Blood Pressure Uncuffed™ Volume 3: Remote Patient Monitoring: Revolutionizing Healthcare from the Comfort of Home
December 7, 2023. By Namita Lokare, PhD
In the fast-paced world of healthcare, staying connected with patients and ensuring their well-being has taken a remarkable leap forward. Remote Patient Monitoring (RPM) is at the forefront of this healthcare revolution, employing medical technology and devices that are sent directly to patients’ homes to continuously monitor vital signs and assess symptoms. The result? A comprehensive approach to healthcare that brings the doctor’s office to the patient’s doorstep.
The RPM Approach: Caring from Afar
At the heart of RPM lies a dedicated team of Remote Patient Monitoring nurses. Their primary role is to meticulously observe and analyze patient data, reaching out to individuals to assess their health status and progress toward their health goals. Initially developed to support patients with complex chronic conditions, RPM has evolved to encompass post-surgery care, ensuring that patients are never alone in their healthcare journey. Information such as weight, blood pressure, blood sugar, heart rate and electrocardiograms can be sent to the healthcare providers using the software tools that are HIPPA compliant, which allows monitoring and early intervention, leading to an improved level of care. An illustration of Remote Patient Monitoring (RPM) in action can be seen in elderly care. With the aging population in the U.S. on the rise, leveraging these systems becomes essential for providing remote care and promptly identifying falls or other emergencies.
Helping Patients: The Comfort of Home Monitoring
For patients, RPM means much more than just convenience – it brings a profound sense of comfort. It assures them that their healthcare provider is keeping an attentive eye on their well-being, even from the comfort of their own homes. This level of continuous care not only boosts patients’ confidence but also empowers them to take control of their health journey.
Empowering Physicians: Real-Time Data at their Fingertips
For physicians, RPM provides a treasure trove of real-time patient data. This invaluable resource enables doctors to make informed decisions promptly, offering the opportunity for timely adjustments to treatment plans. The result? Enhanced patient
Payers on Board: RPM’s Promise of Cost Savings
Payers within the healthcare space are embracing RPM, recognizing its potential to yield significant cost savings. By promoting early intervention, reducing hospital admissions and even shortening hospital stays in some cases, RPM is a win-win solution for patients and payers alike. A recent study in type-2 diabetic patient with the use of RPM has shown improved glycemic control as well as cost savings of 21% for the patient over one and two–year follow up [2]. Another study done by researchers at the Mayo clinic enrolled and engaged high risk COVID-19 patients in an RPM program which showed lower rates of hospitalization, intensive care unit admissions, mortality and a reduction in care costs by roughly 35% than those enrolled in RPM but not engaged [3].
Outlook on the market
The global RPM market was valued at $1.87 billion in 2021, and is estimated to reach $8.45 billion by 2031, growing at a CAGR of 16.3% from 2022 to 2031 [1]. In 2019, Medicare broadened its coverage of Remote Patient Monitoring (RPM) by introducing new billing codes that enable monthly payments for monitoring any type of physiological data [5]. RPM in traditional Medicare saw a significant uptick in demand at the height of the COVID-19 pandemic, reaching more than 6 times the pre-pandemic levels by September 2021. During this period, general services represented 63.1%, cardiology accounted for 19.7%, and pulmonary for 4.1% of the overall Remote Patient Monitoring (RPM) services. Among the general services, hypertension was the dominant primary diagnosis at 62.5% [4].
The pandemic has certainly highlighted the potential of RPM to make healthcare more equitable, accessible, and affordable for all. Barriers such as transportation from rural areas to hospitals and patients who have mobility issues are no longer an issue due to the care being delivered directly to one’s home. As the population in the US continues to age, the prevalence of chronic health conditions will lead to an increasing need for healthcare services, making RPMs a crucial component in managing and monitoring patients’ well-being. Consequently, RPMs will continue to experience significant growth in their adoption and utilization.
