Remote Patient Monitoring — RPM
Americans will generate more clinical grade biological data like daily vital signs in the next 5 years than has previously been recorded in the past 20 years. The data will be more accurate since it won’t be one snapshot in time, but many snapshots in someone’s daily life.
While most clinical grade vital signs are collected and recorded in a healthcare setting like a clinic, hospital, or ER, there are a number of factors changing that quickly. The combination of AI based software & medical devices that have cleared the FDA, payor reimbursement, clinical adoption, and patient adoption are all coming together to bring RPM mainstream.
This is impactful for a number of reasons.
There is a phenomena called White Coat Syndrome. A patient’s blood pressure may be higher in a physician’s office than at home due to many factors: anxiety about seeing the doctor; having just battled traffic while driving to the clinic; having to leave work for the appt; or just having run up the stairs to be on time. When the clinic takes the patient’s blood pressure, it is during that one snapshot in time, which might not be reflective of a patient’s baseline blood pressure in their normal daily environment.
With RPM, the data is collected in the patient’s normal environment and not just an annual snapshot or a snapshot at their sickest. It is a leap forward to collecting clinical grade data 24/7. Clinical grade RPM taken on people in their daily environments captures patients both when they are sick, and when they are healthy. With accurate baselines on healthy individuals, it will become much easier to catch potential medical problems long before they become a big enough problem to require interventions like medication, surgery or hospitalization.
A bonus is that RPM has the ability to document from beginning to end, without humans having to input the data. This frees up the healthcare professional to focus on other more important things than basic data entry. It also reduces errors caused by inputting a number incorrectly — something that happens no matter how conscientious the patient or healthcare professional is when recording numbers.
The great news is that CMS (Medicare) now has multiple reimbursement codes for remote patient monitoring. Providers can now be reimbursed for educating and setting the patient up with remote monitoring, they are reimbursed for having software do the actual monitoring, and the provider is also reimbursed for any communication that happens as a result of the monitoring. Reimbursement by CMS is one of the main steps to widespread adoption in US healthcare, so we can expect to see RPM grow substantially over the next 5 years.
In the near term, RPM is a trend that can make a significant impact on some of the more expensive services like hospital admissions and readmissions.
Remote Patient Monitoring can help alert people they may be getting sick or sicker before that person even knows something is wrong or feels any symptoms. A great example of that is atrial fibrillation, also called a-fib — which can be picked up using an EKG. A-fib is an irregular heartbeat, having to do with the upper 2 chambers of the heart not working in sync. A-fib is usually a completely silent problem — the patient doesn’t feel sick or experience physical symptoms. But — if a patient does have a-fib, they are ~5 times more likely to have a stroke. Catching and treating a-fib before the patient has a stroke can be the difference between life and death.
There are a plethora of FDA cleared clinical grade monitoring devices now with an AI enabled software component. While some of these devices only capture 1 or 2 clinical grade vital signs, over the next few years, we can expect most of these devices to become multi-functional. Apple is one of the companies in the lead with clinical grade SPo2 (blood oxygen) and EKG on their latest watch version. The Apple Watch is also rumored to be close to market with non-invasive glucose monitoring.
Fitbit, now owned by Google, also has FDA clearance for their EKG sensor. Omron is the dominant player in the world in blood pressure monitors, and they launched a blood pressure monitoring watch, the first company to use the cuff method on the wrist. Oxitone has a clinical grade SPo2 monitoring watch, and BioBeats has a watch with a corresponding chest monitor to track multiple vital signs including BP, pulse, Heart Rate (HR) variability, and EKG. What these all have in common is that since they are clinical grade, they can be used on patients in the home who would normally have been hospitalized for monitoring. Not only does this cut healthcare costs substantially, it helps to democratize healthcare. Patients who may not have access to a hospital because of cost, overcrowding or proximity could have access to a clinical grade wearable device and connectivity to be hospitalized at home.
Not only does this cut healthcare costs substantially, it helps to democratize healthcare.
While most of the RPM devices have AI enabled software, there are many companies with AI enabled software platforms that are device agnostic. Medidata is an example of a cloud based SaaS and data analytics platform for managing clinical trials. As part of that, they are able to integrate most devices, so that the patients in a clinical trial can wear an Apple Watch or Omron blood pressure watch everyday, and with the patient’s permission, the data will be automatically integrated into the clinical trial records and analyzed.
There are a lot of companies that integrate into the main Electronic Medical Records (EMRs) hospitals and clinics use like Cerner and Epic. One example is Life365. Life365 integrates into existing medical practices, and has programs that target specific diseases or disorders like hypertension, weight loss, diabetes and cardiac care. The way it works is Life365 sends a box kit of bluetooth-enabled medical devices to the patient’s home, specific to their condition. The diabetes box kit includes a glucose monitor, blood pressure monitor, and a scale. Other box kits may include pulse-oximeters, thermometers, or EKG monitors. The data is automatically uploaded to the cloud, and integrated into the patient’s hospital EMR. The software detects if any of the data from the clinical grade monitoring devices are outside the predetermined range, and alerts the clinician and patient. They also have 24 hour nurses on call, in addition to coaching, education, and can enable a reimbursable telemedicine visit for the clinician.
AlacrityCare is a remote patient monitoring and data analytics company focused on oncology. Oncology treatments are high-cost, toxic and high-risk. For instance, breakthrough and cutting edge Immuno-Oncology treatments induce a fever in the patient 45% of the time. AlacrityCare works with large pharmas during their clinical trials in addition to normal oncology infusions like FDA approved chemotherapy. AlacrityCare uses a patented system to monitor the oncology patient’s vital signs 24/7 including the EEG, EKG, blood pressure, pulse-ox and blood labs in addition to patient recorded symptoms. The AlacrityCare platform and team of oncologists analyze the patient’s data streams, and alert the care team and patient in real-time where there might be a medical problem in the near future that can be avoided by intervening now. For example, Neutropenia is a side effect of cancer treatments that makes patients much more susceptible to life-threatening infections. The earlier problems like Neutropenia are caught, the easier and more successful they are to treat, which in some cases, can save the patient’s life.
CVS has a new remote patient monitoring kit and software called CVS Health Symphony. Depending on the package, the kit is $250 for the more expensive of the two options, with a required $39/month subscription fee. The kit comes with a wearable sensor, 2 motion wall sensors, a fall-detect sensor for the bathroom and a voice-activated smart hub with 2-way communication. This is the type of remote patient monitoring and voice-activated software that can help more seniors age-in-place at home.
Another interesting AI-based software and hardware device is the VitalConnect. They have an FDA cleared 24-hour disposable patch that monitors 8 physiological measurements, including a single lead EKG, heart rate, HR variability, temperature, and posture. They also have the ability to integrate data from a connected blood pressure or pulse-ox device. VitalConnect’s patch — the VitalPatch — can be used in the hospital and then sent home with the patient. They have done a study where the software was able to predict with 80% accuracy a cardiac hospital readmission 6.5 days before the patient actually needed to be readmitted. When dealing with cardiac issues, this type of AI software can be the difference between life and death.
Healthcare is still in the early phases of remote patient monitoring, but over the next 5 years, expect to see a dramatic increase in use cases and number of patients who are benefiting from this trend and technology adoption.
Check back next week for the 6th installment on Virtual Reality
Check out the previous 4 installments on the AI in Healthcare Series with Michael Ferro: