Remote patient monitoring

Sept. 28, 2021
Breaking down walls, barriers for expedient and meaningful use of data

Advances in technology, payment reforms, patient-centered care and the digitization of healthcare delivery have driven a momentous evolution and expansion of patient monitoring over the past two decades. The COVID-19 pandemic has further accelerated patient monitoring trends, with both a desire and a need to deliver care effectively and safely in the home.

Digital technology, including remote monitoring, artificial intelligence and automation, could save health systems around the world anywhere between $1.5 trillion and $3 trillion a year by 2030, according to The McKinsey Global Institute.1

Extension of monitoring from the hospital into the home supports many factors that can improve care quality while reducing costs, such as continuity of care, transition of care from the acute to non-acute setting and care coordination among clinicians. For patients, remote patient monitoring (RPM) offers greater convenience, with the ability for their care teams to monitor their health status without the patient having to leave home.

Monitoring solutions that transmit patient data, within a hospital’s network, remotely back to hospital or office-based clinicians, to home care nurses, or even to an off-site third-party RPM service provider, present challenges as well. These include risks to electronic protected health information (ePHI) and lack of interoperability with connected systems due to proprietary hardware and software.

Then there is the problem of data overload. Monitoring devices generate an abundance of data but it is quality over quantity that counts. Healthcare providers must find ways to cut through the data clutter and garner useful insights to inform care decisions.

Individual manufacturers of monitoring technologies, trade associations, healthcare organizations and other stakeholders are working on ways to leverage advanced patient monitoring capabilities for the benefit of the industry and the patients they serve. The possibilities are endless, and with growing consumer interest in more convenient and accessible care, now is the time to act.

Care delivery ever expanding

In its future of health vision, Deloitte predicts that more care will be delivered to patients at home, or through virtual, outpatient and other settings. The focus of care will shift from treating diseases to promoting wellness and prevention. The consulting firm notes that the transition of care from acute care to outpatient and home settings is already happening today.2

Ushered in by the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) Hospital Without Walls initiative is evidence of this shift. Launched in March 2020, it allowed health systems and hospitals to provide services in locations beyond their existing walls to accommodate patient surges.

CMS expanded this effort in November 2020 with an “Acute Hospital Care At Home” program that provides “eligible hospitals with unprecedented regulatory flexibilities to treat eligible patients in their homes.” As of August 9, 2021, 69 U.S. health systems, including 148 hospitals in 32 states, were approved by CMS to participate in the program.3

Under the program, a registered nurse (RN) evaluates home-based patients once per day (in-person or remotely). The patient also receives two in-person visits daily from either an RN or a mobile integrated health paramedic (based on the patient’s nursing plan and hospital policies).4

Patient monitoring to facilitate care expansion

There are obvious risks in transitioning patients from an acute care hospital to a non-acute facility or to the home. Monitoring of vital signs and other biological parameters is clearly easier when a patient is in a hospital bed versus in a post-acute setting or in the varied and unpredictable setting of a home environment.

Leading manufacturers of monitor technology and other medical equipment with decades of experience in the acute care setting have been innovating to facilitate monitoring of patients well beyond the four walls of a hospital. This includes both monitoring for early detection of emerging issues and for the management of pre-existing conditions.

Hillrom, a medical technology company that nearly 100 years ago was focused on bringing the home into the hospital through more comfortable furnishing, is now leading the charge toward advancing connected care in the hospital and back into the home. In 2015, Hillrom acquired point of care diagnostics provider Welch Allyn, and has since been adapting its hospital grade solutions to facilitate effective, safe and connected monitoring and intelligent diagnostics, delivering data clinicians can trust.

“Our mission has always been to enhance outcomes for patients and caregivers. Technology is a means to do a better job of that,” said Andreas Frank, President, Front Line Care, Hillrom. “Where in the past healthcare was centralized, with a patient going to a hospital or physician office for care, today it is becoming much more distributed and COVID has accelerated that. The need for care expansion is breaking down the walls of the hospital. At Hillrom we find ourselves in a perfect position because we have the trusted experience, footprint and solutions to support this shift, coupled with the desire to help.”

Continuity of care inside and outside of the hospital

The U.S. healthcare industry has increasingly turned to long term acute care (LTAC) facilities to care for higher acuity patients transferred from hospital intensive care units (ICU). The COVID-19 pandemic has accelerated this trend by driving a greater number of sicker patients into LTAC settings as hospitals reach ICU capacity.

