COVID-19 has driven 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 models, not all health systems have the right resources and organizational support to drive this transformation.
Among the many challenges, a key factor concerning CIOs of these health systems is the lack of willingness in the clinical community to support the transformation of IT to adopt new care delivery models.
In the remote monitoring space, the physician community’s lack of confidence in the quality of data, particularly self-monitored and patient-reported data, was a challenge despite the clear benefits of managing large older populations via connected devices.
Given the need to integrate remote patient monitoring, CIOs are forced to look beyond just EHR and explore standalone platforms to enhance their care delivery. As CIOs, they must also utilize available tools and work strategically towards enterprise transformation.
To ensure that these providers make the best use of available resources when planning for the long term, CIOs should consider the following.
Choose the Right Equipment to Receive Reliable Patient Data and Reimbursement
Today, many health devices and wearables are hitting the market, but not all have been approved for reimbursement by CMS. To be reimbursed by CMS, the device must be an FDA-listed device.
However, an FDA approval ensures that a medical device is safe and effective for its intended use. The FDA has classified medical devices into three classes based on the risk to human life. Based on this classification, a medical device must undergo various regulatory processes, including clinical testing.
The FDA also provides essential guidelines for operating a device and supporting documents highlighting the dos and don’ts, and pros and cons, thus helping to make an informed decision.
Remote monitoring devices allow physicians to monitor patients for vitals such as respiratory rate, heart rate, temperature, heart rate variability and blood oxygen saturation level, thus enabling timely informed decision making.
Map therapist workflows and win their trust
Implementing a remote patient monitoring program in a hospital involves stakeholders and clinicians from all specialties with virtual care. Physician input can help identify and prioritize specialized services when defining a road map for remote patient monitoring programs.
Factors that can help prioritize each specialty’s services should include the need to work remotely, available budget, ROI, and a mix of each department’s use case.
Each feature has its own use cases for which they are open to conduct virtual tours. These use cases should be evaluated specifically before shortlisting the tools.
For example, cardiology requires more digital monitoring equipment than other specialties to monitor BP, weight, heart rate and EKG in real time. Plus, dermatology can do just that with a high-resolution, high-quality camera.
Adopting FHIR standards to integrate data with a physician’s daily workflow
A typical day in a busy doctor’s life includes seeing scheduled appointments in outpatient and inpatient rounds and emergency visits in between. Remotely adjusting a patient’s follow-up within the routine requires the physician to have pre-clinical documentation along with the patient’s current vitals.
For a seamless remote follow-up of a patient, the device is integrated within the EHR so that a physician can view the device readings in the context of the patient’s clinical documentation.
Measurements and data from personal health devices must reach caregivers through platforms that are synced with the devices, usually through a mobile application. Today, there are as many formats in which data is sent over personal health gateways as there are devices on the market.
This lack of standards creates challenges for developers who end up writing code for every separate instance of a device. FHIR resources or data packets define the necessary resources needed to transport data from equipment to an FHIR server and eventually to a receiving system such as an EHR in a standard format. When received in standard format and plugged into the EHR, data from these devices can help the clinician to diagnose the patient as a whole.
Remote patient monitoring uses three primary FHIR resources:
- Patients. Patient Resources provides demographic information about the patient. The patient identifier is a key feature within this resource that links the patient to the device. Implementers may choose not to disclose the patient’s PHI or to keep it uncovered.
- equipment. In FHIR, device resource is used to describe static components such as device identifier, manufacturer, name, model number, location, device status and any other information.
- Overview. This resource is the most important component that holds the actual data about the critical parameters being measured. The overview resource includes the actual results of the measured parameters, time stamp, reference range and device description.
The large differences in data collected from physical readings and patient health equipment can be mainly tied to the six types of observations outlined below:
- Scalar: For example, temperature, weight, steps, pulse and glucose – anything that can be described in a single number field.
- Vector: Measurements that require more than one value to describe, such as BP and acceleration.
- Code: When the measures are described by a limited set of options in terms of reading, for example reading time, such as pre-prandial, fasting or bedtime.
- Event/Status: This type of measurement is used for monitoring applications, for example, the status of a humidifier, whether the patient is in or out of an independent living facility room, or a marginal signal in a pulse oximeter.
- Waveform: Periodic data is mapped to waveform data such as an ECG trace.
- String: It captures string data when the measurements are in text format and used for displaying only.
COVID-19 has accelerated the remote patient monitoring market. The updated Physician Fee Schedule, released in December 2020, addresses changes in care management services and remote physical monitoring services reflecting changing medical practice trends.
A physician-friendly reimbursement environment, tools that can be trusted, integrated workflows, and policies to encourage remote patient monitoring will help physicians easily deliver remote care.
Health systems CIOs must overcome financial constraints and resource constraints by turning the situation to their advantage. Start with setting organizational priorities, winning stakeholder and physician trust, and building rigorous governance to drive digital initiatives, while easily tracking the benefits of driving digital transformation with remote patient monitoring in your enterprises and report.
Dr. Joyoti Goswami is the Principal Consultant at Damo Consulting.
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