Products & Technology
Continuous, Connected Care
Remote patient monitoring is critical in terms of care and forging patient and referral partner relationships. Where does it stand and where is it heading?
- By David Kopf
- Jan 01, 2017
How human beings manage their relationships is changing right before
our very eyes. So is how we manage our healthcare, and those changes are creating
new opportunities for improved care and business relationships.
Twenty years ago, you kept in touch with friends and family through actual, realtime
contact — you talked on the phone; you met for coffee; you traveled to visit one
another. Now, thanks to mobile data communications and social media, you keep
in touch with a broad, far reaching range of friends. You might see what your roommate
from college had for lunch. You might see a baby pictures posted by a previous
co-worker from an old job. You might watch and interact a Facebook Live video stream
from a friend who moved to the other side of he world. You make and maintain connections
with people you might not necessarily see all that much in real life.
And while that landscape might seem strange or jarring to some, today’s
permanently connected world is having a positive impact in the healthcare
world, thanks to remote patient monitoring. Now healthcare professionals
can track patients with chronic conditions to see how they are progressing
with their treatment, ensure therapy compliance, and help manage their
care for better outcomes.
And it’s all thanks to ubiquitous data communications. Wireless connectivity
has replaced the public telephone network and LANs as the de-facto
standard for communications technology for most types of connected
home medical devices. In terms of scale, wireless will account for 19.2 million
connections in 2020.
How Big a Trend?
Better yet, it’s creating an ample market opportunity for HME providers.
How big of an opportunity? The number of remotely monitored patients
grew by 51 percent to 4.9 million during 2015, according to “mHealth and
Home Monitoring,” a study from market researchers at Berg Insight that
was released several months ago. (“mHealth” being Berg’s word for mobile
health technology.) Looking ahead, the number of remotely monitored
patients will grow at a compound annual growth rate (CAGR) of 48.9 percent
to reach 36.1 million by 2020, according to the study.
The study tracked patients enrolled in mobile healthcare programs in
which connected medical devices were used as part of their treatment
and care. The study did not include connected medical devices used for
personal health tracking, such as Fitbits and similar gadgets.
Revenues for remote patient monitoring reached roughly $6.8 billion
in 2015. That revenue includes revenues from medical monitoring
devices, mobile health connectivity solutions, care delivery platforms
and mobile healthcare programs. Berg reported it expects remote
patient monitoring revenues to grow at a CAGR of 32.1 percent between
2015 and 2020, to eventually reach $27.4 billion.
And where the home medical equipment market is concerned,
connected medical devices, such as sleep therapy equipment, accounted
for a whopping 71 percent of total remote patient monitoring revenues in
2015, according to Berg. That said, revenues for mobile health connectivity
solutions, care delivery platforms and mobile healthcare programs are
growing at a faster rate and will account for 46.3 percent of total revenues
in 2020, up from just 29 percent in 2015.
The fact that HME is at the center of that growth is critical. For years,
implantable cardiac rhythm management (CRM) has traditionally been
the largest segment of the remote monitoring market, led by companies
such as Medtronic, Biotronik and St Jude Medical. Now, Berg’s report says
that the sleep therapy segment of remote patient monitoring has been
growing at the fastest rate of all, with the number of remotely monitored
sleep therapy patients grew by 170 percent during 2015. Now the report has
pegged sleep to outpace CRM by about the time you are reading this.
And sleep isn’t alone. Other fast-growing remote patient monitoring
categories that will take off over the next five years include blood
glucose monitoring, air flow monitoring and connected pharmaceuticals,
according to the study. But for now, let’s look at where the current sleep
patient monitoring market stands, where it is headed, and whether or not
that can give us clues about where remote patient monitoring is headed
for HME as a whole.
Current State of Remote Monitoring
Currently, sleep is the foundation — or, better yet, launch pad — for remote
patient monitoring in the post-acute care space. In this setting, patients go
home with a PAP therapy device that lets them, the HME provider and the
referring physician or clinician track their care. They can see how they are
performing against various performance metrics on a daily basis; trend that
data; and work to correct events that are happening during their sleep and
improve overall compliance.
