Get an inside look at how continuous remote patient monitoring is transforming high-risk patient care!
Continuous Monitoring: Enhancing Remote Patient Care
Introduction: Enhancing Remote Patient Care
The use of digital medical devices for patient home monitoring (or in locations away from traditional health care facilities) has become commonplace in recent years. Most people are familiar with devices such as digital blood pressure monitors, thermometers, glucometers, and fingertip pulse oximeters.
According to the US Food and Drug Administration (FDA), remote or wearable patient monitoring devices include
- non-invasive remote monitoring devices that measure or detect common physiological parameters, and
- non-invasive monitoring devices that wirelessly transmit patient information to their health care provider or other monitoring entity.
Some of these devices have been around for quite a while and simply provide episodic data that the patient can use to monitor various physiological parameters to aid in carrying out their health care regimen. For example, a diabetic patient uses a digital glucometer throughout the day to keep on top of their blood sugar levels and if appropriate, administers the requisite dose of insulin per their physician’s instruction.
In such cases, neither the patient nor the digital device interacts with off-site technology. Barring unforeseen developments or a clinical emergency, the patient does not need to share information with anyone in particular unless instructed by their physician.
Recently, more sophisticated home monitoring devices have been integrated into the paradigm of remote patient monitoring (RPM), in which episodic data from devices like these is transmitted directly to healthcare providers in facilities or hospitals. The new generation of patient home monitoring devices that interface with smartphone applications can transmit patient data to the cloud, where it can be retrieved by healthcare providers.
Even more recently, the needs of chronic and high-risk patients have given rise to continuous remote patient monitoring (CRPM). This modality is similar to RPM, the difference being that the wearable digital monitoring devices transmit patient data in real time. This provides distinct benefits over RPM and has the real potential to enhance care for chronic and high-risk patients, save money, improve patient lifestyles, and even save lives.
This ebook will discuss the history of digital patient monitoring devices, the evolution of these devices, and related treatment modalities, as well as the development and practical applications of RPM and CRPM.
From the Clinic to the Home
Prior to what many once called the Digital Age, patients who required regular monitoring of certain physiological parameters were only able to do so by visiting their healthcare provider and having them perform the requisite tests. This obviously represented an inconvenience; besides being unavoidable at the time, it added costs and stresses to patients.
Certain medical devices, such as manual blood pressure cuffs and blood sugar test strips, were available for home use and provided some utility, but these were often only marginally reliable in the hands of patients or provided inconsistent results.
With the advent of microprocessors, the landscape of remote health monitoring changed dramatically. Suddenly, patients could monitor physiological parameters such as blood pressure, blood sugar, and blood oxygen at home. Colored test strips for diabetics gave way to testing media that could be read via a portable digital device and finally, to devices that could determine blood sugar directly. These are a major convenience compared to days past, when these parameters could only be measured in a hospital or physician’s office.
In the United States, Medicaid, Medicare, and private insurance use the following initialisms as designations for home medical equipment:
- DME: durable medical equipment
- HME: home medical equipment
- DMEPOS: durable medical equipment, prosthetics, orthotics, and supplies
Nearly all the digital devices used outside of traditional healthcare facilities fall into the HME category. While this technically covers everything from bedpans to ventilators, for the purposes of this discussion, wearable technology and supporting digital devices will also be included.
The Evolution of Wearable Technologies
Fitness consciousness became a popular issue in the 1970s with the proliferation of information and concern related to cardiovascular disease and a spate of fitness-related media, such as Jim Fixx’s best-selling book, The Complete Book of Running. The heightened concern persisted through the next few decades and gave rise to a wide array of personal fitness-related digital products that came about as computer technology evolved. Many of these were wearable devices like pedometers and pulse monitors. These first-generation personal devices continued to evolve, giving way to devices we see today, such as Fitbit and those offered by companies like Apple, Garmin, and Polar.
While the commercial personal fitness industry was developing new and better wearable products on an ongoing basis, engineers and computer programmers working in healthcare looked to develop these technologies to serve clinicians, healthcare organizations, and patients.
With people of the baby boomer generation aging and the subsequent increase in the elderly population, the medical industry has changed significantly. In the technical realm, a focus on the development of biosensors that would enable real-time health monitoring, prevention, and personalized medicine for a variety of chronic and acute diseases emerged. The conventional diagnostic tests commonly used in laboratories and hospitals were seen as time-consuming and costly, requiring highly-trained personnel.1 Increasing regulatory and liability burdens continued to drive overall healthcare costs up, prompting even more focus on personalized healthcare.
Over the last decade or so, healthcare industry interests have put a great deal of effort and resources into the development of wearable biosensors, which use physical signals, such as heart rate, blood pressure, skin temperature, respiratory rate, and physical activity, to access clinically relevant information. Ultimately, these wearable devices evolved into non-invasive biosensors that allow for the monitoring of patients and provide information sufficient for determining health status and even preliminary diagnosis. Finally, wireless technology has facilitated the unfettered use of wearable devices and the transmission of patient data to supported devices and the cloud.