While acute care patients have the same care needs regardless of the setting, caring for critically ill patients is more challenging outside of the ICU. “Patients requiring care in long-term care facilities are disproportionately older and chronically ill, and they often enter long-term care after an acute hospitalization,” states the Agency for Healthcare Research and Quality (AHRQ).5 “When transitioning patients from costly and resource/space constrained ICUs to LTAC facilities, it is critical to maintain a similar level of high acuity monitoring and care to ensure safety and prevent untoward events,” explains Mike Hodge, Director Business Development, Alternate Care Solutions, Dräger. “According to the AHRQ, ‘Patients in long-term care settings may be particularly vulnerable to safety problems in the course of their care.’”5

Dräger has applied its 100+ years of critical care expertise and know-how to specifically address the needs of the LTAC environment. For example, the company’s bedside monitors can be transported along with the patient within hospital units and through to the LTAC. This facilitates continuous ICU level monitoring while eliminating the need for separate transport monitors.

Remote patient monitoring

Remote patient monitoring (RPM) can help providers and patients by facilitating safe and effective continuity of care all the way through to the home. As Frank points out, hospitals struggle to strike a balance between reducing length of stay (LOS) for financial reasons, but not discharging patients so early that they are at risk for readmission (and the risk for reimbursement penalties). Remote monitoring can help overcome this challenge.

“A patient can be discharged with a monitor and instructed to perform spot checks three or four times per day. The data is transmitted to the clinician or a central location to monitor trending and act on it accordingly,” said Frank. “This can significantly reduce the risk to the hospital that the same patient is re-admitted and they don’t get reimbursed for that second stay.”

While there are obvious benefits to this approach, Frank says there are also many logistical challenges to a hospital sending its monitors out into the community. He states:

“You have all of these patients with assets worth thousands of dollars that belong to the hospital. So how do you discharge them and how do you bring them back? There is a whole back-end logistical infrastructure that needs to be put in place.”

Frank says there are service providers that have built businesses around the need to supply and manage remote monitoring equipment, and Hillrom has partnered with some of them. In these cases, Hillrom provides the monitoring devices, and the service providers handle the logistics, as well as engagement strategies to drive patient compliance with the prescribed monitoring.

Early detection and disease management

Patients with chronic conditions require close monitoring to manage health status and detect deterioration. Monitoring patients in their daily lives is fundamental to effective population health management. Even before COVID-19 hit the U.S., 88% of providers surveyed said they had invested or were evaluating investments in RPM to support management of patients with chronic conditions and at risk for hospital readmissions.6

“Early detection and avoiding patient deterioration present a huge value proposition for digital and connected technologies,” explains Frank. “Secondly is managing patients at home. COVID has forced us to do that in many ways, but there is undoubtedly a huge, proven benefit of patients being able to recover in the comfort of their homes with connected infrastructure around them.”

Frank describes how Hillrom has complete solutions for remotely monitoring patients and delivering useful insights back to clinicians. One example is a device for the detection of arrythmias, where the patient wears a sensor that captures every heartbeat for up to two weeks. The device collects the data, transfers it to a central location for analysis and delivers a diagnostic report to the patient’s physician(s) as a service.

Another is a solution that enables providers to easily perform retinal exams in a remote setting. Patients with diabetes can be at risk for losing their eyesight due to retinopathy, so they require regular screening. The clinician uses a device to take a photo of the patient’s eyes, and the image is transmitted to a qualified retina specialist. Upon analysis of the image, the clinician reports back with a diagnostic screening result and recommended course of care, such as referral to a specialist.

Harnessing the value of data

As Frank explains, the volume of data generated by connected devices grows at a rapid rate. In some cases, this data has surpassed the human capacity for analysis, driving the need for artificial intelligence (AI) to help clear through the clutter and get down to what is most valuable for clinicians.

Because there are so many device manufacturers, each with their own proprietary technologies, the challenge for healthcare organizations is finding a way to collect data from each device, aggregate and normalize it, and present it in a way that makes sense. Frank speaks to one business model that has emerged as a solution.

“There are companies serving as neutral data aggregators that provide either connectivity software or data analytics on top of the information they are gathering,” he comments. “They provide back to the healthcare organization workflow insights or clinical insights that drive better outcomes, whether they are better clinical outcomes, lower costs or greater efficiency.”

According to Frank, collaboration throughout the healthcare industry and beyond, including non-healthcare information technology (IT) providers, is key to harnessing the value of connected device data. Hillrom has partnerships with Microsoft, Apple, Amazon and Cerner for cloud, AI and software development work.

For example, combined offerings from Hillrom and Microsoft dynamically analyze real-time sensing data from medical devices and historical medical record information and communicate potential patient risk and hospital protocol actions directly to caregivers at the point of care. They leverage Hillrom’s clinical knowledge and streaming operational data from medical devices and Microsoft’s cloud, including Azure IoT and Azure Machine Learning, to help drive enhanced patient outcomes.

Cybersecurity and data standards

The Internet of Medical Things (IoMT) refers to the countless devices that collect and transmit patient data over various networks, from vital signs monitors to fitness trackers. COVID-19 has driven a surge in IoMT devices, as clinicians and patients seek ways to monitor and manage health remotely.

