United Methodist Communities has early successes with telehealth and RPM
United Methodist Communities, headquartered in Neptune, New Jersey, is a faith-based, not-for-profit senior living and healthcare provider. With more than 110 years of continuous operation, the organization has grown to 13 locations offering independent, residential and assisted living; Tapestries Memory Care; respite; rehabilitation; long-term care; Bridges Hospice and Palliative Care; affordable senior housing; and live-in and in-home personal care through HomeWorks.
United Methodist faced two different problems: One was falls in its skilled nursing environment and the other was effective telehealth visits for residents.
Skilled nursing facilities take care of the frailest of the country’s elders. United Methodist wanted a way to keep its residents safe and protect them from falls, which can have dire consequences for this population. The other problem it was looking to solve was inefficient telehealth visits.
“Our clinical staff could only be reactive to the needs of our residents,” said Larry Carlson, president and CEO of United Methodist Communities. “For example, devices like bed alarms notify staff after a fall or other event occurs. A mild fall for an elderly person can produce clinical complications, which is why it is critical to transition from reactive to proactive technologies using real-time monitoring, machine learning and real-time notifications to inform caregivers before a fall occurs.”
The other challenge United Methodist faced was facilitating specialty and primary care physician visits for residents. The lockdown and quarantine restrictions of the COVID-19 pandemic put a significant burden on residents who required routine specialty and primary care.
“Like many organizations, we alleviated the burden by facilitating two-way video chat telehealth visits to those providers; however, there are some significant limitations using a laptop or iPad when engaging in a telehealth visit,” Carlson explained. “For example, the physician can only see the resident through a limited iPad camera and hear them through an iPad speaker and microphone.”
This may not sound like a tremendous burden; however, many older adults have hearing issues, vision problems and difficulties with projecting their voices. There also are limitations on the clinical information a physician can acquire. Laptops and iPads do not have specialty diagnostic equipment to aid the clinician.
For the problem of falls, United Methodist turned to Virtusense Technologies and their VSTAlert product. This system provides remote patient monitoring for the highest-risk residents.
Frailty and comorbidities make falls critical events in an elderly population. Having technology in place to help prevent them is invaluable, Carlson said.
"This technology is not simply a video chat, but a telehealth station that includes specialty cameras, remote stethoscopes and other diagnostic tools that can be used by the clinician facilitating the telehealth visit."
Larry Carlson, United Methodist Communities
“Part of our mission is establishing high-quality, person-directed care for our residents,” he stated. “New remote monitoring technology leverages advanced machine learning to notify caregivers of movement risk before a fall can occur while allowing our residents to maintain their independence and privacy.”
In addition, United Methodist’s new telehealth system ensures that all residents are given the ability to remotely connect with their primary care providers in a safe and secure environment.
“The goals of the telemedicine program are to drive positive care outcomes, deliver greater staff efficiency and effectiveness, and provide a better experience for the resident,” Carlson explained. “We want to demonstrate how to more effectively use resources within a skilled nursing facility by virtually including specialty consultative physicians and primary care physicians as patient advocates.”
The telehealth technology provides more intensive monitoring and visualization of the patient, which allows for greater intensity of care, he said. By using remote patient monitoring and telehealth, United Methodist will reduce the burden of the COVID-19 restrictions while simultaneously enhancing social distancing efforts, he added.
“We anticipate being able to connect our residents with their care teams more frequently through these visits,” he said. “Studies show that more frequent contact with primary care physicians drives better health outcomes.”
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MEETING THE CHALLENGE
United Methodist has successfully implemented the Virtusense Alert platform in more than 80 skilled nursing rooms across four campuses, strategically placed in the rooms of residents at the highest risk for falls. The VSTAlert system places advanced sensors in these rooms that continuously monitor for activity, falls and vital signs.
“All are connected to a dashboard and in the hands of our nurses on mobile devices, allowing our clinical staff to monitor and respond quickly to any immediate need of our residents,” Carlson explained. “The Virtusense implementation team went to each of our communities for the deployment to properly install and configure the sensors. The clinical staff went through robust training to ensure proper understanding of the systems and its functions.”
