Original article was published on Artificial Intelligence on Medium
5 reasons I believe Remote Patient Management platforms can transform the healthcare industry (and 5 challenges)
The world has changed dramatically since the global pandemic started, especially in the healthcare industry where workers on the front-lines — from doctors, nurses, medical students to volunteers, cleaning staff, and more — are making tremendous sacrifices leading us in our fight against Covid-19.
Over the last 6 months I have had the opportunity to work with Sentinel Healthcare, a Seattle based company that provides a Remote Management Platform (RPM) for clinicians and hospitals to monitor patient health and provide outreach clinical decision-making support. As a technologist sitting outside the healthcare industry, I wanted to consolidate some of my learnings in this article with hopes of inspiring readers who are not familiar with the industry to think about RPMs as an integral part of the future of healthcare. I also want to address some of the roadblocks I see these platforms facing as well as ethical/cultural/societal questions we will have to answer.
An RPM is simply a method of gathering patient data outside of traditional settings. Patients use medical devices such as heart rate monitors, blood pressure cuffs, fitness trackers, and other devices to record their vital signs on a daily basis and in the comfort of their home. These recordings are transmitted back to the clinicians providing them with a stream of data that shows a much clearer picture of the patient’s day-to-day health.
There are 5 reasons why I believe Remote Patient Management platforms are here to stay and can transform services that the healthcare industry is currently providing patients:
1. Legislation has made RPMs and Tele-mediecine economically viable for adoption
The AMA introduced 4 CPT codes in 2018 that can be reimbursed by hospitals and clinics for RPM services as long as the devices meet FDA’s definition of ‘medical device’. The new rules make it so that it’s actually lost money for organizations that don’t cash in these reimbursements. This article illustrates an example of a solo practice that monitors 100 patients and could earn up to $70,416 a year through reimbursement of code 99091 (“Chronic Care Remote Physiologic Monitoring”).
Furthermore, the last few months have brought about immense modifications to existing rules around usage of tele-mediecine by the CMS (the federal agency in charge of Medicaid and Medicare). They’ve published a letter titled Dear Clinicians which walks through the COVID- driven changes. The high- level summary is that tele-mediecine was limited to people who were zoned to RSAs (Rural Statistical Areas) and lacked access to a nearby clinic. Those limitations are all removed because of Covid-19, making it easier and economically feasible for everyone to access healthcare remotely.
2. Continuous data collection provides better quality of care
RPM platforms collect data that empowers physicians to know what is going on with patients on an on-going basis. The traditional method of data collection is a scheduled and periodic visit with large gaps of time between visits during which health deterioration might occur. On-going data collection can change our method of delivering healthcare from prescriptive to predictive, allowing us to identify deteriorating health conditions before they get out of hand. Continuous data collection can reduce admissions and readmissions to hospitals and reduce the number of on-site interventions needed. Continuous data collection can also be useful for the patient to self-monitor and be more conscious of their condition.
3. Improving physician productivity
By 2035 there will be a shortage of 12.9 million healthcare workers. In addition to the impending healthcare worker capacity crunch, existing physicians face high rates of burnout in some practices. There is a dire need for more healthcare workers to work in an environment friendly to their physical and mental wellbeing. RPMs show promise in increasing productivity of physicians by providing them higher quality data in a timely fashion. A McKinsey study explains how e-mail, electronic communication, and scheduled in-person visits are taking up large parts of a physician’s workday. RPM data integrated in an electronic communication platform could be hugely valuable in reducing the amount of time a physician takes to see a patient and can increase the number of patients seen.
4. Improve population health
RPMs can remove the barriers to quality care for patients and reduce the per capita cost of healthcare. RPM data could be aggregated and shared with government and multilateral public health policy institutions to make better decisions and drive for better public health outcomes. If RPMs allow for opt-in GPS tracking, spread of viruses could be better tracked and contained.
5. Personalized care
RPM data combined with advanced analytics and machine learning can create more personalized treatment plans which could improve outcomes for patients significantly. Instead of treating all patients with a specific disease as equal, personalized care plans will look for the best treatments for that particular patient. Personalized care, sometimes known as precision health, requires starting with data and analyzing symptoms based on a particular patient’s medical history and on-going health.
5 challenges RPMs will face:
1. Lack of high-quality and compliant monitoring devices
Since RPM devices and platforms integrated into the healthcare workflow are under the purview of the FDA, new devices and platforms will need to be approved before they can become accessible to clinicians. FDA approval is contingent upon evidence of a statistically significant improvement in the quality of medical care delivered by the device or treatment which can only be proven through randomized control trials. The data to run these trials hasn’t been available until recently, but we are now seeing more trials take place. For example, in 2018 The Apple Watch was recognized by the FDA as a viable electrocardiogram device with software usable for medical applications. In general, the types of high-quality, over-the-counter, non-intrusive, and reliable medical devices are limited and this scarcity is a roadblock in making RPM platforms pervasive.
2. Cyber threats and privacy
Since RPMs are cloud-based platforms, highly sensitive data is transmitted over the internet and is at risk of cyber attacks. Cloud solutions that are HIPAA compliant and secure are crucial to protecting against cybersecurity and data leakage threats. While The HIPAA guidelines serve as a basic framework to guide acceptable usage of RPM data, this legislation often changes and is usually a step behind the status quo. The sharing of data between patients, the RPM platform, and the clinicians brings about questions of data governance — who owns the data? Is it the patient, hospital, or the platform?
3. Patient compliance and ease-of-use
The RPM platform largely depends on active participation by the patient to regularly and correctly upload their device readings. As data from the WHO suggests, the global population is aging, and over the next 30 years the number of people above the age of 60 will double from 11% to 22%. The RPM platforms should be designed to be usable by a growing and aging global population. One of the issues I faced in working with RPM data with Sentinel Healthcare was large gaps of time where patients didn’t upload any readings, sometimes due to negligence but often due to some kind of user error. These gaps and inconsistencies in the readings make performing any kind of analysis on the data extremely difficult.
4. Cloud adoption and internet pervasiveness
In order for RPMs to be adopted widely, these platforms will need to provide an immediate ROI to hospital CIOs or CTOs in order to justify budget allocation. Furthermore, there needs to be a minimum level of cloud adoption by the hospital or clinic to integrate the RPM platform with the rest of the hospital technology stack. Organizations have varying levels of cloud adoption and there are varying levels of internet and mobile device access within the population. Adoption of RPM platforms without an equal distribution of internet and mobile device access could widen the health gap and increase social inequities.
5. Siloed data sources are not interoperable
There are a number of data sources contained that need to interoperate with one another in order for an RPM to be successful. These sources include anything from population details, historical patient record data, to Electronic Medical Records (EMRs) and medical device data streams. These data sources could have inconsistencies in size, granularity, aggregation level, etc.. all of which could be a source of medical error. There is risk in relying heavily on highly sensitive and messy data which may have issues that lie well beneath the surface.
My work with Sentinel Healthcare has shown me first-hand that there is tremendous promise in RPM platforms. While there is lots to be done still to make the adoption of RPM platforms more widespread, I believe the healthcare industry is undergoing a creative disruption due to Covid-19 and this is a crucial time to re-think how healthcare should work. The question to ask is which care providers are not satisfied with the status quo? And which ones will stay the same?