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What Is Remote Patient Monitoring?
Remote patient monitoring (RPM) is gaining popularity as the US Health and Human Services Administration’s Center for Medicare and Medicaid (CMS) continues to approve new CPT codes to reimburse providers for their use. RPM utilization is more advanced outside the behavioral community, but both offer significant precision medicine and patient-centered healthcare benefits. In this article, both medical and behavioral RPM advances are discussed.
By using RPM devices, providers can track vital signs and other specialized metrics related to specific conditions and behaviors. They can help identify and track conditions and behaviors that are detrimental to one’s health, change a treatment plan to reverse negative trends, improve outcomes, and reduce costs. In pulmonology, for example, patients can collect breath-related metrics using digital devices that attach to their smartphones, which relay that information to the physician’s electronic health record (EHR). Aberrations trigger alerts on the medical office’s main EHR screen if the data are in an abnormal range. Otherwise, readings get uploaded in chart form when needed for reference.
When aberrations are flagged in the EHR, the medical staff is alerted that the patient in question needs attention, either immediately or later. Interventions vary, but as an example, the staff might call the patient or caregiver to obtain needed information to determine the next steps. The long-term utility of remote patient monitoring bodes well for health systems employing disorder-specific RPM technology to address the needs of identified groups of people, such as those recently discharged from the hospital and those who require chronic care management.
It doesn’t stop there. Each specialty has its own RPM devices. In cardiology, for example, patients can use watches and other wearable devices to monitor heart rate, rhythm, oxygen saturation, and other metrics. They can wear external transdermal patches and minimally invasive devices to monitor cardiac parameters. They can use RPM-based stethoscopes to allow the medical staff to listen to heart and lung sounds via HIPAA-compliant apps to collect data and transmit it to the treating provider synchronously in real-time and asynchronously. Across specialties, RPM devices have been shown for more than a decade to empower medical providers to provide care when it is most needed. RPM helps providers reduce hospitalizations, prescribe needed medication, and send immediate care via a visiting nurse to deliver care.
The availability of RPM devices is growing steadily. Devices are being deployed for mass marketing now that CMS is steadily increasing the number and comprehensiveness of CPT codes for reimbursement. Medicare payments became available in 2016 when the Centers for Medicare and Medicaid Services (CMS) issued its first CPT codes for RPM. Therefore, the future expansion of remote patient monitoring and its acceptance by healthcare professionals will be determined by CMS.
As detailed in Telehealth.org’s previously published What is Remote Patient Monitoring? in behavioral care, remote patient monitoring devices can help monitor sleep, diet, exercise, mood, and more. The benefits of gathering continuous data without seeing people in person or relying on self-reports make RPM use ideal for behavioral healthcare. See Telehealth.org’s Increased Reimbursement for Remote Patient Monitoring (RPM), and Remote Patient Monitoring Telehealth Can Increase Revenues while Improving Care for further explanation of RPM benefits for clients and practitioners.
Some devices are available for developers to embed in their platforms; others are available for providers to use directly with consumers. Some others are developed and marketed extensively to consumers but not connected to provider offices through telehealth platforms. Telehealth.org’s Buyer’s Guide lists several currently available RPM medical devices.
Misconceptions About Remote Patient Monitoring
Healthcare practitioners are experimenting with various tools, platforms, and techniques to establish remote patient monitoring. At the same time, they’ve been correcting frequent misconceptions as they try to make headway in a rapidly evolving market.
Myth: Remote Patient Monitoring Are Too Expensive
Reality: Remote patient monitoring systems do not have to be expensive to influence clinical outcomes. Indeed, many organizations have established small remote RPM programs that address health conditions, utilizing one or two remote patient monitoring devices that collect only a few data points.
Organizations might claim they are getting a good deal by allowing patients to use their own devices and submit data to providers. However, this might generate complications and undermine the program’s success. From effectively handling care management and positioning a program for sustainability and reimbursement, to delivering devices to chronically ill patients, remote patient monitoring can genuinely improve care and be highly cost-effective.
Remote Patient Monitoring Is Too Complex
Reality: Remote patient monitoring programs frequently employ completely operational devices and are ready to use. Providers have assessed patients for digital literacy and provided any necessary instructions ahead of time. Remote patient monitoring devices are pre-configured to connect through cellular or Wi-Fi, depending on what is available, so all the patient needs to do is switch on the device.