“The newest generation of wearable devices are driven by their own receiver, feature a signal processor, and are battery-powered, enabling them to operate as a microcomputer and allowing for the connection of all processes, from information collection and processing to communication and power supply.”2
The new wearable devices connect to other smart devices via Bluetooth, infrared, radio-frequency identification, and near-field communication technology.
“Together, this connectivity has led to the development of wearable systems for remote and long-term patient monitoring in homes and communities that were previously impossible.”1
The ability of wearable biosensors to passively capture and track continuous health data has spawned a revolution in the field of health informatics. These technological advancements set the stage for the advent of RPM and later, the development of CRPM.
Remote Patient Monitoring
RPM engages technology to enable health care providers to observe various metrics relating to a patient’s health on an ongoing basis while the patient is outside the conventional clinical setting, such as in their home. In short, when using RPM, patient data is collected from a remote location and transmitted electronically to health care providers in another location for assessment. RPM allows health care providers to track such patient data as heart rate, vital signs, weight, activity, blood pressure, and many others.
In addition to increasing access to health care and decreasing delivery costs for healthcare, RPM facilitates the monitoring of chronic conditions that would otherwise be costly (in repeated office visits) and could lead to unwanted physical, mental, and emotional stress for the patient. Remote patient monitoring is not limited to any particular class of patient or conditions; the data collected is contingent upon the digital utilities being used and the requirements of the physician and patient. With the current technology, a single wearable device can now monitor a wide range of medical risk factors and transmit relevant data to a clinician.
Healthcare providers found RPM to be particularly useful in the wake of the COVID-19 pandemic, which necessitated the drastic limitation of contact between individuals. In situations where an inordinate number of visits to healthcare facilities could actually increase the risk of exposure to the coronavirus pathogen in patients with comorbidities, RPM limited much of that risk.
Due to rapidly improving technologies, RPM has become a mainstay in medical facilities across the developed world. While remote monitoring systems do necessitate monetary investment, the increased affordability of these technologies has allowed many medical facilities to take advantage of this modality.
The Limitations of Remote Patient Monitoring
Like any emerging or novel technological paradigm, however, there are both pros and cons attendant to utilizing remote patient monitoring. Some of the limitations (or cons) of remote monitoring are minor issues that can be worked around by providers or addressed by IT departments. Others, however, represent fundamental functional pitfalls that continue to plague medical facilities and health care providers.
Solid broadband connectivity is a must when implementing RPM, which makes doing so difficult for smaller healthcare facilities and those in rural or underserved areas. Economic considerations are often an issue in some of these facilities and even in urban areas that are otherwise well-served but may be operating under economic duress.
Then there’s the fact that not all patients have the technological means to support RPM on their end. Not everybody has a smartphone, after all. There are also patients who aren’t tech-savvy, as well as elderly or significantly infirm patients who may have difficulties using the requisite technologies.
Lack of Patient and Provider Buy-In
According to a New England Journal of Medicine survey, RPM is one of the least effective patient engagement initiatives. Researchers have explained that the relatively low enthusiasm for RPM is due to the fact that wearables aren’t yet accessible for all patients, and that reliance—even in part—on patients to monitor and maintain equipment on their end makes many clinicians skittish. Some physicians have expressed concern over the accuracy of retrieved data, and some patients have balked over security concerns, i.e., their private health data being intercepted by third parties and used for nefarious purposes.
Lack of Provider Engagement
In addition to provider skepticism and resistance to the unfamiliar, some clinicians also cite doubts that RPM technology will help increase patient accountability or prompt higher-risk patients to moderate high-risk behavior. Additionally, some physicians and clinics have balked at the initial expenditure for implementing RPM, the increased software requirements, and compatibility issues with electronic medical record systems.
Error Rates of Existing RPM Utilities
The reliability and accuracy of some wearable devices have also come into question among physicians who have cited the fact that manufacturers provide little or no documentation to support said reliability and accuracy regarding their products. Many of these are reluctant to stake their reputations and patient health on devices for which error rates are unknown. A recent review in JAMA Dermatology showed that smartphone apps for melanoma detection have a 30% failure rate, and comparisons between various wearables showed large variations in accuracy between different devices, with error margins of up to 25%.
