Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which may increase access to care and decrease healthcare delivery costs. RPM involves the constant remote care or monitoring of patients by their physicians or pharmaceutical/biotechnology companies often to track physical symptoms, chronic conditions, or post-hospitalization rehab. RPM is also used extensively in clinical studies. Patient Reported Outcomes (PROs) for clinical trials are captured remotely via a tablet.
Incorporating RPM in chronic-disease management may significantly improve an individual's quality of life, by allowing patients to maintain independence, prevent complications, and to minimize personal costs. RPM facilitates these goals by delivering care through telecommunications. This form of patient monitoring can be 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 emergency department visits, hospitalizations, and the duration of hospital stays. While technologies are continually being developed to tackle this type of health care, physicians may utilize basic communication methods such as Zoom, Snapchat, or even landline phones.
Pilot programs for Remote Patient Monitoring began in 1970s when Kaiser Permanente created monitoring systems for rural communities in order to provide better healthcare to isolated regions. Literature related to Remote Patient Monitoring suggests that interventions based on health behavior models, care pathways, and personalized coaching lead to the best outcomes.
Research on the use of Remote Patient Monitoring technologies has helped determine that further development of telehealth ecosystems, in which physicians can give recommendations and means of care while also receiving transmitted health information, can lead to better patient outcomes and higher patient satisfaction. Researchers also note that Remote Patient Monitoring will become more important as healthcare changes from a volume focus to a value focus.
During the COVID-19 pandemic, Remote Patient Monitoring has been used extensively and allowed for more fields such as psychology or cardiology to use virtual care. By 2025, the Remote Patient Monitoring industry is expected to double, due to factors such as the COVID-19 pandemic and increased at-home care. Use of Remote Patient Monitoring has been proven to ultimately provide better patient compliance and improved physician management, while decreasing costs of care.
Key features of RPM Accessibility Both patients and care providers can access the RPM record anytime from anywhere. Instantaneous access is helpful in making accurate health decisions and improves clinical operations.
Cost effectiveness Not much evidence has been able to support whether or not telehealth is more cost effective or not. There is some research showing that it can be a less expensive way for doctors to provide care because they aren't using any of their physical resources on the patient. Sage journals published a case study researching if telehealth is cost effective for the patient in the comfort of their home. Langabeer et al. (2017), stated that this study's method was to utilize telehealth resources when people called 911 and EMS responded. Once EMS was on scene, they would pull up a virtual system putting them in direct contact with an emergency department provider at the hospital. The provider was then able to triage the patient at the scene of the call and determine the best course of treatment potentially being no transport to the hospital. This in turn is more cost efficient for the patients and the medical providers both. This showed to be helpful in-patient outcomes because the provider was able to determine the critical level of the patient therefore allowing them to determine the best course of action at an earlier time.
Promptness RPM helps in faster decision-making. RPM collects, improves, and analyzes data promptly, which is time-saving. Report-making has become easy through RPM.
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. Sensors can connect back to a central database by WiFi or cellular communication protocols depending on the manufacturer. 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 pressure 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. The following section illustrates examples of RPM applications, but RPM is not limited to those disease states
Cancer Use of RPM among patients with cancer has been proven to improve outcomes overall, with studies showing improvements in re-hospitalization rates and decreased healthcare resource usage. These remote monitoring technologies help to lower severity of pain as well as improving depression.
The RPM has improved the life expectancy of Cancer Patients up to 20%. Remote patient monitoring devices help in early interventions, prescriptions, chemotherapy modifications, etc. RPM has helped in reducing Cancer emergency room visits or prolonged chemotherapy treatments. It is estimated that the hospitalization rate of patients with RPM is 2.8% and without RPM is 13%
COVID-19
RPM can provide continuity of care for symptomatic COVID-19 patients post-discharge from hospital and those with mild to moderate oxygen desaturation levels that do not require hospitalization, and patients with long-COVID symptoms. Due to the nature of the pandemic, RPM is a necessary means of providing care to at-risk patients such as elderly or immunocompromised people.
Studies show that the use of RPM during the pandemic has helped to reduce hospitalizations and decrease the use of acute care resources.
The FDA has given emergency authorized use of RPM technologies for the purpose of decreasing the spread of COVID-19 and to prevent overload for healthcare resources and personnel.
Chronic Obstructive Pulmonary Disease (COPD) For patients with chronic obstructive pulmonary disease, RPM may contribute to increased patient knowledge, earlier interventions, and shared decision making. However, the evidence is varying and issues of cost, and the shift of responsibilities to patients have also been raised.
Dementia and falls
For patients with dementia 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.
Diabetes Diabetes management requires control of multiple parameters: blood pressure, 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 life, improves patient-provider relationships, shortens duration of stay in hospitals, decreases mortality rate, and reduces costs to the healthcare system.
Home hospitalization
RPM is a crucial component of hospital-at-home programs, allowing patients to more safely go without 24/7 in-person nursing.
Infertility A recent study of a remote patient monitoring solution for infertility demonstrated that for appropriately screened patients who had been seeking In-Vitro Fertilization (IVF) treatment, a six-month remote monitoring program had the same pregnancy rate as a cycle of IVF. The remote patient monitoring product and service used had a cost-per-patient of $800, compared to the average cost of a cycle of IVF of $15,000, suggesting a 95% reduction in the cost of care for the same outcome.
Surgery When compared to standard of care with no devices, a 2021 study showed that post-surgical remote patient monitoring detected 30% more medication errors, 10-14% reduction in patient paint, and a 5% reduction in hospital re-admissions. The randomized study, conducted by PJ Devereaux and Micheal McGillion, split 905 patients between a standard of care group and a RPM group, which used at-home clinical grade vital sign devices to transfer their vital signs to a Clinician Portal where they were monitored remotely and could communicate through text, chat, or video calls. The scientists (Devereaux and McGillion) are now conducting two follow-up studies (PVC-RAM 2 and PVC-RAM 3) to investigate secondary findings of PVC RAM1.
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