Backtracking from an earlier proposal that drew heavy criticism, the agency is extending pandemic waivers for the use of telemedicine to prescribe controlled substances until November 11.

Federal officials have extended for six months pandemic waivers designed to enable healthcare providers to prescribe controlled substances via telemedicine.

The announcement, posted this week in the Federal Register, follows a busy few months in which the US Drug Enforcement Administration proposed new rules around telemedicine prescriptions, set to take place when the public health emergency (PHE) ends on May 11, then backtracked after received thousands of comments criticizing those rules.

“The DEA received a record 38,000 comments on its proposed telemedicine rules. We take those comments seriously and are considering them carefully,” DEA Administrator Anne Milgram said in a press release issued on May 9. “We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities for six months while we work to find a way forward to give Americans that access with appropriate safeguards.”

“Access to evidence-based treatment is a pillar of the HHS Overdose Prevention Strategy,” added Miriam E. Delphin-Rittmon, the Health and Human Services Department's Assistant Secretary for Mental Health and Substance Use and the leader of the Substance Abuse and Mental Health Services Administration (SAMHSA), which is assisting the DEA. “We strongly support policies that promote access to effective and safe treatment for opioid use disorder, including through telemedicine platforms, and ensuring continued access to necessary controlled medications past the COVID-PHE.”

The temporary rule taking effect on May 11 will extend the full set of telemedicine waivers adopted in January 2020 to expand telehealth access during the COVID-19 pandemic through November 11, 2023. For providers who have set up a telehealth relationship with a patient for the prescription of controlled substances, the waivers will be extended through November 11, 2024.

The proposed revisions to the telemedicine prescription guidelines unveiled in February drew strong comments from a wide range of stakeholders, including the American Telemedicine Association (ATA), the Alliance for Connected Care, and a group composed of members of the Brookings Institution, Harvard Medical School, David Geffen School of Medicine at UCLA, and Harvard T.H. Chan School of Public Health.

Also weighing in were members of Foley & Lardner's Telemedicine & Digital Health Industry Team.

"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," Nathaniel Lacktman, a partner with Foley & Lardner and the digital health team's chair, wrote in the firm's Health Care Law Today blog. "In so doing, DEA proposed creating two new limited options for telemedicine prescribing of controlled substances without a prior in-person exam. The options [are] both complex and more restrictive than what has been allowed for the past three years under the PHE waivers. The DEA’s proposal will discontinue the ability for telemedicine prescribing of controlled substances where the patient never has any in-person exam (with the exception of an initial prescription period of no more than 30 days’ supply).  Moreover, if the patient requires a Schedule II medication or a Schedule III-V narcotic medication (with the sole exception of buprenorphine for opioid use disorder (OUD) treatment), an initial in-person exam is required before any prescription can be issued."

News that the DEA was changing course was met with positive comments from the ATA.

“The ATA and ATA Action strongly commend the actions that the DEA has taken, jointly with SAMHSA, in temporarily extending flexibilities for the remote prescribing of clinically appropriate controlled substances," Kyle Zebley, the organization's senior vice president of public policy and executive director of its ATA Action lobbying group, said in a press release. “It is especially important and encouraging that these actions cover access to clinically appropriate prescriptions of controlled substances that patients need for a wide variety of medical circumstances, including for mental health and substance use disorders."

“We are hopeful that during this extension period, the DEA will revise the draft rules to address unnecessarily restrictive barriers to equitable and appropriate clinical care, such as mandating in-person visits," he added. "The ATA and ATA Action are committed to continuing our work with the agency and others to help create the most effective and appropriate rules that ensure access to needed treatments."

Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.

Writing in their Health Care Law Today blog earlier this year, Thomas Ferrante and Rachel Goodman, partners with Foley & Lardner and members of the Telemedicine & Digital Health Industry Team, said the waiver of the in-person exam during the PHE ensured that "millions of both established and new patients were able to receive medically necessary prescriptions via telemedicine."

They also pointed out that the DEA's actions this year don’t address a key element of the Ryan Haight Act.

"There have been efforts to amend the Ryan Haight Act and encourage the DEA to activate the telemedicine special registration rule before the PHE expires, including pending federal legislation," they wrote. "However, to date, the Ryan Haight Act has not been changed and the DEA has not activated the telemedicine special registration rule." 

