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The ability to seamlessly connect provider to patients beyond the four walls of the practice comprise a cornerstone for improved patient outcomes, reduced cost and resource allocation, enhanced care quality and other value-based care goals.
Many of the concepts and methods that fall into the broad category of remote patient monitoring (RPM) have been around for years, but technological advancements, changes to reimbursement schedules and patients’ desires to manage their preventative care and chronic conditions within the context of their daily lives have led to greater maturation of the RPM market.
History of Remote Patient Monitoring
RPM (Remote Patient Monitoring) literally got its start in space, launched by NASA (National Aeronautics and Space Administration) in the 1960’s. As NASA’s Directorate of Space Medicine explored the limitations space places on the human body, the agency expanded the bio measurement systems that first debuted on the Mercury and Gemini flights.
Today, a more comprehensive, industry-wide push for connected health began following the Great Recession and the passage of the American Recovery and Reinvestment Act (ARRA) of 2009. ARRA included health information technology (health IT) initiatives to help stimulate economic growth in specific businesses and provided significant investments to modernize the nation’s health IT infrastructure.
The following year, the Obama administration also proposed a national broadband plan that included a call to improve medical networks to “facilitate remote patient monitoring, electronic health records and other technology-based health services such as telemedicine.”
Over the past decade, the explosion of such consumer technologies such as smartphones and wearable devices combined with the build out of broadband and health IT infrastructure to accelerate the adoption of connected health care initiatives. Other market forces — the rise of consumerism, the shift in focus in healthcare from volume to value, the decentralization of care, and a surge in interest in wellness programs continued to transform healthcare and accelerate the need for connected, remote patient care.
The Data Dilemma
Worldwide, 7.1 million patients were being remotely monitored in 2016, according to Berg Insight. That number is projected to grow at a compound annual growth rate of 47.9 percent to reach 50.2 million by 2021.
Market research firm Technavio projects the RPM market specifically to grow at a
compound annual growth rate of 15% through 2021 to just shy of $1 billion — driven by an increasing consumer trend toward online medical purchases, jumps in the number of chronically ill and aging populations, and more demand for patient-friendly devices.
As these market numbers indicate, RPM plays an integral role in much of the interest surrounding healthcare IT today. Integrating data from wearables, medical devices, implants and other sources into healthcare systems’ disparate, complex and costly technology platforms is a cornerstone of many of the industry’s efforts in the Internet of Healthcare Things (IoHT). However, simply providing access to the voluminous amount of raw, rich data generated by remote patient monitoring in and of itself is not enough to fully realize the transformative benefits that IoHT promises in patient-centric care, lower healthcare costs and data-driven health decisions.
In an IoHT world, the hub of healthcare delivery is no longer in the hospital, clinic or physician’s office, but in the patient’s home. Part of that is being driven by patients using their own mobile devices, which are projected to be the preferred device for 22.9 million patients by 2021, according to Berg Insights. Well-designed RPM programs are proving to keep people healthy, allow older and disabled individuals to live at home longer and reduce the number of hospitalizations, readmissions and lengths of stays in hospitals.
Apps, sensors and wearables will continue to pump out streams and streams of patient-generated health data through remote patient monitoring systems. But to motivate patients to become highly engaged partners in their care, healthcare providers also need actionable analytics tightly integrated within their existing clinical workflows and accessible in real time to improve outcomes, treatment protocols, and, ultimately, population health.
If you think of the care pathway as the automated dialogue a clinician would have with a patient, there is a strong need for a well-designed, customizable content management platform to work behind the scenes.
At the lowest level, the system needs to be able to handle branching logic in order to add questions based on answers and be able to insert educational content and then teach back questions solely based on patient inputs. Sophisticated systems need to be able to deploy dynamic pathways which can automatically increase the level of care as appropriate, inserting entirely new clinical protocols based on clinical guidelines and patient responses. This enables a greater level of patient self-management, through dynamically changing automated coaching that is tailored to the individual and their changing conditions.
How RPM Works Today
Change is hard anywhere in healthcare, and this holds especially true when it comes to widespread integration of RPM systems within the clinical workflow. Health systems and health plans alike have struggled in the past to find a unified voice and technology platform that will optimize the benefits of remote patient care.
