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PA R T 1 / WA R M - U PThe Path toImplementationThe following step-by-stepprocess is intended to guide yourpractice through the implementationof a digital health solution.As this is part of Digital HealthImplementation Playbook Series,the steps to implementation willlikely remain the same throughoutthe series, however each Playbookwill focus on a different digitalhealth modality.The first six steps in Part 2 arefundamental to the implementationof remote patient monitoring.The subsequent six steps in Part3 focus on specific details and theunique considerations relevantto implementing remote patientmonitoring in practice.10While we have displayed thesesteps chronologically, we knowthat the real world is not alwaysstraightforward. Use this process asa guide while understanding that:q The order of steps mayshift based on yourpractice or organizationq Some steps may overlap or maybe executed simultaneouslyq Some steps may take moreor less time than othersq You may need to reiterateor circle back to an earlierstep when expanding yourprogram or if challenges ariseWe recommend readingthrough the Playbook in its entiretybefore embarking on the pathto implementation, so you knowwhat lies ahead. Then, once you’vecommenced the process in practice,refer to each step in Part 2 andPart 3 for best practices, checklistsfor success, and practice spotlightstories to guide you along your way.

TIMELINE OF STEPSPA R T 2IDENTIFYING A NEEDWhat’s the problem?FORMING THE TEAMWho needs to be involvedand when?D E F I N I N G S U CC E S SWhat are we trying to achieve?E VA LUAT I N G T H E V E N D O RWhat’s the right technology?MAKING THE CASEHow do we get political andfinancial buy-in?CO N T R AC T I N GWhat’s our expected timing,budget, and plan with our vendor?PA R T 3D E S I G N I N G T H E W O R K F LO WWhat will need to change tointegrate this technology?P R E PA R I N G T H E C A R E T E A MDoes everyone know what theyneed to do to make this successful?PA R T N E R I N G W I T H T H E PAT I E N TWhat does the patient need?IMPLEMENTINGHow does it work in practice?E VA LUAT I N G S U CC E S SDid it work?SCALINGWhat’s next?11

Part 2:Pre-gameThe following six steps willserve as the general foundationfor implementing remote patientmonitoring in practice and willprepare you to embark on thesteps outlined in Part 3,which will help you plan tooperationalize RPM inyour environment.12

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PA R T 2 / P R E - G A M ESTEP 1: IDENTIFYING A NEEDStep 1:Identifyinga NeedGround your remote patientmonitoring in a true need.Start by identifying concrete areas where yourpatients may benefit from remote patientmonitoring. Brainstorm a list of your organization’schallenges—where you lose efficiency, whereyour staff encounter pain points, or where patients’health or satisfaction suffers. The focus on needwill help you avoid the temptation to experimentwith new technologies that ultimately won’t resultin tangible improvements to the efficacy of yourorganization or the health and satisfaction ofyour patients. Before adopting RPM, firstidentify what areas your organizationneeds to address or improve, envisionthe outcome you hope to achieve, andthen look for the right technologythat is capable of delivering thatsolution.14

GOALS TO ACCOMPLISH DURING IDENTIFYING A NEEDq Solicit feedback from staff to identify the biggest pain points andopportunities that exist in your organization (Appendix A.1)q Identify areas of opportunity from patients via satisfaction and/or experience survey responses and ensure that responsesare reflective of the diversity within your patient populationq Prioritize your list of pain points and opportunitiesbased on severity of need and fit with the strategicgoals of the organization (Appendix A.2)q Select a problem that, if solved, would have the greatestvalue to your entire organization and patientsq Envision the expected outcome(s) if that problem were addressedq Research digital health solutions capable ofdelivering the desired outcomeWHY IDENTIFYING A NEED IS IMPORTANTPrioritize resources by centering your initiativearound a true organizational need.This practice also: Brings purpose and context to the project Helps crystalize buy-in from key stakeholders Incites long-term stability for the project15

PA R T 2 / P R E - G A M ESTEP 1: IDENTIFYING A NEEDIdentifyinga NeedBEST PRACTICEAVOIDING A MISSTEPLARGE PRACTICE CALLOUTPrioritize areas or usecases identified byfrontline staff that alignwith your organization’sstrategic goals.Be wary of flashynew technology thatpromise to make hugeimprovements.Prioritization can beespecially difficult forlarge organizations.This ensures time and moneyinvested into any newimplementation will delivermaximum value throughout theentire organization.16The newest technology can bevery compelling. To avoid wastingtime solving a problem that youdon’t really have, take the time todo your due diligence and makesure it is a good fit for your needs.It is difficult when key decisionmakers may not regularlyinteract with front-line staff. Seekfeedback from care teams toavoid misalignment between theorganization’s strategic prioritiesand the day-to-day needs of staffand patients.

