You may be hearing some new words thrown around due to the COVID-19 pandemic. Terms like telehealth, telemedicine, remote-patient monitoring (RPM), virtual care, and digital health have been around for years, but the recent situation is accelerating patient awareness and physician adoption of these technologies.
With a growing need for social isolation, healthcare organizations are actively seeking ways to provide health services to patients with both COVID-19 and other conditions remotely.
These buzz words all fall under growing movement in healthcare — the digital health movement. In 2019, $8.9 billion was poured into digital health companies by venture capital firms. The Health Information Management Systems Society (HIMSS) defines digital health as:
“Digital health connects and empowers people and populations to manage health and wellness, augmented by accessible and supportive provider teams working within flexible, integrated, interoperable and digitally-enabled care environments that strategically leverage digital tools, technologies and services to transform care delivery.”
For those who do not speak “healthcare,” the goal of digital health is the better use of information and communication technology to improve the delivery of healthcare to patients and to arm patients with their own data to help them attain better health.
If you take a moment to think about the American healthcare system you will quickly realize that things are not good. Cost is out of control, our outcomes are comparatively worse than other developed nations, and our individual stories tell powerful stories of failure.
If you think about your most recent experience with your physician, you probably had to make a trip to the office where you may have spent considerable time in a waiting room despite having an appointment. You may have filled out the same paper forms and used your hard-copy insurance card for payment. You may have two separate doctors who fax records to each other or do not communicate at all. Your prescription may have gotten lost on the way to the pharmacy.
Once you get into the exam room your doctor may ask you questions about how you are feeling, your lifestyle, your medications, your diet, and may perform bloodwork or other tests. All this information is recorded in a record that may be paper or electronic. Once recorded, it is up to your physician to analyze the information to produce a diagnosis or treatment plan.
Your 15-minutes with the physician and hour of waiting really does not feel like a good use of your time and you do not have a better handle on your health once its all over.
Once all the tests and questions are answered, you may be sent home to wait for a call, or asked to return to the office for a follow-up. You also may be diagnosed in the office if results are fast enough. Either way, you and your physician will eventually arrive at a plan for treatment.
Your treatment plan likely includes some form of medication, lifestyle changes, exercise regimen, and dietary changes. It may be told to you verbally, or it may be handed to you on a piece of paper. You then leave the office, pick up your prescriptions, and must navigate your new diagnosis and care on your own until the next appointment — which may be a few months away.
You may have received new medications to add to your daily list. Medications are the cornerstone of treatment for many conditions but are also dangerous due to their significant impact on body systems. Your physician may not have checked your entire medication list despite the importance of a thorough medication review.
In that 15-minute meeting with your healthcare provider, you may have a lot of questions, you may not understand what is going on, and you may have questions about your healthcare. You may be worried that things aren’t getting better and you have no way to know if what you are doing is working.
But, things are changing.
Digital health seeks to enhance administrative tools, clinical tools, and patient interaction to make the healthcare experience more effective, efficient, and positive for patients. Healthcare is far behind in technology, and this industry is looking to fill that gap.
Those of us who work in the digital health space want to take your current healthcare experience, which is something like Blockbuster Video in the early 2000s and turn it into Netflix.
We want to give you access to physicians via video chat on your mobile phone — that’s telehealth or telemedicine. We want you to schedule appointments online rather than over the phone, we want to provide your lab results and tests through an app quickly rather than via paper, and we want to keep you out of waiting rooms. In short, we want to make your experience as friendly, effective, and efficient as possible.
Taking it a step further, many of the companies that fall under the umbrella of digital health want to not only improve patient access to care and experience but the actual outcomes for patients — they want to create technologies and models of care delivery that are more effective than the old model explained above.
To do that, it requires the effective use of patient data, patient-clinician communication, and the empowerment of patients. Out of these goals, remote-patient monitoring and digital care management were born.
Let us circle back to that part of the story where patients receive their diagnosis, treatment plan, and then are sent home with little added support.
Currently, patients are largely left to self-manage their conditions and to follow their treatment plan without any support or data to monitor progress.
