertise in remote monitoring to complement the clinical expertise at Cleveland Clinic.

Specifically, the health system sought a partner to offer solutions to enhance clinicians' situational awareness. This can support clinical decision-making and prevent patient deterioration.

"When you're monitoring a panel of patients across hospital wards and hospitals and states or instance, you need to be able to identify who needs your attention right now and who needs your attention in two hours or in three hours," Udeh said. "And then you pair that up with clinical support that's coming from our experts and [their] experience to then make the right interventions at the right time."

What the remote patient monitoring partnership entails

Per the partnership, Cleveland Clinic will integrate its critical and non-critical care central patient monitoring platforms with the Masimo Hospital Automation platform to create a comprehensive solution for hospital-based RPM.

The health system's critical care and non-critical care central patient monitoring platforms, known as eHospital and eCMU, respectively, provide continuous monitoring for various vital signs, including electrocardiograms (ECGs), for patients across 2,000 beds in and outside the ICU.

Meanwhile, the Masimo platform includes monitoring and wearable tools that are integrated with surveillance and data visualization applications, as well as AI capabilities to track patient health trends.

Thus, Udeh stated the resulting combined platform will help drive alerts with more specificity, allowing clinicians to identify patients at risk of deteriorating and intervene.

"We don't want to be alerted when something has gone wrong; we want to catch it even before it starts going wrong," Udeh said. "And so being able to implement or leverage AI tools to better understand and predict patient trajectories is going to be part of this. We don't want to find out when it's raining. We want to know before the rain starts. We don't want to find out when the hurricane has hit. We want to know when it's forming out in the ocean."

The technology integration will initially take place within the ICU and central telemetry units; however, the health system aims to expand the new platform to support multiple use cases along the continuum of care, Udeh explained. For instance, Cleveland Clinic plans to eventually use the technology in the emergency department and general medical units to support remote consultations.

Change management strategies for a successful integration

The COVID-19 pandemic transformed healthcare delivery in numerous ways, including popularizing the use of virtual care modalities like RPM in real-world patient care. As a result, gaining clinical staff buy-in when implementing new technologies is a little easier than it used to be.

However, the broader acceptance of virtual care modalities has not solved the problem entirely. Clinician buy-in remains a significant barrier to deploying new technology-based programs.

"Anytime you're changing practices, it's really an exercise in change management," Udeh noted.

She recommends emphasizing how the new technology will reduce administrative burden and give clinicians support in enhancing patient care.

Additionally, Udeh suggests testing new tools on a small scale first to ensure there are no technical issues and to address workflow kinks. This is why the new hospital-based RPM tools will first be deployed in a few units before being rolled out system-wide.

To assess whether the technology is ready for a system-wide deployment, the health system will examine technical metrics, like whether the tool is reliable and can integrate with other monitoring devices, and clinical metrics, such as patient outcomes.

"Are we getting better results than we already demonstrated in terms of being able to identify patients who are deteriorating, our ability to take care of them, the user experience for the clinicians and the patients?" Udeh said. "Those are all things that we'll continue to monitor. We already have a baseline based on [our] own internal experience."

Further, Cleveland Clinic will focus on adjusting clinical workflows and processes to take advantage of the new capabilities the enhanced technology provides.

The health system is enthusiastic about the prospects of the new partnership, with Udeh noting that, at the very least, it expects to exceed current inpatient care quality and patient experience standards.

"Masimo's got a long history of innovation and excellence in delivering patient monitoring solutions," she said. "And when we partner this with our excellence in patient care and our deliberate, mindful approach to how we take care of patients, I think the results are going to be spectacular. I can't wait to see where we end up."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.