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The Ultimate Starter Kit for Remote Patient Monitoring

Analysis  |  By Sudipto Srivastava  
   February 17, 2022

Health systems have realized the importance of monitoring patients outside the healthcare facility and are building advanced RPM programs to address this need.

Editor's note: Sudipto Srivastava is the vice president of digital solutions at Hospital for Special Surgery.

With the exponential increase in the use of telehealth during the pandemic, patients are now familiar with seeing their clinical team in virtual settings. Simultaneously, health systems have realized the importance of monitoring patients outside the healthcare facility and are building advanced remote patient monitoring (RPM) programs to address this continued need. Creating a scalable RPM program requires careful thought.

There can be pitfalls in implementing a robust RPM program—from distractions like the Shiny Toy syndrome to missed clinical alerts. It is important to remember the 4 D's: Devices, Data, Dialogue, and Dropping charges when getting started.

  1. Devices
  • Pick the right devices: For optimal success, a system should work with vendors that have credibility in the marketplace and FDA clearance. Focus on the vitals relevant to track specific chronic disease processes (e.g., blood pressure, SP02, etc.).
  • Determine how the device will get to the patient: Would they be handed out in the health facility, or shipped to patients? The former option will require staff training to explain the technology. If shipping directly, the device may need to be pre-configured for ease of use.
  • Ensure connectivity: Check to make sure the patient has access to Wi-Fi or other connectivity at home. Consider providing devices that come with a hub or those that can be easily paired with a smartphone without the need to download cumbersome apps.
  • Provide support: Answering patient questions can be a full-time job, so plan for who will answer those calls. Depending on the nature of the problems, this could be best handled by the vendor or the clinical care team—factor in device replacement / warranty protocol at this stage.
  1. Data
  • Frequency: Clinical needs should drive how often the data is obtained. Higher-risk patients may need to send data daily or every few hours whereas other cases can be managed by weekly or monthly reports.
  • Review: It's not always practical or cost-effective to have the vast amount of data analyzed by clinical team members, so consider some amount of automated processing, in addition, to review by a clinician or an MA or technician. A more mature setup may require a "command center."
  • Liability: With data coming in at a higher frequency and volume, missing a concerning reading or failing to recognize a subtle pattern is a possibility, resulting in liability concerns. Include risk and compliance teams in the onboarding process so patients are aware of potential errors.
  • Quality: The clinical team should establish the threshold for whether data is good or bad. They know what clinical guidelines exist for the condition being managed. And they know how to apply those guidelines to serve their individual patients best. 
  • Storage: Before shoving everything into an electronic medical record (EMR), create an intermediate step (like a data lake where the device information lands first) to validate the accuracy of the data and offer visualizations EMRs can't.
  1. Dialogue
  • Notifying patients: Carefully consider if it is okay to send a patient an automated message (voice or text) to confirm readings that look off. Other options include receiving a call from a nurse or doctor or requesting the patient to come into the office.
  • Emergency scenarios: For high-risk patients, clear instructions on what they should do (e.g., call a hotline or 911) should be provided at the outset of enrollment. For less acute situations, instruct the patient to call the office during business hours, or send a text or a voice message.
  • Using bots: Given the volume of data, it is essential to send some communication back to the patients via automated tools and then programming those tools to escalate if things look off.
  1. Dropping charges
  • Payment: As glib as it sounds, if there is no mechanism to pay for this program, it will not scale. But the good part is that there are options available to get reimbursement from CMS for this.
  • Cost: For a program to generate ROI, it needs to either generate sufficient savings or revenue. Setting up a scalable RPM program cannot be outsourced to bots alone. It requires an investment in resources to respond to the incoming information, take care of administrative issues, and coordinate care. The cost of the resources performing these functions is perhaps the largest portion of the total cost of an RPM program—so it needs to factor into the overall ROI calculation.
  • Investment or partnership: Technology and device costs are not trivial for a large-scale program. So, it helps to determine how many devices you need to purchase and the technology platform you choose. It may be prudent to use a vendor if resources are not available internally.

Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at provider and payer organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content. Send questions and submissions to Erika Randall, content manager, erandall@healthleadersmedia.com.


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