Quick Intro: Who We're Helping

• Which role best describes you in the organization? Options: Chief Medical Officer, VP/Director Population Health, Chief Nursing Officer, Director of Care Management, Clinical Informatics/IT Lead, Revenue Cycle/Billing Lead, Other
• How many patients does your organization manage under value-based contracts where preventing hospitalization directly affects margin? Options: <1,000, 1,000–5,000, 5,000–20,000, 20,000+, Unsure
• Which chronic condition cohorts are highest priority for you right now? Options: Hypertension, Heart Failure, Diabetes, COPD, Chronic Kidney Disease, Post-discharge/Transitions, Other
• Tell us briefly about the patient cohort(s) you most want to impact with RPM (age, comorbidity burden, social needs, typical visit cadence).
• Who else on your leadership or operational team will influence an RPM decision? Options: CMO/Medical Leadership, Population Health Director, Finance/Revenue Cycle, IT/EHR Team, Nursing Leadership, Care Management/CM Team, Other

Are You Waiting For the Phone to Ring?

• How comfortable are you acknowledging that most preventable hospitalizations happen between visits and that your current model may be mostly reactive? Options: Completely reactive today, Mostly reactive, Balanced reactive and proactive, Mostly proactive, Fully proactive
• Think of a recent hospitalization you felt could have been prevented—what exactly happened and where did the opportunity for earlier intervention exist?
• About what percentage of admissions for your priority cohorts do you estimate are preventable with better between-visit data? Options: <10%, 10–25%, 26–50%, 51–75%, >75%, Don't know
• How long has this between-visit gap been a recurring problem for your organization? Options: <6 months, 6–12 months, 1–3 years, 3+ years
• When preventable events occur, how does that impact your team emotionally and operationally (morale, capacity, leadership scrutiny)?

What's Keeping Your Team From Acting?

• Is the core problem that your team is overwhelmed by alert volume, that alerts aren’t actionable, or something else entirely? Options: Mostly overwhelmed by volume, Mostly low-actionability, Both equally, Other—please specify
• How many full-time equivalents (FTEs) are currently assigned to triage remote data or similar alert queues? Options: 0, 0.1–0.5, 0.5–1, 1–3, 3–10, 10+
• Describe a typical day for the staff who handle alerts and the biggest friction points they face.
• Roughly what percentage of alerts do clinicians classify as false positives or low-value in your current workflows? Options: <10%, 10–30%, 31–50%, 51–70%, >70%, Don't know
• What approaches have you tried to reduce unnecessary alerts (threshold changes, escalation filters, nurse-only triage) and what were the immediate results?

Where Data Meets the Record—or Gets Lost

• If RPM data is not integrated directly into clinician workflows in the EHR, does it tend to be used or ignored? Options: Actively used in care decisions, Partially used, Rarely used, Ignored/shelfware
• Which EHR(s) are in use and where would you prefer RPM data to land (flowsheet, inbox, problem list, summary, CDS)? Options: Epic, Cerner/Oracle, Allscripts, Meditech, Other, Flowsheet, Inbox/InBasket, Problem list/Problem-oriented, Clinical Decision Support/Best Practice Alerts
• Do you currently have any device-data interfaces, APIs, or middleware in production for external vitals ingestion? Options: Yes — bi-directional feeds, Yes — one-way feeds, Planned, No
• How critical is automated charting and discrete data capture for clinician adoption and reporting? Options: Critical, Very important, Somewhat important, Nice to have, Not important
• If full integration will take time, what interim workflows would clinicians tolerate to still act on RPM data?

Billing, Reimbursement, and ROI — Are You Counting on It?

• Are you confident your organization can sustainably bill for RPM services, or is reimbursement a gating issue for you? Options: Confident, Somewhat confident, Unsure, Reimbursement is a major blocker
• Which RPM or chronic care billing codes are you currently using or planning to use? Options: 99453, 99454, 99457, 99458, 99490, Other/Not sure
• Will billing and revenue cycle for RPM be managed internally, by the vendor, or via a hybrid model? Options: Fully in-house, Vendor-managed, Hybrid (shared responsibilities), Unsure
• What hospitalization-reduction percentage or dollar ROI would make this program an unequivocal yes for leadership?
• How quickly do you expect cost recovery or measurable ROI from device and implementation investments? Options: <6 months, 6–12 months, 1–2 years, 2+ years, Unsure

What Would Success Actually Feel Like?

