Remote Patient Management: Helping bariatric departments track and support patients in the long term

Bariatric departments can face many challenges, chief among them is how to manage and track their patients through a long pre-operative and post-operative journey. One solution, remote patient management, can help these practitioners follow the patient at every step of the pathway, while educating and engaging these patients long after the procedure — potentially improving long-term outcomes.


This paper is intended to help bariatric departments better understand remote patient management, its benefits, and things to consider when deciding whether to implement a remote patient management solution.


The challenges of the bariatric department

Obesity is a complex disease, and as a result, bariatric departments can face multiple challenges in managing their patients, including:

  • Reliably tracking each patient along the care pathway

  • Ensuring patients get the right information at the right time

  • Supporting patients and engaging them in their own long-term care

Most who work in metabolic health would agree that for a bariatric care pathway to be successful, it must be able to not only support the patient prior to surgery, but also to continue that support for a long period following the surgery.

For example, in the months prior to the procedure, patients with obesity will need to fully understand and accept the surgery’s impact on their lifestyle and ideally, begin making changes to their eating and exercise routines.1 After surgery, they must not only adopt new eating habits but as their body changes, they may need help reframing their own mental image, moving from seeing themselves with obesity to seeing themselves as a person of healthy weight.2

In addition, they may also need support as friends and family respond to their changing appearance. And while dieticians and psychologists play an important role in this follow up, patients are usually limited to a certain number of visits with these professionals.

When it comes to readying patients for the procedure itself, it can be a challenge for busy clinics to ensure patients are fully prepared on the day of surgery. And following surgery, additional challenges can present themselves, including:

  • Enabling safe, early discharge that would free up hospital capacity

  • Difficulty tracking and contacting patients who are no longer visiting the department for follow-ups to helping them avoid falling into old habits and regaining the weight.

Remote patient management may be a helpful solution for all of these challenges. The following answers some commonly asked questions about remote patient management:

1. What is remote patient management?

First, it’s important to agree on the definition of the term, “remote patient management.” If you spend time studying the topic, you may find that the term is anything but clear. A variety of products and services are advertised as “patient management,” but in reality, they are limited in scope.

This includes products such as patient portals that primarily focus on administrative processes for managing inpatient admission and discharge, or applications that have been developed for just one or a few indications (e.g., telemedical functional analysis and telemonitoring of cardiac implants).

Remote patient management is actually a more comprehensive concept. It includes:

  • Patient education: Helping the patient understand what to expect and do before, during and after their inpatient stay.

  • Pathway optimization: Designing the solution to be scalable and applicable to different areas (e.g., ERAS® protocols, pre- and post-surgery, same-day discharge).

  • Patient monitoring from a distance: Collecting patient data and transmitting it for assessment by the hospital staff. Clinical staff pre-configure automated rules-based alert system. The threshold values are pre-determined upfront and if a patient enters a value that exceed it, it will give an alert. This improves efficiency as staff do not have to check the transmissions of all patients, only those they are notified of, via the pre-configured alert rules.

  • Patient communication: Actively involving the patient in their treatment and post-treatment care.

2. How is remote patient management used?

Remote patient management is generally used to manage and track patients efficiently throughout their treatment. When it comes to bariatric surgery, it can be used to engage and communicate with the patient as they prepare for the procedure, ensure they’re ready to go on the day of surgery, and keep them on track during the extended follow-up period after the surgery.

Another way it can be used is to digitally integrate every step of the clinical pathway. This way, individual treatment steps can be linked so that information about the patient is available to hospital staff at all times. This increases treatment efficiency, optimizes the use of scarce resources, and also ensures transparency, so patients are fully participating in the treatment process.3

A comprehensive remote patient management solution can provide many benefits, including:


1. Improving a hospital’s efficiency and resource utilization by:

  • Standardizing guideline-based treatment pathways

  • Ensuring standardized, digitally supported patient communication and education that supports the course of treatment4

  • Enabling data-driven treatment decisions

2. Improving patient safety and quality of care by:

  • Standardizing documentation of treatment results

  • Enabling early detection of risks and complications (which can lower overall costs, create positive return on investment)5