United Methodist received full engagement from its associates at each community including its executive directors, healthcare administrators, directors of nursing, nurses, CNAs and others.
The mobile devices are configured to send an alert based on any type of predetermined action. The staff then can respond with their device to signal that they are going to check on the resident. The system allows the clinical staff to communicate with the resident to determine any issues prior to their arrival.
This enables caregivers to respond to residents before they begin an activity that can lead to a fall. For example, the system can detect when a resident is restless in bed. This activity is enough to alert a caregiver to movement before a resident attempts further action.
“Our telehealth solution, from Netsmart Technologies, addresses all the aforementioned limitations of using consumer technology to enable telehealth visits,” he noted. “This technology is not simply a video chat, but a telehealth station that includes specialty cameras, remote stethoscopes and other diagnostic tools that can be used by the clinician facilitating the telehealth visit.”
This enables the remote physician to get a much more detailed analysis of the patient than would otherwise be possible, translating to better remote care and more reliable outcomes, he said.
The fall monitoring system has been highly effective, Carlson said.
“We have seen a significant decrease in ‘never events,’ falls and hospital-acquired pressure ulcers; a decrease in mortality and morbidity of infectious patients, including sepsis; decreased length of stay; decreased time to consultative services from order to the patient; increased frequency of consultative services; increased nursing virtual contact as a percentage of nursing contact compared to baseline; and staff and resident satisfaction,” Carlson reported.
Overall goals are to improve health outcomes through connected care, reduce the costs of delivering healthcare to those most in need, and help facilitate connected care among clinical partners.
“Although these technologies still are in their early phases of deployment, fall metrics have been tracked by United Methodist for a long period of time,” he explained. “We already show measurable improvement in the system’s ability to preempt falls.”
Prior to United Methodist’s newest telehealth platform and specialty telehealth stations, it had completed more than 400 telehealth visits across the organization. The workflows surrounding the new specialized telehealth stations are geared around efficiency. United Methodist aims to make telehealth visits simple for the facilitating caregiver while ensuring the remote physicians have all the data and diagnostic tools to provide the highest quality care.
“These technologies also significantly reduce the strain of caregiving on our clinical staff,” Carlson noted. “United Methodist, along with many other organizations, has had significant issues with staffing. These types of technologies significantly reduce the caregiver burden of physical intervention. Physicians do not have to travel and can be more flexible with their visits, allowing more residents to be seen in a shorter time frame.”
Caregivers do not have to do as many disruptive vital sign checks or bed monitoring. Further downstream, this contributes to enhanced social distancing and reduces the amount of sanitation and cleaning needed.
“For our VSTAlert remote patient monitoring system, the anecdotal evidence and feedback from all of our communities has been overwhelmingly positive,” he added. “The skilled nursing rooms that are protected by VSTAlert all have had more than 30-day fall-free periods with the highest fall-risk residents who could potentially have multiple falls per month.”
First-hand reports from staff also have been very positive once they adapted to the new workflow and the information on the dashboards, he said. These systems provide value to the upstream hospital partners since United Methodist now is better equipped than its competitors to admit and manage high-risk patients, he contended.
USING FCC AWARD FUNDS
United Methodist Communities earlier this year was awarded $909,560 for a remote patient monitoring platform and telehealth-software licenses to be used in a skilled-nursing setting to help prevent falls and other dangerous conditions without requiring excessive in-person monitoring, and to allow for remote consultations in settings where either provider shortages or COVID-19 impacts would delay or prevent access to specialty or nursing care.
“We are looking to expand the amount of care providers available to our residents by including more specialty care and more acute hospital partners with our sophisticated telehealth capabilities,” Carlson said. “The promising short-term data on the decrease in falls shows the power of the technology, and we hope to expand its use in the future.”
Over the course of the grant period, he concluded, United Methodist plans to accomplish all of the aforementioned goals and tactics while being good stewards of the grant funds provided.