By Tina Null
History is filled with stories of “happy accidents” – beneficial outcomes that occur outside of the original intentions. Post-it Notes®, X-rays and the drum sound on Phil Collins’ “In the Air Tonight” are just three of many such examples.
Vascular Care of Texas, PLLC, a practice that serves the vascular needs of thousands of patients each year from its three offices in the Dallas-Ft. Worth area, experienced some of that serendipity early in 2020 with its remote patient monitoring (RPM) solution and how it could be applied to COVID-19 concerns. But first some background.
Initially, the practice was looking for a way to improve the health outcomes for patients with conditions such as peripheral artery disease, carotid artery disease, deep venous thrombosis, critical limb ischemia and other issues. It also wanted to improve outcomes for the 30% of its patients who require dialysis.
The driver behind the implementation was a desire to reduce issues that would occur after surgery. In the post-operative visit, and even one or two weeks later, all tests would look good. As a result, the surgeon would schedule follow-up visits at the standard intervals recommended by the Society of Vascular Surgery. While that schedule was fine for most patients, there was a small percentage for whom something unpredictable would occur between visits, causing their conditions to deteriorate so rapidly and significantly that they would be in trouble.
Edic Stephanian, MD, FACS, a vascular surgeon at Vascular Care of Texas, PLLC and the Medical Director of Acute Aortic Emergency Program & Vascular Surgery at Medical City Plano hospital, had seen stories about telehealth and RPM in other areas of healthcare and thought it might help the practice get ahead of developing issues. What he discovered as he did his research was that none of the RPM vendors had a program for vascular surgery patients.
Undaunted, he found an RPM vendor willing to work with him to develop the entire algorithm for the program. Vascular Care of Texas supplied the specialized knowledge and expertise, which was then adopted into the technology. The result was both organizations co-developed a total of 16 pathways for:
- Aortic aneurisms
- Atrial fibrillation
- Carotid artery disease
- Chronic kidney disease
- Coronary artery disease
- Deep venous thrombosis
- Leg swelling
- Peripheral vascular disease
- Pulmonary embolism
- Peripheral vascular disease with carotid artery disease
- Renal failure
- Tobacco cessation
- Varicose veins
- Weight management
- Wound management
As part of this development, Vascular Care of Texas received permission from various professional organizations such as the National Kidney Foundation (NKF) to include some of its educational content within the pathways and provide a link back to the NKF for patients who wanted more information on a specific topic.
Vascular Care of Texas launched the solution in the fall of 2019 and experienced immediate success. So far, more than 100 post-surgical patients have uploaded their health data, such as temperature, pulse oximetry, standard blood pressure, ankle-brachial index (a comparison of blood pressure measured at the patient’s ankle and arm) and other parameters, on a daily basis. They can either use their own devices or Bluetooth®-enabled devices the practice provides.
To dig deeper, the RPM solution also asks them the same questions that are asked when patients come to the office, such as “How are you feeling today?” or “Are you seeing any rashes or swelling around the wound?” The data and answers are monitored daily, which helps Vascular Care of Texas recognize and react to any developing conditions. If necessary, nurses will follow up by phone or use voice-and-video telehealth encounters to gather more information, saving patients a trip to the office.
While the practice doesn’t have hard data yet, Dr. Stephanian says anecdotally their surgeons and staff are seeing a higher level of patient compliance with their care plans. The practice also expects to find that the volume of complications that lead to emergency department visits, inpatient stays and more surgery will be significantly reduced as well.
When the COVID-19 pandemic struck in March of 2020, the Vascular Care of Texas team was very concerned about how it would affect the practice’s patients. The Centers for Disease Control and Prevention (CDC) stated that patients over 65 as well as those with conditions such as heart disease, chronic kidney disease being treated with dialysis and other co-morbidities are among the most vulnerable to the virus’ worst effects. That description fits most of the practice’s patients.
Those concerns were allayed when the RPM solution issued a pathway that enabled patients to self-screen for COVID-19. The practice immediately sent the pathway to all patients who were participating in the RPM program.
In addition to the screening questions, the pathway also delivered evidence-based information to counteract all of the rumors and bad information circulating around the Internet, especially in the early days. The information enabled patients to recognize the signs of COVID-19 while simultaneously providing reassurance should they develop a normal cough or other minor symptom. The latter was important for helping vulnerable patients avoid needless risk by going to a facility for a COVID-19 test that wasn’t necessary.
One final precaution Vascular Care of Texas took to help its vulnerable patients was to keep a watchful eye on the daily data they were providing to look for sudden temperature spikes and other symptoms. Fortunately, no one has exhibited any symptoms to date.
Even without the COVID-19 concerns, the RPM program has been so successful that Vascular Care of Texas was already planning to expand it to a wider patient group. But the virus experience has solidified its commitment.
As Dr. Stephanian acknowledges, having an RPM solution that can help vulnerable patients remain healthy and drive better outcomes while sheltering-in-place is a huge benefit to both the patients and the practice. It is one more reason to make telehealth a permanent option for all healthcare.
About the author
As Clinical Consultant at Vivify Health, Tina Null, a Master’s prepared registered nurse, builds close relationships with healthcare executives, medical personnel and other professionals, leveraging relationships to strengthen the organization’s market reputation based on performance and outcomes.