DIGITAL HEALTH IMPLEMENTATION PLAYBOOK AMERICAN MEDICAL ASSOCIATION® DIGITAL HEALTH IMPLEMENTATION PLAYBOOK THIS AMA® DIGITAL HEALTH IMPLEMENTATION PLAYBOOK represents information believed to be current best practices, but it is not intended as legal, financial, medical or consulting advice. © 2018 American Medical Association https://www.ama-assn.org/terms-use Table of Contents PART 1 / WARMUP 4 Introduction to the Digital Health Implementation Playbook 6 Introduction to Digital Health Solutions 7 What is Remote Patient Monitoring? 8 Remote Patient Monitoring in Practice: Hypertension 9 The Path to Implementation 10 PART 2 / PRE-GAME 12 Step 1 / Identifying a Need 14 Step 2 / Forming the Team 18 Step 3 / Defining Success 22 Step 4 / Evaluating the Vendor 26 Step 5 / Making the Case 30 Step 6 / Contracting 34 PART 3 / GAME TIME – REMOTE PATIENT MONITORING 38 Step 7 / Designing the Workflow 40 Step 8 / Preparing the Care Team 44 Step 9 / Partnering with the Patient 48 Step 10 / Implementing 52 Step 11 / Evaluating Success 56 Step 12 / Scaling 60 PART 4 / POST GAME – RESOURCES 66 Part 1: Warmup Before you embark on your digital health implementation, it’s important to understand what digital health is and how it’s impacting the world of health care. The following pages define digital health and explain how to use the resources included in this document. 4 5 PART 1 / WARMUP Introduction to the Digital Health Implementation Playbook Digital tools that enable new methods and modalities to improve health care, enable lifestyle change, and create efficiencies are proliferating quickly. Clinical integration of these tools is lacking. We want to change that. At the AMA, we are committed of digital health and its role in adopting these solutions now, your to partnering with physicians to helping deliver better care. Whether organization can improve its ability meet the changing landscape you are a physician, a care team to deliver on the Quadruple Aim of health care. Recent research1 member, health care administrator, of Healthcare.5 found that physicians had four key or a passionate advocate for the requirements for the adoption of implementation of digital health WHERE CAN I USE THE PLAYBOOK? digital health in practice: technology, if you are looking for The Playbook is designed for care guidance to navigate the process and • Does it work? teams and administrators in medical achieve scale, this Playbook is for you. • Will I receive payment? practices of all sizes and areas of specialty. We have consulted with • Will I be liable? WHY SHOULD I USE THE PLAYBOOK? • Will it work in my practice? small private practices and large Implementing digital health health systems, in rural and urban In support of that pursuit, we have technology can be complicated settings, with high income and collaborated2 with physicians and and time-consuming. On average, it Medicaid-dependent populations. thought leaders to create the Digital takes hospitals 23 months to go from No matter where you are, you Health3 Implementation Playbook. identifying a digital innovation need can use this playbook as a guide to scaling a digital solution to meet to successfully implement digital WHAT IS THE DIGITAL HEALTH 4 IMPLEMENTATION PLAYBOOK? that need . The Playbook is designed health solutions in your practice. with input from over 80 physicians, Months of research compiled into care team members, health care HOW DO I USE THE PLAYBOOK? a Playbook documenting the most administrators, and digital health The Playbook is organized into 12 efficient path to implement new thought leaders to help health care key steps to guide you along your digital health solutions including organizations adopt change faster path to implementation. In addition key steps, best practices, and and more successfully. to this timeline, you will also find resources to accelerate and achieve resources, checklists, practice digital health adoption. WHEN SHOULD I USE THE PLAYBOOK? spotlight stories, and examples to WHO IS THIS PLAYBOOK FOR? Refer to this Playbook whenever you provide further guidance along are considering the implementation your journey. This Playbook is intended for those of a digital health solution. By who believe in the importance 6 Introduction to Digital Health Solutions Digital Health is the Future. New technologies are system leaders struggle to drive fundamentally changing the way innovation. They are looking for a people interact with health care. better and more efficient path to Successful implementation of scaled implementation, but report digital health technology will be that knowledge gained by other imperative for improving patient organizations and best practices are outcomes and ensuring financial not readily available. This playbook stability for