  • Providing the ability to document patient satisfaction and patient-reported outcomes

3. Inviting consistent patient engagement in the treatment and healing process by:

  • Standardizing patient communication that is trustworthy, qualitative, and targeted

  • Enabling pre-hospital preparation, post-hospital monitoring, and lifestyle change-management support

  • Providing long-distance care and communication between patients and clinical staff, which can lead to greater patient satisfaction, a sense of security, and support during the recovery process6

  • Creating a transparent treatment process for patients

  • Reducing travel and clinic wait times

3. What are some things to consider when implementing a remote patient management solution?

Some hospitals may shy away from remote patient management because it requires additional expense and resources. However, if a digital deployment project is well-designed and well-managed, they should be able to ramp it up quickly and enjoy the benefits while realizing some cost savings.

In addition, when trying to implement a solution on their own, hospitals can sometimes make inaccurate assumptions that may lead to a longer and more complicated project phase — and still end up with a solution that isn’t ideal. That’s why, for those who wish to deploy their own solution, we offer some tips:


Tip 1: Perform an analysis before the start of the project.

Begin by deciding which of your challenges would most benefit from implementing a remote patient management solution. By targeting your biggest challenge, you can determine what to focus your initial pilot effort on, ensuring that it integrates into your structures and systems, and provides real relief.

To do this, compare your current treatment process with how you would handle it if you were using a remote patient management solution. This will give you a clearer idea which processes can be digitized to realize the full potential of the solution.7


Tip 2: Engage professional change management.

While IT departments play an important role in structurally integrating a digital solution into a hospital’s system landscape, they are not usually well versed in change management. That’s why, with something as broad as a comprehensive remote patient management solution, we recommend professional change management to work in partnership with IT.

A professional change management approach will ensure all groups and functions that will come into contact with the solution are engaged in the process. This will prepare and motivate them for change while gaining important perspective from employees on how remote patient management can be meaningfully integrated into their everyday life.


Tip 3: Think bigger.

In bariatric departments, as different disciplines interact it creates complex processes that may work well, but can also be inefficient.

Oftentimes, the impetus for implementing a remote patient management starts with an isolated process, such as moving the manual documentation of patient data to a digital solution. But what if you took it a step further? What if you could match this digitally recorded patient data with other data in your Hospital Information System (HIS) in real time, helping you to make data-based decisions for surgical planning, or bed occupancy, and more?

In our experience, a comprehensive remote patient management solution often solves more than the one identified problem because it has the ability to intelligently dovetail many of your clinic's digital and analog processes.


4. What should a bariatric department look for in a vendor and remote patient management system?

Here’s a checklist of criteria that can support you in the selection process. A remote patient management solution should offer:

  • Broad coverage of therapy and indication areas based on clinical know-how

  • Flexible usability for a wide variety of clinical processes

  • Adaptability to local requirements, clinic processes, and changing conditions

  • Ability to integrate into the HIS

  • Full compliance with the General Data Protection Regulation (GDPR)

  • A flexible cross-platform solution, available on smartphones, tablets and PC, use via Apple/Android app and web browser

  • Intuitive and easy-to-use interface for clinic staff and patients

The provider should offer:

  • „Professional change management to garner full support and buy-in while optimizing and digitizing treatment pathways

  • Extensive expertise in areas such as digital health, health economics, hospital, surgical and supply chain management, and medicine

  • Benchmarking with other clinics (e.g., to patient related outcomes) for continuous quality improvement

5. What is Get Ready®?

Get Ready is a comprehensive remote patient management solution from Medtronic. It combines a digital platform that actively engages patients with an extensive therapy-specific knowledge database. In addition, Medtronic consultants bring expertise in change management to support the digitization and optimization of treatment pathways.

Get Ready’s GDPR-compliant app, which can be accessed from a smartphone, tablet or PC:

  • Engages patients in their treatment

  • Offers therapy-specific education, diaries and activity reminders to prepare the patient and observe protocol compliance, among other things

  • Features standardized questionnaires to facilitate the information exchange between the patient and treatment team

Comprehensive remote patient management

Get Ready enables clinical teams to look after patients both preoperatively and post operatively. After surgery, follow-up appointments and health monitoring can be done remotely to watch for complications and avoid unnecessary hospital stays. For bariatric patients, Get Ready can also track weight loss progress, and help care teams identify any deterioration of the patient’s health status along the entire pathway.


