Remote Monitoring Offers Opportunity to Improve Patient Care

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Tracking patients may improve treatment for chronic conditions.
Tracking patients may improve treatment for chronic conditions.

When Reena Sangar recently had a sore throat, she photographed it and sent the image to her doctor. Within 8 minutes, she had a message telling her how to manage it.

“That kind of technology is transformative for me as a user,” said Sangar, head of digital and connective health at Ipsos, a global research and consulting firm. “Connected health is absolutely the future and in some instances is already here.”

Two years ago, only about 3% of patients were using health apps, according to Sangar. That percentage has since grown to about 10%. Technology companies are getting in on the trend. Amazon offers health care services through Alexa, and Best Buy's Geek Squad installs Assured Living, which can monitor health information. In July, the Centers for Medicare and Medicaid Services announced an administrative code for remote patient monitoring.

Whether or not health care is headed for a digital revolution remains to be seen, but providers at the very least might want to consider remote monitoring so as not to be left behind.

What is it?

Digital health comes in 2 main forms: tools enabling patient care independent of time and place, and those enabling patients to share information with providers remotely, according to Joseph Kvedar, MD, Vice President for Connected Health at Partners HealthCare in Boston.

When Dr Kvedar used to present information on digital health to health care executives, all he found was skepticism. But doctors have begun to warm to telemedicine to remain current, to monitor large amounts of data than would be possible in an office visit, and an increasing ability to get paid for consulting with patients remotely. “Those are 3 compelling reasons to get going,” he said.

Remote technology includes telehealth visits, digital monitoring of biometrics measures, and newly emerging chatbots that track data or connect patients to their physicians. One innovate digital approach is Pillo Health's digital companion, which is being tested through a pilot program for patients in the Boston area. The countertop device uses voice technology, facial recognition, and artificial intelligence to help patients with newly diagnosed diabetes better manage their care.

The American Association of Retired Persons (AARP) is working with Pillo on this program. Andy Miller, AARP's Senior Vice President of Innovation and Product Development, said this technology reminds people to take medication, connects them with family and caregivers, and enables them to better engage in their own health care.

“Technology makes it easier for providers to monitor and diagnose patients at critical moments and to provide ongoing care without having the patient always in the room with them,” he said. “Providers benefit when they can receive remote diagnostic information, analyze behavioral patterns and be alerted to potential problems before they arise.”

Digital health is being used in a wide range of areas, including heart disease, respiratory conditions such as chronic obstructive pulmonary disease, autoimmune diseases, neurologic problems, and population health management. Digital health also is being introduced in behavioral health applications, offering patients virtual treatment instead of medication management, Sangar said.

Proof in the pudding

Primary care providers began remotely monitoring patients with hypertension about 4 years ago. Melanie McMinn, MD, a physician lead for Atrium Health's Proactive Health program, which is based in Charlotte, North Carolina, said she uses this approach because hypertension is easy to treat and the most common medical condition prompting visits to her office.

When physicians in the program found patients were using fitness trackers and logging data into their own apps, they decided to join in. They created a group with 250 hypertensive patients and put them through a 90-day program that included hypertension education, information on diet and physical activity, and engagement from health advocates. The program was supervised by a nurse who ensured it was well executed and tracked patients' blood pressure data.

Dr McMinn said physicians would be lucky to get 40% of these patients' blood pressure under control with a year of traditional treatment. Through the remote monitoring program, they achieved an 80% control rate in just over 3 months with no doctor's visits.

Because of this success, Atrium has created a 90-day diabetes plan and another plan for weight management. More than 60% of Dr McMinn's interactions with patients are now virtual, she said.  “The idea is to not necessitate a doctor's visit,” Dr McMinn said. “We are taking what we are already doing and making clinical decisions based on data we've never had before.”

Challenges

Although the technology looks promising, a few hiccups need to be overcome before it becomes omnipresent, Dr Kvedar said. First is the workflow change that is required. “We are addicted to this concept of an office visit,” he said.

With remote monitoring, a practice may receive blood pressure or glucose information in an office multiple times in a day. Next, someone must take that information and chart it. Then decisions are made about a patient's management. The workflow is quite different from that of a a typical patient encounter.

Payments are another issue. Partners HealthCare has risk sharing contracts with their payers and measure success through readmission rates. Their heart failure program has documented a 50% drop in readmissions for patients who were remotely monitored with weight scales, blood pressure cuffs, and interactive software.

Dr McMinn said his organization is not making money from their program. Rather, the program is part of a “bigger system commitment to providing value to the patient” for which patients are charged $75 monthly to participate.

The approach will not work with all conditions or at all facilities, Dr Kvedar said. Providers would need to look far downstream to find potential for reducing kidney disease or stroke, for example. “You have to look at it from the perspective of how many of those bad events are we going to prevent over time,” he said.

For the industry to move forward, Sangar said, more doctors need to come on board. If vendors develop new products, doctors should not be afraid to test them. Pilot studies and testimonials are good ways to gauge the safety and efficacy of the products. 

“It needs to grow beyond doctors who are already bought in,” she said. “We need people to come along on the journey.”

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