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The Impact Remote Health Monitoring in the Time of COVID-19

Almost from the moment that COVID-19 became an urgent global health threat, epidemiologists identified proximity as the key to mitigating the spread of the deadly virus. With airborne transmission suspected as the prime mode of transmission, public health measures focused on a concept foreign to most: social distancing. The way to stop the spread, it seemed, was keeping people apart.

For a society and economy built around personal interaction, easier said than done. The healthcare system in particular faces an acute challenge in adapting to the realities of the pandemic. Healthcare depends on one-to-one engagement: You feel sick or get hurt; then you visit the doctor or the hospital to feel better. But that’s not possible if doing so puts you and others at risk of infection from a deadly virus.

One response of the healthcare system to this challenge: A greater sense of urgency toward embracing and further developing the possibilities of remote health monitoring in the time of COVID-19. The push is on to invest in technologies that expand the capabilities of remote health monitoring, both as a way of treating patients with COVID-19 and providing other types of care. One of the lasting legacies of COVID-19 may well be to make remote health monitoring an accepted practice across the system.

Remote health monitoring makes use of technology to deliver patient vital signs and other data to care teams in real-time, or close to it, for immediate intervention. The capability to capture and transmit that data is now as simple as wearing a device on your wrist.

The possibilities with remote health monitoring are moving from reactive to proactive. Integrating artificial intelligence now enables doctors to anticipate problems — to see when patients are showing signs of getting worse — and take action before a situation becomes an emergency.

The increased focus on remote health monitoring in the time of COVID-19 could be transformational. It may well lead to improved quality of life and outcomes for chronically ill patients, better treatments and lower costs — while reducing chances for the virus to spread.

Remote Health Monitoring: A Brief History

Remote patient monitoring is not a new concept. In recent years, though, ideas for implementing it as a standard part of health care have gained in sophistication as we have become more connected through technology.

As with many new ideas, the origins of remote patient monitoring tie to government research projects and related initiatives. Some of the first work in this area came out of NASA in the 1960s, involving astronauts and the nation’s space program, according to a 2013 paper in the International Journal of Environmental Science and Public Health.

One of the first big initiatives involved a partnership between the Kaiser Permanente Foundation and Lockheed-Martin. Kaiser Permanente and Lockheed worked to develop a model that would locate “unmanned” health centers in remote areas where people could seek medical care from physicians located many miles away. The centers would provide video connections and other monitoring equipment to send vital signs and other data for evaluation. The idea of the project was to develop a method for providing remote treatment of astronauts in the U.S. Space program, especially as missions became lengthier.

The idea, as stated, was to create a “completely automated self-administered multiphasic health testing laboratory in which a person in space could perform everything himself, using automated equipment which enters data into the computer which is programmed to provide advice and instructions,” according to an article on the Kaiser Permanente website.

While the test system, deployed at an Indian reservation, showed promise, a series of significant obstacles hindered further progress on remote health monitoring, according to a 2013 paper in the International Journal of Environmental Science and Public Health.

These barriers have included technological challenges, such as the slow rollout of broadband technologies, particularly to rural areas; legal challenges, such as providing the statutory authority for doctors in one state to treat patients in another state; as well as financial difficulties in terms of finding business models that work. Cultural issues also play an important role: remote health monitoring requires a level of trust from patients that the system will provide the same accurate and responsive care they receive in person.

Of course, in some ways, remote patient monitoring has been part of health care for much longer, in simpler forms. Doctors who called their patients to see how they were feeling and assess symptoms were in their own way practicing remote patient monitoring. Over the years, the addition of incremental advances have helped provide improvements in advanced remote monitoring capabilities. For example, the ability to transmit X-rays from one health care site to a diagnostician at another site, that also was a form of remote patient monitoring. Hospitals that created central monitoring stations for the vital signs of patients on their floors were practicing an early form of remote health monitoring. From one location, doctors and nurses can see the blood pressure, heart rate and other data in one place.

More recently, the vision for remote patient monitoring has taken on a greater scale. In the connected world, it’s now possible for doctors to monitor the physiological conditions of their patients, particularly those with chronic illness, as they go about their daily lives. The data is delivered to care teams on a continual basis, rather than during periodic check-ins. And it does not require patients to be homebound, attached to instruments for capturing the data. This vision involves the use of wearable, always-on hospital-grade devices that feed vital signs into a system with applications that can be programmed to give alarms when a patient falls below a baseline. Whether data indicates the need for a pacemaker adjustment or a spike in blood sugar, it is this version of remote health monitoring in the time of COVID-19 that is gaining in momentum.

