Telehealth is one of the hottest technologies at the moment. It is dominating healthcare headlines [1] and is the topic of many discussions we have had here at Healthcare IT Today. However, I do not believe that patients are clamoring for telehealth per se, but rather are demanding care when and where it is convenient (and safe) for them.
In this light, telehealth is just one of many technologies that help patients achieve the goal of receiving care outside the walls of traditional provider facilities. Another technology that isn’t getting as much attention, but that is also experiencing significant growth is remote patient monitoring (RPM).
Remote Patient Monitoring – in the shadows of telehealth
The American Heart Association defines RPM as follows:
Remote patient monitoring (RPM) can empower patients to better manage their health and participate in their health care. When used by clinicians, RPM can provide a more holistic view of a patient’s health over time, increase visibility into a patient’s adherence to a treatment, and enable timely intervention before a costly care episode. Clinicians can strengthen their relationships with, and improve the experience of, their patients by using the data sent to them via RPM to develop a personalized care plan and to engage in joint decision-making to foster better outcomes.
With this definition you could say that RPM is a subset of telehealth but when most people think telehealth, they think of remote visit capability which is not a core component of RPM. In fact, the goal of RPM is often to avoid having a visit with a physician – virtual or otherwise. RPM simply works in the background and this might be why RPM has so far remained in the shadows of telehealth.
To find out more about RPM, I sat down with three key players in this space: Robert Kaul, President and Founder of Cloud DX, makers of a remote patient monitoring platform that includes medical devices, mobile apps, clinical dashboards, artificial intelligence and EMR integration; Dr. Michael McGillion and Dr. PJ Devereaux of the Population Health Research Institute and McMaster University who are conducting a study in partnership with Cloud DX into the impact RPM has on patient outcomes.
RPM is having a moment right now
“A lot of things happened all at once,” stated Kaul, when asked about RPM’s growth during the COVID-19 pandemic. “Hospitals and doctor’s offices closed down, all but life-saving surgeries were stopped, and it became impossible for people to go see a doctor due to the lock downs. Because of this, all of healthcare had to switch to a remote model of care.”
Smartly, governments stepped in to help with this switch by removing regulatory barriers and changing reimbursement guidelines so that care provided virtually was on par with services provided in-person. Physicians, who could no longer see patients safely in their offices or in hospital facilities began to look for ways to continue to care for their patients without being physically present.
This combination of factors fueled significant growth for telehealth and RPM solution providers like Cloud DX. “I think we have seen a 10x increase in business here at Cloud DX since COVID-19 started,” said Kaul. “We have shipped more of our devices to patients these past few months than we have in year prior.”
Dr. McGillion sees a different confluence of events leading to the rise of RPM. “In recent years, documents about virtual care and remote patient monitoring have been largely aspirational and visionary,” he noted. “We agreed that patient empowerment and optimizing efficiency are important, but there were no best practices. The pandemic has allowed innovation to happen more broadly and with more widespread support. We’re now able to think more practically about how these aspirational technologies can work in practical application. We’re finally able to have important conversations around things like integration with health information systems, frequency of patient contact, and cybersecurity.”
Impact on Outcomes
“It’s hard to imagine, but there was a time when no one would take a patient’s vitals in the hospital,” mused Dr. Devereaux. “When we sorted out how to measure someone’s temperature, heart rate and blood pressure, that helped us better differentiate which patients were potentially in trouble and who was doing well.”
According to Dr. Deveraux, during this period where vitals were not a standard part of care procedures, there were few broad scientific studies on the clinical impact of measuring vitals. However, common sense told physicians at the time it was a good practice. Eventually the science caught up and vitals became a wide-spread standard.
Today, Dr. Deveraux and Dr. McGillion, along with Cloud DX are trying to do the same for remote patient monitoring. They are in the middle of a study that is looking into the impact of RPM on outcomes, specifically on patients who have had surgery.
This was a logical place to start, according to Dr. Devereaux, since one in four post-op patients end up back in the ER due to complications. The team wanted to test and see if RPM could impact that metric (along with other outcomes).