This is changing rapidly. RPM systems today allow care programs to be linked
to specific care teams where only their patients are available for viewing. This allows a centralized approach to distributed care, plus maximum flexibility in the way these teams connect to patients remotely.
Is It Simple?
Simple RPM programs around a single condition are predominant, but the leading healthcare organizations are building virtual care competencies to support a wide range of virtual care and remote monitoring. Successful systems are thinking about reducing unplanned care for polychronic patients and patients from multiple disease care programs from within the health system and their accountable care organizations.
To accomplish this, the best connected care platforms, today, combine the existing mobile applications that previously operated in silos. They also consolidate the healthcare organization’s branding across telehealth, virtual care, remote monitoring, home health, hospital at home, marketing and patient engagement programs.
Smart technologies make data collection from remote patient monitoring more convenient than the traditional methods of the past that required physical, on-site visits to physician offices or medical centers. Consumers today can automatically transmit a wide range of their health data to a web portal or a mobile app, including readings on vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart rate and even electrocardiograms, just to name a few biometrics. This remote patient monitoring not only enables consumers to monitor their own health, but it also offers clinicians miles away the opportunity to proactively assess red flags and recommend adjustments in treatment plans in real-time.
What Happened to Paper?
After having to move from paper-based patient records to EHRs, clinicians today fully expect their remote patient monitoring systems to seamlessly integrate standard patient information into the clinical workflow. Remote patient monitoring offers healthcare professionals the opportunity to use data generated through multiple sources within and outside the enterprise to create continuous clinical workflow improvement.
To develop these integrated workflows, a truly collaborative approach is required — one that takes into consideration the needs of the patient as well as the concerns of clinicians and the ways in which they can best deliver quality care. The best remote patient monitoring systems become integrated within the organization and the workflow to achieve the greatest success — through collaboration among physicians, clinicians, patients and even administrators—to understand how to positively impact patient outcomes.
A significant obstacle to optimizing RPM is the continued existence of information islands across the healthcare enterprise—the subsets of patient data that are isolated from the bulk of a patient’s historical data.
What About Data Overload?
Unfiltered patient data may increase patient risk because physicians may be required to locate actionable data (signal) within an overwhelming amount of artifact (noise) including false positive alerts. In addition, inadequate or absent integration of data analytics and intelligent notification protocols into RPM platforms can undermine a wireless medical device or app’s effectiveness by increasing physician workload, inefficiency, and risk. Unfiltered patient data increases risk to physicians who are tasked with finding actionable data within a stream of useless or faulty information.
Today’s RPM systems address these data challenges through an unprecedented commitment to share and analyze data, especially when it comes to more efficiently managing rising-risk, at-risk and aging populations. Frequent engagement with these populations, paired with intelligent clinical escalation algorithms and intervention tools, leads to greatly improved outcomes.
What About Customization?
These advanced platforms can now be easily customized to healthcare’s unique business and reimbursement models, including chronic care management, bundled payments and ACOs. Population analytics incorporated within an RPM platform can also help determine where organizations should dedicate their engagement and remote care investments, while also helping to discover health status down to the patient level on a daily basis.
Disease-specific clinical protocols can also be modified for each patient, expanding community outreach and member marketing efforts simultaneously. This ongoing data stratification also drives business intelligence efforts with continual data streaming in from members, patients and employees.
Actionable analytics gleaned from remote patient monitoring systems today not only help improve patient and population health, but also enable providers to leverage that information through the EHR to more effectively triage patients who need early interventions. The next generation of clinical decision support tools on deck will leverage data from remote patient monitoring systems through machine learning algorithms, enabling providers to conduct and continuously improve upon in-depth analysis of protocols, interventions and outcomes data.
