The Application of Remote Patient Monitoring (RPM)

  Remote patient monitoring, abbreviated as RPM, has been steadily growing as a clinical practice adopted by healthcare professionals from different disciplines.

  The key word in remote patient monitoring is “remote”. It signifies that the patient being monitored is not in the same place as the care team in charge of monitoring.

  To facilitate such remote monitoring of patients, devices are needed. Any RPM package consists of software to collect and coordinate patient data, and devices to read patient data while they are at their homes or other long-term care facilities.

  To demonstrate just how far remote patient monitoring has come, we wanted to go through the exercise of listing every RPM application out there to treat chronic diseases.

  We specifically choose chronic care as it is responsible for 90% of the USA’s 3.8 trillion healthcare expenditures. We also lump behavioral care with chronic care, as mental health conditions are chronic in nature.

Non-Chronic Care Applications That Were Left Out

  Chronic care is contrasted with conditions, diseases or care episodes that do not last forever.

  They include acute care which deals with all types of operations, including pre-operative care, peri-operative care and post-operative care.

  Also included are prenatal care and neonatal care which are only associated with pregnancy. Like acute care, it’s a field where remote patient monitoring is used, but it’s not classified as chronic care.

  Lastly, diseases like cancer which tend to come and go are not included. Again, cancer is an emerging field where there is use of remote patient monitoring, but it’s not considered a chronic disease.

  Drivers of diseases or outcomes, and not the actual disease, were also left out. Such as smoking and suicide. Smoking is a habit that leads to many of the chronic conditions in our list, but it is not a disease itself.

  Similarly, suicide is, unfortunately, more common than we like to admit to, and suicide attempts leads to fatalities. But like tobacco smoking, it is an activity and not the disease, and hence is left out. The condition that could cause suicidal thoughts is a part of behavioral care, and is covered in our list.

Our Ranking Methodology

All RPM Applications Ranked

On The Importance of Measuring Devices

  It would be wasteful to repeat words for every application or RPM, when the principles are the same. Remote monitoring works because they measure vital signs or other biodata which are absolutely crucial to the functioning of a healthy human being.

  When the person develops a condition, these vital signs or biodata fluctuate in a way that is not indicative of an otherwise healthy person. Thus the whole idea is to keep such fluctuations in check by using devices to monitor from afar. This is the concept of remote patient monitoring in a nutshell.

  It’s almost like treating the concept of health like statistics, which is what happens in an inpatient facility like a hospital or emergency center anyway. Yes, the nurses and doctors do their rounds, but the patient’s health is as good as the numbers on the health monitors.

  So for this reason, we briefly describe what each chronic condition is, say what can be measured, and mention the most important monitoring devices that are used.

  Anything beyond this information would start to sound redundant, because the features would be equally applicable to all diseases.

For e.g.,

  • Recovery instructions that include educational resources pertaining to the disease.
  • Workflows that coordinate various clinical resources and trigger responses based on the patient’s condition.
  • Medication adherence reminders to ensure treatment plan protocols.
  • Calorie and exercise logging programs for maintaining a certain lifestyle.
  • Two-way video calls for check-ins.
  • Pre-configured alerts to go off when a certain activity is missed or a certain reading is abnormal.

  So as you can see, such features are part and parcel of any remote care software, and it’s better to go via route of measuring devices in order to truly establish the uniqueness of each remote patient monitoring application.

 

Choosing the Chronic Care Conditions

Vital signs like heart rate, oxygen saturation level, blood glucose level are essential in maintaining health, as they map to some of the most important organs in the human body.

  There are over 55,000 codes for diseases listed by the International Classification of Diseases (ICD), the most deadly of which are usually triggered by one of the major organs being affected and hence reflected in the vital signs or other related biodata.

  Therefore, it is unfeasible to list every single application of remote patient monitoring, because theoretically a connection can be made between a vital sign and most diseases or conditions.

  Thus we use prevalence as a measure of importance. We rank below the most prevalent chronic conditions from highest prevalence to lowest prevalence.

All RPM Applications Ranked

All RPM Applications Ranked
 

Hypertension

Prevalence in USA: 108 million

  Hypertension is the existence of high blood pressure which eventually leads to other complications, such as heart disease. The cuff wraps around the arm and can transmit the blood pressure (BP) reading via Bluetooth or other technology to a BP monitor. The monitor can detect both systolic and diastolic blood pressure, as well as heart rate and other irregular heartbeat detection.