QUICK TIPLook to yournetwork.Seek out colleagueswithin or at practicessimilar to yours whohave previouslycounseled or executedthe implementationof RPM. Foster opencommunication withthese advisors. If you areaffiliated with anotherpractice or healthsystem, explore howthey might supportyour implementationwith existing programsand/or technology.Throughout theimplementation process,rely on their experienceand advice as you runinto challenges.PracticeSpotlightEngage end users to generate buy-in.Many health organizations want to implement meaningfulimprovements but struggle to prioritize which initiatives to pursuefirst. In order to better align strategic and implementation goals,some organizations hold annual staff hackathons, competitions, oracceleration programs. These organizations encourage their staffto submit day-to-day pain points, challenges, or opportunities.Administrators and executives evaluate these submissions todetermine which areas cause the most pain, and therefore, are mostin need of a solution. By sourcing priorities from the bottom up, theseorganizations tend to better understand their needs and foster moreengagement among their staff. Most importantly, these organizationsmake more informed decisions about which initiatives to prioritizebased on the real needs of their staff and patients.— N I C K D O U G H E R T Y, M A N AG I N G D I R E C TO R , M A S S C H A L L E N G EH E A LT H T E C H17

PA R T 2 / P R E - G A M ESTEP 2: FORMING THE TEAMStep 2:Formingthe TeamThe success of any implementationdepends on engaging the right people.Although one person can be accountable fordriving the process forward, the process itself is agroup effort. While you won’t need to directlyengage all the teams right away, it’s helpfulto identify who will be on which teamsand consider when and how differentplayers will be involved. (AppendixB.3) Consider organizing your keystakeholders into four teams:Core, Leadership, Advisory, andImplementation based on thecriteria and responsibilitiesoutlined in Appendix B.1.18

GOALS TO ACCOMPLISHDURING FORMING THE TEAMq Identify the key members of yourCore, Leadership, Advisory, andImplementation teams (Appendix B.2)q Outline and communicate theresponsibilities and time commitmentrequired of each team memberq Set up regular meetings with your Core teamq Solicit input from your Implementation teamWHY FORMING THE TEAMIS IMPORTANTHaving the right peopleinvolved upfrontprovides diverseperspectives.These different viewpoints arecritical to the development,selection, and implementation ofRPM, as they help to: Anticipate barriers from allangles Facilitate buy-in Minimize workflow disruptionduring implementationq Set key checkpoints with the Advisory teamq Pre-seed your program intent with keymembers of your Leadership team19

PA R T 2 / P R E - G A M ESTEP 2: FORMING THE TEAMForming the TeamBEST PRACTICEKeep the enduser in mind.The foundation of your implementation should beinformed by the people you are designing for, so thesolution is tailored to suit their needs. Consider whowill be most impacted by the new technology—including staff and patients—and solicit feedbackearly on. Or, ask representatives for these individualsto sit on the Advisory or Core teams so you cankeep their needs top of mind throughout theimplementation process. Successful RPM will relyon patient engagement, so talk to a diverse set ofpatients to ensure equitable access to the program.20AVOIDING A MISSTEPCarefully considerwho needs to be at the table.It’s possible to have too many players involved, whichcould slow down the process. Alternatively, missing akey person or role during the planning stages can resultin rework or difficulties with developing buy-in.