Technology and Change Management
Legacy technology platforms in healthcare organizations traditionally have presented significant obstacles when making the business case for implementing a remote patient monitoring system. EHRs store retrospective data, not the continuous streams of real-time patient data available from consumer devices in
remote locations that healthcare professionals can then examine to proactively address a patient’s treatment. There are also significant data privacy concerns that need to be addressed – especially for remote patient monitoring systems that may rely on data from consumer devices instead of the health system’s branded and more secure devices. It is also important to have clear direction on which episode or encounter data should be attached, the “signing” authority within the provider organization, and standardized processes for data review prior to integrating the remote patient monitoring data within the EHR.
Workflow issues also need to be addressed on the front end. It is important for the pilot team to consider how the data will be managed and reviewed, what enterprise systems will have access to review the data and raise alerts, and ultimately how the tsunami of information will be managed to avoid clinicians from drowning in data.
Much of this can be achieved by adopting a cloud-based platform. In today’s cloud world, the ability to scale has moved beyond the traditional enterprise technology infrastructure. An “IT-Light and Patient-Heavy” cloud approach to remote patient monitoring systems allows hospitals to stay focused on the patient instead of the technology.
A cloud-based solution also allows patients of any age, health status, or technical ability to easily participate in a remote care program. The days of elaborate in-home set-ups have dissipated into the cloud – today, a fully managed remote care kit program can be shipped to the home, providing plug-and-play capability instantaneously. These cloud-based kits have been thoroughly vetted prior to deployment to ensure they integrate seamlessly with the enterprise IT and clinical processes of provider and health plan organizations.
Cloud-based remote patient monitoring systems are also ideal for working in today’s popular BYOD (Bring Your Own Device) environment of patient desktops, smartphones and tablets. By integrating BYOD into a remote patient monitoring system, providers and health plans can more easily expand their reach to even more sizeable populations – and ultimately better manage specific conditions, shape patient behaviors, and eliminate preventable hospitalizations.
Healthcare organizations are wise to customize their remote patient monitoring systems to best match a patient’s technology savvy and the level of access they desire. System features that can help achieve this flexible approach include interactive voice response (IVR), fully managed kits, BYOD (bring your own device) integration, and video and web-based content that patients can access to self-manage their conditions when needed – avoiding unnecessary and costly interactions with the health system for minor changes in their conditions. The remote patient monitoring system can also build medication reminders into the technology platform, providing real-time alerts to the care team to follow up on any signs of noncompliance by the patient.
New Codes, New Reimbursement.
ROI rates could increase even more in the future as the Centers for Medicare and Medicaid Services (CMS) have made, and continue to make changes designed to improve reimbursement opportunities for remote patient monitoring. In an update to the 2019 Physician Fee Schedule and Quality Pay Program, CMS included three new Current Procedural Terminology (CPT) codes for reimbursement of remote patient monitoring. Physicians can now be reimbursed for remote services that, previously, could only be billed for by physicians providing these services to patients on site.
The new CPT codes separate remote patient monitoring from telehealth. It marks a sea change in how CMS views the value of remote patient monitoring, as the group continues to notice and track how outcomes are improved by allowing doctors to keep tabs on patients between visits, lowering healthcare costs and remotely identifying complications with chronic conditions before they escalate and require an emergency room visit or or other patient care intervention.
RPM & Value-Based Care
Satisfied patients enrolled in RPM programs are typically more compliant patients, and compliance leads to better clinical and financial outcomes. When patients feel good about the care they’re receiving, they are more likely to follow their individual care plans.
That is why it is so important for care managers to develop a bond of
accountability – from clinician to patient, and from patient to clinician – beginning with the first virtual visit. Throughout each subsequent care encounter, they can then focus on expanding the trust within the patient relationship. Contrary to the observation that technology removes the personal part of care, remote patient monitoring done right has proven to improve genuine connections between the care team and patients.
Make It Comfortable.
The best RPM system utilizes technology that is familiar and comfortable to the consumer, while enabling proactive automation and information-sharing with the patient’s care team. With remote patient monitoring, healthcare systems are now able to more effectively close the patient engagement gap, completing the circuit of value-based care.