Sleep providers are seeing that they can help patients manage their
care, provider referral partners with actionable data on patient compliance
and progress, and create real business value for themselves in the
process. One of the key reasons for the success this sector has enjoyed
with remote monitoring is because it is hassle-free for the people who
really matter, the patients.
“Regarding patient care, the best thing about remote compliance
monitoring is that it is easy for the patient,” says Angela Giudice director
of clinical sales and education for sleep and oxygen therapy equipment
maker 3B Medical Inc. “They’re able to take their machine home, set it up
how their provider tells them to, and that’s it. As long as they’re using their
machine they have no worries.”
“And it also gives them peace of mind to know that they’re being monitored,
rather than being sent into the wild with this machine they no nothing
about,” she adds.
And on the provider and referral partner side of that scenario, they stay
on top of that patient’s care.
“With today’s reporting systems, you can pretty much see everything the
patient is doing,” Giudice says. “If they’re having certain types of events;
if they’re having leaks; you can even determine if a mask isn’t right for a
patient. It’s an amazing tool for those that choose to use it. Whether it’s
home health or doctors or clinicians, they have the ability to log in and see
what their patient is doing for literally half their life.
And the numbers bear that out. In October of last year, sleep equipment
ResMed presented results from world’s largest study on sleep apnea and
digital connected care, and that study showed that remote monitoring and
clinical management tools improved patients’ adherence to treatment by 87
percent and 70 percent, respectively.
“Online self-monitoring tools, like ResMed’s myAir, engage patients and
significantly improve their compliance and adherence to treatment,” says
Amy Cook, director of Healthcare Informatics for ResMed. “ … Remote
monitoring reinforces the efforts of clinicians and helps patients keep
themselves informed and motivated, factors long considered to play a
role in effective treatment of sleep apnea and other medical conditions.
Remote monitoring is equally beneficial to home medical equipment
providers and clinicians.”
And beyond clinical benefits, the provider knows that they are going to
get reimbursed for those patients because those patients are complying with their therapy and are ahead of the curve.
“And if a patient falls off that curve, and is not meeting compliance,
they can be the coach in between, because it’s in their best interest to
get paid for the machine they’ve provided,” Giudice adds. “It makes it
easy for [providers] to be the go-between, sitting between the physician
and the patient.”
Plus, the sleep equipment provider is regularly demonstrating its value
and relevance to their partners.
“Demonstrating to referral sources the benefits your practice can
provide, including a focus on clinical outcomes and patient satisfaction, are
key in maintaining good referral relationships,” Cook says. “At ResMed, we
have focused on making management of sleep patients as easy as possible
through both data management systems and connected devices that carry
the weight of this sometimes complex aspect of our system. In providing
these solutions, we hope to help HMEs demonstrate the value of the partnership
between a partner and a sleep practice.”
So it’s no surprise that remote monitoring has become ubiquitous for
patients, providers and partners.
“Very few patients leave the provider or the lab without some kind of
remote monitoring in place,” Giudice notes. “The only patients that I
know that don’t have any kind of monitoring are usually self-pay, cash-pay
patients, where the monitoring doesn’t matter, or patients on their second
or third CPAP where the monitoring doesn’t matter so much. Whereas
almost every insurance payer has gone to compliance monitoring; I don’t
even know of a payer that doesn’t do it.”
Active Patient Participation
The next major, evolutionary step in remote monitoring for sleep therapy
— and perhaps for remote monitoring as a whole — is getting patients
involved. Right now, the process is fairly passive: patients help ensure the
data is collected; the physician or clinician reviews the data; that healthcare
professional then determines what if any tweaks to therapy or equipment
need to happen; and the provider and patient react accordingly.
Now the patient needs to get more involved. Adopting that mindset
should be easy. Living in a Fitbit world, we already use wearable health
devices and smartphone apps to see how we are performing in terms
of diet and fitness. We are actively engaged with our personal health
and try to use technology to manage it. Patients need to have that same
relationship with their sleep therapy devices and treatment.
