Remote Patient Monitoring: Considerations for Telehealth Care
Provided by OSMA's exclusively endorsed partner for medical liability insurance, The Doctors Company.
Sue Boisvert, BSN, MHSA, Senior Patient Safety Risk Manager
Millions of Americans experienced healthcare by telemedicine during the pandemic. Although the use of telehealth for routine care is slowing down, it is gaining popularity in chronic disease management and hospital-at-home care.
Prior to the pandemic, practitioner concerns over how to conduct a physical examination during a virtual visit created a significant barrier to telehealth. Thanks to appropriate telehealth use guidelines and technological advances, however, important components of an in-office visit, such as vital signs and point-of-care testing, are now becoming an in-home reality.
Remote patient monitoring (RPM, or remote physiologic monitoring) devices facilitate clinical data collection in the patient home. In its simplest form, the patient collects RPM data using equipment such as a thermometer, blood pressure cuff, scale, portable ECG monitor with smartphone app, point-of-care blood glucose device, or oxygen saturation monitor. Before the telehealth visit, the practitioner provides the patient with a home vital signs kit (or instructions for purchasing the necessary equipment), training on the equipment’s proper use, and directions for collecting the required information and sharing it at the telehealth visit. The practitioner then assesses the information and adjusts the patient’s treatment plan as needed.
Advanced RPM is proving helpful for managing chronic conditions—such as heart failure, chronic obstructive pulmonary disease, and diabetes—and for patients with implanted cardiac defibrillators or pacemakers. The advanced monitoring equipment collects and transmits physiologic measures to the clinician with little or no input from the patient. During the pandemic, hospital critical care units used remote glucose monitoring to decrease the number of times staff members had to enter a patient’s room, thus decreasing the risk of disease transmission and preserving personal protective equipment.1
The ability to automate data collection and transmission makes advanced RPM ideal for hospital-at-home management, particularly for patients waiting for transplants, high-risk pregnancies, and infants who need cardiac surgery but must reach developmental milestones before surgery can proceed. The equipment used for these patients tends to be highly sophisticated and may include devices that continuously monitor cardiac and respiratory status.
- Shehav-Zaltzman G, Segal G, Konvalina N, Tirosh A. Remote glucose monitoring of hospitalized, quarantined patients with diabetes and COVID-19. Diabetes Care. 2020 Jul;43(7):e75-e76. doi:10.2337/dc20-0696
- World Health Organization. WHO guidance. Ethics and governance of artificial intelligence for health. June 28, 2021. License: CC BY-NC-SA 3.0 IGO. https://www.who.int/publications/i/item/9789240029200
American Hospital Association. Hospital-at-home. https://www.aha.org/hospitalathome
Office of the National Coordinator for Health Information Technology. Conceptualizing a data infrastructure for the capture, use, and sharing of patient-generated health data in care delivery and research through 2024. White paper. 2018. https://www.healthit.gov/sites/default/files/onc_pghd_final_white_paper.pdf
Telehealth.HHS.gov. Telehealth and remote patient monitoring. https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring/
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.