Remote patient monitoring the next wave in telehealth

Photo via Chassey uses a home healthcare kit as part of the COVID-19 Remote Monitoring Program, a joint effort of the Virtual Medical Center and Brooke Army Medical Center, in San Antonio, Dec. 18, 2020.

Telehealth wasn’t the only health care technology that took off during the COVID-19 pandemic. Remote patient monitoring — the use of mobile devices to monitor patient vital signs at home, plus in-home or virtual visits by health care providers — also has increased due to the public health emergency.

Before the pandemic, a big challenge for remote monitoring was helping large health care organizations, systems and plans to prioritize implementing virtual care technologies beyond just a pilot phase, Drew Schiller, co-founder and CEO of the technology firm Validic, said during a recent webinar hosted by the American Telemedicine Association.

“We were stuck in this endless cycle of trying things,” Schiller said. But once the pandemic hit, remote monitoring, telehealth and other technologies “immediately jumped to the forefront” and showed everyone how they could be used to scale remote care,” he said: “It was obviously a regrettable circumstance … but from a health care technology perspective, it has advanced the industry at least five years, if not a full decade, in a very short amount of time.

Remote patient monitoring programs aren’t entirely new, having been used for several years in some countries with single-payer health systems, such as England, Canada, Israel and Australia, Doug Lang, vice president of client growth at Health Recovery Solutions, said during a digital health conference in July hosted by Becker’s Healthcare. The company offers telehealth and remote patient monitoring solutions. Johns Hopkins has had a remote monitoring program in place as far back as 1994, Lang said.

But using mobile technologies to support hospital at-home programs has gained traction over the past year as hospitals recognized the value of allowing patients to be cared for in their own homes while simultaneously freeing up hospital beds for others who are more acutely ill, he said. Many hospitals began such programs to support patients with COVID-19, although they also have used it for conditions such as congestive heart failure, chronic obstructive pulmonary disease, cancer, pneumonia, asthma and deep vein thromboses, and infections such as cellulitis and sepsis.

The U.S. military’s health system actively uses remote monitoring. Brooke Army Medical Center in San Antonio, for example, has a COVID-19 remote monitoring program in which patients are enrolled directly from hospital inpatient units or the emergency department prior to discharge, according to an article on the health system’s website. They are equipped with a home monitoring kit that includes a tablet, an armband outfitted with a monitor, a blood pressure cuff, a temperature patch, and a spirometer (an instrument to measure the air capacity of the lungs). Patients fill out customized questionnaires each day to report how they are feeling. All information is reviewed 24/7 by registered nurses. Each tablet has a button patients can use to contact the nurses, and if needed, there is a secure connection to have a face-to-face video evaluation with a nurse or on-call physician.

Increased use in remote monitoring programs like this has been bolstered by the Centers for Medicare and Medicaid Services (CMS) now agreeing to pay for remote care that can help keep non-COVID-19 patients out of the hospital. As of the start of September, 69 health systems and 156 hospitals in 33 states have been approved by CMS to offer acute hospital care at home. Some programs involve home care groups to offer in-home checkups, while others feature a centralized command center of health professionals who review patient health metrics such as weight, temperature and blood pressure, then check in with patients by video or text during the day, Lang said.

Kaiser Permanente and the Mayo Clinic announced plans in May to collectively invest $100 million into Medically Home, a Boston-based company, to scale and expand their remote monitoring programs, according to an article in Kaiser Health News. In early August, Intermountain Healthcare in Utah announced it would expand the scope and services of its hospital at-home program that first launched in May 2020, Healthcare IT News reported. Their virtual hospital is staffed 24/7 by remote monitoring technicians and has tele-nurses, tele-hospitalists, and other tele-advanced practice providers available depending on the patient’s condition.

Hospitals joining these programs have several goals, Lang said, including reducing length of patient stays and meeting patient demands. In the case of COVID-19, he said, “Patients by design were being totally isolated from human contact and were very nervous and very scared.” In situations where patients were able to be discharged and cared for at home through remote monitoring, he said, families were eager to have them back.

Remote monitoring also can decrease total cost of care, Lang said. “I’ve heard upwards of a 32% reduction in cost of care, which, when you’re talking about a shift to a value-based care model, is very important.” It also can help hospitals gain a competitive advantage against others in a crowded marketplace and can bring in additional revenue, he added.

For all of its benefits, however, there are still some patients who may not be a good fit for these programs, Lang cautioned. This includes people with any mental confusion or delirium or who may need an intensive procedure. If patients are unwilling to participate in such programs, they may need to be admitted to the hospital for care. There also must be a plan in place for how to quickly escalate care or get patients to an inpatient facility if necessary.

Journalists interested in writing about these programs can explore several avenues, including:

  • how individual programs are operating,
  • technologies involved
  • documented cost savings achieved by health systems
  • patients’ and providers’ experiences using these systems.

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