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December 16, 2025
The following is an excerpt from a written by our good friend, Dr. James Chan, whose team at Sault Area Hospital have been pioneers in Digital Patient Engagement. For more information, check out their posted earlier this year.
Starting with a solid strategy
The transition from hospital to home is a critical phase in a patient’s journey, as it significantly impacts recovery and the health system’s efficiency. That’s why it was important for us to launch a surgical transitions remote care monitoring program to help create smoother and safer transitions from hospital to home.
As we were building our strategy for the RCM program, we considered the areas where it would have the most immediate impact, acting as the catalyst to set us on the right course. We decided to first focus on hip and knee replacements, as they are some of the most common surgeries for patients. And while the need continues to grow as the population ages, we’re starting to see that patients undergoing these joint replacements are trending younger.
For the program to be successful, it was imperative that we identified the right technology to engage patients throughout their recovery, but also one that didn’t add unnecessary burden to physicians and other care providers. This meant adopting a solution that would integrate directly into our MEDITECH EHR and virtually guide and remotely monitor patients throughout their episodes of care. We chose , a leading digital care platform.
Creating ways to add value to clinicians is key, and the integration of Ƶ with our Expanse EHR does just that. But there’s more to it than what meets the eye. Providing more information to clinicians isn’t enough. The information isn’t going to be accessed unless it’s easy. If it takes more than one or two clicks or is a hassle in any way, clinicians will just say, ‘forget it’ and move on with their day. The integration overcomes that potential hurdle, as clinicians can access valuable patient information immediately — without leaving the EHR.
The results speak for themselves. An initial evaluation of our surgical program comparing RCM patients to non-enrolled patients showed the following improvements:
- 72% decrease in 30-day ED Visits
- 64% decrease in 30-day Readmissions
- 8% decrease in Length of Stay
We’ve since deployed the RCM program across an additional 13 care pathways, including general surgery, cancer, women’s health, chronic care, and mental health. Most recently, we’ve expanded it to our Medicine Program with a focus on Chronic Obstructive Pulmonary Disease and Congestive Heart Failure, and we’re creating a new Maternity pathway to better support expectant mothers and their families throughout the many transitions of maternal care.
This innovation has also allowed us to increase the number of same-day-surgeries; which is now the case for the majority of patients undergoing joint replacements. Furthermore, the RCM program has augmented homecare or even replaced homecare service if it is not available. In other words, RCM can fill gaps in the system of care if/where any exist, for example, by providing support for wound management and guidance for physiotherapy exercises that patients can do at home.
