Remote patient monitoring (RPM), or telemonitoring, seeks to improve individual care through digitally transmitted health-related data. In practice, RPM may involve third-party applications, including sensors and devices, that may share data with an individual’s electronic health record, allowing healthcare organizations to create their own reports based on the data or use the data for billing purposes.
Remote patient monitoring allows clinicians to monitor the conditions of people who are in their care outside of the healthcare setting and respond proactively. This can improve healthcare access, reduce resource utilization, and potentially provide important cost savings by heading off hospital admissions.
COVID-19 Bolstered Virtual-First Healthcare
Remote patient monitoring is not new. People have been monitoring their health with devices for years, especially people with chronic diseases like heart failure, high blood pressure, diabetes, and chronic lung disease. Some of the more commonly used RPM devices are Bluetooth-enabled glucometers, blood pressure monitors, and digital scales. Data from these devices can be set up to be shared with a clinician via a smartphone app, or it can be shared during a medical appointment. A 2017 systematic review published in Telemedicine Journal and E-Health showed remote monitoring of chronic health conditions results in predominantly positive health outcomes compared to standard care or another technology.
The COVID-19 pandemic marked a pivotal moment for telemedicine, including RPM. During the pandemic, regulatory bodies either expanded virtual care, including remote monitoring opportunities, or paused restrictions on them.
“The phenomena of COVID-19 pushed healthcare even further to a virtual-first environment,” said Katharine Lawrence, MD, MPH, assistant professor in New York University Langone’s Healthcare Innovation Bridging Research, Informatics, and Design (HiBRID) Lab, and author of several peer-reviewed studies on digital innovations in healthcare. “Increasingly, when these tools are used for monitoring and supporting people in their homes versus having them come see their providers in the clinic, we have established a sort of acceptability, even desirability, as we see patients are seeking virtual-first care experiences.”
Benefits of Remote Patient Monitoring
Robert Havasy, senior director, Connected Health, of the Healthcare Information and Management Systems Society (HIMSS), adds that RPM provides several important benefits for individuals. Among the most important for people with chronic health conditions are comfort knowing a nurse, doctor, or ‘the system’ will catch something before it goes wrong, reduce costs including copays and travel or parking fees, and continuity of care.
Providers benefit as well. For example, RPM data can help alert physicians to coach and educate individuals whose numbers suggest they may be having difficulty managing their conditions. Payers can also step in as needed to offer outreach and support to prevent worsening of conditions and, potentially, improve health outcomes. And insurers can increase incentives to providers for keeping their patients’ conditions well-controlled.
The payer and regulatory environments directly influence the success of remote patient monitoring. “Particularly for Medicaid and Medicare, the rules for reimbursement for remote monitoring have taken a great leap forward in the last five years or so,” said Havasy, improving their financial sustainability. But questions remain how long legislative protections, such as removal of certain telehealth requirements instituted during the pandemic, will remain in place. Congress is debating extending these protections now covered in the Telehealth Act to individuals covered by public and private insurance.
Other concerns or limitations involve:
- Liability in cases of technology failures or data breaches.
- The institutional will and effort required to integrate remote monitoring tools and their related data into a health systems’ existing electronic health record platform. This integration of data is needed to yield quality insights.
- The capital investment and logistical, equipment, and data management skills required by providers who practice outside of large health systems to implement remote patient monitoring.
- Training for providers and care teams regarding RPM devices and data use to assist in care programs.
- Lack of clarity over who is responsible for technical support interactions.
- Health equity due to limited access to technology, limited digital literacy, or both.
- Data security, data privacy, and data mining and brokering.
According to published recommendations on RPM from New York-Presbyterian/Weill Cornell Medical Center, RPM works best with:
- Effective integration within a healthcare system’s technology platform.
- Coordinated care between providers who receive health data from RPM.
- Centralized device management and support.
- Using an equity-centered design so that digital literacy is not a factor in RPM success.
Proposed Solutions to Telemonitoring Technology Challenges
Industry groups, like the Digital Medicine Society (DiMe), are working to create standards and norms around data architecture and data management to provide strong foundations on which to add products involved in RPM.
Lawrence suggested several strategies that could be used to optimize remote patient monitoring. In one, a health system buys the hardware/software system and creates a branded experience in which the organization owns the entire pipeline of technology, from the connectivity experience to customer service, billing, and onward.
Another option, Lawrence said, is to create an RPM partnership between a strong healthcare system and a mature company, such as Google or Apple. Though this approach has advantages, such as leveraging existing infrastructure, this avenue has raised some privacy concerns among patients.
Healthcare systems could also partner with established remote patient monitoring companies, such as Dexcom or Medtronic, or with RPM startups.
Payers may have a role to play in this area as well. For example, by applying machine learning to analyze data from RPMs and other sources such as insurance claims, payers may be able to identify needs early and communicate them to providers, thereby giving providers and their patients the chance to avoid health crises.