Remote Patient Monitoring: The Cutting Edge of Care

Remote patient monitoring (RPM) technologies are growing in sophistication and in business. The tools also are ripe for innovation.

RPM’s ability to monitor trends in a patient’s body metrics over time fosters “just-in-time care,” as it can alert physicians to irregularities, preventing a medical crisis and saving lives, says Robert Havasy, corporate team lead, product and technology development at Partners HealthCare’s Center for Connected Health in Boston. In the process, providers can avoid the expense of costly visits to the emergency room.

The RPM industry is booming. Kalorama Information earlier this year reported that the market was valued at  $10.6 billion in 2012, up from $8.9 billion in 2011, and predicts the market will mushroom to $20.9 billion by 2016.

EMR Integration

As RPM gains steam, the healthcare industry is exploring more ways to innovate in this space.

In one pioneering effort, Partners’ Center for Connected Health began transmitting patient data collected at home, including vital signs such as blood pressure, weight and blood glucose, and integrating them into its homegrown EHR system. The goal: make these data available to physicians in their normal workflow.

Patients receive a data hub that wirelessly collects data from devices. So far, the center has collected 1.4 million discrete vital signs. At one time, about 200 heart failure patients and 100 to 150 patients with diabetes and hypertension, who participate in single-disease monitoring programs, transmit data into the EHR. Patients can access this health information via a secure patient portal.

The center designated specific screens that link to clinicians’ view of their patient panels so they know who is on an RPM program and when that patient last sent data, Havasy says. From there, physicians can click through to raw data, graphs and charts.

“An important distinction is we’re not actually pushing data into the medical record or using the medical record database to house these data. Data comes in and remains in a separate system, the Remote Monitoring Data Repository, just like a clinical data repository,” he explains.

A large, randomized trial showed that the center’s RPM effort, the Blood Pressure Connect program, improved participants’ blood pressure control.

As such, Havasy says RPM provides both a medical use case and a financial use case. As Partners is a Pioneer accountable care organization, health outcomes are more tightly linked to reimbursement. “We are broadening this program, looking for lower cost, easier-to-use devices.”

Gathering data

The Mayo Clinic in Rochester, Minn., has had RPM on the mind since the 1990s. The potential to detect patients with irregular heart rhythms, and then prescribe blood thinners to prevent a stroke, prompted an interest in monitoring technology. An ECG at one point in time is inadequate to detect arrhythmias, so Mayo Clinic saw RPM as a means to screen those at risk. 

“When there is a problem, like a ‘systems check required’ on the dashboard of a car, you could remedy the problem. We thought, wouldn’t it be neat if we could do the same for people?” says Mayo cardiologist Charles J. Bruce, MD, who served as principal investigator in studies of the tool. “It was that clinical need that sparked the idea of a dashboard of human wellness.

The BodyGuardian Remote Monitoring System, developed by Bruce and Mayo Clinic cardiology colleagues Paul Friedman, MD,  Virend Somers, MD, and engineer Kevin Bennet, is a small, wearable sensor that adheres to the skin and resembles an adhesive bandage. FDA-approved in August 2012, the device detects and monitors non-lethal cardiac arrhythmias in ambulatory patients, sending the data via wireless and smartphone technology to a cloud-based care platform, where it can be monitored by technologists and accessible to care teams. (Preventice has licensed BodyGuardian’s remote monitoring algorithms from Mayo Clinic).

The system continuously records, stores and periodically transmits ECG, heart rate, respiration and activity data to a remote computer server. All data are uploaded for up to 30 days at a time. Technologists analyzing the data contact a nurse, who then alerts a physician, if a problem arises.

While the device is newly on the market, Bruce reports promising pilot studies. In one, 10 elderly volunteers in an assisted living environment transmitted “very good quality ECG data” using the BodyGuardian.

In another study, researchers monitored 50 post-surgical cardiac patients using the device for three days. The result: high-quality ECG data. The opportunity is exciting, Bruce says, because it offers a low-cost way to get these futuristic devices on patients at high risk. “One can imagine putting these on patients for the first month following a surgery because we know that the first 30 days after someone is released from the hospital, the chances of having some event increases.”

Bruce emphasizes that RPM systems like BodyGuardian can help close the access gap. “Rather than having a few fortunate people benefit from the expertise we can provide, we can turn this medical brick-and-mortar institution into a digital healthcare provider.”

Lessons in Sustainability

For RPM technology to pay off in the long term, providers must overcome physician and patient engagement barriers.

An early adopter of telehealth, Scottsdale Healthcare Home Health in Arizona implemented the McKesson TeleHealth Advisor—which includes more than 30 disease management programs—about eight years ago. For seven years, they have integrated the data into the EHR. If staff know that a physician is seeing a patient with a monitor, they generate reports for that physician. 

The home health agency has 47 remote monitors. Clinical staff need to promote the device to patients, but high turnover can threaten this process, says Shirley Righi, clinical director. “When we’re not having a lot of turnover, we find that we have many more telehealth monitors out in the field.”

Patient engagement is another barrier, as many in the aging population want nothing to do with the technology. “It’s in the timing. You have to develop a positive relationship with the patient so they understand the benefit to them,” she says.

Scottsdale’s monitoring device encompasses three areas: transmission of health stats (blood pressure, weight, etc.); knowledge (questions prompting patients to verify their understanding of their path of physiology); and compliance. If a patient fails to answer questions regarding his or her condition, or fails to adhere to his or her medications, a nurse will know exactly which barrier to target to effectively intervene. Technology must be seen to enhance, not replace, care, Righi says.

Looking Ahead

For continued growth, RPM data must not overload physicians and RPM technologies should be as passive as possible.

“I’m not sure we or anyone else have solved the problem of how best to display long-term, low-frequency data that doesn’t overload clinicians but yet highlights those people who may need an intervention,” says Havasy.

Bruce says the Mayo Clinic team is actively working on how to incorporate data as part of the EHR in a more seamless fashion. “It’s clearly complicated,” he says.

If patients stop sending data after their medication regimens are appropriately tweaked and their biometrics are under control, it begs the question of how preventive these technologies are. Also, even when submitted data requires little effort, it’s challenging to keep people engaged in sending data frequency, Havasy says.

He compares data hubs to smoke detectors that are checked annually. “Once a year you make sure they are still working, but they need to collect data passively. When it gets to the point that the tiles on the floor take my weight when I’m brushing my teeth, then we’ll be somewhere. I think we’re getting closer and closer.”