Sault Area Hospital explains how it uses technology to improve care through patient engagement before, during, and after hospitalization.


Many of the medical issues that surfaced during the pandemic were also left behind in its wake. Everything from clinician burnout and cognitive burden to healthcare worker shortages and hospital backlogs. Whether caused or exacerbated by the pandemic, we cannot sit back and hope these problems will solve themselves.

In 2021, as we attempted to find innovative ways to deal with the pandemic, we took advantage of an opportunity that ended up being far more successful than we had hoped.

During the COVID-19 lockdown, we have had to limit the number of people coming into our hospitals, leading to an increase in virtual care as a way to provide care and stay connected to patients. Now that we are welcoming patients back, the need and desire for virtual solutions remains. Especially as hospitals face a backlog of patients returning for surgeries and other procedures that have been delayed during the pandemic. Since then, we have advanced our intervention and evidence base and expanded our support for patients through remote care monitoring (RCM) capabilities.

As patient numbers increase, we need to find a balance between which patients need to stay in hospital and which can be transitioned home. Especially since we know that there are definite benefits to recovering at home. RCM solutions offer a safe way to achieve this, especially after surgery. This is one way hospitals can manage the demand on valuable resources.

Start with a solid strategy

The transition from hospital to home is a critical step in a patient's journey as it has a significant impact on recovery and the effectiveness of the healthcare system. That's why it was important to launch a surgical transition telemedicine monitoring program to ensure a smoother and safer transition from hospital to home.

In developing our strategy for the RCM program, we considered the areas where this would have the most immediate impact, acting as a catalyst to get things moving in the right direction. We decided to focus first on hip and knee replacements, which are one of the most common surgeries for our patients. While the need continues to increase as the population ages, patients undergoing these joint replacement surgeries are getting younger and younger.

For the program to be successful, it was essential to identify the right technologies that would engage patients during their recovery period, while also not placing unnecessary burden on doctors and other health care providers. This meant adopting a solution that integrated directly into the MEDITECH Expanse EHR and virtually guided and remotely monitored patients throughout their treatment. We chose SeamlessMD, a leading digital care platform.

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Creating ways to add value to clinicians is key, and SeamlessMD's integration with Expanse EHR does just that. But there is more than meets the eye. Providing clinicians with more information is not enough. If information isn't easy, it's not accessible. If it requires more than one or two clicks or is in any way cumbersome, the clinician will say ‘forget it’ and move on with their day. Integration overcomes potential obstacles by giving clinicians immediate access to valuable patient information without leaving the EHR.

The results speak for themselves. An initial evaluation of the surgical program comparing patients with RCM with those not enrolled showed the following improvements:

  • 72% reduction in 30-day emergency room visits
  • 64% reduction in 30-day readmissions
  • 8% reduction in length of stay

We have since deployed the RCM program across an additional 13 care pathways, including:
General surgery, cancer, women's health, chronic disease treatment, mental health. Most recently, we have expanded into medical programs focused on chronic obstructive pulmonary disease and congestive heart failure, and are creating new maternity pathways to better support pregnant women and their families through the multiple transitions of maternal care.

These innovations have also enabled an increase in the number of same-day surgeries. This is currently the case for most patients undergoing joint replacement surgery. Moreover, RCM programs have expanded home care or replaced home care services when they were not available. In other words, RCM can fill a gap in the care system by providing support with wound care and guidance on physical therapy exercises that patients can do at home.

Gain valuable insights

As part of the RCM program, providers send instructions and reminders to patients, receive alerts, and measure analytics through a dashboard launched in Expanse. Patients use their smartphones to manage their condition and complete health checkups. They receive clinical guidance and education throughout their recovery, including when to escalate concerns to a health care provider.

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Your care team will monitor your symptoms along with your recovery progress to identify changes in your health and intervene if necessary. And the ability to easily view detailed patient information without leaving the EHR has improved the delivery of clinical care without burdening clinicians.

The added value to our work is that the solution provides real-time data for clinical use. This is the difference between apps and programs that are not monitored and/or interventions that do not include real-time patient-reported outcome measures (PROMS), which are standardized, validated surveys used to study how patients feel about their health status.

Our head of orthopedic surgery, Dr. As Graham Elder points out, collecting data in real time can provide deeper insight into patients' daily behavior. These previously unknown details, which can be used to inform diagnosis and treatment, can be even more informative when clinicians are assessing unfamiliar patients.

Create a new level of patient engagement

To date, more than 2,000 patients have enrolled in the program and feedback has been overwhelmingly positive. In particular, patients say the program has helped them increase confidence and ease anxiety.

  • 94% felt the program helped them feel more confident before surgery.
  • 91% felt it helped them feel more confident at home after surgery.
  • 37% reported that their registration prevented them from calling the hospital more than once.

Here are some examples of what we regularly hear from RCM patients:

“Obviously this is a great program. Very helpful. It feels good to know that you are being tracked every day. If you have any questions about your care, help is just a click away.”

“Thank you to everyone who participated in the pre-operative, intra-operative and surgical transition programs. This program helped me overcome stress and anxiety. It reminded me of the importance of exercising and taking a walk every day. “I hope this program continues for a long time,” he said.

Stories like these inspire us to continue developing innovative, sustainable programs that improve health care for all. Our success is just one example of how RCM can enable a safer transition from hospital to home, while supporting patients to be active participants in their care journey. At a broader level, these programs can not only efficiently expand access to care, but also serve rural patient populations more effectively, especially as we continue to address health care workforce shortages.

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This is as important now as it was during the pandemic to avoid delays in treatment, which can often result in the need for higher levels of care. When the right technology is provided along with better educational materials and information, patients want to participate.

The solutions are here now and will work even after the pandemic. This is what patients expect. They want to use technology in ways that help them manage their health, just like they use it elsewhere in their daily lives.

Building a better healthcare system

We need strong leaders and bold risk-takers to do everything possible to create an innovative, successful and sustainable future in the short and long term. Unfortunately, there is no panacea. At the macro level, there are those leading discussions on system change, including improving team-based care, emphasizing primary care, and preventive medicine/health promotion. Others struggle with issues like complex payment methods or system measurement requirements that can leave us confused.

While most senior leaders are grappling with many big challenges, we must also work at the macro and micro levels to bring change closer to home. That's exactly what we're doing at Sault Area Hospital.

Complex problems require breadth and depth of response. But it's not enough to simply plant a seed and hope that a thousand flowers bloom. As much as possible, we must be deliberate in our actions and intentional in our patience.

Embark on the digital health transformation that is at the heart of transforming modern healthcare systems. And as we reach the next level of advancement, we must continue to think ahead and create new frontiers for the healthcare landscape. The calls to action are endless. Let us continue our bold efforts to improve patient outcomes and experiences. Because this noble cause is for the betterment of our community now and in the future.

See for yourself how healthcare organizations can use Expanse to provide the best care humanly possible.

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