Remote patient monitoring (RPM) has long been pitched as the panacea for the increasing healthcare burden of rising chronic diseases and an ageing population. And it’s easy to see why. The promise of cheap technology tools, a scalable digital infrastructure and varying degrees of workflow automation means that healthcare workers can monitor patients from a centralized location, intervene for at-risk patients early and automate many time-consuming tasks. As one RPM vendor succinctly put it, “once it’s setup, the doctors often become avid golfers.”
Slow adoption to dateThe reality, however, is that we are still at the starting blocks when it comes to adoption of these technology-enabled solutions in healthcare. While there have certainly been successful pilots, by and large, most healthcare systems still operate via traditional means when managing chronic disease patients. Interoperability, security, usability, and (ironically) even implementation costs of remote monitoring programs have often been raised as concerns in the past, but these practical issues have become less relevant as the underlying technology, industry standards and government guidelines have matured.
2017 and beyond
For example, the hottest topic at HIMSS 2016 was the normalization of data following publication of the HL7 standards, which finally established recognized protocols to ensure different software systems can work together for a unified provider experience, simplifying clinical workflows. In the same way, HIPAA established a set of requirements that ensured that healthcare CIOs don’t have to spend as much time performing their own due diligence on data security. Another major industry trend has been the development and increasing awareness of connected sensors and medical devices which allows critical medical biometrics to be collected and transmitted in a verifiable manner (cf. manual input which may be more error prone).
The convergence of these trends positions 2017 as a breakout year for remote patient monitoring. Certainly, as healthcare systems move on from implementing electronic health records, they will start to look for ways to more fully utilize their digital infrastructure, so it graduates from a records repository to a holistic electronic solution that can generate savings and better patient outcomes. Just a few weeks ago, the VA just awarded four massive $259 million contracts to deliver home telehealth to military veterans and this might just be the beginning.
The economic case for remote patient monitoring
Of course, the investment behind implementing innovative remote monitoring solution is almost entirely an economic decision, which has been made easier with increasing volumes of peer-reviewed studies that find that remote patient monitoring can indeed deliver significant savings AND better patient outcomes. For example, a 2013 study in Quebec found that home telemonitoring generated a saving of 41% over traditional models, resulting in far less consumption of expensive clinical services such as inpatient stays. One can only imagine the savings are even greater in the US healthcare systems where inpatient stays for heart failure averages $10,500 per patient, as opposed to CAD$383 in Canada. In practice too, it’s easy to see where savings are achieved. Consider the example of a CHF (chronic heart failure) patient.
CHF patients must maintain stringent fluid balance to prevent acute pulmonary edema which can result in several days of hospital stay if not treated early. A RPM platform can easily collect metrics such as fluid intake, weight, medication levels, heart sounds and lungs sounds which can be used to determine if early intervention is needed. This can be done through questionnaires and connected medical devices operated by patients or their carers. Patients who are out of range can be flagged by the system, triggering automated workflows set up by the provider (e.g. redoing some measurements) and only those who are confirmed to be at risk will be followed up. This allows providers to focus limited resources, while delivering a superior experience to the patient who can avoid unnecessary contact with their healthcare provider. On a more anecdotal level, this also obviates the need for cardiologists to travel long distances to review the weight charts of a single patient (yes, this still happens!)
The state of technology and what’s next
This brings us to the technology used to deliver remote patient monitoring. Most of these systems were designed with a provider centric approach – essentially dashboards which allows providers to quickly review patients. Many incorporate complex data heuristics which automate clinical workflows that can be customized by the treating physician. At the patient end, most modern RPM systems are phone or tablet based, and primarily serve to achieve two purposes: 1) collecting patient data, 2) delivering feedback through alerts, secure message or video calls. For example, while some RPM systems have their own dedicated patient platform, many use a combination of third party apps (to collect data from connected devices), SMS and video chat plugins to achieve its outcomes. While these systems do work, the user experience and interface were often designed as an after-thought, as the main goal is to keep the provider updated with accurate information.
For small populations, this is fine, as providers and vendors can provide training and support. As we look forward to the expansion of RPM beyond monitoring of the sickest patients though, patient centric experiences with intuitive UI need to be designed to allow RPM to achieve its full potential. For example, at CliniCloud, we are working on just one such interface which allows patients to record different types of biometrics all within one app. The data entry can be done via connected devices, manual entry or even via taking a photo of a screen. Users can also use the app to receive alerts, questionnaires and flag specific recordings for their provider to review. Users can not only monitor themselves but also setup accounts for their entire family, which is useful when you have dependents or are caring for someone else. Data visualization is an also important element, as it helps patients understand their disease trends and engage with their own management.
Another exciting area for RPM is the idea of having health coaching directly in the home to further increase patient engagement and deliver timely alerts and tips. With the recent rise of voice based interfaces such as Amazon Echo and Google Home, many healthcare experts believe that these types of services can dramatically increase the intuitiveness, usability and applicability of RPM systems. Just imagine a device that can take your measurements, advise you on your progress and deliver alerts and questionnaires directly into your home, e.g. “John, I noticed your peak flow is lower than usual. I’d like to get your temperature to rule out an infection. Tell me when you are ready.”
This reality might not be so far-fetched. As the case for RPM gathers momentum, we will start to see entire health systems adopt RPM as their modus operandi. Indeed, the technology itself will transform from a remote tele-monitoring tool for specific chronic diseases into more generalizable platforms designed for patient engagement, thus allowing patients and software to take on much more of the burden of chronic healthcare management.
 Home telemonitoring for chronic disease management: an economic assessment, Paré G, Poba-Nzaou P, Sicotte C., Int J Technol Assess Health Care. 2013 Apr;29(2):155-61. doi: 10.1017/S0266462313000111.
 Costs for Hospital Stays in the United States, 2010, Pfuntner A, Wier L, Steiner C, AHRQ, Healthcare Cost and Utilization (HCUP) Report. 2013, https://www.hcup-us.ahrq.gov/reports/statbriefs/sb146.pdf