The ongoing COVID-19 pandemic has forced the medical industry to adapt significantly. While everybody has witnessed the uptake of remote operation, from remote workers to standard GP appointments, Remote Patient Monitoring (RPM) has firmly come into its own. But how is the medical industry using Remote Patient Monitoring to change the healthcare industry, perhaps forever? What is RPM doing to the medical industry, and what is the future of Remote Patient Monitoring?
What Is Remote Patient Monitoring?
Remote Patient Monitoring is a relatively new phenomenon but has its roots over 200 years ago. Patients who fell ill were typically treated in their homes. Surgery was more likely to be performed in a kitchen rather than in a hospital. The likelihood of Remote Patient Monitoring is that it arose from physicians consulting over the telephone. In the 1940s X-rays were sent over telephone wires, and in 1961, the astronaut Alan Shepard, the first American in space, was tracked with an electrocardiogram, respiratory sensor, and thermometer.
Fast forward to the present day, and there have been significant advancements in RPM, not just to help doctors with telecommunication consultations, but as been a way to facilitate patient monitoring as well as the timely transfer of patient data.
RPM consists of patients having their medical status measurement and having the data transferred through an app to a qualified medical professional using a centralised monitoring system. The benefits of using this are numerous. In light of the ongoing pandemic, where individuals are more cautious to venture to a medical specialist or live further away, RPM can give medical specialists real-time information and help patients with an immediate diagnosis of their current condition.
Charting the Rise of RPM
The evolving nature of technology has given way to significant advancements in RPM. One of the earliest adopters of RPM was the city of Oslo in Norway. In 2010, the local council identified 250 citizens with COPD who lived a distance away from their healthcare providers. The council approached technology companies to develop a monitoring system. Software company Dignio developed a solution comprising wearable patches that took vital signs of the individual before the information was transferred to the patients’ iPads, before being sent to a cloud where healthcare professionals would be alerted to any changes in their condition.
This evolved into the initial technology launched by UCLA Health in 2013, which comprised electrocardiograms, blood pressure gauges, and scales connected to patients’ smartphones or tablets via Bluetooth. The patient uses wi-fi to transmit the readings back to the hospital, where the clinicians use their devices to interpret the data.
The rise of measurable devices isn’t just confined to the medical industry, the wearable devices that have measured cardiovascular health, such as devices like the Fitbit, are significantly widespread. When we look at the evolving technology, combined with the pressures on health services around the world, the rise in RPM is the natural next step as technology continues to dominate the world. In 2016, approximately 7.1 million patients were connected to health monitoring devices, and in 2019, 80% of healthcare providers were considering or investing in RPM solutions.
While Remote Patient Monitoring was on the rise prior to COVID-19, 2020 was the year it made its mark. As the pandemic hit, it created accelerated hospital adoption of RPM as patients were stuck at home looking for medical advice. But while RPM may seem like a short-term solution during the age of COVID, a survey conducted by VivaLNK anticipates Remote Patient Monitoring to either match or surpass inpatient care within the next five years. RPM is key to establishing a more comprehensive coverage of patient care within the medical industry.
Is RPM the Future of Pharma?
COVID-19 has accelerated the need for digital tools in the medical industry. With lockdowns occurring throughout the UK and the rest of the world, we have seen a need for modern disease detection and monitoring. RPM has come into its own in light of COVID, and, according to the Royal College of General Practitioners, the four weeks up to April 12 2020 saw 71% of routine consultations conducted remotely.
The current health situation has demanded a rethink of how medical practitioners engage with their patients. The initial concerns to engage with tech is not a new thing. In fact, it goes back to the failure of the National Programme for Information Technology established in 2002, as clinicians citing various challenges in incorporating these into daily practice. However, RPM has evolved alongside the technology, this is partly to do with the quality of the data and information flow. Due to significant changes in cloud computing, it is easier for data from RPM applications to be uploaded to the cloud, either to Electronic Patient Records or onto a centralised system, which helps to provide a comprehensive patient history using real-time information.
However, this brings up a number of questions. For example, will the technology be easy to use from the perspective of the patient and the practitioner? Can information be anonymised? And is the technology scalable? The opportunities of RPM are too big to ignore, especially in light of COVID-19. And while COVID has become the stimulus to embrace technologies like RPM, coupled with the unprecedented demand on healthcare providers, it is vital to embrace RPM as a fundamental feature going forward.
Is RPM Key to Improving Patient Adherence?
From a medical perspective, adherence to using medication is critical. For optimal therapeutic efficacy, adherence rates need to be in excess of 80% or more. However, approximately 50% of people do not take their medications as prescribed. It is estimated that approximately $300 billion (£269 billion) could be saved globally by improving medication adherence. RPM could be used as a way to meet this challenge. RPM can help clinicians in a number of ways.
Using RPM systems, medical professionals can witness how patients adhere to the medication. Also, interventions such as text message or telephone reminders have proven to be beneficial when they are personal and interactive. While the notion of Remote Patient Monitoring in the form of electronic drug monitors may be unlikely to improve adherence by itself, RPM can be used in conjunction with a personal approach that is frequent and interactive.
Partially, RPM helps in reducing the burden of taking medications regularly, but it has to be embraced by the patient. A wearable solutions provider surveyed in 2019 found that two-thirds of patients aged 40 and older would use a health monitoring device if it could reduce their physical visits to the hospital. But there is a bigger question at play here, notably with regards to ethics.
The Ethics of RPM
While using citizen-generated data from apps and digital devices can improve a patient’s condition over time as they can predict adverse events and alerts relevant professionals, the ethics of using data like this is still a muddy area. RPM data collecting is dependent on the devices, analytics and tools being useful in a clinical environment. With the continuing rise of data breaches, it is vital to incorporate a model where the data is effectively protected.
But RPM’s potential harms don’t just relate to misuse or mishandling of data, but there could be a potential for overdiagnosis. If a device overestimates or over relies on information, if the technology does not detect an issue, this could lead to complacency on the side of the patient and the practitioner. Conversely, if the technology doesn’t detect anything, this adds delay to intervention resulting from a missed diagnosis.
If professionals relied too much on data, this may not give the bigger picture. For example, the mental state of the patient, or the context of the data being recorded. RPM is best used in conjunction with several other services. It is vital that professionals use data in terms of its context. For example, video calls can benefit the patient and the professional as the doctor may notice visual cues that RPM does not bring up.
Additionally, from a personal perspective, RPM may infringe upon a person’s privacy. Using devices that monitor a plethora of vital signs that are fed back to the central system may leave a patient feeling they are being monitored too much. However, the best way to mitigate this is to incorporate consistent communication, improving dialogue between the consultant and the patient, which can improve the overall customer service aspect.
How Can RPM Change Healthcare?
The benefits of RPM are numerous, but the drawbacks are also worth noting. RPM is an excellent way for medical professionals to get a live perspective of what is occurring to identify pressing matters. This can help to greatly reduce readmissions. Currently, this is a vital component resulting from the pandemic. It doesn’t just help the professionals, but it can help patients manage their conditions by themselves, resulting in a greatly reduced number of readmissions and patient appointments, resulting in a far better outcome across the board. RPM is the future and has been signposted for some time as a way forward, but to implement this effectively, there will need to be a combination of methods.