Some Straight Talk on Remote Patient Monitoring in Health Care

“Treating patients in their home allows physicians to treat the whole patient. We see their individual needs and can integrate critical information, such as diet, physical environments and social determinants of health, into their care plans.”

Stephen Parodi, MD, executive vice president of the Permanente Foundation
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Technological innovation has steadily changed the face of modern medicine over the years. The exponential growth in the development of on-body and in-body sensors has created new opportunities for personalized care outside of traditional healthcare settings. One of the significant shifts is the rise of remote patient monitoring to improve health outcomes and increase access to medical care. From 2016 to 2019, the number of people using connected wearable devices across the world has more than doubled, going from 325 million to 722 million users over three years. By 2022, it’s projected that wearable use will reach over one billion consumers. Insider Intelligence estimates 30 million U.S. patients, or 11.2% of the population, will use RPM tools by 2024—marking 28.2% growth from 23.4 million patients in 2020. According to a May 2021 survey by MSI International of some 300 consumers, between 65% and 70% said they’d be willing to participate in an RPM program with their care providers to monitor blood pressure, heart rate, blood sugar, and blood oxygen levels.

Many Americans have relied on this technology on their smartphones, fitness trackers, or smartwatches to provide health data in their day-to-day lives. Using technology to collect and analyze diet, exercise, and basic vital signs have been a part of many people’s personal efforts to improve their health and wellness. Healthcare providers have also incorporated these technologies to provide better care based on a larger and more accurate portrait of a patient’s health.

The COVID-19 pandemic has further influenced healthcare providers’ use of remote patient monitoring. As traditional healthcare sites such as clinics and hospitals became potentially dangerous vectors of transmission, healthcare providers increasingly turned to remote patient monitoring to track patients and help identify those who required in-person care.

Researchers at the Mayo Clinic Cancer Center have demonstrated that COVID-19 patients who got care at home via remote patient monitoring were considerably less likely to require hospitalization for their illness than COVID-19 patients who did not engage in the program. In-home equipment was used to monitor oxygen levels, vital signs, and symptoms of COVID-19 infection, and patients were managed by a centralized virtual care team of nurses and physicians. By November 2020, the initiative had assisted over 8,000 patients in rural and urban settings in 41 states across the U.S.

While many healthcare providers are just now getting into the remote patient monitoring arena, Ochsner Health has scaled its platform to a national level, and is now monitoring more than 20,000 people in health plans across the country. Ochsner is now marketing its RPM services to health plans and businesses around the country, charging a per-month per-member subscription fee. Ochsner says they’ve proven that the platform offers a 3:1 return for diabetes management and a 4:1 return for hypertension management, and they’re working on algorithms that would clarify ROI for other conditions.

What is remote patient monitoring? – Remote patient monitoring systems employ various devices such as implantables, biosensors, blood pressure cuffs, glucometers, and pulse oximetry to gather patient data remotely. There are sensors attached to the patient’s body that gather real-time data and keep sending it to the remote repository. Patients can also measure and share essential health data using different medical devices. Regular health checkups are replaced with round-the-clock monitoring, and qualified healthcare professionals regularly analyze the data.

Who uses remote patient monitoring? – Many methods of remote patient monitoring are designed to address chronic conditions like diabetes, heart conditions, and patients dealing with dementia. In cardiology, patients who used RPM had a 50% lower risk of death from arrhythmias and congestive heart failure than those who had regular, in-person follow-up, according to certain studies. CloudCath, a medtech company based in San Francisco, has created a remote monitoring technology that provides clinicians with data on the spent dialysate fluid of at-home peritoneal dialysis patients. CloudCath is incorporated into the drain line of peritoneal dialysis systems and wirelessly transmits data to the cloud, with proprietary algorithms then highlighting issues, such as infection, to clinicians.

As reported in an article by Megan Hernbroth in Business Insider (subscription required), Swift Medical makes an app that is primarily designed for nurses or clinicians caring for patients with chronic wounds, such as those in diabetic patients. It uses 3D image modeling and artificial intelligence to remotely reconstruct the wound digitally for caregivers, including measurements like width and depth that are hard to standardize in traditional care practices.