• If avoidable admissions were meaningfully reduced in your priority cohort, what would that free up for your organization operationally and strategically?
• Which outcome metrics will convince your board/leadership that RPM is working? Options: Hospitalizations avoided, ED visits avoided, Alert volume per patient, Time-to-intervention, Patient adherence (% readings transmitted), Net cost per avoided admission, Patient satisfaction
• Please list two priority metrics and their current baseline values that you want to improve.
• How frequently would you like performance reporting and in what format for operational decision-making? Options: Real-time dashboard, Daily digest, Weekly dashboard, Monthly report, Quarterly executive review
• Who must be convinced by the pilot metrics for you to move to enterprise adoption? Options: CMO/Medical Leadership, CFO/Finance, Population Health Director, Nursing Leadership, IT/EHR, Board/Executive Committee

Path to Pilot and Governance — Are We Aligned?

• If a pilot lacked clear owners, escalation rules, and acceptance criteria, would it likely stall—or could informal champions carry it forward? Options: Very likely to stall, Some risk of stalling, Informal champions could carry it, Unlikely to stall
• What size pilot (patient count and duration) would you consider sufficient to make a go/no-go decision? Options: 25–50 patients / 3 months, 50–150 / 3–6 months, 150–500 / 6–12 months, 500+ / 12 months+
• Which stakeholders must be on the pilot steering committee for it to have traction? Options: Population Health, Primary Care Leads, Nursing/Care Management, IT/EHR, Finance/Billing, Quality/Safety, Other
• What non-negotiable acceptance criteria would you require to declare a pilot successful (e.g., X% reduction in admissions, Y% adherence, Z alerts per 100 patients)?
• Who will own ongoing governance, tuning of alert logic, and staffing decisions if the program scales? Options: Population Health, Care Management, Clinical Operations, IT, Shared governance committee, Other
• Realistically, how soon could you start a pilot after statement-of-work and contract sign-off? Options: Immediate (2–4 weeks), 1–2 months, 3–6 months, 6+ months, Unsure

• Pre-Experience Alignment
• Patient Scenario Walkthroughs (Diagnosis -> Proof -> Validation)
• Alert Logic & Tuning Workshop (Proof of Future State)
• Workflow & Escalation Simulation (Validation)
• Validation & Pilot Design Decision