“Being able to plug in the CPAP or the Fitbit and know how many hours I
used or how many hours I slept and knowing what’s going on during every part of my sleep or my day and what I’m doing to control my health is really
important to a lot people,” Giudice says. “It’s amazing to see when people
realize how much control they actually have over their health and how much
they can influence their lives and make them better.”
“Instead of a passive experience — a device sends data to a provider,
who can then make decisions — remote monitoring can be something that
brings a patient into their therapy and care options,” Cook explains. “The
future is in engaging patients to be involved with managing their condition,
and data suggests that putting the data and right, actionable information in
front of patients does make a difference.
“One such engagement platform is our patient app myAir, which utilizes
behavioral management techniques and PAP usage data to provide users
with a daily ‘myAir score,’ personalized tips for greater comfort and sleep,
and badges for therapy milestones,” she continues, again referencing her
company’s global study.
That research showed that more than 87 percent of CPAP users were
compliant on therapy when using ResMed’s myAir and monitored by their
provider with AirView (patient therapy management solution), compared to
70 percent compliance for those who were monitored by their provider with
AirView alone. Proof that patient involvement pays off.
What will help foster increased patient involvement is the fact that there
are various stakeholders in not only the patient’s care, but the patient’s life
who want to see that patient stay on top of his or her sleep therapy.
“Especially in the places that are mandating remote monitoring, such
as transportation and aviation,” 3B Medical’s Giudice notes. “They’re
mandating that their drivers and their flyers are doing sleep studies, so
[monitoring] is a very important piece of their medical history and a lot of
people are taking it more seriously as a result.”
More Remote Monitoring Opportunities
Perhaps most important to note is that sleep isn’t the only remote patient
monitoring opportunity. In fact, there are various sectors of post acute care
that are starting to see remote patient monitoring take root and expand,
and those represent key opportunities for HME providers to get involved.
For starters, diabetes care is a big opportunity. Already we are seeing
glucometers that use wireless technology to update patient performance
metrics. One example is the Dario smart glucometer from Dario
Health. The Dario plugs directly to a smartphone’s headphone socket so
that users can view and share their results through the Dario WebPortal
to record, track, analyze, manage, and share their data with physicians
and clinicians via a cloud-based platform. Another example is the
GLUCODARD Shine from Arkray USA Inc. The Shine collects user compliance
data, which can be downloaded into a data management system for
easy tracking and charting. This helps patients and health professionals
monitor and manage performance.
Already the equipment and data sharing portals are there when it comes
to remote monitoring of diabetes patients, and it’s likely that landscape
will only expand with more products. Plus, the data is there to back it up,
according to Cook.
“There is precedence of remote monitoring with diabetic patient apps/monitors that allow a patient to check their own insulin levels and parents
to monitor their child’s insulin levels, and the fields were some of the
first studied at Mass General Hospital in 2009 with promising results for
reducing glucose levels through engagement and patient-focused apps,”
she notes.
And perhaps one of the most revolutionary opportunities for increased
remote patient monitoring in the HME industry is the respiratory care
sector. One manufacturer that has really pursued this has been oxygen
concentrator O2 Concepts. Back in 2014, the company added what it called
Dynamic Network Analysis (DNA) as an option for its Oxlife Independence portable oxygen concentrator. The original value proposition was to
leverage telemetry via GPS and cellular data provided by Verizon to help
providers keep track of their expensive equipment out in the field.
This would help solve the problem of delicate and costly POCs winding
up getting provisioned to patients that, contrary to the ambulation goals
of portable, long-term oxygen therapy, simply decide to stay at home for
whatever reason. This could help the provider identify this point of inefficiency
and work with the physician to outfit that user with something more
within his or her needs. It also meant that providers could remotely check
on POCs to ensure they were performing properly without having to deploy
a tech in a truck.
“Patient monitoring is usually evaluated based on clinical outcomes,
but there are also very important cost impacts to monitoring your
patients,” says O2 Concepts CEO Rob Kent. “When a patient starts using
too many tanks, you put them on non-delivery equipment right? But what
happens when patients on non-delivery equipment stop ambulating?
How do you know?