Novel Devices/Wearables: Enhancing the RPM Experience and Challenges they face
Novel devices that make it easier for users to adhere to taking measurements have the potential to play a pivotal role in ensuring a seamless Remote Patient Monitoring (RPM) experience for patients. One area where they hold tremendous promise is in hypertension management. Traditional cuffs are often uncomfortable, less accurate, and challenging to use, especially for special populations such as pediatrics, stroke survivors, the elderly, and obese individuals. However, new solutions, such as Valencell’s Fingertip™ Blood Pressure Monitor, aims to disrupt the hypertension space by making it easy to adhere to taking spot check measurements to track blood pressure over time. For solutions like this we need to be mindful of the challenges listed below,
The Accuracy Challenge
For such devices to truly impact the RPM space, accuracy is paramount. Physicians demand data that is reliable and actionable for making informed treatment decisions. For hypertension, this necessitates a broader conversation around standardizing validation schemes to ensure only rigorously vetted devices are integrated into RPM systems. A recent study done by Picone et.al. studied blood pressure devices sold on Amazon globally and found that 79% of upper arm cuffs and 83% of those with wrist cuffs were not validated for accuracy. Most non-validated arm cuff devices were sold in India or Australia while most non-validated wrist cuff devices were sold in US or Mexico [6]. This presents challenges for patients who purchase devices without comprehending the accuracy implications. Consequently, educating individuals about the precision of these devices becomes crucial. The responsibility lies with physicians, device manufacturers, and Remote Patient Monitoring (RPM) providers to guide and advise patients on selecting the appropriate devices.
The Data Challenge
Devices that produce a lot of data can be overwhelming to nurses and physicians. Device makers need to take this into account and provide data that is actionable and that helps with patient outcomes. Interoperability is essential for device makers as it enables the product to function effectively within the broader ecosystem, improves user experience and most importantly ensures compliance with regulatory standards. More specifically, RPM solutions that integrate with EHR have benefits in terms of allowing physicians to access and share information in a single place and is also a prerequisite for Medicare coverage.
Numerous government-certified Electronic Health Record (EHR) products, varying in clinical terminologies, technical specifications, and functionalities, are utilized nationwide. The diversity among these systems poses a challenge in establishing a universal interoperability format for seamless data sharing. Even EHR systems on the same platform may lack interoperability due to extensive customization based on organizational workflows and preferences [7]. This is a challenge not only for the healthcare system in the U.S but also for RPM companies and remains a key issue in solving the interoperability issue.
The Future of RPM
Looking ahead, Remote Patient Monitoring is poised to play a central role in healthcare delivery. While in-person doctor visits will still be essential, patients will have the power to monitor their vital signs at home and share this data with their healthcare providers in advance. This approach not only makes the process more efficient but also allows physicians to care for more patients effectively.
References
[2] Mounié, M., Costa, N., Gourdy, P., Latorre, C., Schirr-Bonnans, S., Lagarrigue, J. M., Roussel, H., Martini, J., Buisson, J. C., Chauchard, M. C., Delaunay, J., Taoui, S., Poncet, M. F., Cosma, V., Lablanche, S., Coustols-Valat, M., Chaillous, L., Thivolet, C., Sanz, C., Penfornis, A., … Educ@dom Study Group (2022). Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study. Diabetes therapy : research, treatment and education of diabetes and related disorders, 13(4), 693–708. https://doi.org/10.1007/s13300-022-01207-1
[3] Haddad, T. C., Coffey, J. D., Deng, Y., Glasgow, A. E., Christopherson, L. A., Sangaralingham, L. R., Bell, S. J., Shah, V. P., Pritchett, J. C., Orenstein, R., Speicher, L. L., Maniaci, M. J., Ganesh, R., & Borah, B. J. (2022). Impact of a High-Risk, Ambulatory COVID-19 Remote Patient Monitoring Program on Utilization, Cost, and Mortality. Mayo Clinic proceedings, 97(12), 2215–2225. https://doi.org/10.1016/j.mayocp.2022.08.015
[4] Tang M, Nakamoto CH, Stern AD, Mehrotra A. Trends in Remote Patient Monitoring Use in Traditional Medicare. JAMA Intern Med. 2022;182(9):1005–1006. doi:10.1001/jamainternmed.2022.3043
[5] Centers for Medicare & Medicaid Services. Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations-Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Federal Register. November 23, 2018. https://www.federalregister.gov/d/2018-24170
[6] Picone DS et al. Availability, cost, and consumer ratings of popular nonvalidated vs validated blood pressure–measuring devices sold online in 10 countries. JAMA 2023 May 2; 329:1514.
[7] Reisman M. (2017). EHRs: The Challenge of Making Electronic Data Usable and Interoperable. P & T : a peer-reviewed journal for formulary management, 42(9), 572–575.