A Virtual Success: Nurse-Driven Innovation Improves Patient Experience and Care
When Richard Boyajian, NP, RN, was seeking a better way to provide follow up care for prostate cancer patients five years ago, he thought back to his own experience as a patient receiving a bone marrow transplant in 1996.
“The Dana-Farber/Brigham and Women’s Cancer Center saved my life from leukemia,” said Boyajian. “While I was grateful, I was also tired of traveling into Boston for my care. It cost money my family didn’t have since I was out of work, and it required a family member to take time off work to drive me to the appointment. I envisioned remote care could reduce my travel into Boston.”
Although remote care wasn’t an option for his own care at the time, Boyajian made it a reality for prostate cancer patients in 2016 with the launch of the Virtual Prostate Cancer Clinic (VPCC). Last month, Boyajian and his multidisciplinary colleagues published a case study in NEJM Catalyst, highlighting the growth and impact of the program for patients.
The clinic has conducted approximately 3,857 virtual visits through FY2020. Among 636 patients who responded to a survey about their experience with the remote model of care:
- 94 percent reported that they were comfortable with remote monitoring
- 92 percent reported that they saved time
- 87 percent reported that they saved money
New patient consult visits in the department more than doubled, increasing by nearly 110 percent, over four years compared to FY2015 prior to the VPCC launch. Over that time, virtual appointments replaced 24 percent of in-person follow-up visits.
“When I had the idea of the VPCC, I was not thinking about defining success,” Boyajian recalled. “I was focused on designing the software and the overall program itself. That turned out to be the easy part, and I found out there was a lot more involved in making this clinic a success. Over the past five years, I have sought out mentors to help guide me, and, more importantly, educate me on what I didn’t know.”
Support and Collaboration Throughout the Journey
Boyajian’s innovation journey began in 2013 when he joined the Brigham’s genitourinary radiation oncology team, caring for patients who have been treated for prostate cancer. They required regular follow-up with blood tests to check for early signs of cancer recurrence and with physician visits to report any symptoms.
“A lot of time in the follow-up process was spent on repetitive tasks for physicians and staff,” said Boyajian.
With more than 90 percent of prostate cancer patients surviving for at least 10 years after treatment, that adds up to a lot of physician visits — and a lot of time and travel for patients.
“I try to look at anything I do through the patient’s eyes,” said Boyajian, who began approaching physician colleagues with his idea for the VPCC. “I was beside myself when every single one of the physicians supported my efforts. They not only wholeheartedly supported my pursuit of innovation, but they encouraged me to be the leader of this project.”
Boyajian received a Brigham Care Redesign Incubator and Startup Program (BCRISP) grant to create the virtual program, which enabled patients to have blood drawn at a lab close to home. The results, combined with an online patient survey, were fed into a software program that Boyajian developed. After receiving test and survey results, Boyajian followed up with patients with a virtual visit via phone or video. The program quickly became popular among patients.
“We were all a little shocked at the 90 percent enrollment rate during the pilot,” said Boyajian. “A lot of people are happy not to drive into Boston.”
Prepared for the Pandemic
When Boyajian envisioned using telemedicine, he had no idea how much the program would expand — and how instrumental it would be during the pandemic.
“The virtual prostate cancer clinic was well integrated into genitourinary radiation oncology by the time COVID-19 hit,” he said. “This allowed us to transition in-person visits to the virtual clinic much faster than if we had to create a program from scratch. During the first three months of the pandemic, referrals to the virtual clinic increased by more than 44 percent, and visits increased by almost 72 percent.”
The rapid increase in volume was like a “stress test” for the clinic, Boyajian said. “We discovered that the workflow and software had flaws with added volume.”
At that time, the team was already in the process of designing version 2.0 of the software in collaboration with the Mass General Brigham Healthcare Innovation Platform Team.
Room to Grow
With the launch of the upgraded program in September 2020, Boyajian and the Healthcare Innovation Platform Team are now working on version 2.1. “In the last six months, I have spent a significant amount of time resolving issues that we discovered during an audit to optimize the VPCC in its next upgrade,” he said.
The team is also focusing on scaling the platform to other specialties and assisting clinicians in using digital health to optimize patient care.
Boyajian hopes that the publication of the team’s case study will help others implement digital health.
“We need to understand there are not enough providers to care for the growing population and that we need to embrace digital health to help extend our reach,” he said.
Advice for Fellow Innovators
Boyajian joined the Brigham and Dana-Farber family because of his experience as a patient years ago.
“I wanted to work at the same place that treated me because I was so grateful to all the staff who took care of me. I wanted to be part of this world-renowned place and do for patients what was done for me.” – Rich Boyajian
Boyajian encourages anyone with an idea for improving the care and experience of patients to reach out for support.
“The Brigham’s Digital Innovation Hub can help you move your idea forward,” he said, noting that colleagues should also look into applying for a BCRISP grant. “People can also contact me if they want to discuss an idea.”
He added, “We work at a world-class health system, but it’s important to remember that there’s always room for improvement in how we do things.”