The Needs of Patients with Severe Chronic and Complex Disease
“As the elderly population grows globally, various chronic and acute diseases have become of increasing concern, and the medical industry is changing dramatically due to the need for point-of-care diagnosis and real-time monitoring of long-term health conditions. Wearable devices have evolved gradually in the form of accessories, integrated clothing, body attachments and body inserts. Over the past few decades, the vigorous development of electronics, biocompatible materials and nanomaterials has resulted in the development of implantable devices that enable the diagnosis and prognosis through small sensors and biomedical devices, and have greatly improved the quality and efficacy of medical services.”1
Chronic conditions dominate health care in most parts of the world, including the United States. The available literature holds that the top 5% of severe chronic patients account for 56% of annual care spending. Management of disease by the patient is often central to controlling the effects of chronic disease.
“Varying influences in the patient’s social and physical environments can enhance or impede these management efforts. Interventions to improve management by patients can produce positive outcomes, including better monitoring of a condition, fewer symptoms, enhanced physical and psychosocial functioning, and reduced health care use.”3
Researchers and clinicians agree that patient self-regulation is a promising framework for the development of interventions.
“[However,] serious gaps in understanding and improving disease management by patients remain because of an emphasis on clinical settings for program delivery, neglect of factors beyond patient behavior that enable or deter effective management, and other impediments.”3
A major concern with regard to elderly patients and patients with severe chronic disease is that some of these are manifestly unable to self-manage their disease and thus require continuous monitoring. This presents problems when engaging the remote patient monitoring paradigm, because RPM deals with episodic data, rather than continuous data.
In other words, despite its benefits, RPM is not real-time or continuous patient monitoring, hence the need for enhancing remote patient care.
Continuous Remote Patient Monitoring
Given the needs of the healthcare industry (patients included) and the ongoing improvements in technology, a transformation from episodic, manual, and fragmented care to continuous, automated, and prolonged monitoring is currently taking place. What’s being seen now is an incorporation of the predictive power of artificial intelligence combined with wearable medical technology, giving rise to CRPM.
More than 50% of hospital deaths occur in patients who are not continuously monitored. This is why intensive care units (ICUs) in hospitals employ continuous monitoring. Simply put, continuous full-time patient monitoring provides a remote analog to the ICU for high-risk, chronic patients and facilitates the treatment of mild acute events in the home environment. CRPM is the next logical step in the evolution of remote patient monitoring and management.
The power of continuous remote patient monitoring lies in its ability to deliver detailed, accurate patient data in real time. Conventional remote patient monitoring has great benefits, but since it provides episodic patient data rather than real-time patient data, it is of limited value when dealing with high-risk, chronic patients.
With continuous monitoring, wearable medical devices collect and transmit data as events occur, enabling reliable patient supervision and immediate responses to potential emergencies, whether this means an automatic (technical) intervention or the intervention of a health care provider.
In this new generation of patient monitoring, software employs predictive algorithms that detect even minor deviations from the established patient baseline. Medical intelligence algorithms immediately recognize even minute changes in that baseline and react accordingly. For example, health care providers can be instantly alerted in the case of a change in the respiratory parameters established for a patient suffering from a chronic heart ailment or even less serious occurrences, such as a patient missing a dose of medication. These smart, AI-aided notifications are 100% free of the false alerts generated using the more primitive, threshold-based approach used in RPM.
In the case of high-risk, chronic patients, continuous patient monitoring offers:
- Improved patient quality of life
- Improved quality of care
- Reduced risk of medical crises
Continuous remote patient monitoring also provides therapeutic and medication titration capabilities, optimization of care plans and rehabilitation, and a reduction in hospitalizations and ER visits. Approximately 2 million hospitalizations in the US that occur annually with a diagnosis of acute respiratory could be avoided using CRPM.
Real-time patient monitoring provides an early warning to clinicians regarding potential medical problems, so they can intervene in a more timely manner—ideally, before an actual emergency arises. This type of system facilitates the early recognition of patient distress, which not only can lessen the severity of any complication but also save lives when an emergency does happen.
With real-time monitoring, the system continuously processes the patient’s digital biomarkers, while AI-powered, augmented medical intelligence software compares them to the patient’s baseline. With rapid-response systems in place, if the patient’s vital signs exceed accepted ranges, immediate alerts allow for prompt intervention.
But CRPM doesn’t stop there. Simply programming patient parameters into a system that alerts clinicians if there are irregularities isn’t enough. Patients with chronic conditions frequently experience biomarker irregularities that can trigger non-emergency alerts. CRPM employs special, AI-based smart alert software that notifies care teams in cases of real adverse events and emergencies, instead of engaging clinicians in cases where parameters may have been exceeded but a real emergency doesn’t exist.
This is one of the superior benefits of CRPM and one of the main factors in healthcare facilities adopting this modality. Vital sign trending (facilitated by medical intelligence software) expands on this by “learning” patient parameters and helping health care providers identify true alarms. This way, medical staff can reliably tell whether a patient is stabilizing or destabilizing and respond appropriately.
The new (and continually improving) smart wearable medical technologies allow for comfortable and reliable continuous monitoring. Combining the convenience of wearable tracking devices with state-of-the-art technology, this paradigm offers capabilities previously available only in hospitals and clinics.