"The DEA’s proposed rules are not the special registration process that Congress mandated and could gravely disrupt millions of patients’ treatments and care regimens," Robert Krayn, co-founder and CEO of telepsychiatry company Talkiatry, said in an e-mail to HealthLeaders. "Instead of taking inspiration from more modern state-level prescribing policy already introduced in Connecticut and Florida, the rules reinstate obsolete and counterproductive in-person requirements under the guise of novelty. There is nothing novel about sending vulnerable patients back into the dark ages of care delivery."

The Oregon hospital's director of information systems talks about lessons learned from a 2020 attack by Russian hackers that forced executives to shut all systems down.

Ransomware attacks are a serious threat to healthcare organizations, and nearly every hospital has a strategy in place to deal with one if it happens. But those who've experienced such an attack say even the best-laid plans go awry, and the best strategy is to expect the unexpected.

"We had downtime processes that worked very well for the first 24-48 hours," says John Gaede, director of information systems at Oregon's Sky Lakes Medical Center. "And then they all broke down. We had to invent a lot of what we did in the moment."

Located in Klamath Falls, near the California border, Sky Lakes Medical Center nestles alongside Klamath Lake, surrounded by forests in a high desert region 60 miles south of the Cascades. The area is a popular recreation destination, yet in October 2020 that calm was shattered by a group based halfway across the world in Russia.

According to the FBI and Health and Human Services Department, the hospital was one of a dozen attacked at the same time by Ryuk ransomware threat actors, a group known for being able to change methods on the fly to evade detection. The attack lasted roughly three weeks, though the recovery process took a lot longer and prompted Gaede and his colleagues to re-examine their protocols.

"We've gone to every single department to document what was done before we forget this," he says. "We haven't even finished that playbook yet, but we've learned some valuable lessons."

John Gaede, director of information systems, Sky Lakes Medical Center. Photo courtesy Sky Lakes Medical Center.

Among them, Gaede says: Make sure your partnerships with tech vendors are strong and lean on them for help. And be prepared to be surprised and versatile enough to react to those unexpected effects.

"It's people, processes and technology," he says.

The attack occurred just after noon on October 26, 2020, when an employee clicked on an e-mail with a link that supposedly discussed a bonus (not an unusual or unexpected e-mail, Gaede says). The file was downloaded from Google Drive, and at the same time the employee's computer blinked, and the employee rebooted the computer. Nothing seemed out of the ordinary, so the employee didn't alert anyone.

By 11 that evening, Gaede says, the first encryption efforts were conducted on Windows-based systems, and soon after all systems were slowing down. At 3:30 a.m., he got the phone call from IT alerting him of the ransomware attack.

Suddenly it was all hands on deck. Gaede says they turned to their Vocera communications platform to restore functionality, but everything there was encrypted within minutes.

"We then realized we had to shut everything down," he says.

Now, "shutting down" is a terrifying thought. The 176-bed hospital had to go offline immediately, taking down more than 2,500 PCs and 600 servers and halting some clinical care services, alongside all of the connected care aspects of a hospital serving roughly 120,000 people in a relatively remote area. Even maintenance and environmental services were affected.

This is where the best-laid plans often break down. Hospitals can train their personnel on what to do in the event of a ransomware attack, going through a number of different scenarios and if-this-then-that situations, but eventually the ramifications prove too complex. It's one thing to map out all the results of putting the EHR platform into a downtime mode, and quite another to understand how that affects business operations such as supply chain, pharmacy, and revenue cycle.

For instance, just as the snow was beginning to come down in Oregon, Gaede suddenly found out they didn't have heated sidewalks.

"At this point, every system is not happening," he recalls. "We didn't know what had been compromised. We realized this wasn't going to be easy, and it wasn't going to be like we had planned."

Gaede says hospital executives huddled quickly that morning and then went into action. Asante, the health system located some 70 miles distant in Medford, Oregon, was alerted. The hospital's insurance carrier was contacted, as well as Cisco, which sent in its Cisco Talos. In short order, both Cisco Talos and Kivu Consulting were helping with recovery efforts.

"We had to completely rebuild our network," Gaede says. "That's a laborious process. We had to build backups and test them first to make sure they were clean, then run the [main systems] through tests to validate that they can work. We didn't want to start something up, have it [integrate] with another system and have everything fall apart."