Image credit: Swift Medical

But even beyond these chronic conditions, remote patient monitoring can be a godsend for those without easy access to transportation or who live in areas that are far away from a healthcare provider.

What are the potential benefits of remote patient monitoring? – Multiple studies have demonstrated clear benefits for both healthcare organizations and patients themselves. A compilation of those findings are listed below: For healthcare organizations

  • A reduction in hospitalizations and the associated costs involved. The University of Pittsburgh Medical Center, for example, reduced the risk of hospital readmissions by 76% — and held patient satisfaction scores over 90% — by equipping patients with tablets and RPM equipment. A KLAS Research report surveying 25 healthcare organizations found 38% of healthcare organizations running RPM programs focused on chronic care management reported reduced admissions, while 17% cited cost reductions.
  • RPM saves time and increases the overall capacity for healthcare facilities and physicians to treat more patients, especially in areas like the Emergency Department.
  • Healthcare providers have easy access to the patient’s data and can remotely adjust the treatment plan for patients based on individual needs.
  • RPM solutions facilitate preventive care using reminders for patients to walk, exercise, or take medications, which is better than reactionary care.

For patients and their families

  • Remote Patient Monitoring programs can reduce out-of-pocket costs associated with chronic illnesses.
  • Remote patient monitoring facilitates more rapid access to healthcare.
  • The medical devices can remotely monitor vital signs for patients after surgery. This helps them comply with the aftercare and achieve healthcare targets.
  • Improved medication compliance, patients wear a sensor that detects and records their medication intakes, and hospital care providers track adherence in real-time.
  • RPM ensures access to essential health services for patients in rural or underserved areas. A recent publication titled: “Remote Patient Monitoring in the Safety Net: What Payers and Providers Need to Know” was commissioned by the California Health Care Foundation (CHCF) to offer providers, payers, and policymakers basic information about RPM and its potential application in the safety net. The report is based on research conducted separately by Public Health Institute and AVIA. The research was done between November 2020 and February 2021.
  • Overall improved quality of care.
  • And many of these programs give patients peace of mind in knowing their health is being monitored every day, perhaps even in real-time, by their care providers.

What is the outlook for the adoption of remote patient monitoring? – According to Consumer Technology Association (CTA), nearly 88% of healthcare organizations are investing or considering investing in remote patient monitoring systems. Apart from this, the research also showed that nearly 52% of consumers mentioned they would successfully use RPM solutions as part of their medical treatment if a physician made the recommendation.

What are some guidelines for developing and deploying a successful remote patient monitoring program? – In an excellent HBR article published in July 2020, authors Samantha F. Sanders, Ariel D. Stern, and William J. Gordon outline these guidelines drawn from their own experience managing remote-patient-monitoring programs, including one created specifically to care for Covid-19 patients, and research on the drivers of clinical success of established programs.

  • The technology must be accessible for both patients and clinicians to adopt and continue using.
  • The tools should be incorporated into clinician workflows.
  • Sources of sustainable funding must be identified and tapped.
  • Dedicate sufficient non-physician staff to operate the program.
  • Focus on digital health equity.
  • Start with an initial pilot and expand after demonstrated successes.

What is the future of remote patient monitoring? – Continued technological innovation and increased access to technology indicate a bright future of remote patient monitoring. The next trend in RPM technology is miniaturization. Device makers are making their solutions smaller and less invasive while partnering with new players to expand their market share.

Another trend is the development of in-body sensors that are bioabsorbable. For example, researchers at Northwestern and George Washington universities (GW) have developed the first-ever transient pacemaker — a wireless, battery-free, fully implantable pacing device that disappears after it’s no longer needed. The thin, flexible, lightweight device could be used in patients who require temporary pacing after cardiac surgery or while waiting for a permanent pacemaker. All components of the pacemaker are biocompatible and naturally absorb into the body’s biofluids over five to seven weeks without needing surgical extraction.

Such initiatives underline the fact that remote patient monitoring is ready to become a part of the mainstream healthcare industry and continue to grow even after the pandemic.

If you are interested in learning more about the underlying technologies that support remote patient monitoring, like 5G, RFID, Wifi, and Bluetooth, I highly recommend this online course from my friend and colleague Tom Giordano. His “Plain and Simple” series is excellent.

Image credit: Quovadis Learning Systems

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