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Will remote patient monitoring be a lifeline or a liability?

Medical Economics JournalMedical Economics October 2021
Volume 98
Issue 10

Like any powerful tool or technology, RPM can be used to make things better, but it can also wreak havoc if not done right.

Remote Patient Monitoring (RPM) has gone from being a buzzword to an actionable solution. It’s a powerful tool. Like any powerful tool or technology it can be used to make things better. That power can also wreak havoc. Navigating these two outcomes is a great responsibility.

With RPM, the problem is not the technology but the implementation. Today, rather than implementing RPM to alleviate our fundamental healthcare problems, initial RPM implementations are poised to exacerbate them. The time to do something about this is now.

Understanding seven of these fundamental healthcare problems that are affected by RPM is the first step:

  1. Data silos - for data to be effective it has to be centered around patients.
  2. Workflow challenges - automating tasks that are manual today.
  3. Poor communication - ie fax machines, phone messages. Lead to reactive care rather than preventive care.
  4. Inefficiently spent provider time - providers spend less than 30% of time with patients.
  5. Ineffectively utilizing providers as a resource - providers spend time entering data, chasing insurance companies, getting prescriptions authorized.
  6. Poorly integrated tech - ensuring we use tech that works together.
  7. Ability to measure care outcomes - we have no comprehensive idea how our patients or providers are doing.

Like any technology with great potential, a positive vs negative impact depends on how it is implemented.

So, we have a choice. We can implement RPM in a way that propagates these issues adding additional stress to a healthcare system at capacity. Or, we can implement to solve them. Unfortunately, the initial approaches for RPM implementation today seem to reinforce these fundamental problems rather than alleviate them.

Why it is a Problem

Implementing RPM requires massive cost and complexity. Due to the fundamental problems outlined above, our healthcare system does not have capacity for any more ineffective, expensive mistakes.

Here are two examples of how we are doubling down on the fundamental problems from the above list and why it is a problem.

Data Silos

Most RPM is being implemented with the medical organization or device as the hub for patient data. A patient who sees doctors in two or more organizations or uses different RPM devices that measure different conditions has their data stuck with those entities. In the real life scenario, every patient will have a dizzying number of device and organization accounts where their data will be located. Patients with diabetes and high blood pressure (nearly 25 million people in the US) would have no insight into how those two conditions are affecting each other. This is a problem with current RPM solutions because we cement data silos into our healthcare culture. This makes care even more expensive and misses opportunities to improve quality. We can never have patient-centered care if the data is not centered around the patient first.

Poor Communication

RPM is being implemented to send alarms for issues as they occur rather than as a preventive tool. It reinforces a reactive system of care. It is expensive and causes unnecessary suffering rather than attempting to avoid it. Costly healthcare gets more expensive (healthcare is already the number one cause of bankruptcy in the US). Our families, friends and communities are unable to lead their healthiest, most productive lives. Simply changing the way we are implementing RPM, we can do our best to avoid a heart attack while also being informed if one is imminent. As a physician, I enjoy viewing patient’s lab work, imaging results, EEG’s... and providing them guidance. Similarly, communicate to the doctor relevant RPM information in a follow up visit and they can better guide their patients on preventing some of our most debilitating healthcare issues - heart attacks, strokes, diabetic emergencies.

Why Now?

We must do this now because once large RPM programs are rolled out, reeling it in will be too difficult. There will be too much infrastructure to disassemble and interests at stake. It must be now, because we will roadblock the ability to provide better care to people even more than it already is today.

We have come to the edge of a healthcare cliff. RPM, if implemented badly, is poised to push us over the cliff unless we change our approach.

The old way does not work. The proof is in the results:

  • Costs keep rising https://www.policymed.com/2012/10/a-systemic-approach-to-containing-healthca re-spending.html
  • Quality is stagnant (at best) and disparities worsening https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2019qdr .pdf
  • Life expectancy has been going down https://jamanetwork.com/journals/jama/article-abstract/2776338
  • Patients are resigned to frustration https://www.beckershospitalreview.com/consumerism/71-of-patients-are-frustrate d-with-healthcare-experience-report.html
  • Providers are burnt out https://www.beckershospitalreview.com/hospital-physician-relationships/5-stats-o n-physician-burnout-in-2020.html
  • We have the best diagnostic and treatment capabilities in the world. Yet we can not manage basic needs. https://care.diabetesjournals.org/content/41/8/1631

What is the Solution?

In healthcare, the tail has been wagging the dog for too long. Vendors have been determining priorities and solution implementation. While too many healthcare organizations simply follow. They are hobbled by shifting priorities and paralyzed by old operations and processes.

Outwardly, medical organizations declare they are consumer-oriented businesses. Internally, many do not possess the basic operational tools that consumer-oriented businesses use. Tools needed to lead and create direction.

True consumer oriented businesses have a vision. They have a process and systems to execute that vision. When you take on complex projects you are not equipped to deliver, you end up with the healthcare we have. Ineffective and costly. We must hold off on implementing RPM until these business practices are corrected.

To correct this, we need a new approach modeled after successful, consumer-focused businesses. Businesses who seamlessly factor in priorities, problems and needs when coming up with solutions. Who knows how to lead solutions rather than being led.

How is this done? A process we use, as do some of the most successful businesses in the world, (Netflix, Google, Spotify, iPhone...) is an approach called Service Design. It helps you design, align and optimize your operations and your team. It helps you to create sustainable solutions as well as optimal experiences for your customers and your organization. With RPM, it empowers you to assess and implement solutions more effectively:

  • Your teams will have shared understanding across departments
  • Everyone will understand organization priorities
  • It will give you the tools to operate through the complexity of healthcare
  • You can have confidence in your priorities
  • Your patients will feed off your confidence, security and certainty
  • It will inform and set parameters and expectations for your vendors who will operate using your needs and priorities through your Service Design approach.

There are huge benefits to Service Design beyond just business efficiency and leadership. Service Design can also restore the most essential part of healthcare. Empathy and caring. These two values that have been lost in the chaos can be restored to its proper place.

This is a shot across the bow. It’s time to change. It is not difficult. With Service Design, the plan is there and it’s been done before. Now it is time our healthcare organizations lead that change. With RPM, we have reached a place where it is critical to do so. If we don’t, the consequences for implementing RPM improperly will exponentially increase the cost and health burden on our patients, families, neighbors and communities.

I hope you agree this is something we can, literally, no longer afford? It starts with our healthcare leaders mandating organizational change more effectively. It will be the most impactful step you can make to improve patient care, help your providers and improve your bottom line.

Samant Virk, MD, is a physician, trained in Neurology and Interventional Pain Management. After 15 years of practicing medicine, he stopped. The energy and commitment needed to appropriately care for his patients was not supported by the business side of healthcare that actually created obstacles for doctors to provide positive outcomes for their patients. He now invests his time and energy working on innovative ways to solve the problems he encountered and meet the needs of clinicians and their organizations to provide better care.

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