Breaking Down Barriers with Digital Technology: Reimagining Chronic Care by Empowering Paramedics

(a) Situation faced: The case company, Future Health Services (FHS), provides tele-home monitoring services to chronically ill patients in Southern Ontario. As the population continues to age, the healthcare industry is committed to leveraging technological solutions to provide care for patients in the comfort of their own home. FHS offers a program through collaboration with paramedics that aims to improve patient care at home and quality of life as well as connect patients to a broader network of care providers to appropriate care delivery according to specific patient needs. In implementing this program, paramedic services started to transform and expand their traditional operating model. (b) Action taken: FHS introduced the Community Paramedic Remote Patient Monitoring program, called CPRPM. In this model, paramedics were required to onboard patients, work with patient doctors to establish clinical thresholds, and complete work required to set up and train patients to use remote monitoring devices to manage their condition from home. Once up and running, the CPRPM system alerted paramedics daily if the patient did not take their readings or one (or more) of their readings were outside the clinical threshold. This case will cover action taken by FHS to implement the program across six paramedic communities. (c) Results achieved: Integrating the CPRPM into the care model for patients with chronic disease and leveraging community paramedics as a point of local access, the pilot program saved an estimated $4.7M ($7279/patient) to the overall health system. The program helped patients with chronic disease feel more confident staying in their home and determine when they were at risk of exacerbation, and it was appropriate to seek help (call 911). Implementation success varied across paramedic communities as some communities embraced the change and generated significant benefits for patients and the overall healthcare system, whereas others generated less significant results. (d) Lessons learned: Topping the list of lessons learned is that digital transformation is messy, complicated, and difficult. Traditional business case and implementation planning needs to be refreshed with novel approaches inherent in design thinking and systems thinking. Forming partnerships will pave the path of least resistance, but finding the right partners is critical, and they may not be the ones that come top of mind. Feedback is an important mechanism for stitching together activity across stakeholders in an ecosystem. Finally, transformation initiatives need permission to play and explore, but leadership needs to define parameters to protect their best people and mitigate longer-term risks.