With device connectivity and transfer of ePHI comes heightened concerns over protecting data from cyberattacks. A recent development that points to growing worries around medical device cybersecurity is the U.S. Food & Drug Administration’s (FDA) February 2021 appointment of Kevin Fu as the acting director of medical device cybersecurity within the Center for Devices and Radiological Health (CDRH), which is a newly created position.

There is also movement among the U.S. government and industry stakeholders to create a framework for interoperable, safe, effective and secure integrated medical systems, including the implementation of remote and autonomous care.

Referred to as the medical device interoperability reference architecture (MDIRA), the initiative is funded by the Defense Health Agency through the U.S. Army Medical Research and Development Command (USAMRDC) and led by the Johns Hopkins Applied Physics Laboratory (APL). APL is collaborating with a multidisciplinary team that includes the Johns Hopkins Armstrong Institute for Patient Safety and Quality; Massachusetts General Hospital’s Medical Device Interoperability and Cybersecurity Program; Dräger; Philips Healthcare; DocBox; Trusted Solutions Foundry and Arcos.7

Dräger is contributing expertise in standardized medical device interoperability based on the IEEE 11073 service-oriented device connectivity (SDC) family of standards, which defines a communication protocol for point-of-care (POC) medical devices. The SDC facilitates interoperability among POC medical devices, and secure data exchange between POC devices and HL7 compatible clinical and hospital information systems, such as electronic health records (EHR).

“Medical device interoperability (MDI) can improve patient safety through standardization of healthcare delivery, but medical device industry contribution is needed to define technical aspects of interoperable platforms, architecture, medical devices, standards and data models that can be used across multiple medical areas,” said Tobias Klotz, Systems Architect at Dräger.

“Our contributions to the MDIRA project from a research and development, and hardware and software perspective are important to the establishment of a reference implementation for secure data sharing and use to facilitate advances in healthcare diagnosis and treatment for both the military and civilian healthcare systems,” he added.

The future of patient monitoring

The push toward care outside of the hospital and into the home has no signs of stopping, rather it continues to accelerate. In response to this trend, patient monitoring manufacturers, healthcare IT solutions providers and healthcare organizations must find ways to keep pace with the change.

The global remote patient monitoring market is projected to reach $117.1 billion by 2025, up from $23.2 billion in 2020.8 While this presents significant opportunity for all stakeholders, it also presents challenges and responsibilities.

Frank says there are two key factors that the healthcare industry must address to unlock greater value from connected care.

“The first challenge is taking our proven and trusted hospital-grade technology and making it more consumer friendly,” said Frank. “A nurse may be able to operate a monitor a certain way but that doesn’t mean if I send it home with the patient, they will do the same. We really need to transform our ability to bring functionality into the hands of consumers.”

“The second aspect critical to unlocking value is how we position ourselves to drive our own solutions, while partnering with others in the industry on advancements,” Frank added. “As a device manufacturer, the days where we believed we could do everything ourselves are over. That is not the reality anymore. We will increasingly find ourselves collaborating with others in our space, and companies that may not currently play in healthcare. The question becomes, how do we do that effectively to move together with greater speed for innovation in the heavily regulated healthcare environment?”

References:
1. How the medtech industry can capture value from digital health, The McKinsey Global Institute, May 7, 2021, https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/how-the-medtech-industry-can-capture-value-from-digital-health
2. Hospital Revenue Trends, Deloitte, February 21, 2020, https://www2.deloitte.com/us/en/insights/industry/health-care/outpatient-virtual-health-care-trends.html
3. CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge, CMS, November 25, 2020, https://www.cms.gov/newsroom/press-releases/cms-announces-comprehensive-strategy-enhance-hospital-capacity-amid-covid-19-surge
4. Acute Hospital Care at Home Resources, CMS, accessed August 25, 2021, https://qualitynet.cms.gov/acute-hospital-care-at-home/resources
5. Long-term Care and Patient Safety, AHRQ, https://psnet.ahrq.gov/primer/long-term-care-and-patient-safety
6. Trends in Remote Patient Monitoring 2019, Spyglass Consulting, October 2019, https://www.spyglass-consulting.com/wp_RPM_2019.html
7. Better and Safer Care: Johns Hopkins APL Leads Effort to Improve Performance of Medical Device Systems, Johns Hopkins APL, September 28, 2020, https://www.jhuapl.edu/PressRelease/200928-medical-device-interoperability
8. Remote Patient Monitoring Market by Product End User - Global Forecast to 2025, ReportLinker, November 2020, https://www.reportlinker.com/p05982888/Remote-Patient-Monitoring-Market-by-Product-End-User-Global-Forecast-to.html?utm_source=GNW