In 2016, my family was left in this exact position while caring for my mom after hospitalization for a major deterioration of her chronic myeloid leukemia. A few months after she was admitted she was discharged to our home and her care, previously managed by highly-trained nurses, fell to us.
Fortunately for us, I studied healthcare management and policy, worked in a world-renowned cancer research center, and was, at the time, a nationally-certified emergency medical technician. It was still very hard and many patients and caregivers are not as well equipped.
What if patients could receive more consistent support and data on their condition and success with following their treatment plan?
Thus, remote-patient monitoring and digital care management services were conceptualized and are gaining interest. Here is the situation:
For many conditions, patients will go to periodic checkups on a quarterly basis. But, in the three months between visits, a lot can happen. Patient conditions can deteriorate leading to an emergency department visit or hospitalization.
New medications can be prescribed by other specialists without regard for existing medications. Major life events can occur such as job loss, loss of a family member, or a new diagnosis. Lots of things happen between visits.
Those four visits a year start to seem further and further apart without anyone to help support patients in their journey to stable health. In the time between office visits, health continues to happen.
Through mobile and wireless technologies, data on patient conditions can be self-reported in apps, or collected via internet-enabled devices like blood glucose meters, blood pressure cuffs, and scales.
Now, those same questions asked by healthcare providers during office visits can be asked via an app and those diagnostic tests and vital signs can be collected in the home and transmitted to qualified healthcare professionals that can review. Now, patient progress with both their treatment plan and underlying condition can be monitored.
RPM is all about collecting more clinical data points, more frequently, in order to recognize the continuous nature of a person’s health experience. If something starts to indicate deterioration of a patient’s condition, then a trusted healthcare professional can step in.
This is where RPM starts to lead to the concept of digital care management. RPM provides the data — which is necessary to make effective clinical decisions and to promote patient self-management of conditions — and the health system can provide tweaks and updates to the treatment plan. Now, the mobile-collected data can be used by clinicians to enhance their reach and effectiveness.
The goal here is not to replace the healthcare provider, but to arm them with real-time data and efficient digital communication tools to better manage their patients. This is where digital health, the broad term, meets traditional health services.
Beyond the video conferencing with your physician that is telehealth. RPM and digital care management are more focused on real-time data collection, treatment plan optimization, and chronic disease “coaching” to help patients stay on track, to step in if the deterioration is detected, and to act as a supportive resource as patients navigate the management of their conditions.
There are benefits in terms of patient self-efficacy, convenience, and patient engagement which are all beneficial. But, from a health system perspective, we are concerned with the outcomes from RPM and DCM programs.
In a 2018 review of RPM studies from 27 clinical trials, the general consensus is that these programs are effective — but there are mixed outcomes when looking at the entire field of solutions. This article found that programs with personalized coaching to promote good health behaviors and adherence were the most effective .
RPM programs have grown up around specific conditions with some of the most robust programs focused on congestive heart failure (CHF). In a 2019 study, one RPM program focused on CHF showed a 33% reduction in hospitalizations, a 75% reduction in 30-day readmissions, and a 52% reduction in emergency department visits . Due to these reductions, significant cost savings were found.
For digital-enabled care management programs, there have been positive outcomes shown in clinical studies. In one 2017 study looking at a mobile application for diabetes control, patients tested their blood glucose more frequently and showed fewer hyperglycemic events and lower overall blood glucose levels .
We are still very much in the early stages of the RPM and DCM movement, but successes are being seen across the industry with new models and programs being tested — remote-patient services are needed more than ever in the COVID-19 situation.
While care management has been around for decades, the integration of engaging technology and better use of clinical data is likely to lead to programs that can drive significant health outcomes.
Make no mistake, while there are companies that try to claim that some problems can be solved with technology alone, RPM and DCM must be performed in a way that brings the best of technology and human clinicians together.
Effective health services require a human relationship based on trust. The most effective health models are those that build coach-like relationships between healthcare professionals and patients.
When technology is inserted, it is all about data collection, the generation of actionable clinical information, and the extension of the capabilities of our healthcare professionals to provide care in a more proactive model.