There’s no place like home.
No matter how much providers and staff work to make a hospital stay or office visit pleasant for patients, there’s nothing like being in your own surroundings, with your own creature comforts.
Healthcare providers are increasingly finding ways to keep patients at home when they might otherwise have needed to be at the doctor’s office or in the hospital—particularly those patients who have chronic conditions that require frequent checking, or even those with acute conditions who are able to be discharged. Providers are accomplishing this with emerging remote patient monitoring programs that improve patient outcomes and overall quality of life, as well as reduce costs to providers.
Like much in the telehealth and telemedicine arenas, the development of remote patient monitoring (RPM)—even to the extent of “hospitals at home”—has accelerated dramatically because of the pandemic and the need to keep patients—especially vulnerable ones—safe from exposure to COVID, reduce exposure for healthcare professionals, and free up hospital beds. Also, prior to the pandemic, reimbursement of RPM was limited—but since COVID, Medicare coverage of RPM services has expanded, furthering its growth.
Remote patient monitoring, sometimes called remote patient management or abbreviated as RPM, is a means of delivering healthcare using technology—usually through wireless mobile devices—to capture and transmit patient data, either from a remote healthcare location or outside of traditional healthcare settings altogether—that is, in the patient’s home. Providers remotely monitor and assess the gathered data and give recommendations and directions. Usually RPM is managed by nurses or physicians’ assistants—or contracted third-party RPM administrators—and escalated to a doctor when that’s warranted by a change in the data.
RPM is most commonly used to check on patients with conditions like high blood pressure, diabetes, and obesity. Providers can use RPM to collect a range of health data, including blood pressure, heart rate, weight, and blood sugar levels, via devices like blood-pressure monitors, weight scales, and blood-glucose meters. Medication compliance can even be monitored when patients wear a patch that detects when they take their medications and relays that information to providers. Patients may also be given tablets for video calls with providers, or in order to fill out answers to questions about their symptoms.
“Hospital at home” care is next-level RPM for patients with acute conditions such as pneumonia, congestive heart failure, or even moderate COVID, managed via devices such as spirometers and ECG machines. These patients require more frequent remote monitoring and perhaps also regular home visits by medical providers.
How Did It Start?
Mark VanderWerf, a telehealth and telemedicine advisor and consultant in Worcester, Massachusetts, has seen the evolution of remote patient monitoring over the last three decades. A recognized leader in telemedicine and related technologies from the points of view of technology providers, service providers, and healthcare provider executives, VanderWerf has built successful telehealth programs and founded telemedicine companies.
RPM began with clinician-to-clinician applications, he says—for example, a patient in a rural area would be connected remotely, through the primary-care physician they saw in person, to a specialist elsewhere for treatment.
This type of application has developed in many specialty areas; one where dramatic success has been seen is stroke care. “Say a patient comes into a hospital and a stroke is suspected, but there’s no stroke neurologist on staff that day, or none at all at that hospital,” VanderWerf explains. “With tele-stroke, you can instantly link to a stroke center, and a stroke neurologist can get online and assess that patient. If a clot breaker is needed, that can be administered. Those first couple of hours after a stroke are critical—tele-stroke saves a lot of lives.”
The crush of COVID faced by smaller hospitals has led to the advent of tele-ICU—the use of critical nurses in a central site to monitor patients in other hospitals. “With remote intensivists elsewhere, a small hospital can support more ICU beds,” VanderWerf says. “You can create an ICU anywhere with this.”
Another clinician-to-clinician application of RPM that falls into the larger tele-behavioral health area is crisis intervention. “Tele-behavioral health is most often on-demand and scheduled, but when there’s an emergency where a patient needs to be stabilized immediately, a hospital or doctor can connect the patient with a remote therapist instead of leaving that patient in crisis for hours until a therapist is available,” VanderWerf says. He adds that doctor-to-doctor RPM laid the foundation for patient-to-doctor RPM at home, which is now taking off because of the pandemic.
Why Do It?
The benefits of RPM to patients are numerous:
- Constant monitoring makes RPM just as safe as in-person care in many cases, and in fact RPM is often shown to produce better outcomes. According to VanderWerf, most RPM programs are resulting in anywhere from a 35 percent to a 55 percent reduction in hospitalizations.
- RPM gives patients a sense of control over their medical conditions and allows them to take more ownership of their health; these patients, therefore, have higher compliance rates. They can recognize the connection between changes in how they feel and changes in health data and, by extension, between their lifestyle choices and health outcomes.
- Since RPM can reduce emergency-room visits, readmissions, length of hospital stays, and frequency of office visits—nipping many problems in the bud before other care becomes necessary—it makes life less disruptive for patients and caregivers. RPM can also enable older or disabled people to live at home longer and avoid moving into nursing facilities.
- Patients and caregivers feel reassured that their health conditions are being monitored at home, lessening their stress and fear of surprises.
In addition to healthier, happier patients, RPM provides a number of benefits to healthcare providers, including reduced spending on visits, readmissions, and hospital expansions. For health insurers, the upside is lower-cost care in which quality is not sacrificed.
“In the old days, a lot of patients went home until they got sick again, and then went to the hospital again—and that was a painful and costly cycle for everyone,” VanderWerf says. “Patients want to live life as normally as possible. It’s good to know someone is watching you, can catch a problem before it becomes acute, and will prevent you from having to go in at all.”
What Are the Obstacles?
The biggest challenge to remote patient monitoring is the same as it is throughout telehealth and telemedicine: the digital divide (see “Addressing the Digital Divide,” page 10). Lack of Internet access, device ownership, and digital literacy are obstacles that must be addressed at government and grassroots levels.
Another limiting factor to at-home remote care is who lives with the patient. RPM might not be an option for those who live alone or who don’t have capable caregivers, but need a lot of help. Those who live in tight quarters with a lot of other people might be better served by getting care outside their homes, where they can enjoy rest and privacy.
From the provider’s point of view, the downside to offering RPM is the same as that in launching any new service. “You have to make sure it meets everyone’s needs—doctors, staff, patients—and integrate it into the workflow,” VanderWerf says.
He predicts that RPM will remain one of many digital services that are included in the hybrid model that’s rapidly becoming the healthcare norm. “Even when the smoke of this pandemic clears, RPM will be significant and part of most practices,” he says. “Doctors will have mixed practices of online and in-person, depending on patient preference. It’s good service and good business to offer care the way patients want to receive it.”
Mark VanderWerf, FATA, Telehealth and Telemedicine Advisor/Consultant, Worcester, Massachusetts, MA