Remote patient monitoring
Encyclopedia
Remote patient monitoring (RPM) refers to the use of various point-of-care technologies to monitor a patient’s physiological status and health conditions.
Incorporating RPM in chronic disease management can significantly improve an individual’s quality of life. It allows patients to maintain independence, prevent complications, and minimize personal costs . RPM facilitates these goals by delivering care right to the home. In addition, patients and their family members feel comfort knowing that they are being monitored and will be supported if a problem arises. This is particularly important when patients are managing complex self-care processes such as home hemodialysis .
Key features of RPM, like remote monitoring and trend analysis of physiological parameters, enable early detection of deterioration; thereby, reducing number of emergency department visits, hospitalizations, and duration of hospital stays .
The need for wireless mobility in healthcare facilitates the adoption of RPM both in community and institutional settings. The time saved as a result of RPM implementation increases efficiency, and allows healthcare providers to allocate more time to remotely educate and communicate with patients.
Depending on the disease and the parameters that are monitored, different combinations of sensors, storage, and applications may be deployed. .
and subjective patient data are collected by sensors on peripheral devices. Examples of peripheral devices are: blood pressure cuff, pulse oximeter
, and glucometer. The data are transmitted to healthcare providers or third parties via wireless telecommunication devices. The data are evaluated for potential problems by a healthcare professional or via a clinical decision support algorithm, and patient, caregivers, and health providers are immediately alerted if a problem is detected. . As a result, timely intervention ensures positive patient outcomes. The newer applications also provide education, test and medication reminder alerts, and a means of communication between the patient and the provider.
that are at risk for falls, RPM technology promotes safety and prevents harm through continuous surveillance. . RPM sensors can be affixed to the individual or their assistive mobility devices such as canes and walkers. . The sensors monitor an individual’s location, gait, linear acceleration and angular velocity, and utilize a mathematical algorithm to predict the likelihood for falls, detect movement changes, and alert caregivers if the individual has fallen. . Furthermore, tracking capabilities via Wi-Fi
, global positioning system
(GPS) or radio frequency enables caregivers to locate wandering elders. .
, weight, and blood glucose. The real-time delivery of blood glucose and blood pressure readings enables immediate alerts for patient and healthcare providers to intervene when needed. There is evidence to show that daily diabetes management involving RPM is just as effective as usual clinic visit every 3 months..
, shortens duration of stay in hospitals, decreases mortality rate, and reduces costs to the healthcare system. .
There is a lack of reimbursement guidelines for RPM services, which may deter its incorporation into clinical practice..
The shift of accountability associated with RPM brings up liability issues . There are no clear guidelines in respect to whether clinicians have to intervene every time they receive an alert regardless of the urgency.
The continuous flow of patient data requires a dedicated team of healthcare providers to handle the information, which may, in fact, increase the workload. Although technology is introduced with the intent to increase efficiency, it can become a barrier to some healthcare providers that are not technological.
There are common obstacles that health informatics technologies encounter that applies to RPM. Depending on the comorbidities monitored, RPM involves a diverse selection of devices in its implementation. Standardization is required for data exchange and interoperability among multiple components. Furthermore, RPM deployment is highly dependent on an extensive wireless telecommunications infrastructure, which may not be available or feasible in rural areas. Since RPM involves transmission of sensitive patient data across telecommunication networks, information security is a concern.
, a randomized controlled trial involving congestive heart failure patients concluded that the use of telemonitoring failed to provide a benefit over usual care . The telemonitoring patient group was instructed to answer a series of questions about their symptoms via a keypad during daily calls . Clearly, the process described by Chaudhry et al. (2010) differs from the RPM methodology illustrated in the overview, which involves actual collection and transmission of physiological data through point-of-care devices. With articles from Forbes
associating RPM with the negative findings by Chaudhry et al. (2010), it may be difficult to clear the misconception that telemonitoring is synonymous with remote patient monitoring. The lack of standardization of RPM nomenclature and definition makes it difficult to differentiate between different forms of patient monitoring involving technology.
Incorporating RPM in chronic disease management can significantly improve an individual’s quality of life. It allows patients to maintain independence, prevent complications, and minimize personal costs . RPM facilitates these goals by delivering care right to the home. In addition, patients and their family members feel comfort knowing that they are being monitored and will be supported if a problem arises. This is particularly important when patients are managing complex self-care processes such as home hemodialysis .
Key features of RPM, like remote monitoring and trend analysis of physiological parameters, enable early detection of deterioration; thereby, reducing number of emergency department visits, hospitalizations, and duration of hospital stays .
The need for wireless mobility in healthcare facilitates the adoption of RPM both in community and institutional settings. The time saved as a result of RPM implementation increases efficiency, and allows healthcare providers to allocate more time to remotely educate and communicate with patients.
Technological components
The diverse applications of RPM lead to numerous variations of RPM technology architecture. However, most RPM technologies follow a general architecture that consists of four components. :- Sensors on a device that is enabled by wireless communications to measure physiological parameters.
- Local data storage at patients’ site that interfaces between sensors and other centralized data repository and/or healthcare providers.
- Centralized repository to store data sent from sensors, local data storage, diagnostic applications, and/or healthcare providers.
