Instead of relying on doctor's office visits every few weeks, the health system's new program prompts virtual visits whenever blood pressure is uncontrolled.
AdventHealth is launching a remote patient monitoring (RPM) program to treat high blood pressure earlier and more consistently.
High blood pressure can lead to life-threatening medical conditions, including heart attack and stroke, according to the American Heart Association. Nearly half of U.S. adults have high blood pressure, the AHA says.
The standard of care for hypertension at most health systems, hospitals, and physician practices is for a patient to see their doctor in an office visit every few weeks, according to Jeffrey Kuhlman, MD, MPH, senior vice president as well as chief quality and safety officer at AdventHealth.
The health system's new hypertension program, which will launch this summer, is designed to make a leap forward in the standard of care for high blood pressure.
"Today, it is frustrating that people with high blood pressure only see their doctor every few weeks, when they get one office blood pressure reading," Kuhlman says. "What this new program helps us do is not only get the blood pressure readings at home as part of remote patient monitoring but also take that information and automatically upload it to the patient's electronic medical record."
Patients are trained to use the home-based blood pressure device, which sends remote patient monitoring data to AdventHealth's EMR via a Wi-Fi or cellular service connection.
"When patients get the blood pressure monitor, there is a QR code on the device that they can scan with a smartphone and access YouTube videos that are designed for adults with no medical training," Kuhlman says. "Patients can learn how to use the blood pressure monitor in a minute or two."
Patients also receive written instructions, which are crafted at a third grade reading level and available in several languages other than English.
Jeffrey Kuhlman, MD, MPH, is senior vice president as well as chief quality and safety officer at AdventHealth. Photo courtesy of AdventHealth.
The hypertension program includes an AI tool that analyzes the RPM data.
"If the blood pressure readings are in the normal range, AI will recognize this and send information to the patient and their physician that blood pressure is controlled," Kuhlman says. "If the blood pressure readings are out of control, the patient and their treatment team will be notified and a virtual visit arranged. Critical readings will also be identified and responded to quickly."
Virtual visits, which will be held via video conferencing or telephone at the patient's convenience, will be staffed by nurse practitioners or medication-treatment-management pharmacists who are trained to care for hypertension patients. This care is part of their medical license and their area of specialty for which they maintain certification, Kuhlman explains.
"There are also guidelines from the American Heart Association that they follow," Kuhlman says. "There are clinical pathways that are available to them—it is the same information that is available through our nurse hotlines on these evidence-based pathways."
The hypertension program will strengthen the relationship between patients and their care teams.
"All of the interactions with the care team are documented in AdventHealth's electronic medical record, whether the patient goes to a doctor's office, goes to the emergency room, or has a virtual visit," Kuhlman says. "This program is an extension of the patient's primary care team, which strengthens that relationship."
The hypertension program reflects AdventHealth's focus on proactive care, according to Kuhlman.
"Chronic disease conditions such as hypertension, diabetes, or heart failure need to be more aggressively and proactively monitored and treated," Kuhlman says. "This is a large-scale project for thousands of patients to address controlling hypertension with remote patient monitoring and virtual extended care in conjunction with the primary care team."
Wilmington Health, which has a high-performing accountable care organization, is committed to helping other healthcare providers to perform well in value-based care.
Wilmington Health has partnered with the AMGA to establish the AMGA Value Care Network, a strategic initiative designed to help medical groups and health systems succeed in value-based care.
Medical groups and health systems have been implementing value-based care models such as accountable care organizations (ACOs) for more than a decade. But the fee-for-service model has remained stubbornly in place for many healthcare providers.
In 2013, Wilmington Health launched one of the first ACOs in North Carolina, adopting the Medicare Shared Savings Program ACO model. Currently, Wilmington Health is operating an ACO REACH accountable care organization—a Medicare ACO model that involves full risk.
"The AMGA Value Care Network gives us an opportunity to help other medical groups," says David Schultz, MD, CMO of Wilmington Health. "We have developed competencies with our accountable care organizations, and we think we can share these competencies with other medical groups."