Ironically, doctors and nurses who had spent the last 18 years getting used to the EHR platform now had to go back to the old way of doing things. Bar-code scanning was out, as was typing data into the system, or even jumping online to track down information or do research. Copper line fax machines were back in vogue—though one literally blew up from overuse.

Everything was now written on paper or spreadsheets, and data and messages were conveyed from one department to another by runners, in what came to be called the 'sneakernet.' The hospital ran out of prescription pads, and local retail outlets were swamped with requests for paper.

"Few of them had been trained on how to do medicine on paper," Gaede says. "We went to Walmart [and] Staples and bought all the paper they had."

The hospital also had to shut down its PACS system, and for several days couldn't provide any imaging. Gaede says they contacted Sectra/Electromek, which came in and built a whole new system on the AWS cloud, so that images could be read on an iPad by the following Friday (the RIS was enabled by Saturday). 3M M*Modal then came in to integrate their services for reporting.

On November 9, radiation oncology was back up, and on November 23, the hospital restored its Epic EHR platform, alongside a fully operational PACS and radiology system. While things certainly weren't "normal" at that time, Gaede says everyone in the hospital was able to take a deep breath and relax a bit.

"It was like a brand-new go live," he says.

He says some clinical care was affected, though it's hard to translate that into clinical outcomes. Some services were delayed, some patients were inconvenienced, and Sky Lakes executives, clinicians and staff were all put through the ringer.

The hospital's revenues and cash flow were also affected, forcing executives to dip into cash on hand to make sure everyone got their paychecks. Gaede says the incident will affect their business plan for about three years, with more money invested in security and data protection.

"We were just trying to take care of our community, and we had no notion that state actors were taking aim at us. The potential impact to patient care and patient harm was absolutely real," he says.

But the hospital's disaster plan held up, for the most part. Legacy backups from Cohesity worked as they were supposed to, staff knew what they had to do or they knew how to react when they didn't know what to do. Requests for help were answered, and no ransom was paid.

"We made it a point right from the start that we would be transparent about what happened," Gaede adds. "It was very important to us. And I can look back now and feel we did the right things. Hopefully this will help others in the future."

NYU Langone Health and the Brown University School of Public Health will conduct a five-year study on the effectiveness of OPCs, which give people dealing with substance abuse a safe and supervised place to consume drugs.

NYU Langone Health and Brown University's School of Public Health have been picked to launch a federally funded study of the value of overdose prevention centers (OPCs).

OPCs, also called supervised consumption services (SCS), are designed to provide a sanctioned, safe place for those living with substance abuse issues to consume drugs with sterile equipment under the supervision of trained staff. These centers also stock fentanyl and offer healthcare and counseling services and referrals to other resources.

There are now more than 200 OPCs in 14 countries, though their presence in the US has been met with some criticism. Some have said the centers support substance abuse while not doing enough to help people beat addiction.

The two organizations will receive grants from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), for a five-year program to measure the impact of two of the first publicly funded OPCs in the country. No NIH money will be used to support the centers.

The project seeks to enroll 1,000 participants in what is being called the first study of its kind.

“We have an unprecedented opportunity to study the first publicly recognized overdose prevention centers in the country across two different states, as well as the impact on the communities in which they operate,” Magdalena Cerdá, DrPH, a professor in the Department of Population Health at NYU Langone, director of its Center for Opioid Epidemiology and Policy, and one of the study’s two lead investigators, said in a press release. “This research is urgently needed to inform policies that can best support public health, as more jurisdictions across the country consider implementing OPCs.”

“The overdose crisis has touched every community across America. From coast to coast and across age, gender, and race/ethnicity—people are dying,” added Brandon DL Marshall, PhD, a professor of epidemiology at the Brown University School of Public Health and the founding director of the People, Place & Health Collective at Brown University. “This groundbreaking study will help us determine whether and how OPCs are an effective public health tool as part of a more compassionate, evidence-based response to this crisis in the US.”

According to the US Centers for Disease Control & Prevention (CDC), more than 106,000 people died from overdoses in the US in 2021, the highest number ever recorded and twice as many as had died in 2015.