• Agree on training and SOP updates required for pilot readiness.
• Vendor to produce a scenario-by-scenario 'what changed' summary linking device reading to clinical action and outcome.
• Customer to confirm any clinical edits to thresholds or preferred device choices for each cohort.
• Both teams to identify required EHR documentation points and note where automatic flows vs manual entry are needed.
• Review Baseline Alert Volumes & Capacity
• Produce tuned alert rules for primary cohorts that demonstrably reduce non-actionable alerts.
• Show simulation results that meet agreed staffing capacity targets and sensitivity thresholds.
• Agree on escalation trees and required SLAs for response.
• Vendor to deliver formal alert-rule document with parameter definitions and recommended default tunings.
• Vendor to run a full-cohort simulation (30–90 days) and return projected alert volumes and staffing needs.
• Customer to identify clinical lead(s) authorized to sign off rule changes during pilot tuning.
• Simulation Goals & Success Criteria
• Validate that triage workflows can be executed within capacity targets and prevent escalation to hospitalization in simulated cases.
• Identify and document all friction points and required EHR changes to support the workflow.
• Introductions & Objectives
• Customer clinical lead to approve final SOP edits and designate training participants.
• Vendor to produce EHR build specification and message maps required for automated documentation and escalation.
• Both teams to schedule role-based training sessions before pilot start.
• Recap Validated Future-State Outcomes
• Obtain customer approval to proceed to a defined pilot with agreed success metrics and owners.
• Finalize pilot scope (cohorts, devices, monitoring levels) and the reporting cadence required to evaluate outcomes.
• Assign governance and operational owners and confirm timeline to kickoff.
• Vendor to circulate the pilot proposal document (scope, SLA, success metrics, timeline) for formal sign-off.
• Customer to designate pilot executive sponsor and clinical lead and confirm resource allocation.
• Both teams to schedule pilot kickoff and finalize dates for device provisioning and EHR builds.
• Agree on a crystal-clear one-sentence current-state that describes where monitoring is breaking today.
• Quantify the consequence (clinical, operational, financial) tied to the current-state.
• Define a single-sentence, measurable future-state outcome to be validated during the experience.
• Confirm the real patient cohorts/cases to be used in subsequent walkthroughs.
• Customer to provide anonymized sample records for agreed patient cohorts (vitals, device logs, recent admissions).
• Vendor to draft and circulate the final one-sentence current-state and future-state (for sign-off).
• Both teams to agree on numeric consequence data (hospitalization rate, estimated costs, staff hours) and share supporting reports.
• Capture customer objections/edits to rules or workflows to iterate before pilot design.
• Recap Current & Future State
• Validate that the chosen devices and alert rules produce actionable signals that would have changed outcomes for the presented cases.
• Estimate per-case prevented hospitalizations and clinician time required to act on signals.
• Proposed Pilot Scope & Cohorts
• Run 5 Role-Play Alerts Across Cohorts
• Scenario 1 — Heart Failure (Weight + BP)
• One-Sentence Current State (Facilitated)
• Alert Design Principles & Constraints
• Measure Time-to-Action & Decision Outcomes
• Explicit Consequence Quantification
• Live Rule-Build: Cohort A (High-risk HF)
• Scenario 2 — Hypertension (BP monitoring + med adherence flag)
• Acceptance Criteria & Reporting Plan
• Resourcing, Timeline & Governance
• Scenario 3 — COPD (SpO2 + symptom reporting)
• Live Rule-Build: Cohort B (Hypertension/Diabetes)
• Identify Friction Points (EHR, Staffing, Communication)
• One-Sentence Future State (Outcome Focused)
• Scenario 4 — Diabetes (Glucose trends + education touchpoint)
• Select Real Patient Cohorts & Representative Cases
• Short Simulation & Volume Projection
• Update SOP & Training Needs
• Decision & Next Steps
• Tie Rules Back to the Problem
• Confirm Success Criteria for the Experience
• Synthesis: Expected Impact & Staff Load
• Validation Checkpoints

• Device Provisioning and Shipping
• Patient Device Setup and Remote Configuration
• Connected Vitals Ingestion and Normalization
• Configure Clinical Alert Rules and Thresholds
• Deploy Care Team Monitoring Dashboard
• EHR Integration and Data Mapping
• RPM CPT Coding Templates and Billing Support
• Continuous Clinical Monitoring and Alert Triage
• Clinical Escalation and Clinician Handoff
• Patient Engagement Messaging and Adherence Nudges
• Device Maintenance, Troubleshooting, and Replacement
• Care Team Training on RPM Workflows and Dashboard
• Monthly Outcomes Reports and Hospitalization Metrics

Device Provisioning and Shipping

• Do you want vendor-managed device provisioning and outbound shipping included in scope? Options: Yes, No
• What is the expected initial device volume and ongoing monthly cadence? Options: Less than 100 initial / <50 monthly, 100-500 initial / 50-200 monthly, 500-1,000 initial / 200-500 monthly, More than 1,000 initial / More than 500 monthly, Not sure - need sizing support
• Which device types require provisioning (select all that apply)? Options: Blood pressure monitor, Blood glucose meter, Weight scale, Pulse oximeter, Wearable activity sensor, Other
• Are there labeling, kit-assembly, or custom packaging requirements (e.g., site IDs, multi-device kits)? Options: Yes, No
• If yes, describe labeling, kit composition, or regulatory labeling needs.
• What shipping destinations must be supported (states, facilities, international)? Options: Single state/local, Multi-state (US), National (US), Includes international
• Who owns inventory management, returns, and RMA processes? Options: Vendor-owned, Customer-owned, Shared model
• What acceptance criteria confirm successful provisioning (e.g., device delivered to patient, device registered in portal)?