- Diagnostic application software that develops treatment recommendations and intervention alerts based on the analysis of collected data.
Depending on the disease and the parameters that are monitored, different combinations of sensors, storage, and applications may be deployed. .
Applications
Physiological data such as blood pressureBlood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
and subjective patient data are collected by sensors on peripheral devices. Examples of peripheral devices are: blood pressure cuff, pulse oximeter
Pulse oximeter
A pulse oximeter is a medical device that indirectly monitors the oxygen saturation of a patient's blood and changes in blood volume in the skin, producing a photoplethysmograph. It is often attached to a medical monitor so staff can see a patient's oxygenation at all times...
, and glucometer. The data are transmitted to healthcare providers or third parties via wireless telecommunication devices. The data are evaluated for potential problems by a healthcare professional or via a clinical decision support algorithm, and patient, caregivers, and health providers are immediately alerted if a problem is detected. . As a result, timely intervention ensures positive patient outcomes. The newer applications also provide education, test and medication reminder alerts, and a means of communication between the patient and the provider.
Dementia and falls
For patients with dementiaDementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
that are at risk for falls, RPM technology promotes safety and prevents harm through continuous surveillance. . RPM sensors can be affixed to the individual or their assistive mobility devices such as canes and walkers. . The sensors monitor an individual’s location, gait, linear acceleration and angular velocity, and utilize a mathematical algorithm to predict the likelihood for falls, detect movement changes, and alert caregivers if the individual has fallen. . Furthermore, tracking capabilities via Wi-Fi
Wi-Fi
Wi-Fi or Wifi, is a mechanism for wirelessly connecting electronic devices. A device enabled with Wi-Fi, such as a personal computer, video game console, smartphone, or digital audio player, can connect to the Internet via a wireless network access point. An access point has a range of about 20...
, global positioning system
Global Positioning System
The Global Positioning System is a space-based global navigation satellite system that provides location and time information in all weather, anywhere on or near the Earth, where there is an unobstructed line of sight to four or more GPS satellites...
(GPS) or radio frequency enables caregivers to locate wandering elders. .
Diabetes
Diabetes management requires control of multiple parameters: blood pressureBlood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
, weight, and blood glucose. The real-time delivery of blood glucose and blood pressure readings enables immediate alerts for patient and healthcare providers to intervene when needed. There is evidence to show that daily diabetes management involving RPM is just as effective as usual clinic visit every 3 months..
Congestive heart failure
A systematic review of the literature on home monitoring for heart failure patients indicates that RPM improves quality of lifeQuality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
, shortens duration of stay in hospitals, decreases mortality rate, and reduces costs to the healthcare system. .
Early adopter: Veterans Health Administration
The Veterans Health Administration (VHA), United States’ largest integrated healthcare system, is highly involved in the implementation and evaluation of RPM technologies. It has expanded use of RPM beyond common chronic disease applications, to post-traumatic stress disorder, cancer and palliative care. VHA’s findings indicate improvements in a wide range of metrics, including decrease in emergency department visits, hospitalizations, and nursing home admissions . Findings from the VHA Care Coordination/Home Telehealth program show that RPM deployment resulted in significant savings to the organization..Limitations
RPM is highly dependent on the individual’s motivation to manage their health. Without the patient’s willingness to be an active participant in their care, RPM implementation will likely fail.There is a lack of reimbursement guidelines for RPM services, which may deter its incorporation into clinical practice..
The shift of accountability associated with RPM brings up liability issues . There are no clear guidelines in respect to whether clinicians have to intervene every time they receive an alert regardless of the urgency.
The continuous flow of patient data requires a dedicated team of healthcare providers to handle the information, which may, in fact, increase the workload. Although technology is introduced with the intent to increase efficiency, it can become a barrier to some healthcare providers that are not technological.
There are common obstacles that health informatics technologies encounter that applies to RPM. Depending on the comorbidities monitored, RPM involves a diverse selection of devices in its implementation. Standardization is required for data exchange and interoperability among multiple components. Furthermore, RPM deployment is highly dependent on an extensive wireless telecommunications infrastructure, which may not be available or feasible in rural areas. Since RPM involves transmission of sensitive patient data across telecommunication networks, information security is a concern.
Controversy
Published by the New England Journal of MedicineNew England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
, a randomized controlled trial involving congestive heart failure patients concluded that the use of telemonitoring failed to provide a benefit over usual care . The telemonitoring patient group was instructed to answer a series of questions about their symptoms via a keypad during daily calls . Clearly, the process described by Chaudhry et al. (2010) differs from the RPM methodology illustrated in the overview, which involves actual collection and transmission of physiological data through point-of-care devices. With articles from Forbes
Forbes
Forbes is an American publishing and media company. Its flagship publication, the Forbes magazine, is published biweekly. Its primary competitors in the national business magazine category are Fortune, which is also published biweekly, and Business Week...
associating RPM with the negative findings by Chaudhry et al. (2010), it may be difficult to clear the misconception that telemonitoring is synonymous with remote patient monitoring. The lack of standardization of RPM nomenclature and definition makes it difficult to differentiate between different forms of patient monitoring involving technology.