The Real-Time, Real Benefits of Enhancing Remote Patient Care
The transformation from conventional remote patient monitoring to precisely evaluating patients’ health in real time through continuous remote patient monitoring is quickly becoming a reality.
It should be noted that the distinction between RPM and CRPM has not been sufficiently established outside of the industry. Thus, there are some who mistake one for the other or who mistakenly believe that RPM is real-time (or continuous) monitoring, when it is not.
In the hospital ICU, high-risk, chronic patients are continuously monitored. With CRPM, these patients can benefit from similar technologies and provider access.
Patients with conditions such as congestive heart failure (CHF), for example, may be comfortable in most situations but often encounter physical limitations under stress. More severe symptoms can include an increased respiratory rate or even severe respiratory distress. Patients with CHF have been successfully managed by clinicians for decades, and many continue to live comfortably and productively.
In the past, these symptoms might have meant a trip to the emergency room or a weekend in the ICU. While this was an appropriate measure at the time, a recent study in Critical Care Medicine estimated that hospitals could save $20,000 per bed annually with the help of continuous remote monitoring. According to the Commonwealth Fund, the top 5% of chronic patients account for 50% of annual care spending, which adds up to about $50,000 per patient.
By monitoring a CHF patient’s vital signs through CRPM, clinicians can be alerted immediately regarding the early signs of worsening and help the patient take steps to avoid a clinical emergency. There is far less stress for the patient and far less expense than a trip to the hospital. There are numerous chronic conditions, including chronic obstructive pulmonary disease and obstructive sleep apnea, where millions of patients stand to derive benefits from CRPM.
CRPM: The Newest-Generation Hardware and Software
It has been well-established that a patient with a chronic medical condition can benefit significantly from CRPM and its non-invasive measurements of physiologic parameters, the asynchronous transmission of this data to clinicians, and its interpretation by their physician to guide their ongoing treatment plan. The only question remaining for the healthcare facility is which CRPM solution will be the most viable for the organization and most beneficial to its patients.
The Oxitone platform is a full-suite, FDA-cleared solution that is true continuous remote patient monitoring. In one click, clinicians can access patients’ real-time, intelligent insights and follow up on hundreds of high-risk patients with minimal effort.
Oxitone features advanced, integrated SaaS, a physicians’ web portal and dashboards, secured cloud infrastructure, data analytics tools, reports, API integration tools, and data delivery on demand. The patient/caregiver app helps patients stay compliant with their care plan. Its advanced wearable continuous monitoring solutions enable significantly enhanced monitoring of patients with complex chronic diseases, ensuring the best clinical outcomes.
Oxitone advanced wearables enable:
- Continuous monitoring during home treatment of mild exacerbations
- Continuous monitoring for titration of therapy applications
- Continuous monitoring of post-acute events and rehabilitation progress
- Continuous monitoring of new therapeutics and drugs development
Finally, Oxitone has developed an AI-aided five-emergency level alert system that is 100% free of false alerts.
For the patient, Oxitone provides the Oxitone 1000M—the world’s first FDA-cleared wrist-sensor pulse oximetry monitor. This device is easy to use, supports Bluetooth, has a rechargeable long-life battery, and is CE Mark certified. The Oxitone 1000M multi-parameters monitor provides data on the patient’s skin temperature, pulse rate and HRV, blood oxygen, motion and activity, sleep patterns, and more.
The Oxitone platform is a powerful, full-suite solution that fully addresses the needs of chronic, high-risk patients, and its real-time delivery of data makes it a superior patient solution to remote patient monitoring. Oxitone’s combination of AI’s predictive power and the convenience of wearable medical technology represents the next major development in patient monitoring and chronic disease management.
1Guk K, Han G, Lim J, et al. Evolution of Wearable Devices with Real-Time Disease Monitoring for Personalized Healthcare. Nanomaterials (Basel). 2019;9(6):813. Published 2019 May 29. doi:10.3390/nano9060813.
2Dinh-Le C, Chuang R, Chokshi S, Mann D. Wearable Health Technology and Electronic Health Record Integration: Scoping Review and Future Directions. JMIR Mhealth Uhealth. 2019;7(9):e12861. Published 2019 Sep 11. doi:10.2196/12861.
3Clark, N. Management of Chronic Disease by Patients. Annual Review of Public Health 2003 24:1, 289-313.
Here at Oxitone, we boost value-based healthcare by delivering extraordinary patient, clinical, and economical outcomes at reduced medical utilization and cost. Patients need a prompt response to emergencies. Physicians need an easy and timely follow-up with patients. Our mission is to transform chronic disease management and help save lives worldwide.
Let’s save lives together! To see how we help remote patient monitoring companies and physicians improve the management and care of high-risk patients, contact us today!