#DigitalHealth: Remote Patient Monitoring Part 3: The Ideal RPM System


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.

1.    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.

2.    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.

3.    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.

4.    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.

5.    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.

 

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About davidleescher

David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique's Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.
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5 Responses to #DigitalHealth: Remote Patient Monitoring Part 3: The Ideal RPM System

  1. sjdmd says:

    Wonderful piece, David. Who has built reliable alerts? Aren’t population based alerts an instance of predictive analytics? Does the RPM vendor also have to be a predictive analytics vendor? Would this be an instance where a partnership between the RPM vendor and a sophisticated analytics vendor might be synergistic?

    • Thanks for your comment, Steve. Yes, I would say. The vendor should have the technology with built in analytics. It’s been done and would be cost effective and deliver the best product to the provider.

    • Partnerships can be useful between RPM companies and suppliers of analytics, I know healthcare systems who have incorporated their own analytics.

    • Steve,
      I don’t know how your comment got lost on the radar. You are correct re: vendors partnering with analytics companies (or better the enterprise utilizing analytics across the board and the RPM being one aspect of it). RPM companies are first exploring this important piece of the puzzle. I am crossing my fingers that companies like Samsung and Apple partnering with healthcare companies can achieve this on a scalable level. IBM is a player here as well.

  2. zjmjack says:

    David another good article. It seems that NantHealth has most indeed all, of the requirements. They have the network, Lambarail they purchased and trialled BLL relocating the acquisition from Boston to Phoenix near their super computers (yep the sane system that permits full genomic analysis in 47 seconds) trialled the sensors and home monitoring programs, launched cOS in Florida 4 months ago so the components appear in place. They still need content for their amazing platform and I surmise that Dave Dyell, ex-iSirona CEO now in post acquisition mode management would be authorized by Patrick Soong-Shiong to complete the loop. One wonders what Patrick will hit the media with post cOS. I envisage a programmed shift to home care and shift sway from the current dysfunctional ED in tertiary hospitals that are cactus-capable in the management of severe serious complicated myltisysten disease afflicted elderly that no one seems to want within their cash cow programs disguised as good patient care under the present paradigm. Bring on the health delivery revolution.

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