Schultz shares the primary elements of Wilmington Health's value-based care success in the video below. Click here to read the accompanying HealthLeaders story.
Ivor Douglas shares perspectives on critical care leadership, recruiting physicians to serve in leadership roles, and mentorship.
There are several elements to success in critical care leadership, including an understanding that critical care requires a team approach, the new director of the Department of Medicine at Westchester Medical Center Health Network says.
In June, Ivor Douglas, MD, will become the director of the Department of Medicine at Westchester Medical Center Health Network and chair of the Department of Medicine at New York Medical College. He currently serves as professor of medicine at the University of Colorado as well as chief of pulmonary and critical medicine at Denver Health Medical Center, where he has directed the medical intensive care unit since 2002.
"There must be a recognition that critical care is a team sport and that leaders who are going to succeed in critical care need to understand the imperative that leadership is about both servant leadership in being a member of a multidisciplinary team and transformational leadership," Douglas says. "This is a discipline that is high-risk and expensive, which at times requires leaders to shift leadership style in a way that can transform the practice of the field."
Critical care leaders need to strike a subtle balance between subject matter expertise and high levels of self-regulation and emotional intelligence, with the willingness to step forward to lead a team when needed, according to Douglas.
"You need to have a full spectrum of leadership skills that are developed over time," Douglas says.
Douglas explains that there are three primary elements of physician leadership development in critical care: equanimity, humility, and altruism.
"Equanimity is important in its most reductionist sense that you have grace under fire, but it is a lot more than that," Douglas says. "I sometimes talk about the 'metronome effect' for my fellows and trainees, which is the recognition that to function when things are slow or things are fast, you must self-regulate and be cognizant of the things that get your metronome out of speed. When your metronome wobbles, the risk of error becomes high."
For physician leaders in critical care, humility includes the ability to speak to error, own error, and acknowledge that building redundancies in systems is important to manage error and harm risk, Douglas says. Altruism is also critical for leadership.
"We don't speak about altruism enough when we talk about emulating or role-modeling behaviors," Douglas says. "People come to medicine for a particular set of reasons, and they come to critical care leadership or physician practice a lot because of an altruistic drive."
Ivor Douglas, MD, has been named director of the Department of Medicine at Westchester Medical Center Health Network and chair of the Department of Medicine at New York Medical College. Photo courtesy of Westchester Medical Center Health Network.
Recruiting physicians to serve in leadership roles
For CMOs and other clinical leaders, the biggest vulnerability in recruiting physicians to serve in leadership roles is the tendency to advance people who look like them or behave like them, according to Douglas.
"There is a large and dominant practice in the professions that has weakened our ability to achieve workforce efficiency and diversity," Douglas says. "This practice says, 'I am successful; these are my behaviors and skills, therefore, the people I want to recruit to be leaders need to look like me, behave like me, and emulate my practices.'"
Recruitment of physician leaders should be based on hard-wiring principles such as diversity, equity, inclusiveness, and belonging, Douglas explains.
"These principles should be the strength of our healthcare system," Douglas says. "The imperative in academic leadership particularly involves the ability to ensure workforce effectiveness and resilience."
When they are recruiting physician leaders, CMOs and other clinical leaders should try to identify candidates who possess the skill sets and aptitudes that will ensure fulfillment of the organization's mission, Douglas says.
Qualities of successful physician leaders
The most successful physician leaders have endured adversity and survived professionally, according to Douglas.
"There is a lot to be said of folks who have demonstrated resilience and have learned and grown through the process of career development," Douglas says.
The best physician leaders are willing to acknowledge their mistakes and to learn from them, Douglas explains.
"The ability to speak coherently, humbly, and honestly about past failures is revealing about an individual leader's capability for adaptability and resilience as well as the individual's ability to step into a role where emotional intelligence and maturity must be demonstrated," Douglas says.
Keys to success in mentoring
Mentoring relationships between leaders and physicians should be bi-directional, according to Douglas.
