How COVID-19 Affects the Telehealth, Remote Patient Monitoring Landscape

With lessons learned from the coronavirus pandemic, health systems and telehealth vendors are shaping their connected health strategies – and identifying key trends – for years to come.

May 04, 2021 – The coronavirus pandemic has dramatically altered the telehealth landscape, pushing providers to adopt or expand connected health platforms and tools to meet the demand for virtual care to replace in-person services.  

Vendors are adjusting as well. Reacting to demand from the market, they’re developing platforms and tools that meet the need not only for COVID-19 surveillance and treatment, but for a post-pandemic future that will rely more heavily on concepts like remote patient monitoring, point-of-care diagnosis and virtual care.

“When healthcare weaknesses were exposed during the pandemic, telehealth helped fill in the gaps,” says Christine Storm, who leads Philips’ virtual care solutions business. “COVID-19 showed us that with the right tools, extending care outside the hospital is not only feasible, but in many cases, preferred. Our solutions need to support these evolving areas of care, which are increasingly taking place in the home, and meet the demands of the modern healthcare consumer.”

“Healthcare systems are now able to see how telemedicine will fit going forward,” adds Jason Hallock, MD, chief medical officer for SOC Telemed, which acquired Access Physicians earlier this year to build out its acute telemedicine capabilities. “The pandemic taught us much about how it will look in the future. We estimate as much as 25 percent or more of in-hospital care could be delivered more efficiently via telemedicine.”

This creates an interesting dynamic. As companies watch the healthcare space to see what they should be creating and selling, providers are looking right back at them for clues on how to address future care coordination and management needs. Mergers and acquisitions, new product lines, VC support and promising young start-ups all can factor into telehealth trends. 

Taking Advantage of the Opportunity

The pandemic pushed providers to adopt virtual care at a rapid pace. Aided by emergency federal and state measures that expanded access to and coverage of telehealth, health systems, hospitals, medical practices and clinics took whatever they could find and used it. If they could find a use for Zoom, Snapchat, Google or even a basic landline telephone to talk with patients and manage care, chances are they did.

In time, the less effective platforms (and a few companies) were weeded out, while others bolstered their capabilities. Zoom launched its own healthcare division, while Verizon fine-tuned its BlueJeans video conferencing platform – which the company had acquired in 2020 – to better suit providers who were already using it for virtual visits. Amazon expanded its telehealth offering beyond its own employees, and Microsoft acquired Nuance Communications to fill out a digital health platform that could process and integrate consults and other encounters into the medical record.

“Seemingly overnight, the healthcare industry showed incredible agility when faced with the adversity brought on by COVID-19,” Storm points out. “Technology that has previously been viewed as potentially impersonal became a lifeline to ensure continuity of patient care. Telehealth’s surge has proven invaluable. With COVID-19 forcing healthcare organizations to pivot and adapt quickly, the industry collaborated in incredible ways, and developed and distributed innovations at an unprecedented speed.”

The demand for coordinated and virtualized care created some interesting partnerships. Teladoc joined forces with Livongo to beef up its chronic care management platform, while Doctor On Demand merged with Grand Rounds Health. Bright Health, meanwhile, acquired Zipnosis, Vocera swooped in to grab PatientSafe Solutions, Accolade took in PlushCare and Cigna-backed Evernorth purchased MDLIVE. And Amwell, among the biggest players in the market, announced a partnership with Google Cloud, extended its relationship with Tyto Care and announced plans to go public.

“With the healthcare industry now becoming more open to telehealth, I think we will see more and more providers turn to remote patient monitoring and telehealth solutions to engage with patients and better understand their health outside of the doctor’s office,” says Antoine Robiliard, vice president of Withings’ health solutions business, which rolled out a series of cellular mHealth devices in February aimed at the home monitoring market. “In order for telehealth to continue to be used beyond the pandemic, I think we will see an influx of new technologies and products being developed specifically to be used to monitor vitals from home.”