Patient Device Setup and Remote Configuration

• Do you require remote out-of-box setup support (phone/video) for patients? Options: Yes, No
• Which setup tasks should vendor perform remotely (select all that apply)? Options: Device pairing with cellular/Wi‑Fi, Patient profile creation, App installation and account activation, Education on use and troubleshooting, Consent and RPM enrollment documentation
• What patient populations need special onboarding support (e.g., low digital literacy, non-English speakers)? Options: Seniors/low tech, Non-English speakers, Rural with limited connectivity, Cognitively impaired patients, None/small subset
• Do devices need to be pre-configured with patient assignments before shipping? Options: Yes, pre-assigned, No, assigned after delivery, Flexible - some pre-assigned
• What are your preferred patient contact methods for setup (phone, SMS, video call), and acceptable hours? Options: Phone, SMS/text, Video call, In-person clinic setup
• What success criteria define a completed setup (e.g., first reading received, patient-reported confidence)?
• Do you require enrollment consent capture, RPM eligibility checks, or documentation as part of setup? Options: Yes - all, Yes - some (specify), No

Connected Vitals Ingestion and Normalization

• Which data sources need to be ingested and normalized (select all that apply)? Options: Device manufacturers' APIs, Cellular gateways, Patient smartphone app, Third-party integrations, Manual entry/CSV upload
• What data elements must be normalized and stored (e.g., systolic/diastolic, glucose mg/dL, weight kg/lbs, SpO2, device metadata)?
• How quickly do readings need to appear in the clinical dashboard (near‑real time, hourly, daily)? Options: Near-real time (seconds-minutes), Within 1 hour, Within 24 hours, Daily batch
• Are there existing device vendors/models already approved that must be supported? List makes/models.
• Do any devices transmit proprietary or nonstandard payloads that require custom normalization? Options: Yes, No, Unknown - need to evaluate
• What data retention, audit logging, and HIPAA security expectations apply to ingested vitals?
• What acceptance criteria validate successful ingestion and normalization (e.g., % of readings parsed without errors)?

Configure Clinical Alert Rules and Thresholds

• Do you want vendor-provided default clinical rules or custom rules defined by your clinical leadership? Options: Use vendor defaults, Define custom rules with vendor support, Fully customer-defined
• Which alert types are required (select all that apply)? Options: Absolute thresholds (e.g., BP > 180/110), Delta/change from baseline, Trend alerts (sustained increase/decrease), Missing data/non-adherence alerts, Device malfunction alerts
• Who will own rule governance and tuning post-launch (clinical leadership, vendor clinical team, shared)? Options: Customer clinical leadership, Vendor clinical team, Shared governance model
• What is the desired alert sensitivity vs. specificity tradeoff (minimize false positives vs. maximize detection)? Options: High sensitivity (catch most events), Balanced, High specificity (reduce false alerts)
• Do alerts require multi-parameter correlation (e.g., weight + BP for heart failure) before triggering? Options: Yes, No, Some alerts require correlation
• What clinical acceptance criteria will be used to sign off alert logic (e.g., alert volume per 100 patients/day, % actionable alerts)?
• Do alerts need to be tunable per patient cohort or risk tier? Options: Yes, per cohort, No, uniform rules, Tunable by provider

Deploy Care Team Monitoring Dashboard

• Which roles will use the dashboard (select all that apply)? Options: Nurse/RN, Care manager, Physician/PCP, Respiratory therapist, Population health analyst
• What views and filters are required (e.g., high-risk list, alerts queue, patient timeline)?
• Do you require role-based access controls and audit trails on the dashboard? Options: Yes, No
• What EHR context do clinicians need visible in the dashboard (med list, last visit, care plan)?
• What performance expectations should the dashboard meet (load times, concurrent users)?
• Do you need dashboard embedding inside the EHR or single sign-on (SSO)? Options: Embed in EHR, SSO only, Stand-alone dashboard
• What success metrics validate dashboard deployment (e.g., user adoption %, time-to-first-action on alerts)?