"The most valuable mentoring experiences I have had involved the recognition that the mentoring interaction was as valuable to me as the mentor coaching and exploring as it was for the mentee," Douglas says. "Uni-directional relationships exist; but almost universally, when we look at performance assessments in uni-directional mentoring experiences, they are far less satisfying and durable than bi-directional experiences."
Mentoring relationships should also have a contractual element, Douglas explains.
"A mentoring relationship needs to be one where the roles and expectations are established formally," Douglas says. "The expectations for functional mentoring and the benchmarks must be clear between the mentor and the mentee."
A three-member panel including one CMO shares their perspectives on using technology in clinical care.
The latest webinar for HealthLeaders' The Winning Edge series was held this week on the topic of bolstering clinical care technology.
Artificial intelligence is the hot topic in clinical care technology, but this week's discussion focused on other technology capabilities in the clinical care space. The webinar topics included remote patient monitoring, wearables, standardizing clinical pathways in the electronic health record, and establishing alerts and prompts in the EHR to avoid waste in clinical care.
Tune in to view a video of the webinar to gain all the insights of the panelists on effective strategies to use technology in clinical care, which help position healthcare organizations for success.
This week, a three-member panel of experts convened to participate in a clinical care technology webinar as part of HealthLeaders' The Winning Edge series.
Artificial intelligence may be getting the most hype when it comes to clinical care technology, but there are a range of other technology capabilities such as remote patient monitoring and wearables in the clinical realm.
In the latest webinar installment of The Winning Edge series, three experts discussed a range of clinical care technology capabilities, including how to optimize the electronic health record to make it user-friendly for clinicians. The panelists were as follows: Ruric "Andy" Anderson, MD, MBA, chief medical and quality officer at RWJBarnabas Health; Joey Seliski, MBA, director of technology strategy and digital health at Allegheny Health Network; and Lori Walker, MSN, chief medical information officer at Presbyterian Healthcare Services.
Click on the infographic below to get the panelists' top tips for optimizing the EHR.
A three-member panel of experts shares how to effectively use technology such as remote patient monitoring, wearables, and electronic health records.
The latest webinar for HealthLeaders' The Winning Edge series was held yesterday on the topic of bolstering clinical care technology.
Artificial intelligence is the hot topic in clinical care technology, but yesterday's discussion focused on other technology capabilities in the clinical care space. The webinar topics included remote patient monitoring, wearables, standardizing clinical pathways in the electronic health record, and establishing alerts and prompts in the EHR to avoid waste in clinical care.
It is essential to have an operational staffing model to support remote patient monitoring. Health systems and hospitals need to have internal staff to manage RPM programs and act on RPM data, the panelists said, adding that a strategic partner can supplement internal staff.
Similarly, health systems and hospitals should have a device management strategy that can be managed internally or with a third-party partner, the panelists said.
Regarding RPM devices, they should be patient friendly, and they should be deployed with patient perspectives in mind.
For clinicians, an RPM program should have a defined purpose such as management of chronic illnesses, including congestive heart failure and diabetes, the panelists said. In addition, the data generated by an RPM program should be actionable for clinicians.
Strategies for wearable success
Successful utilization of wearables in the inpatient and outpatient settings mirrors the best practices for RPM programs, according to the panelists. Wearables should be patient-friendly and provider-friendly, and they should generate actionable data for clinicians.
There are many use cases for wearables in the inpatient and outpatient settings, ranging from monitoring heart conditions to monitoring daily habits of patients to encourage them to embrace healthy lifestyles, according to the panelists. In the inpatient setting, wearables are helpful for patient monitoring because they can allow clinicians and nurses to focus on the most critically ill patients.
Ease of use is important with wearables from both the patient perspective and the clinician perspective, according to the panelists. Wearables should generate data that is instructive for patients, and they should produce minimal notifications for clinicians to avoid alert fatigue. The panelists said vendor support can help achieve these goals.
As is the case with RPM programs, staffing models are pivotal in utilization of wearables, and partners can provide clinical staff to augment the staff at health systems and hospitals.
