February 2

The rise of remote patient monitoring ? what?s next?

The use of remote monitoring technologies ? innovations that allow symptoms to be managed and care to be provided at distance, outside of traditional hospital settings ? has surged during the past year.


Healthcare providers are increasingly opting for digital ways of working, to protect those at higher risk and enable patients to be supported from home.

Every so often, a game changer comes along. Is the enthusiastic adoption of remote patient monitoring, also known as RMON or RPM, one of those? We decided to find out.

In this feature, we spoke to healthcare teams and suppliers from across the industry and received a number of case studies, which include using symptom trackers, monitoring devices, portals or patient dashboards, and remote consultations. We hear from the South East to the North East and beyond ? highlighting their successes and learnings.


Who does remote monitoring benefit?


The potential benefits of remote monitoring are vast, with healthcare professionals and suppliers breaking new ground. But just for starters, these new technologies are currently being used:


  • - At home for people with long-term conditions
    - For those living in care homes
    - At home for people with COVID-19.


Dr Shanil Mantri, GP and Clinical Digital Advisor to West of England AHSN, recently said: ?With the current challenges of the COVID-19 pandemic, the ability to manage people remotely in care homes has become an essential tool in preventing any potential spread of infection.

?Remote monitoring technologies have the potential to give clinicians ? including GPs, community staff and hospital consultants ? an up-to-date, more complete picture of a resident?s health status, allowing better management and early detection of acute illness. Use of these technologies can also promote more efficient proactive healthcare by directing health resources to the right individuals.?


Potential for patient empowerment


A common theme that?s cropped up during our research for this feature is that patients also understand the benefits of remote monitoring tools. Therefore, the concept of patient empowerment is an understandable angle being pursued by the NHS.

NHSX, which sets policy and best practice in the fields of tech, digital and data, has provided funding and practical support to regional teams across England. The aim is to speed up the adoption of tech-enabled remote monitoring and digital tools, which will enable new pathways of care to support patients at home. This says Tara Donnelly, Chief Digital Officer at NHSX, can allow them to be ?partners in the management of their health condition[s].?

Tara added: ?During the pandemic we?ve seen a rapid shift to remote consultations, but digitally supported care pathways go much further than this. These digital tools can be truly transformative in the care of those with long-term conditions. Enabling people to better understand and effectively self-manage their health condition and share this information with their clinical team in a timely way. Supporting the team to provide swift, timely interventions to help keep them well for as long as possible.?


An overview of remote monitoring projects


Here are, in brief, some ? but by no means all of ? the remote monitoring projects to keep an eye on in England, region by region.


North East and Yorkshire: A scheme which supports patients to monitor their warfarin dose from home and share the results digitally with clinicians, is set to help 1,000 patients over the next six months. Other schemes include using remote monitoring in care homes and for patients with hypertension.


North West: The region is looking to expand its Health Technology (or Telehealth) service. This was introduced to help people with long term conditions monitor their own health, with the support of health professionals.


London: Optimizing triage and allocating appointments to those with the greatest need and demonstrating how remotely recorded vital signs help in identifying deteriorating patients.


South East: Expanding support for patients diagnosed with COVID-19 who do not need to be cared for in hospital, through remote monitoring at home in a ?virtual ward?. The project is set to expand from covering a population of 450,000 to a population of 1.1m by March 2021.


South West: Plans to expand the use of clinical communication tools and increase the take-up of remote monitoring in care homes and in the care of people with learning disabilities.


Case studies ? successes, challenges and solutions


We could talk about the potential of remote monitoring all day. It?s a fascinating subject and the opportunities seem almost endless. But what about real-world examples and impact on every day lives? We?ve compiled a few case studies below, provided by healthcare teams across England, to illustrate the types of technologies already being used?


Heart and lung disease patients at Norfolk Community Health and Care Trust


Norfolk Community Health and Care Trust introduced a new remote-monitoring service for patients living with heart and lung disease. The focus of the service is for patients to self-manage their health by providing a monitoring device which displays readings for weight, blood pressure, oxygen saturation and pulse. Patients receive an automated phone call at 11am each day to provide the aforementioned readings.

The service also provides fast access to a heart failure nurse and consultant. And it has reported a reduction in A&E admissions and bed days among a group of ?high-dependency? patients.

One such patient, aged 83, stated that the service, ?provides great peace of mind?.


Care home residents in South Tyneside and Sunderland


Prior to the pandemic, South Tyneside and Sunderland were already adopting digital technology to improve the monitoring of care home residents to identify early signs of deterioration and communicate observations across organizations.

The Trust states that ?the local deployment of remote monitoring technology has been integrated within clinical practice. In particular, it has been aligned with tools such as the National Early Warning Signs score to detect and respond to clinical deterioration and ?Is my resident unwell??, a checklist which helps care home staff to pass on concerns to other healthcare professionals.?

RPM technology has allowed care home staff to measure vital signs, take photos, and record assessments which can then be shared between clinicians.

The Trust focused on avoiding face-to-face contact with residents as much as possible during the pandemic with RPM being crucial in this. A three-week period at the start of the pandemic saw training being rolled out for staff in a dozen care homes on the use of RPM equipment.

