The experience overall with VitalStream has been very pleasurable! It is very helpful to my practice and very beneficial to my patients.
Dr M
Vitalstream
Remote Patient Monitoring (RPM) Solution
Vitalstream offers a purpose-built Remote Patient Monitoring (RPM) solution that combines the latest technology, Internet of Medical Things (IoMT) devices, and a highly dedicated team of professionals. Physicians can monitor their patients with chronic conditions outside of the traditional clinical setting. Patients can measure their vitals from the comfort of their home while Vitalstream monitors the results and alerts the physician as needed. The result is a proven system that achieves the quadruple aim of better patient experience, improved health outcomes, improved caregiver experience, and reduced costs of providing better health outcomes.
Vitalstream Dashboard
Simple patient data dashboard
Physicians can manage their patient population from one place with the Vitalstream AI-based patient management platform. Physicians can quickly and easily see whether treatment protocols are moving the patient in the intended direction or take swift action if patient vitals are moving in the wrong direction.
View "at risk" patients at a glance
Vitalstream provides trending analysis of patient population vital signs, alerts for “out-of-range” values, with drill down and automatic visit scheduling for patients showing elevated readings.
About Vitalstream
Our Story
Our Expertise
Our Expertise
Vitalstream is a healthcare-centric enterprise with deep technological expertise and years of developing robust, mission-critical healthcare systems.
With over a hundred and twenty-five staff years of effort Vitalstream has created an RPM platform that helps physicians manage to superior care with a fully outsourced solution if required.
Our Expertise
Our Expertise
Our Expertise
Vitalstreams expertise in AI, Machine Learning and Blockchain allows our applications to go beyond simple data gathering and transport and enable the physician to manage the entire population of patients to better outcomes, saving money and improving patients’ lives.
Our Approach
Our Expertise
Our Approach
The Vitalstream RPM solution allows easy set-up and on-boarding with cellular-enabled devices requiring no external links, NO investment by the practice or individual physicians. Vitalstream provides all the equipment and handles all on-boarding and patient support with all billing events tracked and billed by the Vitalstream RPM platform.
Benefits of Vitalstream RPM in a Sleep Apnea Practice
Interview with Dr M
How has your practice changed since beginning the VitalStream Remote Patient Monitoring (RPM) program:
My practice has changed since using VitalStream RPM as this is a good medical tool. We did not monitor blood pressure and heart rhythm consistently prior to engaging with VitalStream. We now have better monitoring of patients’ overall health in terms of their compliance with using their VitalStream blood pressure monitoring device as well as my CPAP device. Better CPAP compliance correlates with their blood pressure in real time. It gives me greater insight than I had before and provides a better health outcome for my patients by getting real time monitoring updates from VitalStream. When a nurse notifies me there’s an issue, it allows me to intervene much sooner than I would’ve otherwise, especially if the patient didn’t contact the office because the VitalStream nurse is doing real time contact with the patient. I can then direct care, whether medication changes or intervene personally or direct them to another physician’s office to make changes.
Any surprising benefits?
Another example of better health management is the case of one of my patients who had lower blood pressure readings. This alerted us and we subsequently found the stomach bleeding in the G.I. tract. The point is if you start bleeding in your stomach today, you might not have dark stool for 3 to 5 days even though you’re bleeding a lot. VitalStream picks up the drop in blood pressure real-time where you might not clinically notice a difference until a patient winds up in the hospital four days from now. The patient themselves could’ve noticed the drop and then called the office, but we would have to educate them to update us when their blood pressure has been 20 points lower the past three days and they haven’t done anything different. However VitalStream would automatically pick that up as being out of parameter. The net is, I don’t get excited too much about a blood pressure of 100. That’s fine but if they typically run 130 then all of a sudden are getting consistently low blood pressures in the 100s for three or four days, you know a trend like that without anything else changing would be odd and you would ask why?
How has the Relationship with your patient changed?