How COVID-19 is Creating Opportunities to Expand the Use of Remote Patient Monitoring

The healthcare challenges to the standard in-person model of treatment were obvious as the COVID-19 crisis accelerated. Hospitals across the nation instituted emergency protocols to keep patients and healthcare staff safe from the virus, and also took extreme measures to preserve operating capacities by postponing lower-priority procedures such as elective surgeries.

Certainly the most immediate concern was to avoid further transmission, both to providers, staff and other patients. But treating patients with COVID-19 also raised the risk of contamination of healthcare facilities, not just from people with the disease, but those who were asymptomatic. The health care system was in no position to take any facilities offline, even for short periods of time to allow for sterilization.

But providers faced additional challenges at the administrative level. The sudden onset of COVID-19 cases strained hospitals and doctors offices to the breaking point. Those facilities were faced with figuring out who needed to be seen and when, but without the data necessary to make those distinctions. This produced painful scenes such as long lines outside emergency rooms in New York City, where anxious patients lined up for testing or care.

These challenges brought telemedicine generally, and remote patient monitoring specifically, to the forefront early on in the pandemic. The Centers for Disease Control estimates that telehealth visits increased 154% during the last week of March 2020, driving a 50% increase across the year’s first quarter.

The crisis brought into focus the multi-faceted nature of telehealth. Video connections between doctors and patients provide a basic level of remote health monitoring. The doctor and patient see each other and have a dialogue about the patient’s health. In that case, though, the interaction is subjective and not data-based. It’s based on how the patient feels and what the doctor can observe. A higher level of patient monitoring involves the delivery of continuous streams of data to assist in decision-making about treatment, maybe even anticipating and heading off emergencies. Remote monitoring also has a third application in connecting rural populations to care that they might not be able to access otherwise.

Today, remote patient health monitoring is a fragmented system that depends on different devices for collecting data. It also rests heavily on the ability of patients to comply with their doctor’s instructions. They have to remember when it’s time to take their blood pressure or check their blood sugar. They also have to remember how to operate the machines that capture those readings, or to complete surveys about their condition that might allow doctors to react or respond. These are potentially limiting factors in the ability for the healthcare system to enact and expand systems for remote patient monitoring. Patient-driven systems also often rely on qualitative assessments rather than data-informed monitoring.

The emerging alternative is to use devices that provide continuous data flow into intelligent systems that can assess the information and sound alarms when needed. This technology allows health care teams to be “always-on” in their own way — ready to respond and react to alarms when vital signs get out of the appropriate range. The ultimate goal of remote patient monitoring is to recognize the signs of trouble before they even happen to avoid the emergency situations.

A continuous remote patient monitoring system can contribute to improved quality of care, better patient experience and lower costs. That better patient experience takes the form of faster and more timely care, and reduced anxiety over their conditions, said Dr. Victoria Sharp, clinical transformation physician consultant for 3M Health Information Systems. For the healthcare system, Dr. Sharp writes, remote patient monitoring helps enable patients to get the care they need without taking up crucial resources such as hospital beds. It can also provide hospital staff with early warning of the arrival of a patient who may have COVID-19 or some other condition that requires special hospital attention.

Remote patient monitoring, Dr. Sharp believes, allows doctors to care for patients in the time of COVID-19  “while providing the social distance necessary to reduce the spread of the virus.”

Challenges to Realizing the Potential of Remote Patient Monitoring

Yet, there are still obstacles that must be overcome to realize the potential. These are obstacles for both patients and providers in policy, practice and culture that directly impact the increased adoption of remote patient monitoring. Some of these challenges have been highlighted by the experience of the COVID-19 pandemic.

Perhaps the most significant is in the current state of remote patient monitoring. The system is built around the adoption of multiple devices, such as blood pressure cuffs, pulse oximeters, glucometers for blood sugar measurements, heart rate monitors and electrocardiograms for heart conditions, and a range of other emerging devices that capture relevant data in medical care, such as smart pill dispensers.

Each of these devices capture individualized data points, using unique technologies. These create operational considerations. Each data point has to be read, associated with a patient, assigned to the right patient record and reviewed for potential action. The tsunami of data is difficult for doctor’s offices and hospitals to keep up with.

