Thought Leadership

8 Insights from Vancouver Coastal Health’s Richmond Hospital on using Remote Symptom Monitoring to Transform Oncology Care

June 12, 2024
By
Seamless

On a recent webinar hosted by Digital Health Canada, Dr. Jeremy Ho, a Medical Oncologist at Vancouver Coastal Health and the Richmond Hospital Cancer Care Clinic, shared insights and lessons learned on their use of Remote Symptom Monitoring (powered by SeamlessMD) to enhance the cancer journey for patients.

Remote Symptom Monitoring involves leveraging a patient’s own smartphone, tablet or computer to send patients reminders, deliver education, collect Patient-Reported Outcome Measures (PROMs) and remotely monitor symptoms - such as for side effects after chemotherapy treatment cycles.

Called RESPONSe: REmote Symptom and Patient mONitoring System, the goal of the program is to: “provide better patient centered care through the prompt management of treatment related symptoms with the goal of reducing symptom burden and ultimately decreasing the need for acute care visits.”

The RESPONSe program was also recently recognized by British Columbia Minister of Health Adrian Dix as a key innovation to support the opening of the new Richmond Cancer Clinic.

You can watch the whole webinar here. Below are 8 insights that Dr. Ho shared:

1. There is a significant gap in communication between patients and the oncology team – especially between treatment cycles

Dr. Ho’s oncology program had done patient focus group interviews which found:

  • 60% of patients had at least 1 episode where they wished they had more timely care or responses from the clinic
  • 40% of patients did not want to “bother” the clinic to ask about their symptoms
  • 60% of patients felt that some of their symptoms from treatment could have been prevent with better care

Dr. Ho further explained: “We realized that even though we were trying to provide the best patient care, we weren’t meeting all of our patients’ needs. Our chemotherapy nurses were responsible for managing side effects of treatment, but as they became busier with more patients trying to deliver more chemotherapy, patients let us know they weren’t getting the care that they required.”

The oncology team realized that they needed a more proactive way to better support patients between treatment cycles and close the communication gap – eventually turning to technology.

“We knew we had to do better for our patients… We landed on the idea of moving from a REACTIVE to a PROACTIVE model of symptom management through the use of digital technology.”

2. Digital health also enables oncology programs to meet ASCO recommendations for collecting PROMs

Dr. Ho explained that the American Society of Clinical Oncology’s (ASCO) has long advocate for oncology programs to collect patient-reported outcome measures (PROMs) because their use has been associated with improved patient-provider communication, quality of life, lower symptom burden, lower use of acute care services and improved survival.

Implementing Remote Symptom Monitoring allowed the Richmond Cancer Clinic to quickly start collecting PROMs digitally – making it more convenient for both patients and clinicians to benefit from PROMs.

3. Remote Symptom Monitoring workflows and algorithms work best when thoughtfully designed to fit in the existing clinical workflow and patient journey

Here’s the Remote Symptom Monitoring approach the oncology team took:

  • Patients access the SeamlessMD app on their smartphone, tablet or desktop computer
  • The app is personalized to the patient based on reminders, education, PROMs and symptom monitoring workflows vetted by the oncology team
  • While at home, patients are prompted to complete symptom questionnaires at certain time points after each treatment cycle
  • Questionnaires are timed for the highest points of expected side effects: 3 days and 10 days after each chemotherapy treatment cycle 
  • The patient’s responses are run through algorithms, which based on the severity of the patient’s symptoms can lead to a few possible outcomes:some text
    • For minor symptoms, patients get automated, evidence-based education on how to manage at home (e.g. minor constipation)
    • For more severe symptoms, an alert is generated that notifies the care team to review the symptoms on a dashboard and proactively call the patient (e.g. uncontrolled pain)
  • Patients can also complete a symptom questionnaire at any time in case they suddenly develop new symptoms or side effects

4. PROMs collected before a doctor’s visit can be used to enhance the clinical encounter

The oncology team also has the platform prompt the patient to complete a survey 2 days before their next doctor’s visit so they can share any concerns ahead of time – leading to a more productive conversation during the actual encounter.

5. Engaging patients with comprehensive, digital education provides a more complete patient experience

While some oncology programs that provide Remote Symptom Monitoring focus only on tracking symptoms, Dr. Ho explained how the Richmond Cancer Clinic wanted to ensure patients were continuously empowered with the right patient education:

“Patients have access at any time to our comprehensive digital library which includes extensive resources about cancer, practicalities of cancer treatment and how to manage side effects.”

6. Intelligent symptom branching allows Remote Symptom Monitoring to minimize questions and maximize utility for patients

Dr. Ho shared how his team did not want to simply collect PROMs. Rather, they used branching (or adaptive logic) functionality to design 13 unique symptom questioning branches that would be useful to alter the clinical response to patients in a meaningful way. The team used the COSTARs symptom practice guide to help inform the approach.

For example, if a patient reports having constipation, they automatically receive follow up questions on severity, days since last bowel movement, presence of abdominal pain, and so on.

From there, the platform automatically provides an action plan based on the severity – from providing self-care management education directly to patients for low-severity to prompting the oncology team to contact the patients for high-severity.