Standardizing clinical pathways in the EHR
Successful strategies for standardizing clinical pathways in the EHR must be designed with clinicians in mind, according to the panelists.
These clinical pathways must be integrated into clinician workflows, physician leaders should be engaged from the beginning when crafting order sets, and frontline physicians should be engaged in the process to help drive change.
Standardizing clinical pathways in the EHR has a positive impact on outcomes, including reductions in readmissions and mortality, the panelists said.
Efforts to standardize clinical pathways in the EHR should be tested and assessed to avoid alert fatigue for clinicians, and efforts that add "clicks" in the EHR should be selective and thoughtful. As part of these processes, there should be a broad audience for feedback and leaders should be prepared to pivot based on feedback.
Establishing alerts and prompts in the EHR to avoid waste
Clinical and operational rules in the EHR can define next steps for clinicians to avoid waste such as unnecessary laboratory tests, with the necessity of tests set on evidence-based guidelines, according to the panelists.
As is the case with standardizing clinical pathways in the EHR, leaders should be mindful of alert fatigue and have a process in place for establishing new alerts that includes an annual review of alerts.
Alerts should be monitored to know who is getting them and what those staff members are doing with the alerts, the panelists said, adding that health systems and hospitals need to ensure there are not too many alerts while acknowledging that they have a stewardship obligation to control waste.
In the latest webinar of HealthLeaders' The Winning Edge series, a three-member panel will explore clinical care technology beyond artificial intelligence.
In recent years, artificial intelligence has generated much of the hype about technology in clinical care, but AI is just the tip of the clinical care technology iceberg.
To learn about other applications of technology in clinical care, tune in on May 13 from 1 to 2 p.m. EST for the latest webinar of HealthLeaders' The Winning Edge series. You can register to attend the webinar at this link.
The webinar features a three-member panel of experts:
This one-hour webinar will focus on the use of technology other than AI in the clinical realm. The discussion will focus on eight topics:
What are the best practices for implementing remote patient monitoring technology?
What are the best practices for implementing wearables in the inpatient and outpatient settings?
How can technology be used to bolster patient engagement?
How can you standardize clinical pathways in the electronic health record to follow guideline-directed medical therapy and optimize clinical outcomes for specific diseases such as congestive heart failure and chronic obstructive pulmonary disease?
How can you use alerts and prompts in the EHR to reduce waste such as avoiding unnecessary lab testing, radiology testing, blood product usage, and medication use?
How can you use risk assessment technology to flag patients at high risk for deterioration or readmission?
How can you optimize the EHR for ease of use by clinicians?
How can you implement a unified communications platform and provider scheduling system?
This is not just another webinar—it is an opportunity to learn from the best in the business and take away strategies you can implement at your organization. Join us as we explore clinical care technology in depth.
Jeffrey Lee, MD, was appointed CME effective April 1. He has worked at MD Anderson for more than 30 years in multiple leadership roles, including chair of surgical oncology and vice president of medical and academic affairs for the MD Anderson Cancer Network.
"As a leader, I am comfortable working with leaders and teams across our institution," Lee says. "I am deeply curious and highly responsive; I am acutely aware that while these attributes can provide tremendous advantages to a leader, when overused or misapplied they can present challenges in focus, prioritization, or effectiveness."
Building relationships with other leaders and staff is one of Lee's top priorities.
"I'm deeply appreciative of and embrace the opportunity to lean on the expertise of leaders and teammates in their areas of expertise, including administration, finance, legal, HR, operations, academics, research, IT, and innovation," he says.
To boost interactions with faculty and other leaders, Lee has begun hosting "Morning Momentum" breakfast sessions in partnership with the organization's division chiefs.
"These informal gatherings provide an invaluable opportunity for me to connect with different divisions to share experiences, aspirations, and opportunities, and to talk about key issues affecting our faculty, patients, and institution," he says.
Lee embraces servant leadership, pushing the work and achievements of others to the forefront and embracing new ideas and new ways of doing things.
