June 12, 2013

The Role of Remote Patient Monitoring

For those interested in the role of remote patient monitoring (RPM), David Lee Scher, MD is an interesting blogger to follow. He has extensive interest and experience in the field of mobile health. He was a pioneer adopter of RPM as a beta site for Medtronic's Carelink wireless system. This monitored implantable cardiac rhythm devices such as defibrillators and pacemakers.

This has gained attention because of mandated penalties for hospital readmissions for certain diagnoses such as myocardial infarction, congestive heart failure, stroke, and chronic lung disease. RPM is a way of staying in physiologic contact with these patients regardless of their location – at home, during travel, and in care homes. While studies are reflecting radically mixed results, there is promise.

Dr. Scher list five issues he has faced and these are interesting. Please read his blog here and then peruse his blog page here. I will only summarize his writing.

#1. All remote monitoring is the same. There are many definitions for (RPM) from using the telephone for talking to the patients to today's use of implants to cell phones and then to electronic health records.

#2. All remote monitoring is reimbursed. This was a surprise to me. RPM monitoring is reimbursed in the USA and has been for many years. The real surprise is that the rate of reimbursement by the Centers for Medicare and Medicaid Services (CMS) is at a higher level than in-office follow-up.

#3. Patients and physicians will welcome and embrace remote monitoring. Not all physicians are on-board with this and saying that the data is unusable. Many just do not want the expense of having someone to monitor the data being received. Many are utilizing gathering centers and they in turn will notify the individual doctors of alert conditions. With the penalties that are being handed out by CMS, doctors will soon realize they need to use RPM.

#4. Remote monitoring should be totally automated. No, don't take the human factor out. They are needed to individualize the programmed parameters and alerts because each patient will be potentially different. Data can't manage itself, although some physicians wish this were possible. False positives and negative must be correlated to the clinical condition of the patients. Only this will optimize management. Caregivers must be involved and understand what is happening as well.

#5. Remote monitoring is only for recently discharged patients. It is unfortunate that it has taken regulatory requirements to drive digital technology to be adopted. This has caused much poor technology for healthcare and even poorer patient care. It is the failure of health technology that has not adopted the model of the retail and finance sectors that focus on customer satisfaction and transaction outcomes.

The remainder is my thoughts only and not of Dr. Scher. Because of regulations (laws) mandated by Congress, the opportunistic technology business saw huge profit potential and did not care whether their products served the proper purpose. They could always make changes for more profits and therefore the medical and hospitals of our country were sold a faulty product.

Because of Congressional urging and pressure by CMS, some health information technology companies are attempting to address the issue and correct problems now. Others that feel they are too above this are continuing to look for more ways to milk the regulatory cow. As a patient, I can only hope the milk sours for them and forces them out of business. Both physicians and patients need more productive innovation to make our healthcare system both more efficient and profitable for all concerned.

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