A related challenge is in technology protocols. Each device captures data in its own way and must be compatible with and communicate to electronic health record systems and larger health care systems. The diagram in this article from Informatics in Medicine Unlocked shows just how complicated the information architecture can become. Remote patient monitoring also raises questions about matters of IT support and data accuracy.

By the same token, for the individual patient, multiple devices are also a problem. The patient has to be trained in operating each device; not only that, they must remember to take the readings at prescribed intervals and receive some assurance the data has been properly transmitted. As it is with medication, patient compliance will remain a challenge in a fragmented system.

The layers of complexity make it harder for the system to generate an adequate response in the right time frames. The ideal system enables a proactive approach, where the system anticipates problems and alerts doctors for intervention before the onset of emergencies.

Remote patient monitoring has historically been slowed by policy as well. For example, the increase of information captured about a patient inherently requires privacy protections under the HIPAA protocols. The system is also grappling with establishing the right approaches to reimbursement, and has given signs during the pendency of the pandemic that it is ready to adjust to make these technologies affordable for patients and providers alike.

Solutions to these challenges have been in the works for some time, and the experience of the COVID-19 pandemic has accelerated discussion and further development. These solutions range from integrated systems, such as smart medical homes with devices manufactured into the home, to the consumer level, through hospital-grade wrist-worn medical devices such as those pioneered by Oxitone. These emerging solutions demonstrate the impact that remote patient monitoring can have against the backdrop of the COVID-19 pandemic. Across the country, many projects are underway that show the promise.

Remote Health Monitoring in Real-Life Use

The move toward remote patient monitoring has led to a large number of projects that demonstrate its potential for improved care, quality of life and lower costs. A few examples of how remote patient monitoring became a key focus for providers during COVID-19:

●  Recovering COVID-19 patients under the care of Brooke Army Medical Center, part of the U.S. military’s Joint Base San Antonio-Fort Sam Houston in Texas, are being watched for further complications at home through the COVID-19 Remote Monitoring Program. The program provides patients with a home healthcare kit that enables continuous monitoring of vital signs such as temperature, respiratory rate, heart rate and oxygen levels. Patients do additional self assessments. They also provide period monitoring of blood pressure and lung functionality, combined with secure video consultations. Since it was piloted in Texas, the program has been expanded to other military bases across the nation, including the Walter Reed National Military Medical Center in Bethesda, Maryland. The system bridges care from inpatient to outpatient, and provides “an additional level of safety, support and monitoring,” according to the program’s clinical lead.

●  Some remote patient monitoring efforts shifted into overdrive almost as soon as the pandemic’s threat became clear. The University of Iowa Hospitals & Clinics quickly expanded use of a system in mid-March that enabled telehealth care for patients who were not sick enough to be hospitalized. Patients who fit the definition would receive a blood pressure cuff and pulse oximeter, take their own vital signs and report the data to their caregiver. A nurse followed up everyday. If conditions worsened, a doctor would get involved and direct patients to the hospital as needed. The goal was “to protect clinic patients from getting the virus if they didn’t already have it, to stop those with the virus from further spreading it while in the waiting or exam room, and to protect clinicians and staff from being exposed,” according to an article on the American Medical Association website.

●  One of the nation’s premier health centers, the Mayo Clinic in Rochester, Minnesota, quickly developed and implemented a Remote Patient Monitoring Program also built around providing patients with the devices they need to monitor key vital sign parameters. These included a blood pressure cuff, thermometer, pulse oximeter and a weight scale. Patients also received a tablet for transmitting the data. Though adapted to address acute care issues of COVID-19, the program previously existed to provide remote monitoring of patients with chronic conditions. The COVID-19 program recognized that there were two categories of patients it would seek to address: those with pre-existing conditions that put them at high risk from COVID-19 complications, and a second one,  for those with baseline risk levels. Patients received reminders through the Mayo Clinic app to take their measurements.

●  Providence Health & Services, which operates hospitals across eight states, had remotely monitored the conditions of more than 16,000 patients through February of this year. The monitoring program included providing patients with thermometers and pulse oximeters. The system has been used to help monitor both COVID-19 and non-COVID-19 patients. It was eventually deployed at more than 80 hospitals in the western part of the United States. Providence focused on keeping the system simple for patients and was rewarded by generating an 87 percent compliance rate, where patients actively responded to messages from nurses.

