Much has been written about the role of remote monitoring (RPM) in healthcare. Early promise has not always been born out in real-life clinical practice, often due to the complexities of the care pathway involving multiple individuals and fragmented agencies; as well as societal and patient choice factors. This means the results of well conducted trials of digital remote monitoring interventions often cannot be replicated in real-life.
In addition, digital technologies are often adopted without the necessary careful thought to understand what its adoption is hoping to solve, improve, or make more efficient. Adopting a remote monitoring system to complement usual care, may improve user satisfaction and potentially have some benefits on outcome; but it doesn’t necessarily reduce demand on the healthcare system – in fact, often, quite the reverse. The pandemic has caused huge spikes in digital technology adoption as doctors and patients embrace social distancing guidelines. More than 75% of all NHS practices reported that they have used video to see patients in the third week of April 2020 alone, compared to just 10% before the pandemic. This is a tremendous shift.
Covid-19 has sharpened the mind. As lockdown came into effect on March 23rd 2020, we all understood the need for social distancing and minimising footfall to our GP surgeries and hospitals in order to manage infection rates effectively, and ensure healthcare systems were not overwhelmed.
Despite the challenges of implementation, there is now a real imperative for remote patient monitoring (RPM) and management to support patients and help healthcare systems become more efficient. RPM has allowed us to take more control of our own health whilst reducing footfall to our healthcare facilities, allowing resources to be focused on where it is needed most. As demand for healthcare continues to grow, RPM can play a key role in assisting healthcare staff manage increasing demand without over-stretching already strained clinic and staff resources.
Identifying challenges in the adoption of remote monitoring
This shift needs to be permanent: we will need to make better use of remote monitoring and virtual clinics to help meet the growing demands on healthcare in a post-COVID world. RPM has the potential to help clinicians make earlier diagnostic or treatment decisions which is afforded to them by virtue of better data, well presented for fast interpretation; and of course, the introduction of machine learning algorithms can provide decision support functionality. So, where do we start?
Firstly, a thorough understanding of how a remote patient monitoring system is anticipated to support, for example, earlier interventions or improve operational efficiency, are essential to any implementation. And indeed, the anticipated benefits need to be clearly identified and measured before and after implementation.
Secondly, prior to the pandemic, it was clear that many digital health innovations failed as clinicians were reluctant to engage with them, according to Deloitte’s Shaping the future of UK healthcare: Closing the digital gap report, due to the amount of change required to familiar processes, the time taken to implement, and a lack of education and training. Therefore, it is imperative that a proper change management process is followed. This is preferable, and likely to be much more impactful, than the lazy alternative of adding the technology to existing care-pathways.
Third, but of equal importance, is ease-of-use. New technologies must be simple and intuitive for both clinicians and patients if they are to bridge, rather than reinforce, the digital divide.
Finally, digital health technology providers need to understand the regulatory and technical environment the technology will inhabit. It is very likely that the technology may be deployed in hardware that is not high spec; therefore what is developed in a high tech company might not work seamlessly in an NHS hospital with older, less powerful infrastructure.
So, the successful adoption of RPM will require a shift of mindset across both the public and the healthcare sector to embrace new technologies; and indeed Covid-19 may have provided a motivation for them to do exactly that.
Remote monitoring: Key in managing Covid-19 and easing lockdown
The pandemic has prompted hospitals and healthcare organisations to rethink their operations, catalysing the deployment and use of new digital technologies in days and weeks instead of months and years.
The Government, Public Health England and the NHS, have already made a strong push for those with milder Covid symptoms to take advantage of applications that can help individuals self-manage their health and help alleviate the strain on local healthcare systems. This allows clinicians to focus more time on the patients that need emergency care. RPM could potentially have a significant impact in helping healthcare professionals triage patients submitting symptom and vital sign health data from home.
RPM also has the power to improve access to healthcare services for vulnerable groups advised to shield during the Covid pandemic. For example, Sensyne’s GDm-Health digital therapeutic app helps pregnant women and their care teams significantly improve the way they monitor and manage diabetes. The risks to mother and child associated with this condition are significant, and include an increased rate of caesarean section, pre-eclampsia and premature birth. Clinicians use the system to remotely monitor blood glucose levels, and prioritise care to women needing it most. Mums-to-be upload their blood glucose readings from home, and communicate with their care teams through the app. The need for face-to-face appointments is reduced, administrative time is saved, and quality of care is improved. GDm-Health is an exemplar of how RPM can enhance the existing care pathway, improve operational efficiency and help deliver better outcomes for patients.
Equipping scientists with data for drug discovery
The fundamental role of RPM is to improve the quality of data and information flow to deliver timely, effective and safe care. Data from RPM applications can be uploaded to Electronic Patient Records (EPR), which can be used to provide a complete medical history and real-time information source to support early diagnoses. Furthermore, this data can be anonymised, aggregated and used to analyse patterns within a disease and inform clinical research aimed at drug discovery and disease prevention. Gaining insights from anonymised patient data may allow for faster vaccine development and new treatments, not just for Covid-19, but also for other diseases.
As we continue to fight coronavirus, we must recognise the great potential of technology to help us. It is important that RPM solutions are implemented swiftly but with a clear pathway to deliver operational efficiency and improved clinical care in a tightly controlled ethical, information governance and regulatory framework. The hope is that by doing so, healthcare providers can manage future peaks, continue to improve health outcomes, free up time for clinicians to treat more patients and drive scientific research into disease prevention and treatment.
Demand on our healthcare systems will continue to rise, yet it can be better managed with technology that is aimed at earlier detection and intervention, preventing more costly treatments and providing the catalyst for transformative change in medical practice, helping to move from reactive to preventative models of care.
By Lucy Mackillop, CMO, Sensyne Health