“Our DNA technology can also tell you POCs are not being used for
ambulation,” he continues. “We observed a great example recently where
a provider redeployed 20 devices instead of placing another order. We
showed them how to use our platform to find patients not ambulating on
their equipment. By doing this they’ve reduced their average need for
non-delivery equipment by 25 percent.”
That’s a pretty solid business case on its own, but then O2 Concepts and
providers using the Oxlife Independence with DNA started taking a second
look at a the data and realized there was a bigger case to be made.
“Designed as a ‘fleet management’ platform to track POC location,
performance and usage, the usage feature is proving most impactful,” Kent
explains. “With our Oxlife Independence being deployed as a 24/7 solution
(no stationary), our DNA platform can give you a 24-hour snapshot of a
patient’s oxygen use.
“Since launching the platform, the base functionality has not changed
much,” he continues. “However we continue to evolve automated reporting
and alerts based on market feedback. In terms of patient monitoring,
people are most interested in patients’ total usage and ambulatory usage.
We are making the platform smarter by allowing the entry of expected
usage for each device. This allows our system to alert you only of particular
risk points where patients aren’t using oxygen as you would expect.”
And from there, we can see the foundation being laid for physicians, RTs
and other clinicians involved in the patient’s care to start using that data to
engage in targeted outreach and help improve compliance.
“Our DNA platform is also configurable to work with multiple tiers of
users,” Kent explains. “For example we are about to kick of a study with a
provider and major hospital chain. Our Oxlife Independence, dual-mode
TPOC will be deployed on higher-risk patients as they are discharged.
“Our DNA platform will monitor the devices for usage against expectations,”
he continues. “When devices aren’t being used as expected, a
group of telehealth nurses will get an email the next day showing expected
usage compared to actual. They can then reach out to the patient to
assess why they weren’t using oxygen as expected and mitigate a potential
readmit risk.”
And anyone working with hospitals knows that reducing readmissions
is a top priority, given that their reimbursement often depends on it. If a
provider can help a hospital or physician accomplish that goal, it will definitely
establish its indispensable value to those referral partners.
“In this environment, finding automated ways to eliminate risk-points
is a very compelling story,” Kent says. “In this business case, the oxygen
solution and telehealth nurses are already in place. We are just using ‘DNA
technology’ to work smarter.”
And it doesn’t stop with diabetes or oxygen. Even wound care is
starting to see remote patient monitoring, which makes sense given
that wound care really does benefit from constant follow-up. The more
a wound care physician or nurse can inspect how a wound is healing,
the more he or she can adjust compression, medication, dressings, etc.
Bearing that in mind, the SWAN-iCare project taking place in Europe (bit.ly/swanicare) is developing smart negative pressure wound care devices
that perform a number of tasks:
Collect data and monitor several wound parameters via non-invasive
integrated micro-sensors.
Help physicians and other caregivers provide innovative personalized
therapy in combination with the NPWT.
Help healthcare providers remotely track the patient’s condition and
progress,
as well as receive alerts to development that require direct actions.
The net takeaway should be that remote monitoring is coming to post
acute care in any way that it can, because everyone in the care continuum
wants it.
“We feel confident that the model of connected device and patient
engagement
could extend to meet the needs of providers working
with chronic conditions,” says ResMed’s Cook. “Our experience in
sleep has shown us that connected technologies play a huge role in the
areas that are the most important – value-based care, meeting regulatory
standards, providing workflow efficiencies and ensuring the best,
quality outcomes.
“Embracing connected technologies in managing these conditions is
extremely important for doing business in today’s complex regulatory
environment, and end-to-end healthcare informatics solutions will only
continue to improve as the industry moves toward increased connectivity,”
she continues.
“What is most exciting about monitoring technology is the ability to
impact costs so dramatically, and bring an incredibly exciting story to your
referral sources on patient care,” Kent adds.
Ultimately, what remote patient monitoring represents is an enticing
and rewarding blend of technology to help patients while providing a solid
business case for HME providers’ continued — and expanded — role in
the post-acute care market. Now is the time and opportunity for providers
to starting forging the kinds of meaningful, patient-provider-referral
connections across a variety of care sectors that will ensure their longterm
success.
This article originally appeared in the January 2017 issue of HME Business.