How 1 hospital bucked a remote patient monitoring trend

While at-home monitoring is less common for kids, one children's hospital now has 11 remote management programs for its pediatric patients.

Children's Hospital of Philadelphia remotely monitors patients with such conditions as lung abnormalities, epilepsy and concussions.

The health system started by monitoring infants born with a single heart ventricle, a complex, life-threatening condition that requires multiple surgeries. The babies are sent home with a mobile app for periodic telehealth check-ins, as well as a digital vital sign monitor, stethoscope and scale.

With the digital stethoscope, CHOP's cardiology team can remotely listen for heart murmurs during telehealth visits. One in 8 patients enrolled in the program has had a clinically significant finding from the device that changed the course of their treatment.

"So that was our first signal. It was like, 'Wow, we can really do this with the tools that are available,'" CHOP Chief Health Informatics Officer Bimal Desai, MD, told Becker's. "And we very rapidly put out an assessment to all of our clinical areas to say, 'Where else would this come in handy?'"

After receiving a "huge number" of ideas for new programs, CHOP narrowed it down to 11, all of which are now live, he said. The hospital plans to remotely monitor 11,000 kids a year once the programs are fully enrolled.

Still, remote patient monitoring is more prevalent among adults because pediatric patients tend to have more complex conditions that require multiple digital health devices, Dr. Desai said.

"So you have an adult with high blood pressure, you send them out with a blood pressure cuff, right? You have an adult with COPD, you can send them home with a device to assess their respiratory status," he explained. "It's complicated when you go home with a child with medical complexity. Anything that health systems can do — like CHOP is doing — to help bridge that gap is worth doing."

CHOP groups its programs into four areas:

—Transitioning patients from inpatient to outpatient care (infants going home from the neonatal intensive care unit with supplemental oxygen and/or tube feeding; single ventricle patients; pulmonary hypoplasia).

—Episodic and chronic care (febrile neutropenia; post-concussion surveillance and management; and introduction of the ketogenic diet for children with epilepsy).

—Perioperative and periprocedural care (surgical gastrostomy tube postoperative care; postoperative ear tube placement, tonsillectomy or adenoidectomy; perioperative and postoperative care for high-risk urology patients; and kidney stone management).

—Operational efficiency (specialty pharmacy).

CHOP has already experienced a drop in readmissions among the first 200 NICU transition patients enlisted in remote patient management, Dr. Desai said.

"We consistently have these good catches — we're finding all kinds of things that might otherwise fall through the cracks," he said. "So we're improving our surveillance. We're improving our ability to meet patients' needs. We're troubleshooting medical devices. We're helping them with supplies that didn't get delivered on time. Whatever the issue is, we can intervene right there and prevent some deterioration."

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