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Remote Patient Monitoring Poised for Growth

By Doug Desjardins  
   October 18, 2013

New penalties for preventable hospital readmissions are prompting hospitals to adopt technologies that allow patients to measure blood pressure, heart rate, and other vital signs from home.

This article originally appeared in Medicine on the Net, November 2013.

Remote patient monitoring has been around for nearly a decade, but the practice is beginning to gain more traction on the strength of new technologies and a more urgent need to keep costs down, two factors that are expected to drive growth and generate billions of dollars in cost savings over the next five years.

Helping to drive that expansion are new regulations that penalize hospitals that exceed set standards for preventable readmissions of Medicare patients. The threat of those penalties is prompting hospitals to devise new ways to keep patients healthy so that they don't come back, something remote patient monitoring is designed to do.

Vital signs
The Center for Connected Health has been testing remote patient monitoring for nearly a decade through a variety of programs. In 2006, it introduced a pilot program in the Boston area with Partners HealthCare called the Connected Cardiac Care Program (CCCP). Since then, the program has enrolled more than 1,200 patients and produced a 50% reduction in heart failure-related 30-day readmissions and a 44% reduction in non-heart failure-related readmissions.

"What we found is that patients take better care of themselves when they're being monitored," said Joseph Kvedar, MD, founder and director of the Center for Connected Health. "They also learn how certain behaviors can affect their health and those two things have combined to produce a 50% reduction in preventable readmissions."

Kvedar said the CCCP equips high-risk patients, typically cardiac surgery patients who also suffer from a chronic condition such as diabetes, with a table-top monitoring device when they're discharged from the hospital. The device allows patients to measure their blood pressure, heart rate, and other vital signs from home and have the data relayed to their physician at least once a day.

"By reviewing the data each day, doctors and nurses can see when something is wrong and touch base with the patient," said Kvedar. "By the same token, if a patient doesn't send the information on a particular day, they'll get a call to find out why and to make sure they're OK."

After a few months in the program, the overall health of patients tends to improve through a combination of monitoring and education. "For example, if we notice a patient's blood pressure has spiked, a nurse will call and ask them what they've been doing or what they've been eating," said Kvedar. "In some instances, it turns out the patient ate something loaded with sodium and they learn to avoid that food in the future."

Since the launch of the CCCP, the Center for Connected Health and Partners Healthcare have expanded the remote patient monitoring concept to include programs for patients who suffer from diabetes, colorectal cancer, and patients recovering from a stroke. The programs now draw patients from seven hospitals in the Boston area and Partners Community HealthCare, a management services organization with more than 5,500 affiliated physicians.

CCCP was launched in 2006 and those changes are making it easier for providers to use remote monitoring programs. The use of smart phones and apps is opening new avenues of remote care and allowing providers and patients to launch simple programs based on texting or the use of healthcare apps.

"When we started out 10 years ago, we didn't have smart phones or tablet computers and they're certainly going to drive adoption," said Kvedar. "And the fact that so many healthcare providers are entering ACOs and other partnerships with a shared-risk arrangement should help drive growth as everyone tries to keep costs down."

According to a report from Partners HealthCare, the Connected Cardiac Care Program has generated $10.3 million in cost savings since it was introduced. It estimates the average cost for each patient participating in the program is $1,500 but the average cost-savings per patient is $9,655.

Cloud-based data and plastic strips
Another pilot program being conducted in California is attempting to reduce the rate of 30-day readmissions among high-risk patients. The program teams Oceanside, Calif. –based Tri-City Medical Center, medical supply firm Valued Relationships Inc. (VRI), and Qualcomm Inc., a San Diego technology firm best known for manufacturing chips for cell phones.

The pilot, launched in January 2013, is using a remote monitoring system developed by Qualcomm called 2Net and plastic strips developed by VRI. The strips are embedded with sensors that monitor patient vital signs including blood pressure, heart rate, and blood oxygen levels. That information is then relayed to the 2Net system.

Under the program, Tri-City Medical Center sends a select group of patients considered to be at a high-risk of readmission home with the 2Net Hub platform and the sensors. Using the system, physicians can monitor patient vital signs several times a day and deploy an early intervention when those vital signs are off.

"By better coordinating care for our patients, we're better able to keep them going about their daily activities from the comfort of their own homes," said Tri-City Medical Center CEO Larry Anderson.

The 2Net Hub uses three short range radios to collect data from the biometric sensors and transmit the data to physicians using the 2Net cloud platform. Qualcomm Life, a division of the parent company that develops healthcare technology, said the simplicity of the system should make it easy for other hospitals and health systems to adopt.

"The plug-and-play nature of the 2Net Hub pairs well with Tri-City Medical Center's and VRI's commitment to remote monitoring," said Rick Valencia, vice president and general manager of Qualcomm Life in a statement. "And, given the fact the Medicare 30-day Readmission Rule is now in effect across the U.S., this effort could not be timelier."

A Tri-City Medical Center spokesman said the hospital hasn't released results of the program yet but expects to release its findings in 2014 after the pilot has been operating for a full year.

Rapid growth and skepticism
Two recent studies are projecting huge growth in remote patient monitoring over the next few years but one of those studies shows that some providers aren't completely sold on the idea.

A July 2013 report from Juniper Research predicts that remote patient monitoring is poised to take a major leap forward during the next five years. The report projects "cumulative cost savings from remote patient monitoring of up to $35 billion [worldwide] over the next five years as the healthcare industry moves to accountable care." The growth will be fueled in part by the expansion of healthcare apps, which are expected to have 96 million users by 2018 compared to 15 million in 2013.

But another recent study shows healthcare providers aren't so sure how effective remote patient monitoring programs will be, at least in terms of being a good business model. A study conducting by Spyglass Consulting Group found that 55% of ACOs in the United States are using some type of remote monitoring system and predicts the practice is poised for "robust growth" over the next several years.

The study also found that 71% of organizations surveyed expressed concerns about integrating remote patient monitoring technology with existing clinical information systems and electronic health record systems. And 50% of executives surveyed questioned the clinical effectiveness of remote patient monitoring technology and whether the costs of operating the systems will outweigh the cost savings they generate.

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