Some vendors are even partnering up. In Canada, three of that country’s larger virtual care providers, Cloud DX, Maple and Curatio, have announced plans to launch a remote patient monitoring program for COVID-19 patients, called the Virtual COVID-19 Outpatient Program (VCOP). And they’re going to share the revenues.

“We’re at a critical stage right now, especially with new variants of concern which are exacerbating the resource challenges that hospitals are already facing,” Brett Belchetz, Maple’s CEO and Co-founder, said in a press release. “We’re pleased to partner on this innovative remote patient monitoring program to support healthcare facilities in coping with the influx of COVID-19 patients.”

ADVANCING THE MHEALTH MARKET

With the pandemic reducing in-person care to curb the spread of the virus, the industry turned to mHealth devices to facilitate diagnosis and treatment. Smartphone apps, wearables, smart devices and sensor-embedded clothing were used in pilots and programs aimed at detecting early signs of the virus, so that people could be identified, isolated and treated before the virus spread.

Some device makers saw an opportunity to market their products to a growing number of providers using remote patient monitoring concepts.

“The pandemic has expanded interest industry-wide in telehealth and also amplified the need for connected health devices to execute remote monitoring programs long-term,” Robiliard says.

“We’ve had a lot of conversations with healthcare providers to understand what devices and solutions they need for their telehealth programs, what vitals they most want to monitor and what pain points they’ve previously encountered with connected health solutions,” he says. “What we’ve learned is that there is a need for connected health devices that are simple for both the patients and their providers to use long-term. If a connected health device is difficult for patients to set up and use daily, and providers have to go through extra steps to access their patients’ data, the telehealth program won’t be successful no matter what data the product provides.”

“Managing chronic health conditions and access to medical care became a more mainstream conversation and an even bigger challenge during the pandemic,” says Ranndy Kellogg, president and CEO of connected device maker OMRON Healthcare, whose new VitalSight platform is designed to integrate the company’s connected devices into an RPM program that melds with the EMR. “Recent reports show that heart attack death rates have more than doubled during the COVID-19 pandemic with fewer patients going to the hospital when experiencing chest pain or other symptoms. One hundred and sixteen million U.S. adults are hypertensive… . More than 37 million Americans have uncontrolled stage 2 hypertension, which carries greater risk of heart attack and stroke.”

“The last year marked an awakening to telehealth and technologies that will aid in remote connections from patients to their physicians and care teams,” he adds. “Leading health systems and physicians have expressed interest in remote patient monitoring, and consumers are now more willing to use telehealth tools to manage their conditions as a result of social distancing measures.”

This is also spurring the consumer health market, with companies like Fitbit, Apple and Garmin developing new wearables and expanded mHealth platforms that allow consumers to do more of their own monitoring at home. They’re even partnering with companies, colleges and sport teams to provide monitoring devices and platforms for employees, students, staff and athletes – first for COVID-19, and later for other viruses and even chronic concerns.

THE BUZZ AROUND REMOTE PATIENT MONITORING

RPM has been slowly gathering momentum for the past few years, with pilots and programs aimed at giving providers access to tools that monitor their patients at home, in between doctors’ visits or after they’ve been discharged from the hospital.

COVID-19 pushed that concept into overdrive. Suddenly everyone was looking for a way to keep patients at home, rather than in overcrowded and overstressed hospitals and medical clinics. RPM offered an ideal opportunity to monitor and treat infected patients from afar, isolating them while giving doctors and nurses the opportunity to treat more patients at a safe distance.

As the pandemic wears out its welcome, providers want to keep their RPM programs going, by treating different populations. This would include those with chronic conditions, patients in need of post-discharge rehab, even those who might otherwise be in a skilled nursing facility. 