Through the study, investigators in New York City and Providence, Rhode Island, will:

• Investigate whether enrolled participants who visit OPCs experience lower rates of fatal or nonfatal overdoses, drug-related health problems, and emergency department visits, and whether they are more likely to enter treatment for substance use disorders compared to people who use drugs but do not visit OPCs.
• Examine the community impact of OPCs by assessing whether neighborhoods surrounding OPCs experience a greater change in overdoses, public disorder such as drug-related litter, arrests and noise complaints, and economic activity compared to similar neighborhood blocks that do not have an OPC.
• Estimate the operational costs of OPCs and the potential cost savings to the healthcare and criminal justice systems associated with OPC use.

“Overdose prevention centers have saved lives over the past year,” Ashwin Vasan, MD, PhD, commissioner of the New York City Department of Health and Mental Hygiene, said in the press release. “Their operation in New York City also offers a unique opportunity in the years ahead to learn about their clients, the services offered, and their wider impact on the communities served. We look forward to partnering with NYU Langone, OnPoint, and the State of Rhode Island on a robust, long-term study. The findings, when they’re ready, could have national implications as we all fight the rising tide of overdose deaths in the US."

A new survey finds that providers and patients see the potential in AI, but not just yet

AI tools like ChatGPT may have a place in the healthcare system of the future, but both providers and patients are wary of using them in their present form.

That's one of many takeaways from a survey of 500 healthcare professionals and 1,000 patients by Tebra, the practice management company formed in 2021 by the merger of Kareo and PatientPop. The survey shows an industry interested in the new technology, especially for improving efficiency and saving time, while also wary of the loss of human interaction.

According to the survey, one in 10 providers are now using AI technology, and roughly half have plans to adopt AI tools. Slightly more than half plan to use the technology for data entry, while 42% cited appointment scheduling, 38% listed medical research, 36% cited patient communication, and 35% picked either providing clinical notes to patients or as a virtual medical assistant.

When asked about benefits, 60% of providers surveyed cited increased efficiency, while 55% named cost savings by automating tasks and 45% noted giving time back to providers and caregivers. In describing the drawbacks, 55% cited less human interaction, half of those surveyed listed data privacy concerns, 49% noted an over-reliance on AI, and 44 % listed lack of human empathy.

Perhaps for those reasons, some 42% of providers surveyed said they were "not excited" about the integration of AI at this point, while 26% said they were excited and one-third said they were "moderately excited."

That's similar to how patients see the use of AI in healthcare, at least at present. While 80% of those surveyed say the technology has the potential to improve quality, reduce costs, and boost accessibility, only a third said they are moderately comfortable with a provider using AI to diagnose and treat a medical condition. Some 31% said they are slightly comfortable and 18% are not comfortable at all with AI being used in that fashion, while 12% a very comfortable and 4% are extremely comfortable.

When asked about the benefits of AI, patients mirrored the thoughts of their care providers. Some 63% cited increased efficiency, while 56% selected cost savings by automating tasks, 53% noted improved diagnosis and treatment, 45% cited research and development assistance, and 43% noted increased accessibility.

One area in which AI, and in particular ChatGPT, may have a more immediate impact is in behavioral health, which is struggling due to a surge in people needing help combined with a shortage of care providers. Some 25% of patient surveyed said they would be more likely to talk to an AI chatbot instead of attending therapy, and of those who have already used ChatGPT for therapy advice, 80% said that advice was an effective alternative to attending in-person treatment.

Roughly one-quarter of patients surveyed, meanwhile, went so far to say they wouldn't visit a provider who refuses to embrace AI technology.

Finally, 52% of the patients surveyed said they'd place their trust in the technology for faster care, while 47% said they'd visit a provider using AI to reduce the risk of human error in medical decision-making, 42% selected either telemedicine and more accurate diagnoses, and 41% said they'd go to a provider using AI for more access to advanced medical technologies.

When asked what would keep them away from AI in the doctor's office, 53% said a belief that AI technology can't fully replace the experience of seeing a doctor in person, while 47% cited concerns about reliability in diagnoses and treatments, 43% said they preferred the human interaction with a care provider, 42% cited data privacy and security concerns, and one-third of those surveyed see a concern with biased algorithms leading to unfair or discriminatory treatment.