Healthcare organizations invest millions of dollars each year to guarantee that the customer experience is as seamless as possible. Coordinators for remote patient monitoring assist hospitals with the setup and implementation procedure. Furthermore, effective remote patient monitoring devices connect with electronic health records (EHRs). The capacity of a care provider to incorporate data with treatment plans and diagnoses in the EHR ensures effective care management and coordination, reducing gaps in care that result in costly therapies and adverse health outcomes.
Remote Patient Monitoring Only Works With High-Speed Internet Access
Reality: Many programs rely on Wi-Fi that involves internet service, which is difficult to obtain in isolated or rural areas and too expensive for some individuals. Some remote patient monitoring projects employ technology other than Wi-Fi to maintain access in rural areas, avoiding bandwidth concerns. Bluetooth-enabled mHealth apps can link to smartphones, tablets, or home computers and transfer data to care providers. Aside from Bluetooth, cellular networks route through hubs or gateways, allowing some providers to reach people with RPM devices in households that do not have Wi-Fi or cell phones.
Remote Patient Monitoring Concentrates on Limiting Hospitalizations
Reality: While many remote patient monitoring programs began with the idea that they primarily exist to prevent future re-hospitalizations, the landscape is rapidly moving to embrace programs that focus on care management and long-term health, including mental health. Healthcare professionals employ remote patient monitoring to address chronic care management post-discharge from rehabilitation and link clients to care teams for as long as required, which benefits patients with long-term care requirements.
A variety of heart rate variability (HRV) measures, an advanced form of biofeedback, can now be obtained in Apple Watches, Oura rings, Garmin watches, to name a few. While most of the above devices do not use telehealth systems to connect clients to their providers, they are being developed with that purpose in mind. Currently available devices for research purposes include Biosensics. Behavioral clinicians can expect many more wearable health devices to come, recording HRV in naturalistic real-life contexts. These devices may be a valuable strategy to gain more reliable insight into affective and other disorders. A May 2020 meta-analysis by Lehrer and colleagues reported:
Our initial review yielded 1868 papers, from which 58 met inclusion criteria. A significant small to moderate effect size was found favoring HRVB, which does not differ from that of other effective treatments. With a small number of studies for each, HRVB has the largest effect sizes for anxiety, depression, anger, and athletic/artistic performance and the smallest effect sizes on PTSD, sleep, and quality of life. We found no significant differences for the number of treatment sessions or weeks between pretest and post-test, whether the outcome measure was targeted to the population or year of publication. Effect sizes are larger in comparison to inactive than active control conditions, although significant for both. HRVB improves symptoms and functioning in many areas, both in the normal and pathological ranges. It appears useful as a complementary treatment.1
A significant body of research also focuses on how HRV relates to mental health resilience (MHR). Published in 2020, an article by Perna and colleagues concluded that their work supports “the idea of HRV as a plausible, noninvasive, and easily applicable biomarker of MHR.”2 Using HRV in the form of RPM, clinicians are better positioned to evaluate the effects of stress and its relation to vulnerability to psychiatric disorders.
HRV Benefits to Clients/Patients
More importantly, individually-worn HRV devices can directly help clients and patients monitor their autonomic nervous system reactions to help identify who, what and where stressors are particularly damaging. With such knowledge, stressors can be recognized, negotiated, or avoided to minimize the risk of triggering underlying psychiatric vulnerabilities.
In conclusion, most misconceptions about RPM stem from legitimate concerns. By debunking myths, healthcare providers can help clients and patients harness RPM’s full potential to make it an integral part of their day-to-day health routine. Especially with the repeated focus of CMS on steadily increasing the availability of reimbursable RPM CPT codes since 2016, HRV and other services are likely to expand so that patients and providers have more precise information to discuss.
1. Lehrer, P., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., … & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: a systematic review and meta-analysis. Applied psychophysiology and biofeedback, 45(3), 109-129.
2. Perna, G., Riva, A., Defillo, A., Sangiorgio, E., Nobile, M., & Caldirola, D. (2020). Heart rate variability: Can it serve as a marker of mental health resilience?: Special Section on “Translational and Neuroscience Studies in Affective Disorders” Section Editor, Maria Nobile MD, Ph.D. Journal of affective disorders, 263, 754-761.
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