The system is extremely user-friendly. The system has changed the way that I interact with my patients. VitalStream is designed to enhance the patient relationship by getting more data for more interaction. The patients are more involved, we review the patient’s VitalStream data and nurse notes just like I have the print out of their CPAP data. So it allows me to discuss things that they might not otherwise discuss with me. Like the woman today, she had a blood pressure discussion with me. She might not otherwise discuss this with me but they want my input. Even though they know I’m not managing their blood pressure, usually most of my patients have a cardiologist, but they want my input because they value it; so it fosters a closer relationship with all my patients as they trust me and it extends the conversation beyond the CPAP element. I think it helps the patient to comply more every day since they have comfort that you are watching them. If nothing else a lot of times they will often forget why they use the CPAP and then it fosters a discussion. They often think it’s their lungs and don’t realize that it is a breathing problem. It allows me to focus and reiterate that Sleep Apnea has nothing to do with your lungs, as your sleep doctor and being on a CPAP I could care less what your lung function is as it has nothing to do with lungs. I then focus on all of the benefits of the CPAP, so many of them being cardiovascular; this includes monitoring their pulse which is data VitalStream provides since it gets picked up by the blood pressure cuff.
How do you use VitalStream specifically?
When I am seeing a patient, I will go into VitalStream and I will pull up the patient’s report. I do a visualization of the past month, three months, six months and usually I will download a six month report unless I’ve seen them less than that. Then I review the report with them when they’re in the office or when I get an update from the VitalStream nurse. If I don’t have an appointment with the patient, I can download the data in the PDF form, attach it to an email to the patient and say “Hey I got a call from the nurse and we’re looking at your data. This is what I see over the past months, please see the attachment. I want you to call your cardiologist or call your primary care and you go over this with them so that they can better manage what we are seeing here.”
Has your relationship with other Physicians changed?
My relationship with other physicians is enhanced because I’m getting data from VitalStream which allows greater interaction with them. The cardiologist whose practice does not have access to RPM is anxious to know my data. VitalStream allows me to share patient data with them so that they can better manage the patient as well. Most of these other practices don’t have the ability to participate in RPM because they’re in a bigger type of practice without the flexibility to decide to participate in RPM .
What is the impact of medication and how does VitalStream RPM change this?
You know a little bit of pressure from the CPAP reduces Hypertension so then medication needs to be adjusted otherwise the patient is overmedicated. If their blood pressure is too low the outcomes are potentially tragic; low blood pressure causes blood to run out of their brain. God decides to put them flat by having them pass out and they can break something and if a 90 year old broke their hip, its end of life. So you know in terms of the benefit it could be huge because you could stop somebody from having too low blood pressure and knowing about it reduces the chance of an accident. What’s more you can simplify an extensive medication list. It’s not uncommon to have a patient on 20 medications and they’re on three different medicines to slow down their heart rate and depending on who’s making the changes, sometimes it’s a battle between the primary care physician and cardiologist. If neither of those practices are using the RPM like I am, I can pick up on trends and I’ll discuss it with them and then at least point them in the right direction and say “look this is what you need to do”. It allows us to simplify the medications that the patient is taking. Actually a female patient I saw today is going to be able to come off one medication. Depending on the medicine, whether it’s generic or not, it could be savings for the patients. You know some of these medications are not inexpensive so saving of $50 a month adds up over 12 months.
How does VitalStream help in compliance with CPAP or other PAPs?
So blood pressure readings map to the CPAP readings. When someone’s not using their CPAP properly I know because their blood pressure does not improve or the blood pressure goes up. We note this especially if they have been really compliant with the CPAP and then for some reason they can’t use it. For example, a patient might have some type of dermatologic surgery on their face and they can’t wear the CPAP for a month while healing, you’ll see their blood pressure reading rise maybe 2 to 10 particularly the systolic. I have seen that the CPAP is not as effective, by seeing the blood pressure rise if something changes within the patient, and the prior settings of the CPAP are inadequate. So for example if someone gains 20 or 30 pounds the CPAP may become less effective and then their blood pressure and pulse will go up - that’ll be a big deal.
If they develop a new problem they didn’t have before, for example, they have a heart attack and it puts them in the hospital for a week and they come out after that. Maybe their heart isn’t working as well and they have heart failure, now that’ll show up on both the CPAP and the blood pressure readings.
What would you do then? Do you adjust the CPAP? It depends, after the heart attack or stroke I might even need to do a whole new sleep study. Their machine may not be appropriate anymore. I know we’re talking about CPAP a lot but that’s just one form of PAP. There are lots of types of PAP and sometimes CPAP isn’t appropriate for the patient and they may have to go on a little bit more complex treatment. So when I see that the blood pressure statistics from RPM are not coming into play, that forces me to go back and look at the PAP and say OK something needs to be adjusted or question whether it’s even the right PAP. Having the blood pressure data from RPM allows me to properly adjust the treatment.
Do you think real time O2 readings would help your practice?