health care practices. is an effort to provide widespread access to institutional knowledge The landscape of digital health and best practices currently held by technology is seemingly endless experts in the field. Currently, this playbook and spans from internal efficiency provides resources for the solutions to data management This playbook is a living document implementation of: to population health to patient that will be updated to include new interaction tools. You’ve likely content over time. As the playbook Remote Patient Monitoring been exposed to or considered evolves, it will provide helpful If you are currently interested implementing a number of frameworks and resources for your in learning more about these solutions. practice related to specific digital digital health, you can find health solutions. Despite the increasing more resources at the AMA’s 6 prevalence of digital health, health digital health website . 7 PART 1 / WARMUP Introduction to Digital Health Solutions WHAT IS REMOTE PATIENT MONITORING? Remote patient monitoring (RPM) is a digital health solution that captures and records patient physiologic data outside of a traditional health care environment. RPM solutions transmit that data to it provides visibility into patients’ “I had a young mom, she kept health care professionals for review, lives outside of their scheduled passing out, saw multiple diagnosis, or clinical management. appointments, which has historically physicians, etc., so we did a With this data, the care team been a barrier to timely and effective remote monitoring device. Sure can monitor chronic conditions diagnosis and management. With enough, within two months, we outside of the traditional health data collected over time, care team picked up a rhythm that was easily curable for life. Once we care environment and intervene in members can manage and treat cured the rhythm, she comes disease management as necessary. chronic conditions in a way that back and first thing she says is timely, meaningful, and realistic With seven out of the 10 leading is, ‘This has changed my life.’ to the patient’s lifestyle. The data causes of death in the United Traditional ways for looking for generated through RPM can help States and 86% of U.S. health rhythms and all that stuff just facilitate conversations between expenditures attributed to people didn’t pick things up, and using patients and physicians around the this newer technology, we were with chronic medical or mental impact of disease and response to able to really impact her life.” health conditions7, finding a solution treatment and provide opportunities is essential to population health and —DR. RAJ S., CARDIOLOGIST to intervene more quickly when (SCL Health) the fiscal solvency of the U.S. health health conditions worsen. care system. According to Healthbox “Because they’re involved, and their recent Remote Monitoring In addition to providing care [patients] take a more proactive and Connected Care report, “Remote teams with better, more actionable role in their health, so they’re monitoring programs present an information earlier, RPM has been able to send info to me, I’m able opportunity to better understand and praised for engaging patients in to send info back to them. You manage chronic diseases including their own care by providing them know, for some of them, it’s sort of diabetes, COPD, asthma, and chronic access to their own data so they a way to remind them of things in between visits. So, I think it heart failure.” 8 can better understand the impact has certainly improved some of of their treatment and advocate for RPM is particularly helpful in the health outcomes.” their medical needs. managing these conditions because —DR. B, PRACTICING PHYSICIAN 8 REMOTE PATIENT MONITORING IN PRACTICE: HYPERTENSION A 2018 study published in JAMA demonstrates how remote patient monitoring has the potential to significantly increase blood pressure control9. Hypertension affects about 46% of q Frequent blood pressure The AMA and their partners focus U.S. adults10, has estimated costs monitoring over longer periods on reducing chronic disease and exceeding $50 billion annually, of time, yielding a more achieving the vision that everyone and is the most common chronic accurate assessment of patient’s with hypertension in the U.S. will condition for which patients see true blood pressure and risk of meet their goal blood pressure. This primary care physicians.11,12 Since future cardiovascular events playbook will contribute to that hypertension often has few or q Providers’ and patients’ access to goal by providing best practices no symptoms, it is commonly daily blood pressures to assess for RPM implementation. We undertreated, leading to severe and the need for and response to