Remote Patient Monitoring: The Standard of Care has Changed

By Elan Hekier, Chief Medical Informatics Officer, and Daniel Nimoy, Director, Strategy, Care Transformation & OpEx, Sharp Rees-Stealy Medical Group

What if our healthcare system was designed where patients were truly at the center? What would care look like if chronic conditions were proactively monitored as a standard of care and patients were supported and guided in managing the disease(s) across the continuum of care? 

What is the reality? In the US today, it is estimated that a staggering 50% of people are living with at least one major chronic disease, 42% have two or more, and 12% have at least five (e.g., heart disease, cancer, diabetes, obesity, hypertension) as defined by the US Department of Health and Human Services. Five of the top 10 leading causes of death in the US are strongly associated with preventable and treatable chronic diseases. 

Today, and historically, the US healthcare system focuses on treating the downstream patient outcomes of preventable diseases in our hospitals and emergency departments (EDs). This approach has led to worsening patient outcomes, a higher cost of care for the patient and the “system”, and an overall declining health of the population.

One thing is crystal clear: As we think about the dilemma the US healthcare “system” faces today and the decades-long approach of managing chronic disease, the “system” has failed patients and physicians. 

The standard of care has changed, and we must engage the most underutilized member of the care team, the patient.

Meet Margaret, a 68-year-old patient who was diagnosed with hypertension five years ago; the diagnosis came unexpectedly during a routine checkup with her primary care physician (PCP). Upon receiving the diagnosis, during the follow-up visit, the doctor provided a textbook full of information, suggesting that Margaret modify her diet, purchase a blood pressure (BP) cuff from the pharmacy, take her BP every morning and evening and document the numbers in a journal. Unfortunately, over the past four years, Margaret has had many challenges managing her condition, leading to multiple ED visits and hospital admissions. There are many patients, just like Margaret. 

It is time to turn healthcare upside down for the 100 plus million patients managing one or more chronic diseases like Margaret. It is evident that the standard of care has changed, and we must engage the most underutilized member of the care team, the patient.  

Now imagine, today, upon Margaret’s diagnosis, she enrolls in a hypertension RPM program. She receives her RPM cellular-based BP cuff and weight scale. The only tech requirement for the cellular-based devices is one single bar of LTE cellular service which covers approximately 97% of the country, removing one of the major barriers to access. Additionally, she would onboard the program with a customized care plan to achieve her goals and receive instructions on how to use the devices; many of which can be operated with a single click. As Margaret completes her daily care plan and captures her vitals, the data captured is continuously monitored by algorithms, and flagged for appropriate intervention by the care team only when needed. The care team proactively identifies declining trends in Margaret’s vitals, proactively outreach to triage, and prevents ED visits. 

What we now call ‘remote patient monitoring’ or ‘RPM’ will one day be called just patient care. Increasingly, the walls of hospitals and clinics have become blurred. Patient monitoring that used to require a patient to be in a specialized location of the healthcare setting can now be done with widely available wearable devices and technology and performed wherever the patient is located. We are seeing continued growth in virtual care delivery and many hospital services are shifting to the home; a ‘fascinating’ shift in the traditional healthcare paradigm that will only continue and accelerate in the coming 1-3 years.  

At Sharp Rees-Stealy Medical Group in San Diego, CA, we have used traditional RPM for many years. This includes post-hospital discharge programs, chronic heart failure, hypertension, and more, with positive outcomes and patient engagement. We currently utilize our population health team of experts to reach out to patients when vital signs clinically fall out of range. This allows us to assess whether an out-of-range vital sign is clinically significant or not, needing proactive intervention by a care team member. The follow-up could be by phone or video, and frequently, a digital questionnaire can be sent to the patient to answer some additional questions; aiding the care team by understanding more context or a “story” behind the data point.  

Post-pandemic, Sharp Rees-Stealy Medical Group decided to move to a modern, full-service RPM program, which required close partnership with the technology industry and IT teams. As we look forward, both at Sharp Rees-Stealy Medical Group and beyond, we remain focused on the goal of trying to bring RPM to any patient without limitations across the entire technology access to care spectrum from wireless, cell-enabled devices to the hottest ‘medical selfies’ taking five key vital signs with a 45-second selfie video. 

RPM is the new standard of care; here are some insights to getting started.  

1. Define your organization’s business case—private practices, large medical groups or hospital systems; knowing the value proposition to getting started is critical.  
2. Find a partner who understands healthcare, not just a tech company.  
3. Established companies provide ‘security’; smaller startups allow for more nimbleness, rapid design, and streamlined innovation. 
4. Understand that RPM is not just about gathering data but driving action.