Remote Patient Monitoring: Benefits, Challenges, and Applications

Medical Science has proven time and again that when resources are provided, great progress in the treatment, cure, and prevention of disease can occur. — Michael J. Fox

The above quote by Michael Fox is quite relevant with the Remote Patient Monitoring (RPM), which is achieved by using the progress in the Information Technology for better healthcare.

Traditional healthcare always required the patient to visit a clinic or hospital and consult a doctor for health checkups and treatments for any problems. This takes time in terms of appointments for the doctor and the patient unless it an emergency, and this would also require patient transportation. Although no healthcare system so far sacrificed patient care in any way, delays were inevitable. With the advent of RPM in healthcare, this is set to change significantly.

What Is Remote Patient Monitoring?

Remote Patient Monitoring is a method that helps in healthcare delivery using the latest advances in IT. This is almost taking the major part of healthcare to the patient doorsteps instead of the patient having to visit the clinic or hospital. Remote Patient Technology uses specific devices that gather information about patient health to be conveyed to the doctor with the desired regularity.

The devices used in RPM are similar to Smartphones and tabs but are built to gather measurement and connect up with a specific facility or a doctor for data transmission. Patients would require wearing specific sensors that need to be hooked with these devices that transmit the physiological information to the doctor. The doctors then use this information to assess the patient condition and advise the next actions, medication, and care.

RPM monitors can also be used to set reminders about medication, exercises, diet, sleep or even instructions to fight anxiety. Depending on the choice, the RPM devices also support self-monitoring technology that helps patients take care of their health by themselves by going through instructions, flow charts, and other information. In the cases of Home Healthcare providers, the visiting nurses or medical staff could be assisted with the RPM technology located at the patient’s place.

The concept of RPM is made possible with the widespread availability of wearable devices that provide physiological measurements to the doctors and the medical staff even from a remote location. This enables the patient’s condition assessment without requiring patient proximity.

Remote Patient Monitoring Technology is made up of five major parts as discussed below:

• Input Devices: Devices that stay with the patients along with the sensors that not only provide a regular transmission of the patient conditions through data related to various parameters, but also provide assistance to the patients by providing reminders, alerts, prescriptions, communication with the doctor, and any self-assistance required. The patient can manually enter the data or else the sensors can automatically feed them into the device. These devices are the chief components that differentiate an RPM system from any other Telehealth system.

• Local Data Storage: For a given treatment cycle it is essential to hold the data related to the patient health parameters in the device (such as a USB device) or in a central repository to be extracted by the device whenever required.

• Diagnostic Application: The application on the patient’s device include diagnostic applications as it could be necessary in some cases such as heart patients. This might even advise a patient about the next steps to be taken.

• Network: Network and communication is another part of the solution that actually helps connect the EHR system with the patient’s input device. The service providers often provide this network to establish the patient-doctor communication. There are different types of networks available and it is important to ensure the ability of the input device to connect to the network. This could be achieved via Wi-Fi, Wired or Mobile connection or in some cases Bluetooth connection of different generations and types.

• Central Repository: Patient data is stored in EHR systems maintained by the clinics and the hospitals. This could be formed by one or more of data repositories applicable to a healthcare system. Healthcare software can use this data and provide the information to the medical practitioners related to the patient’s condition for diagnosis, medication, and treatment.

RPM and Telehealth

RPM may sound like Telehealth but is not. Telehealth also uses Information and Communication technologies but does not use specific devices to gather health information. It is achieved by using communication such as telephones or Mobile phones, video or other means of teleconferencing to interact with the patient at a distant place to assess the condition and prescribe medication.

From purpose point of view, RPM is a specific application of Telehealth, if Telehealth is viewed as a broader term about delivering healthcare nearer to the patient.

Remote Patient Monitoring – Challenges and Barriers

There are many challenges and barriers related to the systems and regulations that must be overcome in order to successfully achieving a fool-proof functioning of an RPM system:

• Network Availability and Connectivity:

  The success of RPM (or even Telehealth) depends heavily on the availability of network and connectivity of the device, especially at any patient’s premises. This is true for Telehealth in general and any type of network, WiFi, Mobile, Wired, or any other type. Especially when large data packets are being transmitted over the network, interruptions could hamper the diagnosis; for example in any case that requires continuous monitoring such as the heart conditions or brain conditions, network interruptions at critical times may prove to be unwanted. The input devices often are situated close to the patients, so the patients need to ensure availability of the uninterrupted network for continuous communication with the EHR system. Depending on the adoption rate, Network providers could come up with network types that assure this.

• Sensors and Wearable Devices:

  An RPM system’s chief differentiator is the inclusion of sensors and wearable devices. These could be available in various sizes and types which patients could be asked to wear on various parts of the body; it is the question of suitability, usability, comfort, and convenience. For example, a device like Fitbit (activity tracking watches) or such others may not be suitable for shower although it is water resistant. Many of the electronic devices are unsuitable for use near hot places like barbecues. Some of the battery operated devices could run out of power faster in cold weathers. In general, the design of devices especially the wearable ones, may require revision from time to time.