"While the strength of our institution's reputation continues to propel us forward, and while I am deeply committed to MD Anderson's mission, I remain curious and eager to learn from other institutions and organizations focused on improved health outcomes," he says.
Jeffrey Lee, MD, is chief medical executive at University of Texas MD Anderson Cancer Center. Photo courtesy of University of Texas MD Anderson Cancer Center.
Promoting physician leadership development
Lee says he wants to support MD Anderson's efforts in physician leadership development.
"Our physician leadership development program is comprised of formal leadership education and development through MD Anderson's Leadership Institute," he says. "The institute fosters leadership excellence and promotes professional development, propelling leaders to transform the institution's unique challenges into opportunities to further MD Anderson's mission."
The Leadership Institute takes a comprehensive approach to developing current leaders and creates trained talent pathways.
"The program integrates physicians and other care providers into joint programs and involves one-on-one coaching," Lee says. "The institute offers both personalized and team-based curricula, tailored to the growth needs of individuals at all career stages, whether they aspire to become leaders or are seeking personal and professional development within their current positions."
Leaders are also trained in emotional intelligence, oral communication, strategic thinking, and service orientation.
"We emphasize training in areas core to our culture at the institution, including the principles of high reliability, collaboration, ensuring a just culture, and psychological safety," Lee says.
Working with partners
Lee is also committed to working with other health systems and hospitals to boost quality, improve clinical outcomes, and advance research.
"We know that we cannot alone achieve our mission to end cancer," he says. "It requires collaboration locally, nationally, and globally to improve care, fuel groundbreaking research, and implement effective prevention and screening approaches."
"Through these relationships, we join in bi-directional learning to enhance capabilities, share knowledge, and expand access to better treat and prevent disease," Lee adds. "We currently partner with seven hospitals and health systems to serve the needs of patients across the country."
Lee says the health system looks for certain characteristics in its partners.
"MD Anderson seeks those with existing evidence of high-quality care delivery, existing quality infrastructure, and a focus on system-based care," he says. "We seek institutions that demonstrate cultural alignment with MD Anderson, focusing on key areas such as a commitment to continuous improvement, psychological safety, just culture, and high-reliability principles."
There is also an emphasis on measurement.
"From the onset, we work with collaborating organizations and institutions to establish key metrics for success and implement standard platforms supporting measurement," Lee says. "These include measures of quality in oncology care, including delivery of multidisciplinary care, continuity of care, nursing, general care, oncology standards of care, and patient satisfaction."
Advocate Health strives to listen to groups of patients and individuals, then redesign care at scale.
Patient experience is crucial for healthcare organizations because it impacts health outcomes and patient satisfaction. A positive patient experience leads to greater patient adherence to care plans. A negative patient experience leads to decreased patient loyalty.
Advocate Health, which operates 69 hospitals, tracks patient experience for more than 6 million patients annually and implements related redesign of care at scale.
Listening to the feedback of millions of patients then redesigning care based on that feedback is a differentiator for Advocate Health, according to Bradley Kruger, MA, MBA, vice president for patient experience at the Charlotte, North Carolina-based health system.
"We get more than 2.5 million patient experience surveys back every year," Kruger says. "That is a lot of feedback, and the patterns we see are actionable."
An example of patient experience feedback that is actionable in real-time is related to medication, Kruger explains. A patient may have a medication change, and with that change, they could not afford to pick up their script.
"We have feedback loops hard-wired at the clinic level," Kruger says. "When we get feedback, we call the patient and learn more, then help them get the resources they need to get their medication."
Advocate Health aggregates other feedback and looks at the patterns across different groups of patients. Scale allows the health system to hear things that other health systems may not hear, according to Kruger. For instance, during this year's flu season, there were a lot of RSV cases, so there was a large respiratory illness spike in January and February that resulted in patient feedback.
"We could see the impact that spike had on patient experience, quality, and safety through listening and feedback," Kruger says.
Advocate Health is taking the information it gathered on the respiratory illness spike and planning for the future.