EHR Integration and Data Mapping

• Which EHR(s) must be integrated with (select all that apply)? Options: Epic, Cerner/Oracle, Allscripts, Athenahealth, Other/Custom
• What integration methods are acceptable (select all that apply)? Options: Direct API/FHIR, HL7 v2 messages, SMART on FHIR app, Bulk CSV/EDI, Custom connector
• What specific data flows are required into the EHR (vitals flowsheet, discrete observations, encounter notes, alerts)?
• Who will own the EHR build and testing (customer IT, vendor integration team, third party)? Options: Customer IT, Vendor, Third party integrator, Shared
• Are there existing EHR templates or flowsheets we must map to, or do we need to create new ones? Options: Use existing templates, Create new templates, Combination
• What project timelines and go‑live windows must EHR integration align with?
• What acceptance tests will confirm successful integration (e.g., sample patient data appears in flowsheet, alerts create inbox tasks)?

RPM CPT Coding Templates and Billing Support

• Do you want vendor-provided CPT code templates and claim examples for RPM billing? Options: Yes, No
• Which payer types should billing templates cover (select all that apply)? Options: Medicare Fee-for-Service, Medicare Advantage, Commercial, Medicaid, All payers
• Do you need assistance creating documentation workflows that support CPT requirements (time tracking, patient consent, device supply documentation)? Options: Yes, No
• Who will perform claims submission and revenue cycle management for RPM services? Options: Customer RCM team, Vendor-managed billing, Third-party billing vendor
• Do you require training for clinicians/billing staff on RPM coding and reimbursement changes? Options: Yes, No
• What acceptance criteria confirm billing readiness (e.g., successful test claim, expected reimbursement rate)?

Continuous Clinical Monitoring and Alert Triage

• What monitoring service level is required (select one)? Options: 24/7 vendor clinical monitoring, Business hours monitoring with after-hours escalation, Customer-run monitoring with vendor support
• What is the expected patient panel size per monitoring FTE (to estimate staffing)? Options: <250 patients per FTE, 250-500 per FTE, 500-1,000 per FTE, Customize - provide staffing model
• What workflows should triage handle vs. escalate to clinicians (e.g., medication changes, urgent referrals)?
• Do you require documented SOPs for triage decisions and clinical documentation standards? Options: Yes, No
• What response time SLAs do you require for actionable alerts (minutes, hours)? Options: Within 15 minutes, Within 1 hour, Within 4 hours, By end of business day
• What metrics define successful triage operations (e.g., % alerts reviewed within SLA, % escalations appropriate)?

Clinical Escalation and Clinician Handoff

• What escalation pathways should be supported (select all that apply)? Options: Phone call to on-call clinician, EHR inbox message, Secure message, ED recommendation/911, Care manager outreach
• Who is the designated receiving clinician(s) for escalations and what are their contact preferences?
• Do escalations require structured documentation to be appended to the EHR encounter (e.g., templated note)? Options: Yes, No
• Are there defined clinical escalation thresholds that require immediate action vs. routine follow-up? Options: Yes - provide thresholds, No - use triage judgement, Need vendor clinical team to define with you
• Do you need built escalation routing rules based on patient risk strata, geography, or clinic hours? Options: Yes, No

• Master Services Agreement (MSA)
• Statement of Work (SOW)
• Service Level Agreement (SLA)
• Pricing & Commercial Terms
• Pilot Agreement & Acceptance Criteria
• Reimbursement Support Addendum
• Business Associate Agreement (BAA) / Data Processing Agreement (DPA)
• EHR Integration & Interface Agreement
• Device Provisioning & Ownership Terms
• Implementation Timeline & Governance Charter
• Training & Change Management Plan
• Security & Compliance Assessment Sign-off
• Clinical Escalation & Oversight Protocol
• Change Order & Scope Management
• Termination, Transition & Renewal Terms

• Success Validation Review
• Alert Volume & Tuning Workshop
• Hospitalization Case Review & Root Cause Analysis (RCA)
• Workflow Iteration & Training Sync
• Success Governance & Quarterly Business Review (QBR)