“If you don’t have the right people involved upfront, you’ll face pushback down the road.”— D R . K AT I E R I C H A R D S O N , H E A LT H C A R E I N N O VAT I O N L E A D E R ,CO LO R A D O P E R M A N E N T E M E D I C A L G R O U PPracticeSpotlightQUICK TIPPre-seed yourimplementationidea with theLeadershipteam.Use standing meetingsor casual conversationsto keep Leadership teammembers updated onyour program rather thankeep it a secret. Shareyour intent and provideinitial exposure to yourimplementation beforeseeking official approvalto secure high-levelsponsorship and increasebuy-in potential.In many organizations, the implementation ofnew technology is set by upper management.For instance, when Sarah Ortiz, a health care administrator, wasinterested in using a different remote monitoring system, shediscovered that a group consisting of a senior director, senior projectmanager, and one physician solely determined which technologieswere used across all clinics in her organization. As a result, practicemanagers often had to backtrack and meet with the care teams todiscuss the project, scope, roles, and importance of teamwork andhost Q&A sessions with vendor representatives. To avoid a great dealof inefficiency, she recommended that the individuals responsiblefor selecting new technology engage their end users early on forperspective and incorporate their feedback prior to implementation.— S A R A H O R T I Z , H E A LT H C A R E A D M I N I S T R ATO R21

PA R T 2 / P R E - G A M ESTEP 3: DEFINING SUCCESSStep 3:DefiningSuccessDefine what success looks like early.Once you’re aligned with your Core team onan overall vision for success, use this phase toset specific short- and long-term goals withmeasurable metrics metrics using the AMA Returnon Health framework (Appendix E.3) and a processfor tracking your progress to guide your teamalong the way.22

GOALS TO ACCOMPLISHDURING DEFINING SUCCESSq Research the the various ways RPMcan deliver value for your practiceor organization (Appendix E.3)q Identify 3–5 goals that are most importantfor your entire practice or organizationq Identify which metrics are most appropriatefor assessing progress toward these goalsq Ensure each goal is S.M.A.R.T. (Appendix C.2)q Set up a process or system to collect dataand track progress against the goals aboveq Establish specific checkpoints to collect dataq Set clear endpoint criteria to re-evaluateas needed or to scale the programq Plan for how and when you’ll establishbaseline metrics as a comparisonpoint for your program’s successWHY DEFINING SUCCESSIS IMPORTANTEnvisioning successbrings clarity to the goalyou are trying to achieve.This helps: Identify the right vendors Rally the team around acommon goal Bring rigor to tracking metrics23

PA R T 2 / P R E - G A M ESTEP 3: DEFINING SUCCESSDefining SuccessBEST PRACTICEAlign your goals to theQuadruple Aim of Health Care,inclusive of health equity.By focusing on health outcomes, improving thepatient experience, reducing cost and/or increasingprovider satisfaction, you will inevitably impact theend user, care team or patient, in a positive way. Thesegoals are also more likely to align with the strategicimperatives of your organization which will be anadvantage when seeking approval and resources laterin the process. (Appendix C.1)QUICK TIPExplore how digitalhealth solutions fit intogovernment programs.24AVOIDING A MISSTEPDon’t skip this step!Failing to establish a clear vision for successand a way to measure progress can lead to confusion,the need to rework, and frustration, which canultimately jeopardize the fate of your implementation.See how digital health solutions (i.e., remote patientmonitoring) could help your practice or organization meetthe participation requirements for programs such as theQuality Payment Program (QPP), Merit-based IncentivePayment System (MIPS), and/or Alternative PaymentModels (APMs).

“What’s the destination? Where am I headed? Implementation isabout picking your destination and knowing where you’re goingand then working your way backwards on how to get there.”— D R . R A N D A L L W I L L I A M S , C A R D I O LO G I S T,D I G I TA L H E A LT H F O U N D AT I O NPracticeSpotlightAmidst the many considerations associated with theimplementation of digital health—patient privacy, clinicalworkflow, financial viability, etc.—it’s tempting to approach onestep at a time, while neglecting to consider the larger picture.When executing a digital health solution in the treatment of diabetes and hypertension, the implementation teamat Froedtert & Medical College of Wisconsin knew it was important to envision what success looked like upfront.Otherwise, they risked being derailed by several items, including how quickly to react to patient shared data, how todesign and coordinate cross team workflows, as well as how to demonstrate the value of using the tool to patients.As a result of beginning with the end in mind, they now have promising data to demonstrate the benefit of digitalsolutions, which is encouraging patients and the organization to think beyond current care delivery models in favorof a more digitally enabled, patient-centric approach.— I M P L E M E N TAT I O N T E A M , F R O E DT E R T & M E D I C A L CO L L E G E O F W I S CO N S I N25