The changes to South Tyneside and Sunderland?s approach to the care of residents through the use of RPM will stay in place post-pandemic and has shown ?the potential to help avoid non-elective admissions, lower A&E attendance, and improve patient outcomes and satisfaction.? The Trust has also stated that the pandemic has ?prompted the exploration of additional features with the existing technology? such as the sharing of images and virtual contact.


INR digital monitoring in Darlington and Durham


The remote testing of the INR?(international normalized ratio)?service was set up at Durham and Darlington NHS Foundation Trust in? 2014 ?and has supported over 2,500 patients taking warfarin and other anticoagulants.

The digital solutions ?enable? INR levels to be remotely monitored. ?This involves reducing? the requirement to attend a GP practice or hospital in person for face-to-face appointments; decreasing the risk of infections but also providing? patients with the assurances that their health care professionals are monitoring their? health and providing the correct treatment.

Take-aways from the testing included:


  • - In an audit of 77 patients by Durham and Darlington, 100% of those on the home INR self-testing service said they?d recommend the service to others.
    - Patients who monitor their own blood levels in this way have better levels of control and spend much longer in the therapeutic range, significantly reducing their chance of a stroke.
    - 70% of patients in the service experienced sustainable clinically significant improvements in their INR management.

COVID Oximetry in the South East


NHS England and NHS Improvement has supplied pulse oximeters to local clinical commissioning groups (CCGs) free of charge, where there is an urgent local need such as increased infection rate of COVID-19.

During the first peak of COVID-19, it was common for patients to present extremely late with silent hypoxia. The new service aims to detect earlier a dangerous drop in oxygen levels and help to provide a faster intervention.

Hampshire Hospitals, with a population of around 600,000 people, wanted to embed a remote monitoring service that would empower patients to recognize COVID-19 symptoms and when to call for help. It implemented remote oximetry in community care based upon the ?virtual ward? concept where patients are:


  • - triaged and have either a face-to-face or virtual assessment
    - classified based on oxygen levels, NEWS2 scores, symptoms and age/comorbidities as Red (high risk), Amber (medium risk) and Green (low risk).


Patients with different levels in severity of symptoms were considered for different levels of care and, if accepted to the ?virtual ward?, used pulse oximetry monitoring three times a day to enable the clinical team to track their vital signs.

Matt Inada-Kim, Consultant Acute Physician at Hampshire Hospital, said: ?We are learning more and more about COVID-19 from our patients as time goes on. It is vital that we turn this learning into pathway redesign across all care settings to optimize outcomes.?

Challenges included ensuring people?s voices were ?heard? when discussing treatment, supporting patients with language barriers and arranging a staffed single phone point of access for patients who deteriorated.

Results collected by Hampshire Hospitals and the Isle of White support the emerging evidence base that shows oxygen saturation can be a predictor of mortality and deterioration. They also found:


  • - Reduction of suspected COVID-19 Emergency Department (ED) mortality rates
    - >35% reduction ED attendances
    - >20% reduction hospital admission from care homes
    - Reduction ED attendances from assessment centers.


Feedback was that patients particularly liked being able to speak to the same person each time, enabling relationships to be built. While learnings included the need to form a specific team to lead with strong clinical leadership, develop a standardised template for data entry and capture, not to ignore COVID-19 negative patients, to be prepared to give strong nursing support and also to ascertain patients? day zero.


Supporting vulnerable residents in the South West


In the South West region, there are plans for entire health and care system to make best use of available technologies to support vulnerable residents during the winter months. This includes residents in care homes, those who live with frailty, and people with learning disabilities.

Some of the main strands are:


  • - Improving remote monitoring of residents ? helping care homes to communicate and share information about patients more easily with other care providers, such as GPs, hospitals and pharmacists.
    - ?Virtual ward? approaches with care homes, using video consultation, pulse oximetry, blood pressure, temperature and RESTORE2 technologies and tools.


Also in the South West, in Dorset 4,000 Pulse Oximeter devices have been made available for patients, who are asked to monitor themselves through a finger reading three times a day. The readings are sent by SMS or directly over the phone with the Dorset Healthcare team.

These are services run out of primary, community or hospital settings, where people with COVID-19 are given a device to measure their blood oxygen levels (a pulse oximeter) teamed with an app on their smartphone. This enables them to track their symptoms and share their results with the clinical team.

The first sites using these models found patients ?hugely appreciated? seeing their results had been reviewed. They also reportedly found it reassuring that if they wanted to contact a clinician, they could do so easily via a video or phone call within the app. Clinicians found the dashboards helpful in giving them ongoing information about progress and rapid information on any deterioration, so they could focus on those patients that most needed their input.

Simon Longman, Dorset Integrated Care System and Dorset CCG, said: ?Remote monitoring can help reduce admissions to local emergency departments, means patients can be discharged faster, and people?s medicine needs are reduced, but also immediately accessible where required. These are great outcomes for patients as they don?t need to be in hospital and can stay in their own homes, which we know is better for recovery. It also means fewer GP appointments are needed, freeing up valuable doctor time for other patients and means fewer trips for often vulnerable patients who live with frailty.?

Plans to provide improved remote and digital support for people with learning disabilities, aims to reduce health inequalities, will include helping people manage their long-term conditions and track potential COVID-19 symptoms and using tools to increase the uptake of annual health checks.


This article was originally published by Health Tech Newspaper


Tags

remote patient care, Remote Patient Monitoring, telehealth


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