"We found that patients needed information on access urgently and acutely," Kruger says. "Wait times became a concern for patients in the emergency room and urgent care centers."
By listening intently to patient experience feedback, Advocate Health also implements changes based on the experience of individual patients.
"We had a patient at Advocate Illinois Masonic Medical Center in Chicago who had been hit by a car while riding a bicycle and came into the emergency room," Kruger says. "As part of the care process, she had to have her hijab cut off. She put into her survey feedback how unsafe that made her feel."
Advocate Health investigated the incident and looked for ways to avoid a repeat patient experience.
"We partnered with a Muslim-owned startup that makes disposable hijabs," Kruger says. "Now we have disposable hijabs stocked across the enterprise."
Bradley Kruger, MA, MBA, is vice president for patient experience at Advocate Health. Photo courtesy of Advocate Health.
Using volunteers to improve patient experience
Advocate Health is using volunteers to boost patient experience.
"At Advocate Health, we have more than 10,000 volunteers who contribute more than 500,000 hours of effort every year," Kruger says. "That time supports patients at the bedside—we are using the volunteers to improve patient experience, quality, and safety across the organization."
One volunteer initiative uses 100 virtual volunteers who are mainly pre-med students.
"They learn how to navigate Epic and how to talk with patients," Kruger says. "They call patients within 24 hours of them being admitted to a hospital, mostly patients over the age of 65 who have been admitted from the emergency room."
The virtual volunteers welcome the patients and ask whether there are any family members that they would want to contact. If they do, the volunteer can reach out to family members and connect them to the patients.
The virtual volunteers also ask patients whether they left any essential items at home before they were hospitalized. For example, if a patient comes to the emergency room via ambulance with trouble breathing and they are admitted to the hospital, they might have left their hearing aids or glasses at home.
"In the past, this would be communicated to a nurse, and the nurse would have to call the family," Kruger says. "Now, a virtual volunteer can take this task off the nurse's plate—the volunteer can contact the family and coordinate pickup and delivery of anything the patient may need that was left at home."
Volunteers are a touch point that can personalize and individualize the patient experience, Kruger says.
Keys to patient experience success
To provide a positive patient experience, listening is crucial. According to Kruger, leaders must put aside any premise they may have as an individual, healthcare leader, or health system and listen to the patient
"You need to ask questions. You need to ask what you can do to improve," Kruger says. "It needs to be a continuous process that becomes part of your culture. We are constantly listening, then by acting, we move into innovation."
Health systems should constantly look for new ways to engage patients, Kruger explains.
"You need to look at creating new communication pathways or implementing new technology to help a specific group of patients feel that they understand their plan of care, understand their medications, and understand how to live their healthiest life," Kruger says. "You must utilize resources across the health system to help achieve these goals."
Health systems need to listen to their patients then act on the feedback, according to Kruger.
"Listening then acting tends to move healthcare organizations and drive innovation," Kruger says. "It also provides the ability to use new technologies in a way that moves outcomes and personalizes care for patients."
ProMedica is using artificial intelligence tools across a wide range of clinical care use cases.
In this episode of HL Shorts, Brian Miller, MD, the top artificial intelligence officer at ProMedica shares how the Toledo, Ohio-based health system is using AI in ways that impact clinical care. Miller is chief medical information officer and vice president of telehealth at ProMedica. Tune in to hear his insights.
Jeffrey Kuhlman, MD, MPH, is senior vice president as well as chief quality and safety officer at AdventHealth. Photo courtesy of AdventHealth.
Ivor Douglas, MD, has been named director of the Department of Medicine at Westchester Medical Center Health Network and chair of the Department of Medicine at New York Medical College. Photo courtesy of Westchester Medical Center Health Network.
Jeffrey Lee, MD, is chief medical executive at University of Texas MD Anderson Cancer Center. Photo courtesy of University of Texas MD Anderson Cancer Center.
Bradley Kruger, MA, MBA, is vice president for patient experience at Advocate Health. Photo courtesy of Advocate Health.