More than 1,000 patients were enrolled in the study across seven hospitals. The patients either followed traditional post-op care guidelines (following up with the surgeon after a predetermined amount of time) or given remote monitoring devices and tablet with an app that connected them to nurses 24/7 once they got home.
Those that got the devices, measured their vitals on a regular basis and answered periodic survey questions. The collected data was sent back to the healthcare organization in real-time. If a nurse had a question about the data, they could jump on a video chat to see what was happening and make adjustments. Conversely, if the patient had questions or concerns, they could request a conversation with their assigned nurse.
Results so far
Since the study is still ongoing, Drs. McGillion and Devereaux do not yet know the final results. However, there are two anecdotal cases that show the huge upside of RPM.
One patient who had been discharged following a urological procedure was experiencing a lot of pain upon returning home. The patient easily initiated a video interaction with a nurse, who contacted Dr. Devereaux (as he was the physician on call). When the patient described severe abdominal pain along with burning urination, Dr. Devereaux suspected it was a urinary tract infection (UTI). Dr. Devereaux called the patient’s pharmacy and arranged to have an antibiotic delivered to the patient’s house. He then scheduled an appointment for the patient to go to a local lab (the patient lived about an hour from the hospital) to have a urinalysis to confirm the diagnosis.
The alternative would have involved the patient either reporting to a local hospital where they didn’t have his history or up-to-date data, or driving an hour to the hospital where he had the surgery, only to wait in the ER for several hours just to get an antibiotic. The remote monitoring + video consult capability provided an efficient, convenient way to resolve the issue.
In another case, an older male patient was discharged following heart surgery with Cloud DX’s devices. After seeing that the patient’s heart rate was dangerously low at around 32 (well below the patient’s baseline), a nurse called the house and his wife. The wife told the nurse that the patient was exhausted after the surgery and she wanted to let him rest. The nurse consulted with the physician, and the physician called the patient’s wife back to explain why this was a potentially critical situation.
When the patient arrived at the hospital, it became obvious that the patient wasn’t just tired; he was suffering from a decreased level of consciousness and was found to have a heart block, requiring a pacemaker. Although it will never be 100% certain, it is entirely possible that remote monitoring saved this patient’s life.
Keys to success for remote patient monitoring
According to Kaul, there are three constituents who need to buy-in in order for RPM to succeed at scale:
- Patients need to have a good experience with the technology. The more they enjoy using it, the more they will want to keep trying it, expand what they use it for, and recommend it to friends and family.
- Clinicians need to see the technology actual work. Historically, healthcare has had an “if it ain’t broke, don’t fix it” mentality about trying new things. While the pandemic is forcing us to try new things, now is the time to strike with new technologies that will delight clinicians as much as they delight patients.
- Payers need to get onboard and see the benefits of RPM – in particular the reduction in healthcare costs due to the prevention of readmissions.
“We need to move from CAN we do it to HOW we do it,” said Dr. McGillion. “It’s now about innovating to maximize the efficiency of these new tools and find the best models to preserve health and safety while optimizing care delivery and impacting outcomes. It’s really an opportunity for us to explore how we can scale these innovations.”
Dr. McGillion also noted that delivering robust evidence about the best ways to use and benefit from remote monitoring is absolutely vital. (See what I did there?) “What needs to happen is large-scale clinical trial evidence to inform decisions.”
I for one am anxiously awaiting the results of this study.
Here are the full interviews with Kaul, Dr. McGillion and Dr. Devereaux.
Final thoughts
At the end of our interview, Dr. Devereaux made sure to express his thanks and gratitude for the patients, researchers, hospital administration, clinicians, and all those that helped make the research possible.
Cloud DX recently announced a Connected Health Kit and Rapid Deployment Program for COVID-19 Remote Patient Monitoring.
[1] We analyze the headlines of 17 healthcare IT publications on a monthly basis and publish the results of our analysis as a report – HITMC Insights. Telehealth has been consistently in the headlines for the past 5 months.