Main Monitoring Devices: Blood pressure cuff and blood pressure monitor.

 

Non-alcoholic Fatty Liver Disease (NAFLD)

Prevalence in USA: 80 million

  Non-alcoholic Fatty Liver Disease occurs when there is excess fat in the liver. The liver’s normal functionality is reduced and over time it can lead to cirrhosis, where scar tissue replaces otherwise healthy liver tissue. It’s possible to gauge the health of the patient suffering from NAFLD by gauging their blood pressure, blood glucose levels and heart rate.

Main Monitoring Devices: Blood pressure cuffs, glucometers, pulse oximeters.

 

Obesity

Prevalence in USA: 70 million

Obesity is a condition where you have excessive body fat. It has a correlation to multiple other chronic health problems. To keep track of weight, weight scales can remotely transmit the patient’s weight to clinicians. Smart scales measure more than your body weight, such as body fat percentage, bone and muscle mass, etc.

Main Monitoring Devices: Weight scale, smart scale.

 

Arthritis

Prevalence in USA: 54 million

  Arthritis is a condition that causes swelling and tenderness of joints which leads to pain and stiffness. By wearing sensors on the arms which detect the degree of movements of the joints, clinicians are able to track the severity of the condition over time. Apps can also use the camera to detect a range of extensions of arms.

Main Monitoring Devices: Wearable sensors and cameras.

 

Anxiety & Depression

Prevalence in USA: 40 million

  Anxiety and depression are conditions related to behavioral health which are grouped together because of their co-occurrence. Depression causes low mood while anxiety causes worry. The idea is to keep trends on sensor-based behavioral data such as  physical activity, social activity and phone usage. Mental health questionnaires are also widely used for treatment, though that is not an actual biometric measurement.

Main Monitoring Devices: Wearable sensors such as patches and headbands.

 

Chronic Kidney Disease

Prevalence in USA: 37 million

  Chronic Kidney Disease is the gradual loss of kidney function over time, where the inability to remove waste from the system leads to other complications. For patients receiving peritoneal dialysis whose kidneys are failing, it’s important to remotely track their biometric information such as weight and blood pressure.

Main Monitoring Devices: Weight Scale, and blood pressure cuffs and monitors.

 

Diabetes

Prevalence in USA: 34 million

  Diabetes is a condition where you can’t produce or process insulin adequately. It leads to high blood sugar in the bloodstream and can lead to very serious consequences if not managed properly. By remotely monitoring blood glucose or blood sugar levels, physicians can manage diabetic patients. Glucose measuring kits can include fingersticks and strips to collect the blood or continuous monitors that use sensors on the skin to obtain glucose readings.

Main Monitoring Devices: Continuous glucose monitor, insulin pumps, fingerstick.

 

Asthma

Prevalence in USA: 25 million

  Asthma is similar to COPD (later down in the list), where it narrows your airways and produces mucus which makes it difficult to breathe. It’s possible to remotely manage the treatment of asthma by counting inhaler medication dosages and monitoring the severity of asthma via measuring SpO2 levels.

Main Monitoring Devices: Pulse Oximeter, Bluetooth Spirometer, Smart Inhalers.

 

Obstructive Sleep Apnea

Prevalence in USA: 22 million

  Obstructive Sleep Apnea is a serious sleeping disorder where irregular breathing starts and stops to prevent a good night’s sleep. CPAP devices are used to deliver positive airway pressure as a treatment. Some of such devices have a remote function, which allows clinicians to remotely monitor the patient’s sleep to identify issues. There are now also wristwatches that measure the peripheral arterial tonometry, which provides a recording of sleep apnea.

Main Monitoring Devices: Wrist Devices, CPAP Devices.

 

Coronary Heart Disease

Prevalence in USA: 18 million

  Coronary heart disease is the most common type of heart disease where the arteries become too constricted to deliver enough oxygenated blood to the heart. There are many implantable devices such as pacemakers, defibrillators and loop recorders that can remotely transmit the cardiac rhythm signals to the care team. It’s also equally important to maintain healthy blood pressure.

Main Monitoring Devices: Wearable ECG/EKG monitors, Blood pressure cuffs and monitors.

 

Chronic Obstructive Pulmonary Disorder (COPD)

Prevalence in USA: 16 million

  COPD is inflammation of the lungs that decreases oxygen absorption and inhibits airflow. It is commonly caused by tobacco smoking but can develop purely because of genetics or second hand smoking as well.   By remotely monitoring the patient’s oxygen saturation levels, the care team is able to better guide the patient and avoid any regression of the condition.