The Mayo Clinc Platform, the health system's innovation base, is adding Israel's Sheba Medical Center, Brazil's Hospital Israelita Albert Einstein, and Canada's University Health Network to its distributed data network, which already includes Missouri's Mercy health system.

The Mayo Clinic is expanding its AI-based data sharing network on a global scale.

The health system's innovation base, Mayo Clinic Platform, announced today that its distributed data network, called Mayo Clinic Platform_Connect, will include Hospital Israelita Albert Einstein in Brazil, Sheba Medical Center in Israel, and University Health Network in Canada. They join the Missouri-based Mercy health system, which joined the platform in 2022.

The announcement adds an international flavor to a fast-developing segment of healthcare. Those within the Mayo Clinic network will be able to use de-identified clinical data on the Data Behind Glass platform to test AI-enhanced solutions for clinical care.

"We describe the data needed for fair, equitable AI as having depth (types of information), breadth (number of patients) and spread (heterogeneity)," Mayo Clinic Platform President John Halamka, MD, said in a press release. "To transform healthcare globally, we must expand our distributed data networks to every continent. We must protect privacy, adhere to international laws and regulations, and incorporate knowledge from every language."

Officials said the partnership will initially focus on:

• Information Collaboration. "Secure cloud-based use of Data Behind Glass allows each collaborator to base decisions on a wider range of clinical outcomes gathered over time," officials said. "The information will help scientists analyze patterns of effective disease treatment and, more importantly, disease prevention in new ways, based on reviews of incremental clinical patient data over time."
• Solution and Algorithm Development, Validation, and Deployment. "The resulting AI-based solutions will provide proven treatment paths based on years of patient outcomes, representing the next generation of proactive and predictive medicine that can be used by care providers around the world," the press release noted.

The Mayo Clinic has been on the front lines of integrating AI into healthcare, and is a member of the Coalition for Health AI (CHAI), launched just last month. In 2021, the health system launched the Remote Diagnostics and Management Platform (RDMP), designed to aid AI and clinical diagnostics opportunities in remote patient monitoring programs.

This latest announcement pushes the platform out into the global healthcare market, with partnerships with three health systems known for their innovation.

"We are thrilled to be part of this historic alliance to transform the future of health," Eyal Zimlichman, MD, chief transformation officer and chief innovation officer at Sheba Medical Center and director and founder of ARC Innovation at Sheba Medical Center, said in the press release. "Creating a truly global network that will break down language barriers and enable the inclusion of diverse populations, we are unlocking the potential of AI solutions to revolutionize health care worldwide. This is not just a game-changer, but a visionary leap toward data-driven healthcare."

Reacting to a wave of complaints against its earlier proposed revision of rules for prescribing controlled substances via telemedicine, the DEA is changing course yet again.

The US Drug Enforcement Administration is revising proposed regulations for the prescription of controlled substances via telemedicine after receiving thousands of complaints.

A statement issued today by DEA Administrator Anne Milgram says the DEA, coordinating with the Health and Human Services Department, is submitting a draft temporary rule to the Office of Management and Budget for the "Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Substances."

Details of the new rule will be released when it is published in the Federal Register.

"The Drug Enforcement Administration received a record 38,000 comments on its proposed telemedicine rules," Milgram said in her statement. "We take those comments seriously and are considering them carefully. We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards." 

The use of telemedicine in prescribing controlled substances has long been stringently regulated by the federal government. Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.

The DEA had eased its rules during the pandemic to allow healthcare providers to prescribe controlled substances via telemedicine without the need to first conduct an in-person exam. With the COVID-19 public health emergency scheduled to end on May 19, the agency unveiled a proposed revision in February that would have expanded some telemedicine uses but also established a new set of guidelines.

The FDA's proposed rules would allow providers to use telemedicine to prescribe 30-day supplies of Schedule III-V non-narcotic controlled medications and buprenorphine, the latter specifically for the treatment of opioid abuse disorder, for new patients and without the need for an in-person evaluation..

Reaction to that proposal was quick—and very much against the new rules.

"Leading professional associations, respected think tanks, and experienced clinicians submitted compelling and noteworthy comment letters explaining how the proposed rule will result in limitations on access to care, harm patients in rural and urban areas alike, and likely result in otherwise avoidable overdoses and deaths when patients are denied access to their medically-important medications," several lawyers from the Foley & Lardner law firm wrote in a blog.

