Article

Optimizing Your Oncology Care Team Efficiency with the Internet of Medical Things

Hospitals in the U.S. are using a variety of digital health tools from the internet of medical things (IoMT), including apps, mobile patient portals, clinical grade medical device remote monitoring, consumer device remote monitoring, texting, and telehealth.According to a connected health survey, 81 percent of hospitals report their facilities are using at least one of the IoMT technologies, 67 percent use multiple solutions, each to support different facets of their connected health initiatives, and 52 percent have implemented three or more tools.1

Many cancer centers are reinventing their workflows and improving coordinated care delivery with systems, devices, and sensors that are finding the right care team member at the right time to ensure the highest quality treatment produces the most optimized outcome at the best cost for every patient.

Real-time location system monitors patients and resources

One international cancer center’s surgical facility implemented a real-time location system (RTLS) to monitor patients, family members, staff, and other resources with the goal to improve recovery, coordinated care, outcomes, and workflow.3

This RTLS system is helping manage 12 operating rooms, 40 beds, and 40 to 50 cases per day.Each patient and their family members receive an RTLS badge upon arrival and staff members are able to enter a patient's name into the system and receive information on the location of the family members throughout the facility.3

Healthcare providers can see real-time status updates based on the location of a patient by viewing one of the nearly 40 "glance-and-go" electronic whiteboards located in staff areas.3 These boards show when an operating room or hospital bed has become available or is ready for cleaning, as well as surgery schedules, and how long a patient has waited or remained unattended.3

Due to a high level of information integration--30 data points from six separate systems, including badges--staff can glance at a status board and tell how rapidly patient recovery goals are being met, which department a patient is in following surgery, as well as their recovery status based on how much ambulatory movement they have engaged in to meet that goal.3

One post-operative screen can show visual alerts that signify each care milestone a patient must achieve before discharge, which allows a nurse or provider immediate understanding of where that patient is on their clinical care pathway.2 And if goals for well-being and activity are not being met, then care delivery can be re-prioritized.2

Patients who have met their goals during post-op recovery will automatically trigger the system to indicate and notify staff they are ready for discharge, allowing the patient to return home as soon as possible.2 This automatic discharge notification and preparation also allows space usage to be optimized by also alerting staff when rooms are ready for turnover.2

From managing 12 operating rooms in a single facility, to streamlining and improving care delivery at multi-site clinic locations, digital health and the IoMT are being leveraged in oncology practices big and small to meet new value-based criteria.

Standardizing, unifying, and analyzing from all locations

The Oncology Care Model Initiative of the Centers for Medicare and Medicaid Services provides financial incentives to more than 190 oncology practices selected to participate in transforming their services to meet value-based criteria.4 Providers implement strategies such as enhanced coordination, patient navigation, and guideline-based treatment to improve the value of patient care and decrease the costs to Medicare.4

At one of the participating cancer centers, web-based tools are used to unify previously siloed data, including electronic health records (EHR), practice management, claims, and treatment pathways.4 By combining disparate information, the team is able to build a more complete picture of their patients on an individual basis and also as a whole population.4

Symptom management is a key care area being standardized.4 To address this, a nurse-facing patient triage platform was implemented so that the standard of care for symptom management is maintained at a high level regardless of which clinic location a patient may call or visit--this is reducing costly emergency visits and readmissions.4

Another initiative, a treatment standardization decision-support tool for various disease sites, is ensuring that physicians always know the best standards of care for chemotherapy regardless of where the patient is seen.4 When there is more than one therapeutic option and all are equal in efficacy and toxicity, the system recommends the least costly.4 Additionally, each pathway is updated quarterly so the most up-to-date care is always at their fingertips.4

Population health analytics tools are providing staff with invaluable quality and cost insights regarding inpatient admission incidence, hospice care, and emergency visits--the three highest cost areas whose improvement can have the biggest impact.4 Usage of healthcare services can be evaluated on an individual level, as well as by cancer type, provider, and location.4 As a result, cancer care teams now have unprecedented levels of access and visibility into understanding their patient populations.4 Ultimately, it means an enhanced capability for selecting the most effective and appropriate treatment pathways.4

In addition, the center is able to report their progress and performance and submit all required documentation for the Oncology Care Model program deadlines without additional staff time and energy to research, mine, and analyze all the data themselves.4

Accelerating outcome measures development for quality improvement

Quality measures are in frequent use, but focus on processes (i.e., if a standard of care was followed) rather than the outcome.5 While the International Consortium for Health Outcomes Measurement is developing standardized sets for all medical conditions that incorporate patient-reported outcomes, a Texas cancer center decided to develop their own based on the diseases they treat.5 Their health outcome measures are used to drive internal quality improvement as well as external benchmarking and include both provider-generated and patient-reported outcomes.5

By enlisting a small group of in-house experts, the center could achieve consensus quickly, and for patient feedback, they mined previous focus groups.Those steps were the key to accelerating the development of their patient-centered outcome-measure sets from a seven-month timeframe reported by the International Consortium for Health Outcomes Measurement to one to two months per disease site.5

The center's sets are incorporated into clinical practice workflows via electronic health records (EHR) integration.5 Patient-reported outcome surveys can be administered at clinically relevant points during treatment through the patient portal so that survey responses are stored in the EHR. For example, patients can complete surveys at home or in the waiting room before appointments, as well as at specified intervals throughout and after treatment is completed.5 Survey automation and EHR integration or responses streamlines workflows by reducing the burden of provider review time and analysis.5

Recommendations for other small individual sites to develop their own measure sets include defining each patient population at the start to avoid a one-size-fits-all approach, stratifying outcomes based on specifics, such as age and pretreatment baseline status, and narrowing and prioritizing the list of outcomes to minimize both the burden of data recording and survey completion.5

REFERENCES:

  1. 2016 Connected Health Survey. Healthcare Information and Management Systems Society (HIMSS) https://www.himss.org/2016-connected-health-survey Accessed 4/2/2019
  2. New York cancer hospital uses RTLS to monitor patients. IoT M2M Council  https://www.iotm2mcouncil.org/mskver Accessed 4/2/2019
  3. Memorial Sloan Kettering Facility Uses RTLS to Monitor Patient Recovery. RFID Journal https://www.rfidjournal.com/articles/view?14250/2 Accessed 4/2/2019
  4. UPMC Hillman Cancer Center uses analytics to improve care quality with CMS Oncology Care Model. Healthcare IT News https://www.healthcareitnews.com/news/upmc-hillman-cancer-center-uses-analytics-improve-care-quality-cms-oncology-care-model Accessed 4/2/2019
  5. How a Cancer Center Rapidly Developed Patient-Centered Outcome Measures. NEJM Catalyst  https://catalyst.nejm.org/cancer-center-rapidly-developed-patient-centered-outcome-measures/ Accessed 4/2/2019