Jamison Feramisco

Technology continues to play an increasingly important role in patient care. COVID-19 prompted many doctors to implement virtual care, sparking huge growth in telemedicine and remote patient monitoring. In its simplest form, RPM involves the collection and analysis of patient physiologic data that are used to develop and manage treatment plans for chronic medical conditions.

Often, digital technologies are used to monitor and capture medical data from patients and electronically transmit this information to healthcare providers for assessment and, when necessary, recommendations and treatments. RPM is especially useful in skilled nursing facilities, where patients develop more co-morbidities and chronic medical conditions over the years.  

The key to effective care in the SNF setting is consistent and comprehensive care by providers and strong medical director oversight. RPM requires numerous interactive operational and clinical considerations to be effectively implemented in the SNF. To implement RPM, there are two elements required: a monitoring device, such as a blood pressure monitor or blood glucose monitor to capture patient data, and a coordinating technology platform, to record and share patient data with the clinician. 

In long-term care facilities, the growing use of RPM technologies has brought many benefits to both residents and caregivers. The ability for a facility to care for its residents with diabetes and other chronic conditions is a significant step forward for improving patient outcomes (i.e. reducing unnecessary acute transfers to the emergency room), staff satisfaction, better resource management and will help in value based and quality care initiatives. Adding an RPM system to a long-term care facility can quickly add efficiency to even the most well-run programs. 

Remote patient monitoring improves efficiency

On average, long-term care residents are prescribed over 10 different medications and have one or more chronic conditions which increases complexity and challenges in caring for this patient population.  For a condition such as diabetes, blood glucose readings can be ordered by a physician anywhere from once daily to upwards of four or more. This requires caregivers to administer, track and upload readings to an EHR system so the physician can determine the correct medication. This is a time-consuming and manual process, which can lead to inaccuracies. In addition, there are many regulatory and infection control standards that complicate testing blood glucose with a single shared glucose monitor. 

Long-term care facilities are often understaffed and rely on antiquated processes, such as tracking glucose levels via pen and paper — adding to staff stress and inefficiencies. With an RPM system in place, readings are communicated to the doctor through an automated connected device — in real time. This single step unloads a significant burden of paperwork and processing from the caregivers. 

Real-time data improves accuracy 

Another benefit to RPM systems is the ability to communicate patient data in real time with physicians, ensuring the accuracy and immediacy of the information. Manual tracking is not only inefficient, but it leaves room for errors throughout the process — from misreading handwriting to stroking the wrong computer key. Manual tracking also adds lag, which prevents physicians from the most up-to-date picture of the patients’ health. 

Typically, RPM devices use Bluetooth technology to capture and transmit data but this technology has limitations. LTC facilities and physicians are realizing the benefits of newer, cellular-based RPM technologies, which automatically share blood glucose and other physiological data with built-in cellular connectivity.

This means clinicians can monitor patients on an ongoing basis without any of the extra steps — such as downloading apps, data, connecting to a wireless network or to a hub — which are required with Bluetooth devices. With conditions like diabetes, there are variables that change hourly, impacting insulin dosages, making accurate data key to improving resident health.

Remote patient monitoring enhances patient care 

An RPM program can also improve residents’ overall health and safety. For example, physicians can get real-time alerts if a resident has an out-of-range glucose reading and act quickly to help prevent adverse events for hypo and hyperglycemia. In addition, RPM contributes to infection prevention, as it has been shown to decrease the need for in-person physician appointments and emergency room visits.  

The physician can be alerted immediately of an acute abnormality and chronic patterns of sub-optimal clinical control of the chronic condition. For example, a clinician will get real-time alerts and can engage in a telemedicine encounter at any time in order to treat the episode or change in condition. A specialist in endocrinology can also be consulted for a new gold standard of patient care.  With this active feedback loop, patient care is enhanced.  Studies have demonstrated significant reductions of Hemoglobin A1c in diabetic patients whereby RPM has been used in care plans.

Furthermore, RPM provides peace of mind to long-term care residents and their families that they are receiving consistent medical care and monitoring of their chronic condition, regardless of outside factors and environments. Whether because of a public health quarantine, a bad snowstorm, or other factors, residents who use RPM are able to get the same level of care without needing to leave their suite. 

The future of patient monitoring

While still gaining momentum and adoption nationwide, COVID-19 shone a light on why RPM is very helpful to the improved episodic and longitudinal care of patients. As of today, RPM is most commonly used for chronic conditions such as diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease, but the possibilities are much broader. There is an opportunity to use RPM as a mechanism to improve the diagnosis, monitoring, and treatment to reduce the morbidities and costs associated with chronic diseases. As we continue to advance technology across healthcare — we need to take the opportunity to apply these programs in long term care facilities to improve access to care and quality of care at reduced cost to the system. 

Jamison Feramisco, M.D., Ph.D., is a practicing physician with a focus in health and wellness across the continuum of care, including home to hospital to post-acute and back to home. He has worked for years to eliminate healthcare system waste through evidence-based clinical care delivery, deep data analytics, and disruptive and innovative health technology like telemedicine, pharmacogenomics and wearables.