Nathaniel Lacktman, a partner in the firm and chair of its national Telemedicine & Digital Health Industry Team, and his colleagues produced a legal guidebook shortly after the proposed rules were unveiled, and submitted a 15-page letter picking apart various aspects of the rules on March 30. Others submitting critical comments (the Foley & Lardner team called it a "tsunami of criticism") include the American Telemedicine Association, the Alliance for Connected Care, and a group composed of members of the Brookings Institution, Harvard Medical School, David Geffen School of Medicine at UCLA, and Harvard T.H. Chan School of Public Health.

Healthcare organizations across the country are launching RPM programs aimed at monitoring specific patient populations outside the hospital.

As healthcare organizations look to improve care management for patients outside the hospital setting, they're embracing remote patient monitoring in droves. New programs launched across the country are using everything from digital health tools and wearables to smart home technology and telehealth to connect patients to care teams.

"It's truly a new service model," says Karie Ryan, clinical transformation lead for connected care at Philips, who has been watching the growth of programs for the healthcare technology giant. "A lot of hospitals know it's the right thing to do and know it has value, but they don't know how to do it."

Ryan says large health systems "are well-positioned to own RPM" because they can use the platform as a population health tool, but smaller hospitals might not have the numbers to achieve sustainability and are looking at outsourcing to an RPM provider.

"There are many different ways" to develop an RPM program, she says. "None of them are wrong, but hospitals have to be very careful in planning these programs. We've seen many that were implemented during COVID that were never meant to be long-term solutions."

To that end, Ryan says she's worried that some health systems "jumped on the bandwagon" before plotting a sustainable use case, and they’re either just barely hanging on or dropping the program and giving RPM a black eye.

Among the factors that health system leaders need to address in developing an RPM program:

• Identifying the right patients to be monitored at home;
• Assessing the patient's home environment to ensure an RPM program will work;
• Understanding what data needs to be collected, and how to collect it;
• Identifying the technology needed, both at home and at the health system;
• Identifying participating members of the care team and developing or adjusting workflows to monitor patients at home;
• Establishing parameters and protocols for interventions, including emergency consults and hospitalizations;
• Setting parameters for the length a patient participates in an RPM program, and how to return technology once that participation has ended;
• Setting benchmarks for a program's success, sustainability, and scalability; and
• Incorporating other care providers into the program to address SDOH.

Among the more common reasons for launching an RPM program is to monitor patients living with chronic care needs, or helping patients recover and rehabilitate at home after a hospital stay. The more common goals are reduced hospitalizations or adverse health events, a reduction in healthcare costs and in-person visits, and improved clinical outcomes.

Ryan says the RPM model will evolve as the technology becomes more sophisticated and health systems understand more about how they want to collaborate with patients at home. She says the platform could also be used in advance of a hospital stay, to prepare patients for scheduled treatments such as surgeries.

To gauge how RPM is evolving, HealthLeaders spoke with three different health systems about their programs.

Using RPM for Chronic Care Management

Community Health Systems opted to partner with Cadence in 2022 to launch an RPM program covering hypertension and congestive heart failure, and has since added diabetes to the roster. Through this partnership, the Tennessee-based, 79-hospital network relies on care teams employed by Cadence to handle daily monitoring duties, with more urgent cases handled by CHS providers.

"We had had physicians that had tried [to launch RPM programs] and they were just overwhelmed by all the data," says Lynn Simon, MD, MBA, the health system's president of clinical operations and chief medical officer. "So we had to focus on reducing that burden on our physicians. Once we had the process down, it became very easy."

Lynn Simon, MD, MBA, president of clinical operations and chief medical officer, Community Health Systems. Photo courtesy CHS.

Simon says CHS wanted to focus on chronic conditions that would show improvement with regular monitoring and adjustments to the care plan, alongside a patient population that could manage using devices at home to gather data for the care team. The health system looked at more than a dozen RPM vendors before choosing Cadence, opting for a company that would help the health system's primary care providers with enrollment and monitoring. and loop in clinicians when necessary.

"We did a lot of work to select the right partner and make sure our doctors were on board," she says. "We didn't want it to feel like we were handing our patients off to another company, and that [Cadence care teams] were part of our care team. We also wanted to make sure there is still that connection to the primary care providers."

