Remote patient monitoring of rural patients at risk of hospital admission using commonly available software

Abstract

The Hospital Admission Risk Program (HARP) aims to decrease hospital demand through provision of comprehensive assessment, self-management education, care coordination and timely responsive specialist care in the ambulatory or community setting for people with complex needs. Remote Patient Monitoring (RPM) involves real-time remote provision of clinical assessment, intervention and/or consultation services. Historically, RPM for HARP clients at this rural health service was facilitated via commercially available software (Tunstall Integrated Care Platform). On April 2024, this software was withdrawn from the market and a quality improvement activity commenced to develop an alternative RPM process for the HARP. Methods: A non-commercial RPM solution was developed utilising software already in use at the health service. Variants were developed for specific disease states (Heart Failure, Chronic Obstructive Pulmonary Disease). The solution was developed using the Model for Improvement. Results: The final solution was based on four applications and developed through seventeen Plan-Do-Study-Act cycles. REDCap was utilised for all data entry, Microsoft PowerAutomate for semi-automated transition of data to Microsoft Excel and PowerBI to provide the clinician end-user visualisation. The process involves clinicians on-boarding clients using a generic REDCap survey. Once on-boarded, clients receive daily emails (6am) with a unique, single use link to submit the RPM observations and health questionnaire responses. Data is transferred to a spread sheet which is used as the data source for a PowerBI dashboard which updates hourly. The dashboard was codesigned with clinicians and stylistically imitates an inpatient observation chart. Clinicians review the RPM platform daily and contact clients when values fall outside pre-determined parameters. Parameters are set by the general practitioner prior to RPM commencement. Clinicians can update client details using a client-specific link which is generated at on-boarding and sent to a generic HARP email inbox. These links are also used to discharge clients from RPM. Discussion: Although formal evaluation remains underway, this quality improvement activity provides proof of concept evidence that RPM solutions utilising commonly available software is possible. This may provide alternatives for health services aiming to facilitate RPM but unable to source a commercial, custom-designed solution.