Remote Patient Monitoring in Telehealth: It's not just the technology!

Remote Patient Monitoring in Telehealth: It's not just the technology!

Since the arrival of the Coronary Care Unit (CCU) within the early 1960s, the sector of cardiology has led to the introduction of the latest healthcare technology. Cardiac monitoring and resuscitation lowered the deathrate for attack patients by 50 percent. This was followed by approaches in cardiac imaging, avoidance, monitoring techniques, and therapeutic interventions. The result has been a rise in our longevity.

However, thereupon longevity comes a price to pay in terms of the diseases of aging. The foremost obvious is dementia, but heart condition, particularly coronary failure, has been on the increase in recent decades. Today, there are an estimated 6 million Americans with clinical coronary failure. It’s the foremost common explanation for hospitalization under the Medicare program also because of the largest expenditure. The result has been an effort to shift the management of coronary failure to the outpatient setting to enhance cost-effectiveness. The creation of programs for remote patient monitoring including efforts at patient and caregiver education has been a challenge because reimbursement for these services has lagged behind albeit they need to be proven to save lots of money. Using the parameter of 30-day rehospitalization rates, successful monitoring programs have achieved a 30 percent reduction in rehospitalization with significant cost savings, but, at an equivalent time, other programs using similar technology have did not demonstrate benefit. What can explain the disparity within the results?

Let’s start with the technology. The measurement of daily weight with a scale has long been the surrogate for fluid retention that's the hallmark of worsening coronary failure. Keeping in mind that a gallon of water weighs a touch of quite 8 pounds, a sudden change in weight signals the onset of fluid retention which is followed by the event of the congestive symptoms.

Anyone, however, who has worked during a hospital, knows how unreliable this measurement is often. Uncertainty of the device, conformance of the sensor, observer variability and recording of results are all sources of error. to deal with this problem, recent technology employing impedance devices, radar devices, and pressure sensors has been introduced.

Impedance measurement was first attempted using surface electrodes to live changes in electrical impedance as a mirrored image of thoracic fluid content.

The first attempts reception monitoring utilized a telephone landline, a scale, a pad, and a pencil

This technique proved too cumbersome to realize widespread acceptance. This idea, however, evolved into the incorporation of impedance measurement between the leads of implanted defibrillators. During this small select group of patients shown to be in danger of overtime, the results were too variable to entertain the widespread implantation of those devices.

Radar devices that use lung dielectric sensing, a more direct measure of lung fluid, are now being developed and introduced. they're non-invasive and may easily provide serial measurements of thoracic fluid content in both the inpatient and outpatient settings. The incorporation of those sensors into the quality monitoring platforms which can be discussed below may offer a big advantage.

Implantable pressure monitors or MEMS (Micro Electro- Mechanical Sensor) are gaining traction since being introduced nearly a decade ago. These devices, implanted within the arteria pulmonalis or left atrium of the heart, are designed to detect the elevation of back pressure from the guts which is an early sign of decompensation. The MEMS device may provide an earlier alarm, but there has been no head to go studies to prove superior outcomes. The implanted devices can also be more accurate but accompany a group of invasive procedure risks.

So, we have an array of sensors starting from the size which costs $20 to the MEMS which costs $20,000. Besides cost and procedural risks, the implants also eliminate patient engagement from the method which cannot be an honest thing as we consider monitoring within the outpatient and residential setting. We must now consider the human factors because technology without acceptance by the end-users always in mind will end in poor results.

The first attempts reception monitoring utilized a telephone landline, a scale, a pad, and a pencil. These efforts proved ineffective due to the inaccuracy of the scales, the lack of the patient to accurately record or sometimes even see the numbers on the size and therefore the delay in transferring the knowledge to a responsible clinician. Undaunted by these problems, we saw the introduction of monitoring platforms which added a vital sign, pulse, oxygen saturation and a series of subjective questions on how the patient was feeling. Improvements to the present system included Bluetooth technology for the transfer of measurements from the sensors to the platform and wireless technology for transmission of knowledge from the platform to a monitoring station. These upgrades on the info acquisition end including data monitoring by dedicated nurses who were ready to interact with the patients in real-time improved the results. Studies have shown that structured telephone support with consistent providers creates the simplest outcomes. the last word goal is that patient-generated data (PGD) including knowledgeable providers interacting with and educating patients could eventually cause a state of self-management for the patients. A lofty goal, not yet achieved.

An early lesson learned from the Coronary Care Unit experience was that smart alarm systems provided a false sense of security which an unwatched heart monitor benefitted nobody. Within the world of remote patient monitoring, an equivalent warning applies. Data integration, electronic records, AI, and improved technology aren't enough. to possess a totally functional system there must be an engagement of physician leaders, administrators, skilled nurses, patients, and caregivers. Performance standards must be developed and outcome studies must be performed so as to convince health insurers to supply reimbursement for these services. The available technology can provide actionable data. The challenge now's to interact with the stakeholders to require action.

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