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Remote Patient Monitoring: Can It Be A Solution to a Key Healthcare Problem?

September 12, 2013
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As healthcare reform forces a reimbursement shift from the traditional fee-for-service model to the new pay-for-performance model, keeping people healthy will force healthcare providers to do things such as prevent hospital readmissions, or keep people from needing a hospital stay at all. And that will happen only if providers have some insight into what patients are doing at home.

The concept is that better chronic care management will keep costs down. If patients can manage their health better outside of the hospital, costly major medical episodes are less likely to occur. After all, Medicare will levy $227 million in penalties against hospitals in every state but one for the second round of the government’s campaign to reduce the number of patients readmitted within 30 days.

If you’ll remember, I blogged last month about how readmissions—while a cause for concern—are not as big a problem as many might think. While I genuinely believe that to be true, how to prevent readmissions is still a question that many hospitals still grapple with.

One answer might be in the form of remote patient monitoring (RPM)—a technology to enable monitoring of patients outside of conventional clinical settings—comes in. RPM is a critical piece in increasing access to care and decreasing healthcare delivery costs, and recently, many efforts have been made by healthcare systems to turn to this burgeoning technology.

For one, a new 24/7 remote monitoring system from the Mayo Clinic will improve care and shorten hospital stays for critically ill patients, according to Mayo officials. The Enhanced Critical Care program will offer monitoring of the sickest patients at six Mayo Clinic Health System hospitals in Austin, Albert Lea, Fairmont and Mankato, Minn.; and Eau Claire and La Crosse, Wis.

"It's like having an extra set of eyes on every patient," Dany Abou Abdallah, M.D., a pulmonologist and director of the critical care unit in Eau Claire, said. "With this program, operations center nurses and physicians continuously review patients' vital signs and other data. The minute they notice a potential problem, they can alert the local care team.”

The Center for Connected Health (CCH) in Boston and the Oakland, Calif.-based Center for Technology and Aging (CTA) have also collaborated on the development of a tool for analyzing the return on investment (ROI) for RPM technologies, enabling healthcare providers to evaluate the financial benefit of these technologies for patients with chronic heart disease.

The ROI Tool was developed and tested with a number of healthcare organizations participating in the CTA Diffusion Grants Program. HealthCare Partners (HCP), a large physician group practice based in southern California, used the ROI tool to quantify the value of its remote patient monitoring program for chronic obstructive pulmonary disease (COPD). Using the ROI tool, HCP’s interactive voice response program had a positive ROI of 1.3 to 1 after one year, and is projected to increase dramatically to 18.9 to 1 by year five.

Another example is when the use of a home telemonitoring system helped reduce 30-day hospital readmission rates by 44 percent among patients with congestive heart failure, according to the Danville, Pa.-based Geisinger Health Plan's evaluation of its patient monitoring program. Geisinger's home telemonitoring system allows patients to receive scheduled calls through an interactive voice response system developed by telehealth company AMC Health. The calls ask patients about their symptoms and then store the responses online and in patients' electronic health records. The responses then are analyzed to determine whether the patient requires a follow-up visit with a nurse or case manager.

There are many more examples of RPM technologies being used, and mounting evidence points to a growing market. According to a research report from the New York City-based Kalorama Information, sales of advanced remote patient monitoring devices have risen 20 percent from the year before. The market for the devices has constantly ticked up, going from $4 billion in 2007 to $10.6 billion in 2012.

And over the next five years, remote patient monitoring will result in cost savings of up to $36 billion worldwide, according to an announcement on the mHealth market from Juniper Research. Additionally, research published in January by analyst firm Berg Insight estimated that 2.8 million patients worldwide were using a home monitoring service based on equipment with integrated connectivity at the end of 2012, and Berg predicted those number of connections would climb to 9.4 million worldwide by 2017.




Remote Patient Monitoring still requires much work to turn it into an effective clinical tool. The article in JMIR accurately points to the inadequacies in most of the studies done to demonstrate its effectiveness. These studies have been often been flawed and lacked the statistical power to demonstrate value.
In contrast the marketing reports which espouse huge numbers and unlimited clinical value seem to be predominantly driven by the imaginations of their authors and designed to drive the VC community to invest in RPM startups.
Whilst I believe RPM has great potential it needs to be developed as a clinical tool not a technology demonstration.

Dr George Margelis

Thanks for the comment, Dr. Margelis! I agree with you that market reports can be misleading--I hope you didn't think that was the focus of my post! While there are still challenges to be met, I also agree that RPM has incredible potential as a clinical tool, as seen in several of the examples I gave. Remote monitoring is effective because it alerts physicians of a problem before patients end up in the ER.