• Draft updated SOPs and circulate for clinical sign-off within 7 days (owner: Clinical Ops).
• Assign clear owners and deadlines for the highest-priority corrective actions.
• Opening & Objectives
• Case Selection & Objective
• Determine whether the hospitalization was preventable and identify specific failures in monitoring or workflow.
• Assign corrective and preventive actions with owners, deadlines, and verification steps.
• Ensure RCA outcomes are captured for trend analysis and reported in the next QBR.
• Publish RCA report with timeline, root causes, and assigned corrective actions to the shared channel and clinical record (owner: Quality Lead).
• Implement immediate fixes that can prevent recurrence within 30 days (owner: Clinical Ops).
• Log the case in the program risk register and surface to governance if systemic (owner: Program Manager).
• If reimbursement/coding action is relevant, prepare documentation and consult revenue cycle for retroactive claims (owner: Billing Lead).
• Ensure patient engagement changes are ready to be piloted and measured.
• Recap of Recent Validation Findings
• Approve a concrete workflow and training rollout plan that addresses validated gaps.
• Assign owners for updating SOPs and delivering training with clear timelines.
• Produce an actionable short-list of tuning and operational items for execution before the next review.
• Schedule targeted training sessions and create short refresher materials for clinicians (owner: Training Lead).
• Deploy revised patient onboarding scripts and measure effect on adherence over 30 days (owner: Patient Engagement).
• Add post-training competence checks to verify adoption and report results at next operational review (owner: Program Manager).
• Executive Summary vs Success Signals
• Secure leadership alignment on program performance and whether to scale, pause, or modify the engagement.
• Approve prioritized investments or escalations with committed budgets/timelines where applicable.
• Confirm governance cadences, decision rights, and the persistent shared communication channel for rapid issue resolution.
• Produce a QBR packet with metric dashboards, RCA highlights, financial summary, and roadmap items (owner: Analytics/Program Lead).
• Publish executive decisions and approved backlog to the shared channel and schedule required follow-up meetings (owner: Program Manager).
• If funding or scope changes are approved, update commercial/legal contacts and amend the pilot/commercial plan (owner: Commercial Lead).
• Confirm the next QBR date and interim governance touchpoints (owner: Executive Sponsor).
• Confirm whether program metrics meet each agreed success signal and highlight gaps.
• Export and circulate the prior 30/90-day dashboard with cohort breakdowns to attendees (owner: Analytics Lead).
• Create prioritized tuning requests (alerts thresholds, escalation rules) with expected impact estimates (owner: Clinical Ops).
• Post summary of decisions and assigned owners to the shared channel with deadlines (owner: Program Manager).
• Open ticket for any identified EHR data or integration blockers and link to action plan (owner: IT Lead).
• Pre-work Review & Current State One-Sentence
• Reduce actionable alert volume to a level that matches clinical capacity without materially increasing missed events.
• Agree on a prioritized list of tuning changes with measurable acceptance criteria and rollback plans.
• Ensure clinicians validate that proposed logic preserves clinical intent for each cohort.
• Apply agreed tuning scenario in staging and produce a 14-day simulated alert volume report (owner: Vendor Ops).
• Update clinical runbook with new triage rules and escalation contacts (owner: Clinical Lead).
• Schedule a 2-week follow-up to verify real-world alert volumes and clinician burden post-change (owner: Program Manager).
• Document any device or patient-behavior causes and create patient education scripts to reduce noise (owner: Patient Engagement).
• Timeline & Data Review
• Clinical Outcomes & Utilization Impact
• Identify Workflow Changes Needed
• Current State Snapshot
• Representative Case Walkthroughs
• Root Cause Mapping
• Compare Metrics to Success Signals
• Adherence to Escalation Pathway
• Training Needs Assessment
• Operational Health
• Identify Root Causes & Contributing Factors
• Proposed Tuning Options & Simulation
• Financial & Reimbursement Update
• Create Implementation Plan
• Trend & Segment Analysis
• Staffing Capacity & Escalation Alignment
• Corrective Actions & Preventive Measures
• Patient Adoption & Engagement Adjustments
• Improvement Backlog & Roadmap
• Decisions & Triage of Actions