The future of remote patient monitoring? Not too distant, health industry leaders say.
Once reserved for the nation’s largest healthcare systems, industry leaders expect remote patient monitoring will enter mainstream practices in ever-growing numbers in the coming years. But certain barriers to entry, they say, mean the technology may not be right for every health practitioner—yet.
Early adopters—many of them academic or otherwise well-funded health systems—have been experimenting with remote patient monitoring for the better part of a decade. But the cost of the technology, coupled with regulatory questions and an absence of readily available data on the efficacy of the devices, has prevented many smaller clinics from incorporating remote monitoring into their practice.
This may soon change. Even as a growing body of evidence emerges from the nation’s universities, the Centers for Medicare and Medicaid has announced plans to begin reimbursing doctors’ use of remote monitoring devices in 2020, and an expansion of the Federal Communications Commission’s Rural Health Care Program may be waiting in the wings. Taken together, this convergence of events could radically change physicians’ ability to integrate remote monitoring into their practice, according to David Gordon, director of the Karen S. Rheuban Center for Telehealth at the University of Virginia Health System.
“We are at an inflection point with this technology,” he said. “I can’t state how important the alignment of clinical evidence is, with federal policy and Medicare and Medicaid—when they decided to start paying for this, that changes everything.”
It’s difficult to say for sure just how many healthcare practitioners have already begun to use remote patient monitoring. A December 2017 survey by the Center for Connected Medicine found that less than half of the nation’s 35 largest health systems—systems with an average net revenue of $4.9 billion per year—reported having been reimbursed for remote monitoring in 2017. In some systems, according to the report, the lack of reimbursement had not hindered the introduction or growth of monitoring-related pilot programs. But for many, the survey found the lack of reimbursement limited even these health systems’ ability to invest in the new technology.
Yet all surveyed health executives said they believed their systems would offer remote monitoring services in the future. The question, according to the report, was timeframe—whether it would be 3-5, or 5-10 years before the industry sees widespread adoption of monitoring technologies.
That fits with what Brian Wayling, executive director of technology and development at Utah-based Intermountain Healthcare, said he’s seeing on the ground, though he leans toward the shorter end of the spectrum.
“The momentum and scale” at which remote monitoring will be adopted in the next five years, Wayling predicted, “will fundamentally change how we engage with patients.”
With 22 hospitals and 1,500 providers of its own, Intermountain is the largest health system in the Intermountain West. But Intermountain isn’t quite as far along with its own monitoring programs as the University of Virginia.
While the Virginia healthcare system has already deployed multiple monitoring-based programs among its patients, Intermountain plans to implement its first system-wide monitoring initiatives in 2020 following successful pilot programs that ended in 2018.
The fact that this corresponds with the timeline for CMS reimbursement is coincidental, Wayling said—but he expects that many other health systems will begin to follow suit in light of the announcement.
As other barriers to entry are removed—such as access to reliable broadband, the revolution that started in academic institutions such as his own will eventually spread to more moderately-sized hospitals, and eventually to individual, even rural clinics, Gordon predicted.
That doesn’t mean that remote patient monitoring is the right solution for every patient, or even every doctor, Gordon said. A review published in January 2018 in Digital Medicine found that, overall, the data on whether remote patient monitoring results in improved patient outcomes remains sparse. That means that doctors will still need to conduct pilot programs of their own to determine how remote patient monitoring will work within their unique circumstances.
“We’re still at that moment where people need to be able to put their foot in the digital stream,” he said. “You’ve got to really look at the new tools that are available to you, and make that decision if it’s right for your practice, all the while knowing that … we are undergoing a remarkable transformation.”
In their experience, Wayling said, access to remote monitoring technology changes the way medical teams work together, so they’ve had to establish new protocols about who will contact the patient, and when. Determining how patients prefer to engage in the absence of traditional in-office visits has also required some thought.
“I and lots of other people are wrapped up in technology,” Wayling said. “But for some people, that’s still something new. It’s not something they engage with, and having that capability there is equally important. That’s been a real lesson.”
At the end of the day, Wayling said, Intermountain simply wants to get their implementation of the technology right the first time. “Measure twice, cut once,” he said.
Emma Penrod – Pactio
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