Update on the Remote Patient Monitoring Program
Remote patient monitoring (RPM) is a form of asynchronous telehealth that allows a patient and family to transmit health information to a medical team from home. This allows the healthcare team to identify health problems earlier, but also may allow a child’s health to be managed from home. Health management at home avoids several barriers to access to care, such as transportation, childcare, and time away from work.
In January 2021, Cincinnati Children’s launched an RPM program for infants hospitalized for poor weight gain.1 Initially this program was only available to patients who access one of Cincinnati Children’s Primary Care Clinics, but we are now able to offer this service to all patients in the community. At the time of discharge, interested families are sent home with a hospital-grade infant scale and a mobile app for their smart phone. They receive education on how to accurately use the scale and instructions on how to use the app. Once home, families submit a weekly weight and answer a questionnaire that explores issues like feeding intolerance, food insecurity, difficulty breastfeeding, and formula mixing. A team of Cincinnati Children’s RPM nurses field the weights and questionnaire responses and have a direct line of communication with the families via text and video call through the app.
Partnership and communication with the primary care provider (PCP) are top priorities for the RPM nurses and dietitian. At the time of enrollment, a letter is faxed to the PCP that notifies them of a patient’s enrollment, details of the program, and contact information for questions and concerns. During a patient’s enrollment, if there is weight loss or concerning answers on the questionnaire, the nursing team contacts the family to triage concerns. If there are concerns after discussing with the family, the RPM team will call the patient’s PCP to inform them of the situation and receive their recommendations for next steps. The RPM nurses can continue to be a resource in these scenarios (e.g., closing the loop of communication with a family if the plan is to observe, or telling the family to call the clinic to schedule an in-person appointment). Additionally, the RPM dietician can be a resource to the PCP to help manage feeds with fortification or calorie changes as indicated. The level of involvement of the RPM dietician can be specific to the PCP’s preferences. Weights are transmitted weekly through routine communication to the primary care clinic by the preferred communication method listed in Epic. All information is also updated in Epic on a real-time basis and there is a specific growth chart titled “RPM” where all RPM weights can be visualized on a growth curve.
Once a patient has had adequate weight gain (defined as goal weight gain determined by the dietician) for 6 weeks, then the RPM team will contact the family and the PCP about “graduating” the patient from the program. Alternatively, if a patient does not submit data and/or is unable to be reached for 4 weeks, then they will be discharged from the program for inactivity and the primary care provider will be notified. The RPM team is happy to partner with PCPs to either prolong or shorten enrollment duration based on patient factors and provider preferences.
Patients are billed for this service, and it is covered by public insurance. We have not heard about costs to patients with private insurance but would like to hear about it if that is an issue.
Contacting the RPM Team
The RPM nurses are available:
• 7 days a week from 7:00 A.M. to 7:00 P.M.
You can contact the RPM nurses by:
• Phone call to 513-636-8993.
• Email to remotecare@cchmc.org.
You can contact Dr. Courtney Sump (Courtney.sump@cchmc.org), who is the supervising Hospital Medicine physician for this program, or Kylee Denker (kylee.denker@cchmc.org), who is the nurse manager, any time for questions, concerns, or feedback on the program.
1. Sump C, Denker K, DeBlasio D, Ruschman J, White C, Riddle S. Postdischarge Remote Patient Monitoring for Children Hospitalized for Failure to Thrive. Acad Pediatr. Published online August 5, 2022. doi:10.1016/j.acap.2022.07.023