Simon says CHS held webinars and meetings to educate its providers on the value of an RPM program, and used a handful of early adapters to highlight the partnership with Cadence.

CHS has enrolled more than 2,300 patients in its programs to date, with plans to give another 700-800 providers access to the program and scale up to more patient populations. So far, she says, only about 1% of the RPM encounters has had to be elevated to a physician intervention.

"I thought it would be a little more challenging to get enough information back," she says. "But that hasn't been the case. And we're hearing anecdotal information [and] some good stories about how we've been able to avoid hospitalizations."

Targeting a High-Risk Population

At Kentucky-based Baptist Health, officials launched an RPM program in late 2021 to address care management for high-risk patients living with CHF. The health system partnered with Current Health, the healthcare arm of Best Buy, to launch the program with plug-and-play technology, which includes a tablet, blood pressure cuff, and a wearable.

Steven Heatherly, MD, the nine-hospital health system's medical director of heart failure and pulmonary hypertension, says Baptist Health specifically targeted an at-risk population that is 18% more likely to be rehospitalized and/or develop acute health concerns. These patients, he says, have an average age in their 70s, and often have problems following doctor's orders in between visits.

Through the RPM program, care teams gather data from patients three times a day and connect with patients via phone when necessary.

Steven Heatherly, MD, medical director of heart failure and pulmonary hypertension, Baptist Health. Photo courtesy Baptist Health.

"We decided not to do routine phone calls," Heatherly says, noting nurses would call if they weren't getting data from the devices in the patient's home or if that data indicated a health concern. "We didn't get excessive amounts of workflow out of this. It worked very well for us and didn't overwhelm" the care providers.

In the first 10 months of the program, he says, the health system did see an increase in clinic visits—not exactly a surprise, given the patients' ages and their acute conditions. But only one patient was rehospitalized, for an unrelated medical concern, and only two patients died. In addition, the patients in the program paid more attention to their care plans.

Heatherly says Baptist Health is now expanding the RPM program to other patients, including those with COPD and hypertension, and will be using the platform to follow patients after they've been discharged from a hospital. They're also opening the program to more hospitals and clinics.

"We've seen how it works with high-risk patients, so now we know what we can do," he says. "There are a lot more patients that can benefit from this.

Heatherly also wants to track data on quality of life and medication adherence, among other factors. And they'll be talking to payers about the benefits of the program.

'Even I was skeptical at first," he says. "But the results so far have been very good."

Continuing Care From the Hospital to the Home

The Beacon Health System launched its first RPM program earlier this year with a focus on patients with complex chronic conditions who'd been recently discharged from a hospital. The Indiana-based health system is partnering with Biofourmis on the population health program, using a platform that includes digital health tools and a mobile dashboard for clinicians. Biofourmis also assists in monitoring patients for the health system, primarily overnight and on weekends.

Roughly 80% of the patients chosen for the program are monitored episodically, with data gathered at specific times during the day or week; the other 20% are monitored continuously.

"We're really looking at the patients who need the most intervention to stay stable in the ambulatory space," says John Bruinsma, Beacon Health's manager of care coordination and population health. "These are high-need, high-cost patients who go through a cyclical pattern of needing multiple readmissions."

John Bruinsma, manager of care coordination and population health, Beacon Health System. Photo courtesy Beacon Health.

Bruinsma says the health system pulled in staff from care coordination, population health, IT, health information management, and finance to plan out the program, which was initially funded by COVID-19 funding from the CARES Act.

He says one of the biggest challenges was designing a process that matched the right care providers with the right patients after they went home.

"It took a lot of talking with the key stakeholders, but we're very optimistic about the answers that this program will provide up front," he says. "This is another tool we can use to help patients who are struggling to manage their symptoms at home or to interpret their symptoms."

Bruinsma says Beacon Health is looking at long-term outcomes with this program, as well as identifying and addressing social determinants of health that may be affecting access to care from the home. They're also tracking ED visits, rehospitalizations, adherence with scheduled doctor's appointments, and medication management and adherence.

He anticipates that patients might spend up to 30 days in the program before transitioning out.

"We might integrate with in-person visits, maybe look at a Hospital at Home program," he says. "We've looked at it, and we decided to start in the middle for now. Factoring in long-term care management might be the next step."