7. Patient engagement and satisfaction with Remote Symptom Monitoring is high

Already the Richmond Cancer Clinic has demonstrated incredible results over the first 30 patients (as of March 31, 2024):

  • 92% of patients activated and engaged
  • 79% of patients completing symptom & PROMs questionnaires
  • 22 education pages read on average by each patient

The patient feedback has also been fantastic. As one patient shared: “I feel extremely confident managing my symptoms as I go through treatment, because I noticed the symptom management nurse responded quickly.”

8. Nurses and physicians find that Remote Symptom Monitoring allows them to focus more on direct patient care instead of fielding phone calls

Anecdotal reports from patients, nurses and physicians show the program to have many benefits, including:

  1. Patients feel that they are being supported by the clinic through their treatment
  2. Patients appreciate automatic contact from nurses when they report a problem
  3. Patients find reassurance in being directed to relevant library resources depending on their issue
  4. Chemotherapy nurses can focus on administering IV treatment without interruptions
  5. Physicians find the symptom management nurse an effective go-between for assessing and managing patient symptoms
  6. Physicians recognizing the utility of being able to review PROMs results prior to a patient appointment

Dr. Ho further explained: “Our chemotherapy nurses find they can focus on administering chemotherapy to the patients in front of them instead of managing the phone line. Physicians find that this has taken work off our plate since the symptom management nurses doing the monitoring is an effective go-between for assessing and managing patient symptoms.”

Want to bring Remote Symptom Monitoring to your Oncology program?

Vancouver Coastal Health and the Richmond Cancer Clinic partnered with SeamlessMD for their Remote Symptom Monitoring program.

If you are keen to learn how we could help you do the same, contact us here.

For more information about how SeamlessMD supports oncology programs, click here to learn more.

8 Insights from Vancouver Coastal Health’s Richmond Hospital on using Remote Symptom Monitoring to Transform Oncology Care

Posted by:
Seamless
on
June 12, 2024

On a recent webinar hosted by Digital Health Canada, Dr. Jeremy Ho, a Medical Oncologist at Vancouver Coastal Health and the Richmond Hospital Cancer Care Clinic, shared insights and lessons learned on their use of Remote Symptom Monitoring (powered by SeamlessMD) to enhance the cancer journey for patients.

Remote Symptom Monitoring involves leveraging a patient’s own smartphone, tablet or computer to send patients reminders, deliver education, collect Patient-Reported Outcome Measures (PROMs) and remotely monitor symptoms - such as for side effects after chemotherapy treatment cycles.

Called RESPONSe: REmote Symptom and Patient mONitoring System, the goal of the program is to: “provide better patient centered care through the prompt management of treatment related symptoms with the goal of reducing symptom burden and ultimately decreasing the need for acute care visits.”

The RESPONSe program was also recently recognized by British Columbia Minister of Health Adrian Dix as a key innovation to support the opening of the new Richmond Cancer Clinic.

You can watch the whole webinar here. Below are 8 insights that Dr. Ho shared:

1. There is a significant gap in communication between patients and the oncology team – especially between treatment cycles

Dr. Ho’s oncology program had done patient focus group interviews which found:

  • 60% of patients had at least 1 episode where they wished they had more timely care or responses from the clinic
  • 40% of patients did not want to “bother” the clinic to ask about their symptoms
  • 60% of patients felt that some of their symptoms from treatment could have been prevent with better care

Dr. Ho further explained: “We realized that even though we were trying to provide the best patient care, we weren’t meeting all of our patients’ needs. Our chemotherapy nurses were responsible for managing side effects of treatment, but as they became busier with more patients trying to deliver more chemotherapy, patients let us know they weren’t getting the care that they required.”

The oncology team realized that they needed a more proactive way to better support patients between treatment cycles and close the communication gap – eventually turning to technology.

“We knew we had to do better for our patients… We landed on the idea of moving from a REACTIVE to a PROACTIVE model of symptom management through the use of digital technology.”

2. Digital health also enables oncology programs to meet ASCO recommendations for collecting PROMs

Dr. Ho explained that the American Society of Clinical Oncology’s (ASCO) has long advocate for oncology programs to collect patient-reported outcome measures (PROMs) because their use has been associated with improved patient-provider communication, quality of life, lower symptom burden, lower use of acute care services and improved survival.

Implementing Remote Symptom Monitoring allowed the Richmond Cancer Clinic to quickly start collecting PROMs digitally – making it more convenient for both patients and clinicians to benefit from PROMs.

