“[The ability of] remote patient monitoring to provide targeted clinical information to physicians and elevate critical information for review and earlier intervention is enhancing patient communication and care delivery,” said Jim Brown, MD.
Remote patient monitoring (RPM), a form of telehealth that allows patients to use connected sensors to send important data to a provider, is increasingly being incorporated into physician practices. The evidence thus far suggests that RPM can improve the delivery, outcomes, and economics of health care.
With chronic disease management, patients are handling challenging diseases such as diabetes, cardiac disease and chronic obstructive pulmonary disease. RPM not only gives chronic disease patients additional tools to improve their ability to manage their condition but also allows doctors to monitor and manage their patients’ chronic conditions remotely.
For example, there are RPM devices with continuous glucose monitors that remind diabetes patients to take their insulin and help physicians monitor the disease. Others have digital blood pressure monitors that let patients remotely send physicians their blood pressure and blood oxygen readings.
Bethany Doran, MD, MPH, a cardiologist and CEO of Enabled Healthcare, a physician-led, hybrid clinic offering medical monitoring, notes that RPM is vital because it allows patients and their families to be active participants in medical care and to see the information their provider is using to make health decisions.
“It also allows family members to stay abreast of how patients are doing and provides doctors a window into how the patient is doing in real life rather than in the clinic, which can sometimes not be as accurate about their day-to-day health,” she says.
Jim Brown, MD, medical director-RPM for Rhythm Management Group, says that for individuals living with one or more chronic conditions, regular monitoring of vitals through RPM can provide a more holistic view of a patient’s health over time, increase visibility to treatment adherence, and enable timely intervention before a costly care episode.
“RPM’s ability to provide targeted clinical information to physicians and elevate critical information for review and earlier intervention is enhancing patient communication and care delivery,” he says.
He cites a recent Mount Sinai Health System internal quality-improvement matched cohort analysis of 218 patients, which looked at the effects of RPM on blood pressure control and health care utilization versus normal care in the clinic. The results found that 61% of patients in the RPM group achieved blood pressure control from baseline at three months, compared with 43% of patients in the usual care group. At six months, 72% of patients in the RPM group achieved blood pressure control, compared with 53% of the usual care group.
What’s more, patients using RPM had lower rates of emergency department and inpatient visits over 12 months, and staff observed an overall reduced total cost of care for patients enrolled with RPM compared with usual care. Specifically, the RPM patients experienced 19 hospitalizations, compared with 56 for usual care patients, equating to nearly $21,976 and $814,000 estimated cost savings for emergency department visits and hospitalizations, respectively, for RPM patients over 12 months.
Bryan Lubel, executive vice president for Connected Health, which works with many of the largest third-party providers of RPM technology and systems, says that another area RPM can make a difference is in decentralized clinical trials. In these trials, participants can have their data collected via connected devices, as well as record information in electronic diaries, which is then sent to the teams that are managing the clinical trials.
“This can shorten the time to market for new treatments by eliminating data errors, ensuring that the data are collected within the protocol of the clinical trial, and eliminating or reducing the need for participants to be routinely present at a physical trial site, which improves participation and can help to diversity the participant pool,” he says.
For physicians who have not yet implemented RPM, one of the most challenging aspects is determining how to get started. Practices can elect to implement RPM independently in-house or select a third-party partner.
“There are countless considerations—from selecting and managing the equipment and logistics to communicating and educating patients. The entire process can seem daunting,” Brown says. “Practices that choose to implement RPM alone must be prepared to add a significant number of tasks to staff members’ workloads. To successfully run a comprehensive in-house program, significant clinical and administrative staff time is required.”
A recent report determined that in order to effectively monitor 1,000 patients, a practice needs one dedicated clinician and at least three supporting administrative staff, he adds. Before starting a program, clinics need to be sure they have the bandwidth to support RPM.
“There needs to be dedicated staff to review the vitals of patients and be able to call and follow up with any patients with abnormal values,” Doran says. “RPM needs to be incorporated into clinical pathways and also needs to be streamlined from a prescription standpoint.”
The next step is researching the different platforms and costs, plus deciding how to deploy the platforms in patients’ homes. Although some systems are truly plug-and-play and connect by Wi-Fi, others are more complicated and may require a cellular phone plan, which can be costly for patients, or may require an app, which can be challenging for older patients.
“Making sure that technology is extremely easy to use for patients who are older and less familiar with apps while balancing cost is definitely a major challenge any clinic will have to figure out,” Doran says.
Devices, sensors, logistics, connectivity, cloud services, integration and software tools create the basic framework of RPM.
“This complex ecosystem can involve as many as five different service providers for procuring devices, activating those devices to be sent to patients, the connectivity to route data, the cloud services for computing and storing data, and the software to analyze and display the data,” Lubel says. “Quality of service, as well as time and cost management, are going to be key factors when utilizing the many different providers, so it is important to understand how these different partners and components work together.”
When choosing a third-party vendor, practices should look for an RPM partner that provides a fully managed suite of services and technology that can be tailored to fit their needs and grow with them as their programs evolve and scale, according to Brown.
“Key features for consideration include enhanced data analytics, prioritized alerts with clinical context that streamline physician reviews, billing and reimbursement support, and risk stratification reports,” he says.
Health care facilities should also examine what type of technology is being used and how it fits into their patients’ lives.
For example, if Doran is working with ultra-fit athletes who want to utilize RPM to improve their exercise performance, they are likely using apps and would be comfortable setting up the account, using an app to connect and get data from their medical devices, and sharing the data with their doctors. But if it’s an older patient, they will likely need a more plug-and-play solution that seamlessly sends information to their provider without them having to use an app.
“They should evaluate the cost of the devices and whether there is a warranty or any minimum order or time commitment,” Doran says. “They should also evaluate the security and HIPAA (Health Insurance Portability and Accountability Act) compliance of what is being done with the data and how secure it is. You will have to sign a BAA (Business Associates Agreement) with any vendors that also notes that you have reviewed their procedures for patient-level data—and if a breach of your patients’ data happens, make sure you are protected.”
Over the past few years, there has been a significant increase in the use of remote patient monitoring, but there is still room for growth. In fact, research firm Insider Intelligence estimates 70.6 million patients in the U.S. will use RPM tools by 2025.
Plus, with payers such as Centers for Medicare & Medicaid Services establishing RPM standards, billing codes and guidelines, there will be more research and development along with enhancement and adoption of innovative technologies for management of acute and chronic health conditions in the years ahead.
Doran notes that the companies that can get RPM right and into the hands of patients who need it will be able to expand access to care into rural areas and to patients who normally have very poor access to care. “This could open up a new paradigm of high quality care for patients who typically have been left out of the digital health revolution,” she says.
As RPM adoption grows, so too does evidence of its ability to positively impact the experience of all health care stakeholders.