How to Get Started
The proactive, automated care that remote patient monitoring helps create is the future of healthcare. Data coming from such a large population of engaged patients is proving to be some of the freshest data in all of healthcare – making it an ideal source of relevant healthcare data to leverage to generate
even better population health outcomes through the use of machine learning, neural networks and artificial intelligence platforms. With AI or machine learning, it becomes possible to improve clinical monitoring rules and create greater efficiencies for care teams by comparing claims data as the “truth data” with reported outcomes from the system. A learning monitoring system can provide more time for clinicians to respond when a patient begins to decompensate in their clinical condition, often before the patient, loved ones or care teams can “see” the health deterioration.
The best approach to better remote engagement with patients is through regular, purpose-driven outreach in the least intrusive modalities available. Easy-to-use remote patient monitoring systems can reach patients in ways that work and at times where the impact of that engagement is maximized. These systems offer an easier path for patients to connect directly to their care teams from remote locations, while the platform itself can deliver streams of their health data in real time back to the care team.
Here are some tips to get started on the road to remote patient monitoring:
Keep It Simple.
Health systems which have been ahead of the curve are incorporating remote patient monitoring for as many as 20+ clinical conditions being monitored across multiple service lines. If you are just getting started, don’t shoot for the moon. Most initial remote care pilot programs aim simply to reduce the number of in-office visits or improve outcomes for one chronic condition. That makes prenatal care an ideal population to test remote patient monitoring. The outcomes for pregnant patients are quickly clear – the remote patient monitoring system can measure reductions in-office visits, reductions in short- and long-term complications, and even patient satisfaction.
From there, consider extending remote patient monitoring for patients suffering from conditions such as hypertension or diabetes, or by incorporating into existing wellness and prevention-based treatment programs to support core use cases.
Easy Does It.
Your patient population has widely diverging comfort levels when it comes to using technology. That’s why it is crucial to make it easy for patients to get started.
Ensure your remote patient monitoring system is purpose-built for specific patient populations. Older patients being treated for heart failure, for instance, may not be tech savvy, or they may resist learning new or complex technologies. It’s important to meet those patients where they are in life – with pre-configured devices that are easy to use. Such devices have proven to be between 20% and 30% more effective in daily compliance and adherence to remote care activities.
For younger, rising-risk patient populations, a BYOD approach may be more appropriate, letting patients use their personal smart-phones and tablets. And don’t forget the land-line – although most folks have “cut the cord,” many older patients still rely on the old phone on the wall.
By keeping patients’ familiarity with devices and adaptability to user interfaces in mind, care teams can help overcome any initial anxiety their patients may have to remote patient monitoring.
(Consumable) Content is King.
Seeing is believing…and understanding. YouTube has proven this to any amateur Mr. FixIt trying to make a DIY repair of a leaky sink or a faulty light switch. Compelling educational videos can help reduce unnecessary clinical visits for basic questions, or times spent on the phone explaining simple care concepts to patients.
Videos, health tips, and teach-back questions can often minimize or even eliminate situations where patients feel they need to interact directly with the care team – allowing the care time to dedicate its time to patients with more important care issues.
Communication is Key.
It is not enough to view remote patient care as just a way to reduce unnecessary, costly readmissions or clinical visits. To truly empower patients within their care plan, it is imperative that they can also take advantage of features such as embedded video conferencing to share information with their providers more frequently. Embedded video communications unleash the full power of patient engagement – where the patient becomes a true partner of the care team.
Proactive vs. Reactive.
Post-discharge clinical pathways traditionally have been executed in a reactive manner – waiting for the opportunity to interact directly in person with the patient on site, calling them, or asking them to log in to a patient portal to answer questions about their condition.
Social engagement capabilities within a remote patient monitoring system radically transform the entire consumer-facing conversation. Low-cost engagement solutions such as secure text messages open a survey through a smart-phone browser so the patient can answer post-discharge questions through a secure, app-like experience.
Closing the Loop.
The remote patient monitoring system should not operate in a vacuum. It is important to close the loop by integrating the platform with your healthcare enterprise’s portal and app strategies.
Using a simple text, patients can be guided through a remote patient monitoring system to access even more information through other health system apps, or even connected directly to the secure EHR patient platform that contains their personal record.
The benefit to your care teams? They won’t have to spend valuable time chasing down the 85% of patients who struggle to access those services on their own.