PA R T 2 / P R E - G A M ES T E P 4 : E VA LUAT I N G T H E V E N D O RStep 4:Evaluatingthe VendorEvaluate possible vendors across keycriteria that will enable your goals.Go into the process with the intent of findingsomeone who will be a long-term partner andnot just someone to execute a transaction. Selecta shortlist of quality RPM products/vendors byspeaking with organizations or practices similarto yours. Alternatively, attending health caretechnology conferences like HIMSS (andlocal HIMSS chapters), HLTH, or RockHealth; collaborating with a health careaccelerator or incubator; or leveragingthe AMA’s Physician InnovationNetwork12 to connect with one of1,500 companies, can exposeyou to possible vendors andpractical solutions.26

GOALS TO ACCOMPLISH DURINGEVALUATING THE VENDORWHY EVALUATING THEVENDOR IS IMPORTANTq Research potential vendorsSelect a vendor who isworthy of a long-termpartnership.q Build a Request for Proposal (RFP), clearlyoutlining the goals you identified in Step 3q Send RFPs to vendors that mostclosely align to your goalsq Review RFP responses alongsidekey representatives from theCore and Advisory teamsThis ensures you will have: An expert resource always onhand in challenging situations Support throughout theimplementation process, fromstart to finish (and beyond) A partner who is equallymotivated as you to achieve asuccessful outcomeq Ask for case studies and referralsq Schedule live vendor demos withselect members of the Core, Advisoryand Implementation teamsq Evaluate vendors across six criticalfactors: Business, Information Technology,Security, Usability, Customer Service, andClinical Validation (Appendix D.1)q Narrow your options to one or two preferredvendors to include in your pitch to leadership27

PA R T 2 / P R E - G A M ES T E P 4 : E VA LUAT I N G T H E V E N D O REvaluating the VendorBEST PRACTICEEvaluate vendors across six key variables to find your best partner.(Appendix D.2) If you’re struggling to identify a vendor that’s right for you, consider engagingexternal resources, such as as your state or specialty society, the Medical Group ManagementAssociation (MGMA), or the Xcertia mHealth App Guidelines, for support. Remember toincorporate legal feedback and security standards to make sure risk and liability is properlyassessed (Appendix E.2) and reference the AMA’s Privacy Principles.28BUSINESS:I N F O R M AT I O N T E C H N O LO G Y:U S A B I L I T Y: Organizational overview– tenure, funding source,financial stability, affiliations,notable customers, etc. Impact to program ROI—product cost, business model,reimbursement rates, risksharing, support paymentprogram participation, etc. Commitment toorganizational diversity,equity, and inclusion Ability to integrate withyour current IT landscape,particularly your EHR system Cost, process, and timelineassociated with integrationand product updates Ensure the data elementsof most importance to yourclinicians and patients canbe captured13 User experience of deviceand interface for patientsand care team members Patient and care teamengagement metrics Ability to engage with andencourage participationfrom patients Degree to which thistechnology/vendor will reducedisruption to existing workflow Diverse users considered inthe development and designof the technology and userexperienceC L I N I C A L VA L I D AT I O N :S E C U R I T Y: ( A P P E N D I X D. 3 )C U S TO M E R S E R V I C E : Documented clinicaloutcomes Published peer-reviewedresearch Product and outcomesresearch includespatients from historicallymarginalized andminoritized populations HIPAA compliance andprocess for ensuringprotection of confidentialpatient information Liability and processfor managing potentialsecurity breaches Level of support availableto practice during and afterimplementation—stafftraining, patient education,project management, dataanalysis and insights, etc. Degree of technical supportavai

digital health solutions including key steps, best practices, and resources to accelerate and achieve digital health adoption. WHO IS THIS PLAYBOOK FOR? This Playbook is intended for those who believe in the importance of digital health and its role in helping deli