Over the past six months we have been working with Community Healthcare Network, (www.chnnyc.org) (a network of 15 FQHCs in the NY area) in a remote care program.
Funded by HRSA, CHN has started a remote monitor program for patients with hypertension. It has been a great experience, one in which both CHN and Prevvy have learned a lot and overcome challenges that are common to these types of programs. Together, we have broken (and continue to break) barriers that make remote care programs difficult to expand.
On the patient side, we found the following barriers:
Digital barrier: A key part of remote care is taking advantage of all the technological advances that make remote care much more convenient and efficient (from telehealth to remote monitoring). However, some patients, especially among those cared for at FQHCs struggle making use of these technologies, or at least the first few times. This is why combining high tech with high touch is so important. At Prevvy, we want to strengthen the relationship between patients and their care team, not substitute it, so we understand the importance of those touch points with patients, especially at the beginning to make sure they understand how to use the technology and where to reach out for help when needed. The team at CHN is using a combination of health home team members and nutritionists as well as nursing staff to set up patients for success
Language barrier: For many of CHN’s patients, English is not their first language, as it is common in many FQHCs. Being able to communicate with the patient in their own language adds a level of trust that strengthens patient engagement. Prevvy incorporates Google translate into its platform, so the patient can interact with Prevvy in their chosen languages. Furthermore, soon it will be possible to invite translators via a link to telehealth visits so the patient and provider can have a videocall and the translator can join only in audio to protect the privacy of the patient. Additionally, soon the patient and clinical team will be able to activate subtitles in their language.
Lack of engagement: No technology platform will ever have the impact that a call from your care team can have. At Prevvy, we encourage our clients to keep that relationship and be in charge of those important touch points to keep patients engaged. While we incorporate automated messages to the patients motivating them to keep good habits or reminding them to login after days of inactivity, there is an escalation to the care team to re-engage with the patients when needed
There were also internal barriers on the care team side:
Administrative barriers: Starting a remote care program, especially the first one at an organization is always going to find some resistance. We were lucky to work with an interdisciplinary team at CHN that was committed to making it work. When we needed additional support to initiate patients in the program, the nutrition team became part of the program and now part of the care team initiating patients in the program.
Workflow barriers: Early on we realized that documenting patient consent was an important step in the patient initiation process and required printing, signing and scanning. At Prevvy, we created an electronic consent form (blessed by CHN’s legal team) so now, once patients are set up in the platform, they are asked to review the consent form, sign in their phones and it is automatically saved in Prevvy and accessible for any care team member.
Other workflow barriers, like sharing data with the EMR, will be soon a thing of the past, as required by the 21st Century Cures Act for EMRs to share data with SMART-FHIR apps. While the number of EMRs offering access to these apps continues to grow, we will see additional growth this year as EMRs finalize their plans to comply with ONC requirements.
As we continue this journey of digital transformation in healthcare, we will continue to find new barriers and it will be our (clinical care teams and technology vendors) job to continue to find ways to break them, so more patients can benefit from the advantages we already enjoy in many other aspects of our lives.
As always, we will be happy to share our experiences in more detail and would love to hear about other experiences with these programs. Have you started one? What barriers have you found? Are you thinking of starting a remote care program? What is stopping you?
You can contact me at firstname.lastname@example.org for more information.
1 More Apps are Integrating with EHRs. HealthIT Buzz. Office of National Coordination: https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/research-results-published-more-apps-are-integrating-with-ehrs