In the past at Atrium Health’s Sanger Heart and Vascular Institute, as in many other hospitals, postoperative cardiac patients were discharged with a vague understanding of what recovery entails. Uncertainty can lead to preventable poor outcomes and readmissions for issues that could have been managed in the outpatient setting.

THE PROBLEM

Anxiety is common in patients preparing for cardiac surgery. Patients prefer to be home, but recovering from invasive surgery without expert guidance can be scary and dangerous.

Providers need up-to-date, reliable data to inform post-surgery decision-making, but collecting that data and turning it into insights can be a chore, said Dr. John Frederick, chief of cardiovascular surgery at Atrium Health’s Sanger Heart and Vascular Institute.

“Collecting biometric data before remote monitoring meant nurse navigators had to rely on patients to manually record and report the information,” he noted.

PROPOSAL

Health IT vendor Carium proposed a care experience platform to be added to Sanger Heart and Vascular’s Perfect Care program that provides a complete ecosystem for virtual care.

“The care experience platform would ensure patients remain connected with their care teams, and that care teams remain connected with invaluable patient data to improve clinical decision-making,” Frederick explained.

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The growth of remote patient monitoring technology and telehealth over the past two years is transforming the way hospitals, health systems and clinics deliver healthcare. Remote patient monitoring technology in particular is set to explode. But with so much change happening so fast, even the terms themselves are the subject of some confusion.

So, what is remote patient monitoring, exactly, and how does it differ from telehealth? Because the market for these technologies is expected to explode in the next five years, it’s important to define our terms.

Telehealth is an umbrella term

Simply put, telehealth is an umbrella term describing the use of technology to deliver healthcare remotely.

Several organizations have published their own definitions of telehealth, although healthcare providers are usually most concerned with definitions released by the Centers for Medicaid and Medicare Services. In a resource on telemedicine published for healthcare providers, CMS defines telehealth as “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.”

Thus, telehealth refers to a suite of services for delivering remote care, both in and out of traditional care settings. One subset of those services is remote patient monitoring.

Defining of remote patient monitoring

Remote patient monitoring is the use of technology, often wearable devices, to monitor patients outside of clinical settings. These devices are internet-enabled and can thus send information on patient health directly to the offices of care providers.

Combined with technology platforms that can aggregate and analyze the data as well as integrate it into clinical workflows for care delivery, remote patient monitoring has the potential to transform patient care for the better – and reduce its cost.

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Remote patient monitoring (RPM) holds incredible promise for improving the management and treatment of chronic diseases. Even though RPM is still relatively new, it has proven effective for managing many chronic illnesses, such as diabetes, high cholesterol, high blood pressure and respiratory diseases. In some cases, taking these measurements remotely increases accuracy, such as with blood pressure readings.

The challenge is to find a sustainable way to use RPM data to intervene sooner and improve chronic disease management. While RPM has automated the collection of data from patients outside the clinic, and algorithms can sift through information to flag the patients who need follow up, the follow up still comes from humans—from doctors, nurses and other trained professionals.

Fighting burnout

As much as healthcare professionals welcome better tools for taking care of patients, many are at their breaking point: from fighting the Covid-19 pandemic, limited time with patients, increasing administrative burden, working too many hours and other challenges. In a 2021 survey, 47 percent of physicians reported they were experiencing burnout, up from 42 percent in 2020, with a bigger increase for emergency physicians, from 43 percent in 2020 to 60 percent in 2021.

The situation is so severe that U.S. Surgeon General Dr. Vivek Murthy issued a Surgeon General’s Advisory on health worker burnout and well-being in May. As Dr. Murthy wrote two months later for The New England Journal of Medicine, “Health worker burnout is a serious threat to the nation’s health and economic security.”

For providers, the clinical demands of delivering recommended care are a significant factor driving burnout. Primary care physicians seeing an average patient population would need nearly 27 hours per day to meet all the U.S. guidelines for preventive, chronic disease and acute care, according to a study conducted by the University of Chicago, Johns Hopkins University and Imperial College London.

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Remote patient monitoring allows parsing out different digital phenotypes within certain disease states to effectively match treatment with the patient. Goldsack says, “In those broad disease states, where there’s very little that we can do to either ameliorate symptoms of the disease or cure the disease — something like Parkinson’s or Alzheimer’s disease. We’re hopeful that these new measures can start to advance the field.”

Goldsack believes there is a much more practical reason for remote patient monitoring to become an essential focus of care: the evolving role and methods of healthcare today.

“We must start thinking about how we can start to monitor people’s health outside the clinic walls,” she explains. “How can we think about patients with complex chronic diseases who may have episodic conditions with flare-ups? How can we monitor their well-being and health performance under clinicians’ care without bringing them into the hospital every time?”

The reality that healthcare presently faces  is a shortage of doctors and clinicians to treat the number of patients. Remote patient care is one healthcare solution that helps ensure the patient gets the best care possible, even with reduced resources available. “We can use remote patient monitoring to get early signals… [and] we can intervene and care for them before those outcomes become bad and before they become pricey,” Goldsack says.

The technology behind remote patient monitoring must be high quality to make high-quality clinical decisions. Clinical validation of the gathered data is vital in this process. Goldsack says it’s also crucial that the technology deployed is an affordable solution, because if it isn’t, then it won’t be sustainable.

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The study, which focused on at-home blood pressure monitoring programs, found that a program fusing health coaching with remote patient monitoring was able to lower blood pressure by anywhere from 53 to 85 percent, depending on the severity of condition at baseline.

“This is the first peer-reviewed, published study reporting the long-term experience of a digital health application for blood pressure management, with a magnitude of association that is clinically meaningful,” Alexis Beatty, MD, MAS, a cardiologist and associate professor at the University of California, San Francisco, and the lead author of the study, said in a statement emailed to journalists.

Using remote patient monitoring for chronic disease management is not a novel concept; healthcare professionals have employed mHealth tools for at-home care management for some time, but according to the researchers, improvements using technology alone have been negligible in hypertensive patients.

“BP self-monitoring has been proposed as an intervention to achieve better BP control,” the researchers wrote in the study’s introduction. “However, studies suggest that BP self-monitoring alone is insufficient to lower BP without other co-interventions, such as lifestyle counseling.”

The researchers enrolled just over 28,000 adults with varying degrees of hypertension into Hello Heart, a remote patient monitoring program that uses at-home blood pressure monitoring paired with some health coaching via a patient engagement app, to much avail.

Median systolic blood pressure improved for 53 percent of the participants with baseline elevated blood pressure, by 70 percent among those with stage 1 hypertension, and by 85 percent among those with stage 2 hypertension.

That translates into a mean systolic blood pressure drop of 7.2 mm Hg for those with elevated blood pressure, 12.2 mm Hg for those with stage 1 hypertension, and 20.9 mm Hg for those with stage 2 hypertension.

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