●  Some of the accelerated remote monitoring projects are providing useful data to help understand the strengths and weaknesses of various systems. A project involving an acute-care hospital in Washington, D.C., documented in Emergency Medical Journal, discussed results for the first 83 enrolled COVID-19 patients. Like other programs, these patients were given thermometers and pulse oximeters. As part of the program, they had to take and report their own vital signs, complete surveys and answer check-ins from the care team. Of the 83 patients, 39 were flagged for the potential need for in-person care. But through virtual intervention and review of data, 22 of the 39 were able to be handled remotely. For those patients, the health system was able to “avoid unnecessary exposure and related personal protective equipment use.” Interestingly, the program was built on existing telehealth initiatives focused on individuals in maritime, aviation or other remote occupations.

Potential for Continuous Monitoring to Provide Greater Benefits

One thing in common in each of these examples: they all require active involvement of patients in terms of taking and transmitting their vital signs, responding to surveys or text messages or being available for phone call or video consultations.

Human nature says that compliance with all those requirements will never be 100 percent. If patients don’t remember to respond, the data flow may be irregular and doctors may not be seeing the data that indicates the need for a response.

A critical care nurse now working for device-maker Medtronic related her experiences with intermittent monitoring in a blog post. The nurse writes about her days on a critical care floor with constant alarms going off from pulse-oximeters, but intervention “rarely told us the cause,” she writes. She and her team quickly concluded that “checking vital signs alone is an incomplete way to prevent respiratory depression.”

The better alternative, she writes, is continuous remote patient monitoring. Living as we do in the age of automation, it is possible now to provide patients with hospital-grade wearable devices that capture and transmit vital signs automatically.

That is the vision of the team at Oxitone, makers of the Oxitone 1000M, a hospital-grade device that records a range of vital signs, including pulse rate, skin temperature, oxygen saturation, heart rate variability, and respiratory rate. The device, the first of its kind to be FDA approved, is worn on the wrist and is not much bigger than today’s fitness trackers.

The Oxitone 1000M1000M provides continuous remote monitoring which is crucial for patients with severe chronic conditions such as COPD, and, as hospitals and doctors have discovered, for complications from acute conditions such as COVID-19.

The continuous nature of the data flow makes the difference. In one click, clinicians can unlock patients’ real-time intelligent insights and effortlessly follow-up with hundreds of high-risk patients. Continuous data flow is the next level of remote patient monitoring.

The ultimate value of continuous patient monitoring lies in the ability to integrate the data flow into a suite of artificial intelligence tools. By measuring the baseline state for every patient, the system can recognize when problems seem to be developing and initiate a response before emergencies happen.

Artificial intelligence tools allow doctors to classify patients into clearly defined diagnostic categories and severities and to identify predictive trends and multiparameter baseline variations.

The Oxitone 1000M also includes a full-suite of capabilities that include a mobile app and clinical hub, cloud-based AI tools and reports and a clinician portal. This system maps out a constant connection between the patient and the provider.

COVID-19 highlighted the gaps in using modern telehealth for complex disease care. The currently  fragmented and multi-device approach to telehealth prevents it from generating an adequate response to challenges that come from chronic conditions.

With changes in policy and an increased sense of urgency, continuous remote health monitoring in the time of COVID-19 holds the potential to provide better quality of life for chronically ill patients, streamlined workflow for providers and lower costs. Visit www.oxitone.com for more information.

Here at Oxitone, we boost value-based healthcare by delivering extraordinary patient, clinical, and economical outcomes at reduced medical utilization and cost. Patients need a prompt response to emergencies. Physicians need an easy and timely follow-up with patients. Our mission is to transform chronic disease management and help save lives worldwide.

Let’s save lives together! To see how we help remote patient monitoring companies and physicians improve the management and care of high-risk patients, contact us toda

Here at Oxitone, we boost value-based healthcare by delivering extraordinary patient, clinical, and economical outcomes at reduced medical utilization and cost. Patients need a prompt response to emergencies. Physicians need an easy and timely follow-up with patients. Our mission is to transform chronic disease management and help save lives worldwide.

Let’s save lives together! To see how we help remote patient monitoring companies and physicians improve the management and care of high-risk patients, contact us toda