Cancer care: This renowned provider’s remote patient monitoring programme serves three directly adjacent boroughs in Manhattan, which represent a stark contrast in population.
With eight hospital campuses in the New York metropolitan area and a large regional network of outpatient facilities, Mount Sinai is committed to improving health equity and access to care. Its expertise in community health care, as well as serving socioeconomic, demographic and cultural populations, means that Mount Sinai is uniquely positioned to meet the challenge of providing high-quality health care to underserved people.
THE PROBLEM
“Our largest outpatient cancer centre is located in three neighbouring boroughs in Manhattan, which represent a stark contrast in population,” says Dr Cardinale Smith, Chief Quality Officer for Oncology at Mount Sinai.
“East Harlem is a high-poverty area dominated by Hispanics and blacks. Central Harlem also has a high poverty rate and is dominated by blacks and Hispanics,” Smith continued. The majority of residents in both Harlems live in public housing.”
“In contrast, the Upper East Side is one of the wealthiest white-dominated areas of the country,” she added. “The inequalities in health care for the patients we care for became even more pronounced during the pandemic.”
Like many health systems at the start of the pandemic, Mount Sinai faced a dramatic reduction in cancer screening and treatment. By April 2020, outpatient and inpatient services at Mount Sinai had dropped by 25%, indicating a reluctance of patients to come to the health facility.
This meant that many vulnerable patients were either not receiving or delaying cancer care, potentially disrupting their treatment plans. Despite an exponential increase in the number of telemedicine visits via telephone or video link, Mount Sinai oncologists were limited by the information patients could share without additional clinical data.
“Patients only need to plug the Home Hub into an outlet to get started and all other monitoring devices will be preconfigured and connected for the patient in their preferred language.”
— Dr Cardinale Smith, Mount Sinai
“Mount Sinai Oncology was looking for a solution that would improve physician-patient communication, enhance virtual care and remove barriers to comprehensive home care,” Smith explained. “Mount Sinai chose Current Health’s remote patient monitoring solution to enhance oncologists’ ability to provide care to cancer patients in the comfort of the home and provide patients with the tools and infrastructure they need, including internet connectivity.”
According to Smith, Current Health’s device and platform has enabled oncologists to provide cancer care remotely at the expense of:
- Reducing repeat hospital admissions through early detection of deteriorating health conditions
- Providing more comprehensive care outside the cancer centre
- Preventing patients from potentially contracting infections by providing more services virtually
- Bridging the digital health gap as involvement in telemedicine grows.
“In addition, a key point for Mount Sinai was the ability to provide equal access to digital health solutions for all patients, including people of colour and seniors who are less likely to use telehealth services due to accessibility, connectivity or technical literacy issues,” Smith said.
PROPOSAL
Current Health provides care to patients at home through a remote care management platform that provides healthcare systems with the home health information they need to intervene early and prevent hospitalisation of patients, Smith said.
“The platform centralises health data from a variety of sources, including the FDA-certified wearable continuous monitoring device Current Health, other remote patient monitoring peripherals, patient surveys and the electronic medical record,” she said.
The platform brings all the different data together in a streamlined way as a decision support tool for physicians.” In addition, the platform provides a video conferencing function for virtual intervention either from the healthcare system itself or through a 24/7 Current Health command centre staffed by clinical staff.
“Everything from vital signs collection, patient education modules and clinical alarm configuration can be tailored to the specific clinical use case, creating a single enterprise solution to provide remote care,” said Smith.
“For healthcare equity, the vendor provides a pre-configured monitoring kit that includes everything a patient needs to get started, including Wi-Fi or cellular connectivity via a home hub and tablet that will guide patients through the setup process in multiple languages, as well as built-in communication tools that allow patients to seamlessly communicate with their care team when needed,” she added.
MEETING THE CHALLENGE
Mount Sinai chose Current Health over other players in this market for several reasons: a small device that captures multiple indicators, the ability to customize, and ease of installation, Smith noted. The vendor also provided the device, as well as the cellular connectivity needed to ensure continuous monitoring of patients, she added.
“The vendor’s next-generation device, no larger than an Oreo, attaches discreetly to the patient’s upper arm and continuously captures vital signs data – such as breathing rate, oxygen saturation, mobility, pulse rate and axillary temperature – with ICU-level accuracy,” Smith said.
“In addition, the vendor’s platform integrates with a wireless blood pressure cuff and an adhesive patch to measure body temperature to capture additional vital signs that can help Mount Sinai identify deteriorating cancer patients,” she added.
Cancer patients identified by oncologists as those who would benefit from the RPM kit can either have it sent home or receive it at home after training at the cancer centre.
“To get started, patients just need to plug the home hub into an outlet and all other monitoring devices will be preconfigured and connected in the patient’s preferred language,” Smith explained. The tablet device walks the patient through the simple process of applying the wearable device and ensuring connectivity.”
“In addition to wearing the device around the clock for continuous monitoring, patients take daily blood pressure measurements, which are transmitted wirelessly to the dashboard, and complete daily symptom questionnaires,” she added. “The collected data is then transmitted back to the medical facility where the patient is staying, and through prompt alerts alert doctors if the data indicates any abnormalities or potential problems with care.”
Doctors can then proactively intervene as needed – rather than relying on patients to determine when they may or may not need medical attention – and determine whether the problem can be resolved remotely or whether the patient needs to be taken to hospital. Current Health integrates with Epic, enabling Mount Sinai physicians to receive alerts as part of their EHR, as well as store vital signs data and patient interaction notes.
RESULTS
Mount Sinai is still in the early stages of using technology to remotely monitor patients with cancer and does not yet have reliable results.
ADVICE FOR OTHERS
Remote patient monitoring is an emerging technology that can be used in a variety of clinical settings, Smith said.
“Both doctors and patients have an initial learning curve, but there is great potential to improve the quality of care we can provide outside our facilities in a more convenient way,” she concluded. “With the use of this technology we can be more proactive and less reactive in the way we care for our patients. I hope that the reimbursement situation will continue to support this model of care so that it can continue to expand in a sustainable way.”