3. Remote Symptom Monitoring workflows and algorithms work best when thoughtfully designed to fit in the existing clinical workflow and patient journey

Here’s the Remote Symptom Monitoring approach the oncology team took:

  • Patients access the SeamlessMD app on their smartphone, tablet or desktop computer
  • The app is personalized to the patient based on reminders, education, PROMs and symptom monitoring workflows vetted by the oncology team
  • While at home, patients are prompted to complete symptom questionnaires at certain time points after each treatment cycle
  • Questionnaires are timed for the highest points of expected side effects: 3 days and 10 days after each chemotherapy treatment cycle 
  • The patient’s responses are run through algorithms, which based on the severity of the patient’s symptoms can lead to a few possible outcomes:some text
    • For minor symptoms, patients get automated, evidence-based education on how to manage at home (e.g. minor constipation)
    • For more severe symptoms, an alert is generated that notifies the care team to review the symptoms on a dashboard and proactively call the patient (e.g. uncontrolled pain)
  • Patients can also complete a symptom questionnaire at any time in case they suddenly develop new symptoms or side effects

4. PROMs collected before a doctor’s visit can be used to enhance the clinical encounter

The oncology team also has the platform prompt the patient to complete a survey 2 days before their next doctor’s visit so they can share any concerns ahead of time – leading to a more productive conversation during the actual encounter.

5. Engaging patients with comprehensive, digital education provides a more complete patient experience

While some oncology programs that provide Remote Symptom Monitoring focus only on tracking symptoms, Dr. Ho explained how the Richmond Cancer Clinic wanted to ensure patients were continuously empowered with the right patient education:

“Patients have access at any time to our comprehensive digital library which includes extensive resources about cancer, practicalities of cancer treatment and how to manage side effects.”

6. Intelligent symptom branching allows Remote Symptom Monitoring to minimize questions and maximize utility for patients

Dr. Ho shared how his team did not want to simply collect PROMs. Rather, they used branching (or adaptive logic) functionality to design 13 unique symptom questioning branches that would be useful to alter the clinical response to patients in a meaningful way. The team used the COSTARs symptom practice guide to help inform the approach.

For example, if a patient reports having constipation, they automatically receive follow up questions on severity, days since last bowel movement, presence of abdominal pain, and so on.

From there, the platform automatically provides an action plan based on the severity – from providing self-care management education directly to patients for low-severity to prompting the oncology team to contact the patients for high-severity.

7. Patient engagement and satisfaction with Remote Symptom Monitoring is high

Already the Richmond Cancer Clinic has demonstrated incredible results over the first 30 patients (as of March 31, 2024):

  • 92% of patients activated and engaged
  • 79% of patients completing symptom & PROMs questionnaires
  • 22 education pages read on average by each patient

The patient feedback has also been fantastic. As one patient shared: “I feel extremely confident managing my symptoms as I go through treatment, because I noticed the symptom management nurse responded quickly.”

8. Nurses and physicians find that Remote Symptom Monitoring allows them to focus more on direct patient care instead of fielding phone calls

Anecdotal reports from patients, nurses and physicians show the program to have many benefits, including:

  1. Patients feel that they are being supported by the clinic through their treatment
  2. Patients appreciate automatic contact from nurses when they report a problem
  3. Patients find reassurance in being directed to relevant library resources depending on their issue
  4. Chemotherapy nurses can focus on administering IV treatment without interruptions
  5. Physicians find the symptom management nurse an effective go-between for assessing and managing patient symptoms
  6. Physicians recognizing the utility of being able to review PROMs results prior to a patient appointment

Dr. Ho further explained: “Our chemotherapy nurses find they can focus on administering chemotherapy to the patients in front of them instead of managing the phone line. Physicians find that this has taken work off our plate since the symptom management nurses doing the monitoring is an effective go-between for assessing and managing patient symptoms.”

Want to bring Remote Symptom Monitoring to your Oncology program?

Vancouver Coastal Health and the Richmond Cancer Clinic partnered with SeamlessMD for their Remote Symptom Monitoring program.

If you are keen to learn how we could help you do the same, contact us here.

For more information about how SeamlessMD supports oncology programs, click here to learn more.

Recent news from SeamlessMD

TDP 135: Baptist Memorial's CMIO, Dr. Jake Lancaster: Adapting How You Talk About AI to Get Stakeholder Adoption, Saving Nurses 20 Minutes Per Shift Without Tech, and Exploring Systemic Healthcare Issues Through Fiction
July 11, 2024

TDP 135: Baptist Memorial's CMIO, Dr. Jake Lancaster: Adapting How You Talk About AI to Get Stakeholder Adoption, Saving Nurses 20 Minutes Per Shift Without Tech, and Exploring Systemic Healthcare Issues Through Fiction

Learn More
TDP 134: UMass Memorial Health Care’s CQO & CCIO, Dr. Eric Alper: Strategies for Scaling Hospital at Home, Exploring the Intersection of Informatics and Quality, and How Incentives Drive Patient Care
June 27, 2024

TDP 134: UMass Memorial Health Care’s CQO & CCIO, Dr. Eric Alper: Strategies for Scaling Hospital at Home, Exploring the Intersection of Informatics and Quality, and How Incentives Drive Patient Care

Learn More
TDP 133: Memorial Healthcare System's CMIO, Dr. Jennifer Goldman:  Eliminating Over 800,000 Daily Clicks, Actioning SDoH Data, and Mastering Change Management in a WFH Environment
June 20, 2024

TDP 133: Memorial Healthcare System's CMIO, Dr. Jennifer Goldman: Eliminating Over 800,000 Daily Clicks, Actioning SDoH Data, and Mastering Change Management in a WFH Environment

Learn More