• Training and Adaptability:

  Even if the RPM devices are usable to a good extent, a multiplicity of sensors and complexity of devices may require some training to be imparted to the patients. The extent of training may depend on the patient’s background and conditions.

• Accuracy of Data:

  The success of the RPM system also depends on the data quality. Even if the system, the sensors, and the network are running fine, the reliability of the data provided to the diagnosing practitioner would be dependent on the accuracy of data from the system. This may need verification and calibration of the RPM system from time to time in order to maintain reasonable accuracy.

• Security and Privacy:
  

  Since the RPM systems work over digital networks they are prone to hacking and the associated breach of privacy and other security issues. Security standards normally applicable to other Healthcare management systems could become applicable to RPM systems also. HIPAA and similar other norms require patient privacy to be protected; although this could be part of information security and perceived as a larger subject requiring a healthy clinic-patient relationship.

• FDA Approval:

  The RPM systems and devices must meet the FDA regulation norms for healthcare use. FDA approval itself brings a challenge to the system providers; it could require scrutiny of manufacturing/development processes, quality assurance, patient worthiness certification and life cycle assessments. While FDA approval itself may be beneficial to the patients which could ensure high device standards, it may eventually end up pushing the device costs higher due to related overheads.

• Cost and Affordability:

  The process overheads and extra approval steps may lead to increased costs thus making RPM devices expensive to adopt. However mass scale adoption in due course of time could make it affordable and even necessary.

We are discussing the challenges to understand the implications of this technology as it exists; these are problems to be solved and barriers to be overcome sooner than later. Understanding them is necessary to arrive at effective solutions and thus making the RPM system more reliable.

Remote Patient Monitoring – Benefits and Examples

The benefits from a Remote Patient Health Monitoring system can be seen from two angles, the patient and the doctor. These benefits are rendered by a continuous share of health information update from the remote patient to the medical staff.

For the Patient:

• Reduced lead time (required for appointments) and travel effort/time.
• Timely detection and action for specific conditions which require quick attention.
• Assisted and rapid diagnoses that may help arrive at logical conclusions.
• Reduction in hospitalization and related time, effort, and costs.
• Better adherence to the medication schedule.
• Home or familiar premises may be more amenable for several patients than hospitals.

For the Doctor:

• Continuous patient monitoring data streaming could provide near real-time patient supervision.
• Balances out the workload and time; no need for rounds to assess patients in such cases.
• Better utilization of medical resources such as the equipment, medical staff, and others.

For Others in Healthcare:

For healthcare providers, RPM systems could render an alternative to be offered to patients unwilling to visit the hospital premises frequently. Home healthcare providers can augment their services and optimize their services by letting part of the care to be rendered by RPM systems.

RPM Applications:

RPM system could find applications in numerous healthcare cases some of which are quoted below:

• Heart Patients: Recovering heart patients could require continuous monitoring to assess the conditions and quick care/medication. Devices which include heart resynchronization therapy and pacemakers are especially useful in preventing problems for heart patients. The diagnostic software combined with the device capabilities could almost double-up as a doctor in the vicinity.

• Senility or Dementia Problems: Old age people often suffer from senility and forgetfulness; this could bring some problems such as losing the way or such people falling down at some places. The surveillance and assistance provided by RPM devices could help such people; if these are GPS enabled, they could even help track their locations.

• Diabetes and Hypertension Control: Diabetic or high BP patients require continuous monitoring and control of blood pressure and blood sugar; this can be achieved by an RPM system that not only monitors but could also provide alerts for controlling them. The diagnostic software could provide not only the condition but even advice the diet control or medication necessary to bring the blood sugar to acceptable levels.

• Clinical Trials: In specific clinical trials, which may require long-term observation of the subjects during and after the trials, this may be achieved with the RPM systems.

Future of Remote Patient Monitoring

Remote Patient Monitoring comes with a lot of promise and has evolved into a finer service than Telehealth. It is going to continue evolving with time in terms of growth and innovation. The following trends are foreseen in the future for Remote Patient Monitoring:

• Increased adoption of Remote Patient Monitoring in Practice Management and Research.
• Consolidation and convergence of technologies participating in RPM.
• Increasing patient participation in RPM adoption and utilization.
• Improvements in devices and technologies with increasing utilization and information share.
• Application of analytics leading to a better study of patient condition information and the related assessments.

Conclusion

Remote Patient Monitoring systems are especially useful because they let the patients live their life while at the same time afford constant medical attention. The need for visiting the clinic/doctor is pushed to only deserving cases. Offline or online RPM devices are effective patient companions at all times.

RPM systems can be used by even seemingly healthy people who may foresee health problems in the future. RPM systems will continue to evolve with increasing awareness, utilization and improving technologies.

Author's Bio

Shailendra Sinhasane