Joseph
COVID-19 has spurred the adoption of telehealth and remote patient monitoring across the United States, with 36 percent of US consumers now using telehealth to replace health care visits.
While this has created an opportunity for health systems to digitally transform their care delivery model, not all health systems have the appropriate resources and organizational support to drive this change.
Among the many challenges, an important factor related to IT managers in these health systems is the unwillingness of the clinical community to support the IT transformation to adopt new models of care delivery.
In the remote monitoring space, the medical community’s lack of confidence in the quality of the data, especially the self-monitored data reported by the patient, was a challenge despite the clear benefits of managing large chronic populations through connected devices.
Given the need to integrate remote patient monitoring, IT managers are forced to look beyond electronic health records and explore stand-alone platforms to enhance their care delivery. As CIOs, they must also use the tools available and work strategically towards transforming the organization.
To ensure that these providers make the best use of available resources while planning for the long term, IT managers should consider the following.
Choose the right device to obtain reliable patient data and compensation
Today, many health devices and wearables are on the market, but not all of them are approved by a CMS for cost reimbursement. To compensate by CMS, the device has to be FDA listed.
However, approval by the US Food and Drug Administration (FDA) ensures that the medical device is safe and effective for its intended use. The Food and Drug Administration (FDA) classifies medical devices into three categories based on the risks to human life. Depending on this classification, a medical device must undergo various regulatory processes, including a clinical trial.
The FDA also provides necessary guidance for operating the device and supporting documents that highlight do’s and don’ts, pros and cons, and thus aid in making informed decisions.
Remote monitoring devices allow doctors to monitor patients for vital elements such as respiratory rate, heart rate, temperature, heart rate variability and levels of oxygen saturation in the blood, enabling informed decisions in a timely manner.
Map your doctor’s workflow and gain confidence
The implementation of a remote patient monitoring program in the hospital involves stakeholders and doctors of all specialties with virtual care. Physician input can help define and prioritize specialist services when defining a roadmap for remote patient monitoring programs.
Factors that can help prioritize the services of each discipline should include the need for remote work, available budget, return on investment, and use case mix for each department under study.
Each specialty has its own use cases that are open for virtual visits. These use cases should be evaluated before selecting devices by specialty.
For example, cardiology requires more digital monitoring devices than other specialties to monitor blood pressure, weight, heart rate and ECG in real time. At the same time, dermatology may simply use a high-resolution, high-quality camera.
Adopting FHIR standards to integrate data into a physician’s daily workflow
A typical day in the life of a busy physician includes seeing scheduled appointments in the outpatient setting and inpatient tours and emergency visits in between. To accommodate remote patient follow-up within the routine, the physician is required to have advance clinical documentation along with the patient’s current vital elements.
For seamless remote patient monitoring, devices have been integrated into the physician’s electronic health records to display device readings in the context of the patient’s clinical documentation.
Measurements and data from personal health devices must reach caregivers through platforms synchronized with the devices, usually through a mobile app. Today, there are many formats in which data is sent to personal health portals such as devices on the market.
This lack of standards creates challenges for developers who end up writing code for each separate instance of the device. FHIR resources or data packets define the primary resources required to transfer data from devices to FHIR servers and ultimately to receiving systems such as EHRs in a standard format. When received in standard format and connected to electronic health records, data from these devices can assist the physician in diagnosing the patient holistically.
Remote patient monitoring uses three primary resources from FHIR:
- Patient. The patient resource provides demographic information about the patient. The patient ID within this resource is an essential attribute that links the patient to the device. Implementers can choose not to disclose the patient’s protected health information or keep it open.
- Device. In FHIR, a device resource is used to describe fixed components such as device ID, manufacturer, name, model number, location, device status, and any other information.
- Note. This resource is the most important component that contains the actual data about the dynamic parameters being measured. The monitoring resource contains the actual results, timestamp, reference ranges, and device details for the measured parameters.
The large variation in physiological readings and data collected from patient health devices can be grouped into six basic types of observations listed below:
- Numerical: for example, temperature, weight, steps, pulse, glucose – anything that can be described in a single number field.
- Vector: Measurements that require more than one value to describe it, such as BP and acceleration.
- Code: When actions are described with a limited set of options in the context of reading, for example timing of reading, such as before eating, fasting or bedtime.
- Event / Condition: This type of measurement is used to monitor applications, for example, the condition of the humidifier, whether the patient is in or out of a room in an independent living facility, or a peripheral signal in the pulse oximeter.
- Waveform: Periodic data is mapped to waveform data, such as ECG traces.
- String: Captures string data, when measurements are in text format and only used for display.
COVID-19 has provided impetus to the remote patient monitoring market. The updated physician fee schedule issued in December 2020 addressed the changes in care management services and telemetric physiological monitoring services, reflecting changing medical practice trends.
A physician-friendly payment environment, dependable devices, integrated workflows, and policies that encourage remote patient monitoring will help clinicians easily provide remote care.
IT managers in health systems must overcome financial constraints and resource shortages by turning the situation in their favor. Start by setting organizational priorities, gain the trust of stakeholders and the doctor, and build rigorous governance to drive digital initiatives, while tracking and reporting benefits to drive digital transformation by easily monitoring patients remotely in their organizations.
Dr. Joyote Goswami is a Senior Consultant at Damo Consulting.