RPM “is here,” says Hallock, of SOC Telemed. “With telemedicine it is relatively easy to provide care that looks much like it does in the hospital at home. Simple monitoring can assist the not-very-sick at home. That’s easy to visualize. More comprehensive strategies such as bedside nurses paired with multi-specialty telemedicine technology are the keys to the ‘hospital at home’ concept.”

At Philips, Storm says providers are looking for solutions that address a wide range of services that previously had been done in the hospital.

“By taking a holistic approach to acute care, from monitoring patients before an admission through post-discharge, we can activate timely interventions, reduce readmissions and better allocate resources according to a patient’s risk,” she says. “For example, for acute patients that would typically be admitted and monitored by a physician during rounds, when possible, we’ll start to see organizations pivot to remote patient monitoring to manage these monitoring phases of acute care from within the home.”

“In addition to acute care, for both COVID-19 patients and those with pre-existing medical conditions or non COVID-related health issues, remote patient monitoring capabilities have proven crucial,” she adds. “Moving beyond the pandemic, these solutions will continue to enable faster, quality care while keeping patients in the comfort of their homes. Remote patient monitoring can be enabled through a variety of connected solutions – from wearable sensors, patient-owned technology to connected devices and predictive algorithms.”

In addition, RPM programs give providers an opportunity to test out new technologies and care plans.

“Telehealth has much broader use beyond one-off video chats or phone calls to support complex care for patients both within the hospital and at home,” Storm says. “Specifically, for at-home telehealth, the value shines through when it comes to chronic condition management. For patients with chronic conditions, like sleep apnea, cardiac disease or COPD, cost and quality are significant variables in being able to continue to age and heal at home. Frequent visits to the doctor’s office, and the risk of readmissions due to an adverse event, limit one’s quality of life. These patients can use telehealth to stay connected to providers to manage their conditions from home, preventing them from hospital admission when possible, while still ensuring they have the oversight they need.”

With RPM comes the ability to pull more data from the home setting. This also means finding the right technology to sort and stratify that data.

“We learned the role health informatics, like data integration and artificial intelligence, play in navigating effective transitions of care,” Storm says. “All too often, transitions of care settings can lead to blind spots and impact a patient’s outcomes. Data-driven, connected care solutions can provide clinicians with access to patient insights anytime, anywhere, and helps them determine the most appropriate course of action and setting for care delivery. COVID-19 has demonstrated the necessity of triaging and monitoring patients according to risk, managing patients from home accordingly, and optimizing allocation of hospital resources.”

“While the growth of telehealth means a significant increase in data capture taking place outside of the hospital, health informatics, data integration, and cloud technology can help accomplish connectivity in a secure, scalable way and provide patient management wherever and whenever care is being deployed,” she adds. “All entities in the healthcare industry, including providers, payers and patients, must work to absorb telehealth into existing clinical and operational workflows to optimize location-independent care delivery.”

“To ensure data can be accessed and shared seamlessly across settings, and that our innovation is interoperable and secure, it’s essential that the informatics behind these solutions mature with them, activating a secure flow of data where and when it’s needed, in a vendor-agnostic way. Through the cloud, data can be accessed anytime and anywhere – including the home, outpatient clinic, and traditional hospital environments.”

That strategy ties neatly into Converge, a new service recently unveiled by Amwell that seeks to gather all telehealth and RPM services – including connected devices – under one platform and codebase. Company co-founder and CEO Roy Schoenberg cited “the dire need for simplicity, speed and reliability” as the impetus for Converge.

“Telehealth was asked in no uncertain terms to save the day,” he said during AmWell’s user conference. And that means gathering all of the tools available together onto “a single chassis … for the digital distribution of care.”

Providers will also be continuing to pull their connected health programs together on one enterprise-wide platform. Prior to COVID-19, many of those programs had sprung up on their own in individual departments, hospitals or clinics, spurred on by one particular use case or physician champion. But now those disparate programs need to be pulled out of their silos and consolidated.