One of the many benefits of Get Ready is its ability to help hospitals meet their goals of shortening hospital length of stay for patients while providing safe and effective care from a distance. In the case of the Neurosurgery department at the University Hospital in Amiens, France, Medtronic helped implement Enhanced Recovery after Surgery (ERAS®) protocols, and using Get Ready, the hospital was able to optimize the pathway, thereby shortening hospital length of stay from 5.6 days to 4.3 days.


Flexibility is paramount

The Get Ready solution can be configured and used very flexibly for different areas of application, including ERAS® protocols, operation preparation and follow-up, as well as introducing day surgery. This flexibility includes the ability to modify and automate — in real time — to the needs of an individual patient, thanks to its patient screening questionnaires and other functionality.

During set up, the clinic, in partnership with the consultant team, decides when the patients should receive which information and which data (e.g., quality of life questionnaires or tracking a patient’s weight) will provide added value for daily work and the quality of treatment. Get Ready’s knowledge database currently covers 42 different disease treatment pathways for areas such as colorectal, cardiac, spine and bariatrics. And each pathway can be adapted to local requirements.

Meaningful networking

With their expertise, Medtronic consultants ensure that the remote patient management solution is sensibly embedded in daily clinical processes. This way, existing processes such as patient admission and patient communication can be optimized.

6. How does Medtronic work to meet the non-medical device needs of hospitals?

Medtronic sees itself as a long-term partner for the digital transformation in hospitals. Together with medical institutions, they develop innovative solutions to increase efficiency, reduce costs, improve patient satisfaction, facilitate access to therapy for patients, and optimize results.

Currently, more than 350 Medtronic experts (including digital health, health economics, hospital, surgical and supply chain management) work with 230+ clinics in the EMEA region. This enables a comprehensive transfer of knowledge and benchmarking between the institutions. Medtronic not only has the capital resources and know-how for process optimization and change management, but also an extensive therapy knowledge. And in the case of bariatrics, these experts work closely with their colleagues who specialize in obesity and metabolic health, and have complete understanding of the disease and treatment and can tailor solutions accordingly.

Are you ready for truly connected care for your hospital? Read more about Get Ready here


References:

1. Brown WA, Burton PR, Shaw K, Smith B, Maffescioni S, Comitti B, Cowley MA, Laurie C, Way A, Nottle P. A Pre-Hospital Patient Education Program Improves Outcomes of Bariatric Surgery. Obes Surg. 2016 Sep;26(9):2074-2081.

2. Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, Hjelmesæth J, Kinzl J, Leitner DR, Makaronidis JM, Schindler K, Toplak H, Yumuk V. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts. 2017;10(6):597-632.

3. Kirchner, K, Lemke, C, Brenner, W. Neue Formen der Wertschöpfung im

digitalen Zeitalter. In: Barton, T, Müller, C, Seel, C. Digitalisierung in Unternehmen. Wiesbaden. Springer Fachmedien. 2018; 40.

4. Hwang H. Electronic wound monitoring after ambulatory breast cancer surgery: improving patient care and satisfaction using a smart phone app. B C Med J. 2016;58(8):448–53.

5. Campbell K, Louie P, Levine B, Gililland J. Using Patient Engagement Platforms in the Postoperative Management of Patients. Curr Rev Musculoskelet Med. 2020 Aug;13(4):479-484.

6. Campbell K, Louie P, Levine B, Gililland J. Using Patient Engagement Platforms in the Postoperative Management of Patients. Curr Rev Musculoskelet Med. 2020 Aug;13(4):479-484.

7. Wurm, A, Döhr, R, Zapp, W. Prozessgestaltung im Krankenhaus – Darstellung, Analyse und Evaluation eines Patientenentlassungsprozesses. In: Zapp, W, Ahrens, J. Von der Prozess-Analyse zum Prozess-Controlling. Controlling im Krankenhaus. Wiesbaden. Springer Gabler. 2017; 21.