5 Key Considerations for Effective Remote Patient Monitoring

These steps can help care providers build out effective remote patient monitoring programs.

Dr. Joel Klein is the CIO and senior vice president of the University of Maryland Medical System in Baltimore, Md.

The most important benefit of remote patient monitoring is that it helps clinicians remain vigilant about treatment-sensitive conditions that, if left undertreated, have a high degree of morbidity. RPM gives a more clinical focus to conditions that need extra attention from healthcare professionals.

For example, with RPM for a disease such as congestive heart failure (CHF), patients’ weight can be closely monitored over months to keep them out of the hospital. If they don’t fill their medications or lapse on their salt intake, health professionals can intervene. Without RPM, these patients might be seen every six to eight weeks for office visits, but this scenario can sometimes lead providers to miss opportunities to provide additional care.

However, delivery of RPM is contingent on reliable bandwidth, which was already a concern before the pandemic. Healthcare organizations are under tremendous stress, and they have to deal with competing priorities. Providers must carefully choose which patients to monitor remotely and have strategies in place to deal with potential problems.

To field a successful RPM program, healthcare organizations should follow these five important practices.

1. Plan Carefully Before Starting

Healthcare organizations should involve two groups in RPM planning. The first is the clinical group, which must define the patient population that will be monitored and the problem it’s trying to solve with RPM. This group also must determine how monitoring will be conducted; for instance, via devices such as glucose or heart monitors, or by questionnaires that can be administered through secure email or a patient portal.

The other group is the IT team. Often, clinicians don’t realize that their plans for RPM may face technical limitations. They also might not have extensive experience with implementing technology, especially solutions that are located in a patient’s home, such as wearable devices. It’s critical to have a partnership between IT and clinical stakeholders from the very beginning.

RPM planning should first consider the clinical problem the team is trying to solve, then identify the monitoring tools needed to accomplish this goal. Clinical teams should avoid saying, “We should do RPM. Let’s pick a disease.” That’s a solution in search of a problem. A program in which the technology drives the strategy will not be successful.

Avoid overcomplicating RPM. Keep it as simple as you can and build success incrementally.

Dr. Joel Klein CIO and senior VP of the University of Maryland Medical System in Baltimore

2. Focus on Simplicity First, Then Build on Success

Avoid overcomplicating RPM. Keep it as simple as you can and build success incrementally. One of most effective kinds of RPM is the phone call. For example, our health systems uses structured discharge phone calls with the patient, which can be made by staff members or by an automated phone system.

Simple RPM approaches exist for a number of diseases. CHF is one of them because patient monitoring is straightforward; it typically involves having patients use a scale to record their weight. If the weight starts to increase, you can quickly manage the situation before problems occur. Diabetes is another good example; if you monitor a patient’s blood sugar, it’s easy to intervene.

The issues you monitor should be those you can address with an action such as changing a patient’s medication or increasing the dosage.

3. Choose Devices That Best Meet Your Needs

Hospitals have several options for managing RPM devices. Some manage the entire process in-house: The provider buys and configures the devices so they feed patient data to the electronic health record. Some hire companies to handle the entire RPM process, including case management. Each hospital should choose the approach that works best for its patients and staff.

In making this decision, you need to understand where you have the necessary expertise and bandwidth. Devices may break or malfunction, and you can’t just leave patients to troubleshoot on their own or they’ll abandon the endeavor. Decide what you’re willing to take on and what’s cost-effective.

4. Make Sure Objectives and Processes Are Clear

The most important thing to communicate about RPM is why you’re doing it. Both the staff and patients need to believe in what you’re doing; otherwise, participation will quickly fade.

Tailor communication toward each group. Both clinicians and patients must understand the training they receive: Patients must demonstrate that they can submit their weight electronically; if they can’t, they need further training. Clinicians must be able to determine which patients are having problems.

When you’re running an RPM program, you also must ensure the technology works. For example, if you send a patient home with a scale that depends on internet access, but the patient doesn’t have internet at home, you need to find a way to provide it, such as through a cellular device.

Ultimately, ensure you have processes for emergencies. If a patient reports an abrupt, massive weight increase or alarming psychiatric symptoms, near real-time response expectations must be clear for all stakeholders.

57%

The percentage of healthcare consumers who say they would be willing to receive remote monitoring of ongoing health issues through at-home devices

Source: Accenture, “How Can Leaders Make Recent Digital Health Gains Last?” September 2020

5. Measure Success by Patient-Oriented Outcomes

Finally, determine how to measure success. A process-oriented outcome may increase the number of patients participating in an RPM program. If 5,000 patients send in at least one report this month, that may be an increase over last month — but it’s still just a number.

By contrast, if an RPM pool of 500 patients saw their monthly hospitalization rate fall from 7 percent to 4 percent, that would be a patient-oriented outcome. Patient-based metrics are more important. You must define them in advance, and they must be meaningful.

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