Remote monitoring more than a remote possibility

Sept. 23, 2019

Vital signs, glucose, blood pressure, heart rate, respiratory readings — all of that and much more can now be monitored effectively by the clinician remotely, and not only when patients are at home but also in ambulatory care centers, nursing facilities, and other settings.

While remote monitoring and telehealth technologies have yet to make it to mainstream healthcare, according to increasing studies, market reports, and adoption by healthcare providers, it’s just a matter of time. So, what is it about these remote devices that make them so appealing? Are they truly effective in delivering the data doctors and nurses need to make sound clinical decisions? Are some health conditions a better match for remote monitoring technologies than others? Should healthcare facilities make the investment in the equipment and training?

“Remote monitoring has potential if implemented and used properly,” said Frank Federico, RPh, Vice President and Senior Safety Expert, Institute for Healthcare Improvement (IHI). “An example that I have witnessed work well is home monitoring for a patient with congestive heart failure. It includes daily check of weight, blood pressure, and oxygen levels in the blood. If any one parameter is outside of desired range, the situation can most likely be treated through a phone call to the patient at home, for example, an adjustment of medications or change in diet to minimize salt intake. It reduces the need to visit a doctor or hospital in some situations and reduces the burden on patients and families.”
“We think it’s a good thing. It is a sign that the industry is actively pursuing solutions, and rapid iterations are a key to developing products that ultimately meet market needs,” said Jiang Li, CEO, VivaLNK. “It is also important to apply proper disciplines without shortcuts to ensure medically sound products. Based on CDC’s estimate, 90 percent of the healthcare cost is attributed to chronic and mental health conditions. Remote patient monitoring will be greatly beneficial for the management of such conditions for lower cost and better outcome of patients.”

VivaLNK provides a wide variety of technologies for keeping all types of patients connected to their providers. In this discussion, Li explained how the company’s chemo-patient monitoring system works.

“It starts with our unique form factor, which is an ultra-light wearable patch. Weighing just 7.5 grams, the comfort is key to patient adherence,” he said. “From there, the technology ensures continuous multi-vital data capture in ambulatory situations, with real-time monitoring capabilities. A common problem facing chemo patients is the occurrence of neutropenic fever post treatment; in some cases, the fever can be severe enough to cause re-hospitalization. By using RPM to obtain advanced notice of the impending event through the monitoring of temperature and other vitals, care providers can intervene to prevent re-hospitalization—thereby improving patient safety, efficiencies, and reducing costs to the hospital.”

We participated in a southern California cancer center to monitor chemo patients after treatment,” Li continued. “The goal was to monitor for neutropenic fever in the days following treatment to identify an impending re-admission event. The study looked at tracking three key vital signs (temperature, heart rate, respiratory rate) to develop a correlation that predicts the event. The solution involved wearable sensors and a patient companion app on a mobile device. Results of the study showed the ability to detect a readmission event up to 18 hours in advance.”

In brief, it cannot be stressed enough that when introducing patients to remote monitoring technologies, be certain they understand exactly what the system is designed to do and how to use it safely. “[It] is important for manufacturers to prioritize ensuring that instructions for use of any products that will be actively used by patients and families are created with them and they should conduct adequate testing to ensure that devices can be safely used,” said Patricia McGaffigan, RN, MS, CPPS, Vice President, Safety Programs, IHI.
Erin Kyle, DNP, RN, CNOR, NEA-BC, a Perioperative Practice Specialist at the Association for periOperative Registered Nurses (AORN), said she is happy about the advances taking place. “More information is better than less information when it comes to evaluating patients’ health status and response to interventions,” she said. “I am excited about emerging technologies that have promise to improve surgical outcomes. One example of postoperative monitoring is described in The Journal of Arthroplasty where researchers enrolled 25 total knee arthroplasty patients in a pilot to evaluate postoperative progress of patients after discharge from the hospital. Patients downloaded a mobile application preoperatively to collect baseline activity and “patient-reported outcomes data” or PROMs. During admission, patients were issued a wearable knee sleeve that was paired to their smartphone. After discharge, patients were monitored for up to three months for mobility (step count), range of motion, PROMs, opioid consumption and home exercise program compliance.

“Researchers reported that all of the patients had uninterrupted passive data collection, meaning that the wearable knee sleeve, application, and paired smartphone were successful in achieving data collection,” continued Kyle. “The surgeon even received a notification if the patient did not achieve the expected knee flexion at two weeks postop. This continuous monitoring and automated surgeon notification simplified and streamlined data sharing between patient and surgeon in this study. With technologies like these, surgeons can almost literally see how their patients are doing while recovering at home. When surgeons have insight into their patient’s progress using remote monitoring, they may be able to anticipate a problem before it becomes a bigger, more painful, and costlier issue.” 

About the Author

Valerie J. Dimond | Managing Editor

Valerie J. Dimond was previously Managing Editor of Healthcare Purchasing News.