Remote patient monitoring for chronic care: Promises and limitations
At the height of the pandemic, hospitals rapidly adopted remote patient monitoring (RPM) technologies to engage and manage patients with chronic conditions who, under normal circumstances, would routinely go to the doctor’s office. Now that providers and patients have returned to in-person appointments, the industry is seeking evidence that continued RPM utilization makes clinical and financial sense.
Recent research provides mixed results. Evidence shows RPM helped patients manage their blood pressure and recover from COVID-19 infection but had minimal impact on other chronic conditions.
First, the good news. Papers in Massachusetts and Italy both showed home-based blood pressure control was better during and after the pandemic’s peak than it was prior to widespread stay-at-home orders. The former study, based at Mass General Brigham, found nearly 22% increase in the number of patients who reached their blood pressure goal, influenced in part by a 71% increase in blood pressure measurements taken at home. The Italian study found an improvement in medication adherence during the pandemic, due in part to increased blood pressure measurement.
In addition, three studies – at Kaiser Permanente, Mayo Clinic, and the Veterans Health Administration – deemed RPM an effective alternative to hospitalization for treating COVID-19. The mortality rate for patients enrolled in home-based monitoring was 0.4% across the three sites, compared to a national mortality rate of 1.1% as reported by Johns Hopkins. In fact, the success of RPM in preventing deaths related to COVID-19 – both at the hospital and at home – has led to calls for continuous pulse oximetry and heart rate monitoring for all patients in the hospital, regardless of diagnosis.
Other chronic conditions didn’t see the same results, however. One literature review saw “little to no difference” in blood glucose levels, along with a “small negative effect” on quality of life, among patients using RPM to manage diabetes. A second paper reported slight improvement to blood glucose levels but also an increases hospitalization rate and “no significant improvement” to quality of life among RPM users. Looking at the big picture, a third paper found RPM “not compatible” with managing patients with multiple chronic conditions, while KLAS Research reported fewer than 40% of providers running RPM programs managed to reduce readmissions.
Remote patient monitoring variability explained
What makes RPM work for some conditions but not others? The research summarized here, along with guidance from the Department of Health and Human Services, offers some clues.
Infrastructure. Health systems demonstrating positive outcomes with blood pressure management had telemedicine infrastructure and RPM programming in place prior to the pandemic. Implementing on the fly stretches resources thin and distracts from a program’s long-term goals.
Integration. RPM needs to fit into clinical workflows. Sending clinical staff to a standalone application to monitor data, answer alerts, or respond to patients will only slow down the process and frustrate providers and patients alike.
Scalability. As with any digital health initiative, RPM succeeds when it can scale beyond the initial patient sub-population. Organizations need the technology infrastructure to handle more users – and the strategic vision to know where and when to deploy RPM next.
Volume. Separate reports from Health Affairs and the Office of the National Coordinator for Health IT confirm that a small percentage of providers account for the majority of reimbursable RPM and telehealth encounters. Once providers buy in and recognize the benefits, adoption rises.
Collaboration. Entire clinical teams benefit from insights derived from RPM, not just the individual physicians overseeing the program. This enables shared decision-making and care plan coordination, which can improve outcomes while reducing utilization.