“As health systems assess what they achieved last year, they are now able to focus on the end-users, which include patients, nurses and care teams,” Hallock, of SOC Telemed, points out. “There is a growing understanding that a system cannot allow the end-user to access telemedicine 20 to 40 different ways. Any business – healthcare included – that has 40 ways of doing the same thing isn’t doing something right.”

NEW OPPORTUNITIES FOR IN-PATIENT TELEHEALTH

The COVID-19 crisis also taught health systems the value of telemedicine platforms inside the hospital. Many are looking into technology that can improve patient monitoring without increasing room visits, as well as platforms that allow nurses to monitor multiple patients.

“Another place we’re seeing growth for telehealth is the implementation of centralized command center models to improve care transitions,” Storm says. “The intelligence that comes with collecting, analyzing and representing data, which allows providers to act on it with confidence, plays a critical role in managing the care of our sickest patients and informing resource allocation decisions within the hospital.”

“For example, the ICU is the most expensive area of a hospital with high mortality and resource constraints,” she points out. “In the face of a shortage of intensivists, tele-ICUs can act as an air traffic control center, and mitigate data and access challenges, extending critical care resources to the bedside no matter where the hospital is. Particularly during COVID-19, these solutions became essential to responding to ICU surges and controlling infection spread – by extending monitoring capabilities beyond the bedside, clinicians could avoid repeatedly entering a COVID-19 patient’s rooms while maintaining line-of-sight into their condition.”

And as the nation moves past the pandemic, health systems are realizing they should keep these platforms in place, not only to be prepared for the next pandemic or public health emergency but also to make in-patient care more streamlined and adaptive.

SHINING A LIGHT ON INFRASTRUCTURE

The popularity of RPM programs also puts the spotlight on telemedicine platforms that handle the gathering and transmission of data from home to hospital and back again. For a long time, that market was dominated by Philips, Qualcomm (with its 2net hub, later farmed out to Capsule Tech and acquired this year by Philips) and Validic.

More companies are jumping into that sandbox, operating on the idea that these platforms need to be less expansive and complex – to attract budget-conscious hospitals and clinics – and more nimble – to include the growing range of mHealth devices, including those on the consumer market.

Even providers are getting involved. In April, the Mayo Clinic unveiled the Remote Diagnostic and Management Platform (RDMP), designed to integrate devices and AI resources on one platform to support clinical decision-making.

“The dramatically increased use of remote patient telemetry devices coupled with the rapidly accelerating development of AI and machine learning algorithms has the potential to revolutionize diagnostic medicine,” John Halamka, MD, president of the Mayo Clinic Platform, said in a press release. “With RDMP, clinicians will have access to best-in-class algorithms and care protocols and will be able to serve more patients effectively in remote care settings. The platform will also enable patients to take more control of their health and make better decisions based on insights delivered directly to them.”

The Mayo Clinic spun out two new companies to market that platform: Lucem Health, launched in a partnership with Commure to help providers and mHealth innovators gather and analyze data from any device involved in a remote patient telemetry setting; and Anumana, launched in a partnership with nference to target the cardiac care space.

Stel Life, a small Philadelphia-based company that launched in 2018, focused its marketing efforts around the Federal Communications Commission’s COVID-19 Telehealth Program and Connected Care Pilot Program, both of which are issuing millions of dollars in grants to healthcare providers looking to improve their broadband networks to boost telehealth programs.

Company CEO Sid Kandan says providers jumping into the RPM space need the technology in the home to link devices back to the hospital and the electronic health record. That’s where the Stel Vitals Hub comes into play.

“COVID-19 gave us a huge increase in demand,” he says. “And with the FCC programs we see where we can keep that growth growing.”

Kandan says the company has been analyzing how the FCC grants were awarded, what the money has been used for and how the winning providers are setting up their RPM platforms. This, in turn, helps the company to tailor its products to meet that demand, and to anticipate what they’ll need in the future to sustain that growth.

RPM “will be a standard of care in the future,” he says. “That’s where the market will go.”