I really try not to dabble too much with oxygen saturation in my sleep patient because sleep is a breathing problem, it’s not a lung problem. Patients are so easily confused so I try to really drive home the difference between a lung problem and a sleep problem; my patients have a breathing problem and it is completely different.
Do you do telehealth?
Yes, I do Telehealth visits as that capability is part of the VitalStream Platform. Before the call we will email both the CPAP and the RPM blood pressure data just like I do in person for them to go over during the visit.
What EMR do you use?
I use Practice Fusion and print out a PDF from VitalStream and add to their notes by uploading it in Practice Fusion. I must do the same upload with the CPAP, depending on the company; whether it’s Respironics or ResMed, I download it from Luna on their individual PM sites.
Do you think automating the download would make your life easier? I don’t know how to streamline it and making it easier vs making it more complex and not make it any better. It could easily confuse me so I don’t mind just doing the simple upload. The VitalStream site is just as easy for me to use as the various Device sites.
What feedback do you hear from your patients about VitalStream?
Number one, they like the immediate data, they like seeing their own readings and knowing everything is good. They also like knowing that it’s being monitored both from my end as well as the nurse with the VitalStream service; specifically they like the VitalStream nurse who has a great rapport with all the patients. They know that this allows them to better monitor their own health. The only negative feedback is from the occasional patient who doesn’t want to talk to the nurse, so I explain to them it’s part of the program: “Do you want the government to pay for it? That’s the price. If not, you can go buy blood pressure cuff yourself, and do all your own reporting and you’ve got to write down everything. It’s not going to be a nice concise report we can generate, but that’s up to you.” It’s not too many people to be honest.
What factors influence whether or not you recommend RPM to them?
First off, will they benefit? Not all my apnea patients have cardiac problems even though that’s the risk. They don’t have high blood pressure; not a huge amount, but maybe 10 to 15%. If that’s the case, I’m not necessarily going to see any benefit that I don’t learn with my CPAP. You know when patients aren’t symptomatic or they don’t have medical problems even if it’s not an everyday feeling symptom, they don’t see the benefit. So the biggest difficultly I have with the CPAP is when the patients aren’t tired because when they’re not tired, they don’t get immediate benefit of CPAP. Then it’s well - “you need to trust me that the CPAP is helping your high blood pressure, helping your stroke or this is helping” - you’ve got to convince them of it. Most are open to it at least when they see immediate impact, for example when they’re tired and the CPAP stops that after day 2 or day 3, I don’t need to convince them to use their CPAP; they come in and say “you can take my spouse but you’re not taking my CPAP because I haven’t felt this good in years.” Same thing with the RPM. When they see the benefit because they’re getting better control of their blood pressure and they dropped a medicine it’s easier to get them to do it. If I think there is going to be a big benefit, I might push it. I might say: “This is why I think you really need this…” When I take the time, I talk to my patient face to face and avoid my computer. Every minute with them is their time so I don’t shortchange them and I take my work with me. I get very good compliance with whatever I’m administering whether RPM or the CPAP.
How else would you like to see VitalStream utilized?
Usually Medicare sets the standards. So if Medicare says patients get a new CPAP in five years well then the private payers follow suit and get their patients a new CPAP after five years as well. I’d love to see VitalStream for all my non-Medicare patients as they’re going to benefit the most from RPM. I saw a guy today, late 30s, ridiculously overweight at about 280 pounds. He was 5’4” and has horrible apnea; 58 times an hour so once a minute and he already has got blood pressure problems. He’s going to benefit more than my 80 year old, so I’d love to see the private payers go ahead and accept RPM.
What works well in motivating Patients to take their blood pressure readings?
Because as part of the program we have to get 16 readings a month we try to encourage them to utilize it just like they utilize their CPAP; you know at least every other day. For example, Monday, Wednesday, Friday take your blood pressure each day or Tuesday, Thursday, Saturday - whatever the case may be, so it’s not that hard to be honest.
Do you think there is a difference for general CPAP adherence vs RPM?
The patient who is problematic for CPAP is also going to be problematic for the RPM. The patient that drops out of the RPM program will drop out the CPAP as well. I do not beg people to wear their CPAP. I offer them a solution: “This is a tool that will benefit you if you value your health and you think this is going to help us manage it. I’m not going to make you do it; if you go home tonight and you don’t use it and you have apnea that’s OK too. I say this three times a day - your health is just that, it’s your health. The government hasn’t taken over that yet and you have a choice and I’m here to help but whether you go home and wear your CPAP tonight doesn’t affect me at all. I’m here to help you, but I’m not going to drag you along.”
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