Remote monitoring technology has certainly proved its worth during the pandemic and is an exciting area of innovation in healthcare that is set to grow.
The healthcare resource problems exposed by the eruption of Covid have advanced the use of this technology to assist in patient recovery.
A study at Brigham and Women’s Hospital in Boston in the US, for example. found care at home using remote monitoring technology improves outcomes and reduces costs by 40 per cent. Participating patients were 70 per cent less likely to be readmitted.
In the UK, remote monitoring has helped reduce the likelihood of Covid transmission and even the requirement for personal protective equipment. In Northampton staff monitored chronic illness in patients recovering from coronavirus infections, while in Liverpool, the remote use of blood oximeters enabled the creation of virtual wards in people’s homes for those who were symptomatic. In a recent example in London, “wearables” in the form of patches collected the vital signs of people quarantining before or after travelling abroad.
These obvious benefits demonstrate we are on the threshold of great developments in remote monitoring, provided device companies and start-ups learn four key lessons, which are outlined here:
- We need to address the valid concerns of GPs and clinicians about being overwhelmed by the volume of data generated by remote devices. The volume of data is why separate teams manage monitoring. To enable GPs to retain oversight and maintain their crucial doctor-patient relationship, device companies need to integrate data back into GPs’ systems. Remote monitoring has worked well in specific situations during the pandemic but we need solutions that work for long-term monitoring and integration system-wide.
- To avoid overwhelming clinicians, devices must help the team manage by exception. This can be through notifications to the care team or even recommended interventions. Medical devices need to be capable of making decisions for this to happen, but any device with this capability immediately becomes a type of Class II device requiring adherence to a far stricter set of regulations. The EU Medical Directive, which came in effect from May this year, can be an obstacle for start-ups especially, so new entrants should give this full consideration.
- Because so many devices require their own infrastructure, achieving business case approval for remote monitoring is still a huge issue. Therefore, in the business case not only are you carrying often sizeable running costs, you are also weighed down by a large cost of setting the service up with the accompanying infrastructure. This is why having open standards-based interoperability baked into a product from the start is so important, so it can run on shared infrastructure. Being able to use an interoperability standard such as HL7 FHIR is hugely advantageous as it works across the internet. Whether it’s medical grade devices or even consumer devices secure internet-based interoperability is what is required.
- Integration with third-party electronic medical record (EMR) systems that clinicians use may well seem to be the most attractive way to surface data from remote devices, but this is not for the faint-hearted. EMRs are built in a way where they own much of the master data and assume ownership of other data. An EMR is a medico-legal record, so device companies must manage carefully how data enters the record from third-party applications. They may not have been designed to allow third-party apps to update information in the EMR or to record that it was done remotely by a machine. This is because they cannot assure the provenance, accuracy or preciseness of the data. This is another reason why separate teams look after monitored patients using standalone systems.
This presents device companies with a decision. They can work with each EMR vendor individually to allow integration which is not realistic given the number of vendors in the market. Alternatively, a more innovative way is to use SMART (Substitutable Medical Applications and Reusable Technologies) on FHIR, which is a straightforward way for third-party apps to authenticate and integrate with other healthcare applications, including EMRs. These applications essentially snap-on to other SMART-enabled applications with very little set-up.
Many EMRs support this standard, so if the remote monitoring software aggregates the data for each patient into an application that supports SMART on FHIR it will work seamlessly with other SMART on FHIR-enabled EMRs. By standardising these processes, health care providers can utilise more apps, and MedTech developers can write apps for a wider audience.
In summary, for remote monitoring to fulfil its potential, device data must be accessible, integrated in to the EMR and must not overload clinicians. It should be possible to run any clinical decision support in a separate SMART on FHIR application, separating the device from value-adding logic. This application will also be a medical device, but with the option of competing on the clinical decision support services in a separate application that could operate across multiple devices. This should require little or no extra infrastructure, with internet operability generating high levels of cost-effectiveness. Any device should also integrate into EMRs in a safe way.
The modernisation of care will undoubtedly include remote monitoring devices. Devices will support clinicians and ease the burden on hospital resources. What is essential for this to advance smoothly and quickly, however, is the integration of their data with health IT systems and delivery across the internet. This is as essential as compliance with regulation. Then the world of remote monitoring will deliver the major benefits indicated during the pandemic and advance to fulfil its true potential.