David Scher, MD, DLS Healthcare Consulting
Remote patient monitoring may serve patients who are in the post-acute care phase of recovery from a hospitalization as well as those with chronic diseases. Monitoring may consist of communication tools or measurements of medication adherence, glucose measurements for diabetics, oxygen saturation measurements for those recovering from pneumonia or who have chronic lung or heart disease, symptom reporting, and vital sign measurements, and other potential parameters. Most important to consider is that these tools must be used in a context of a comprehensive approach to monitoring. A strategy regarding workflow and dedicated human resource support needs to be designed prior to implementation. Once implemented on a small-scale initially, it needs to be reexamined with an eye on identifying pain points in logistics, communication, and outcomes. The following consist of what I consider five characteristics of an ideal RPM system, however individual needs might vary.
- Single vendor for all technologies. There are currently vendors which can furnish multiple technologies and even some with more than an organization or healthcare system might want. Be careful about a one size fits all proposal. Consider whether it would be of benefit to have the technology provided by a wireless carrier or not.
- Easily implemented and unobtrusive to the user. Anyone who has experienced difficulties with setting up a new TV or smartphone understands frustrations with technology implementation. Considerations for assisting the healthcare system, Senior living facility, and the individual user are an important point of an RPM business plan. If the tool is difficult to set up or significantly gets in the way of daily activities of living, it will not be utilized. Involving a caregiver with instructions is crucial in this regard as well.
- Must have optimized population alerts and superimposed personalized alerts. Optimized alerts are those determined from evidenced based medicine, professional societies, or physicians associated with the customer. In addition, these alerts should be customizable for the individual patient whose baseline measurements or variations might be atypical. Both of the above should result in alerts to non-physician healthcare providers which are actionable only. What this means is that measurements which do not prompt a provider to recommend a change in course of treatment or other action should be stored but not transmitted. There might even be different levels of alerts which, after verified, are conveyed to the physician or other provider which ideally via an algorithm, would prompt different actions. The aim is to minimize false positive alerts while maintaining a high degree of specificity.
- It needs to be a closed loop system. This refers to every alert being addressed with an interaction. This might be a human interaction (phone call) or algorithmically determined digital message with instructions. It also refers to a follow-up afterwards to determine adherence to the instructions. This system must be bidirectional to work. There also needs to be a human component to discuss symptoms and interact with patients with limited capabilities.
- There must be seamless integration with PHR and EHR. The incorporation of data into the PHR and EHR is imperative. This is a logical progression of collection of data. It must be filtered so as not to clutter an electronic file with endless unimportant data points. It must be in an easily identifiable part of the electronic record. It must be able to be shared with the caregiver and all designated providers in an interoperable fashion.
Hopefully the Telehealth Promotions Act of 2012 will be approved in this Congressional session and pave the way for widespread adoption of these technologies which are sorely needed. It is up to both industry and adopters to optimize implementation and utilization and to create outcomes measures which might translate to health and financial ROIs.David Lee Scher, MD,FACP, FACC, FHRS, is Founder and Director at DLS HEALTHCARE CONSULTING, LLC advising digital health companies and their partnering institutions, companies, and providers.He is a former cardiac electrophysiologist with over 25 years in patient care. He leverages his experiences as a major clinical trial investigator, human subject research committee chair, Medicare committee member, and medical device industry consultant and key opinion leader in advising clients on best product and business development practices and adoption of digital health technologies He travels worldwide speaking to professional organizations and the general public on topics related to remote patient monitoring and digital health. Board Certified in Internal Medicine, Cardiovascular Diseases, and Clinical Cardiac Electrophysiology, Dr. Scher was a pioneer adopter of remote patient monitoring. He was named one of the ten cardiologists to follow on Twitter and author of one of the ten best healthcare technology blogs. . He is senior medical adviser at Happtique. As chair of Happtique’s Blue Ribbon Panel, he oversees the certification process of health apps. firstname.lastname@example.org