Main Monitoring Devices: Pulse Oximeter, Bluetooth Spirometer.

 

Alzheimer’s Disease

Prevalence in USA: 6 million

  Alzheimer’s disease is a neurologic disorder that gradually erodes memory. It causes the brain to atrophy over time that impairs cognitive abilities. It is the most common form of dementia and it decreases the ability of a person to function independently. It is especially dangerous when the person tends to wander, and so remote patient monitoring helps to keep tabs on the person’s movement.

Main Monitoring Devices: Surveillance monitors, fall alert systems.

 

Congestive Heart Failure (CHF)

Prevalence in USA: 5 million

  Congestive Heart Failure is a condition that weakens the pumping ability of the heart. By remotely monitoring the patient’s weight daily, fluid retention can be detected immediately, which is one of the earliest symptoms of worsening CHF. It’s also important to measure the heart rate which can be done using many instruments, such as the pulse oximeter that goes on the index finger. There are also thumb rings available that do the job.

Main Monitoring Devices: Weight scale, Pulse Oximeters, O2 Rings.

 

Atrial Fibrillation

Prevalence in USA: 2.7 million

  Atrial Fibrillation is a heart condition marked by an irregular and often rapid heart rate that can lead to blood clots, stroke, heart failure and other heart-related conditions. Thankfully, it is possible to monitor such fluctuations of heartbeats through a host of remote patient monitoring devices. The anticoagulation device is a point of care device that can check for blood clots in a minute.

Main Monitoring Devices: Electrocardiography (ECG) devices, heart rate monitors, Anticoagulation testing device, wearable optical sensor.

 

Parkinson’s Disease

Prevalence in USA: 1 million

  Parkinson’s Disease is a nervous system disorder that affects body movement. It leads to shaking, stiffness and general difficulty with walking, balance and coordination. The care team can remotely monitor indicators of gait and tremor via camera and sensors. The course of care can thus be appropriately altered as needed.

Main Monitoring Devices: Grip Strength Sensor, camera.

Conclusion: Accessibility & Future

Accessibility Future

  We see how from a prevalence of 108 million to 1 million, different chronic care conditions ravage the healthcare system. Even if the life expectancy of patients improves or their conditions are better stabilized due to better healthcare, they still have to be monitored remotely. It’s why we chose to highlight chronic care, because they have become such a mainstay of the healthcare system as it exists currently. 

  While every chronic care patient is not monitored remotely at the present, that is indeed where things are going as we look to shift to value-based healthcare. 

 As more people are added to the list of patients with such chronic diseases, a larger percentage of them will be referred to remote care as the benefits of RPM become more widely touted.

  As the remote monitoring devices become more miniaturized and multi-functional, it could be possible that a simple wearable like a patch or wristwatch is all one needs. If more than sensors are needed to access a reading, the same device could come with a fingerstick to collect a blood sample.

  We have already seen entrants like Apple and Google into the healthcare market. With more complicated features like the ability to decipher various ECG waves, a wristwatch or other accessories could recreate a healthcare setting away from the hospital or clinic.

  But then, there are questions to be answered on the level of comfort people have in wearing intrusive technology, and if such devices get the necessary FDA clearance. As it stands, there is still room in the culture to embrace remote patient monitoring more fully, by prescribing the right apps and devices to people who need them.

References

https://en.wikipedia.org/wiki/International_Classification_of_Diseases

https://www.cdc.gov/bloodpressure/facts.htm

https://www.emoryhealthcare.org/heart-vascular/wellness/heart-failure-statistics.html

https://www.healthline.com/health/copd/facts-statistics-infographic

https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2015_SHS_Table_A-15.pdf

https://www.alz.org/alzheimers-dementia/facts-figures

https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

https://www.cdc.gov/nchs/fastats/liver-disease.htm

https://adaa.org/understanding-anxiety/facts-statistics

https://www.parkinson.org/Understanding-Parkinsons/Statistics

https://www.cdc.gov/heartdisease/facts.htm

https://www.cdc.gov/arthritis/data_statistics/national-statistics.html

https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html

https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743497/

https://www.cdc.gov/chronicdisease/about/costs/index.htm

https://www.humhealth.com/the-state-of-chronic-care-management-today/

https://www.humhealth.com/the-role-of-remote-care-in-integrating-behavioral-health/

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