Year after year, new technology opens avenues for greater convenience, ease and possibility. This is especially so in healthcare environments, where a higher level of digitalization, distancing and efficiency is being demanded every day. Each patient is expecting to receive the utmost quality of care, yet doctors and nurses are struggling more than ever to deliver, as they’re constantly pressured to balance their time and attention between a multitude of patients who may be scattered all over a hospital campus or city. As a result, those charged with optimizing acute care models are looking at just how far remote patient monitoring can go in closing the gap.
So, we have turned once again to Zebra’s top two healthcare experts – Chris Sullivan, Zebra’s global healthcare lead, and Rikki Jennings, Zebra’s Chief Nursing Informatics Officer (CNIO) – to better understand how remote patient monitoring is being used today both in patient homes and hospitals. Learn more about the ways it may reshape the healthcare world as we know it moving forward…
Your Edge Blog Team: We’ve been talking a lot about telehealth lately, and we know through conversations with others that remote patient monitoring may be viewed as a component of telehealth. So, to kick things off, can you paint a better picture of what remote patient monitoring actually is and clarify its relationship with telehealth?
Chris: Most clinicians define remote patient monitoring – sometimes abbreviated to RPM – as the ability to monitor the status of patients located across any distance, whether that be inside or outside a healthcare facility.
During the pandemic, more patients have been given wellness tracking tools like pulse oximeters, blood pressure monitors, and blood glucose monitors to use at home so they could report vitals back to their care teams without having to go into the clinic as frequently for these types of checkups. Some of the devices can trigger alerts when someone’s blood pressure is too high or their medication is no longer keeping cholesterol levels under control, prompting a nurse to check in or a physician to request a video consult with the patient. And there’s a new echo stethoscope that some practitioners are issuing, including one that can intermittently capture heart sounds and get an EKG.
However, many at-home devices aren’t plugged into healthcare information systems, meaning care team members can’t always monitor them in real time. But that’s okay, because patients are now empowered to monitor their own vitals and report into their care teams when something is concerning. They don’t have to wait until their next scheduled appointment or go into the clinic just to have their vitals checked. They can be more proactive in managing their personal health day to day.
Your Edge Blog Team: So, it sounds like RPM tools are giving patients more autonomy, but providers are still relying on the patient to convey health information back to them?
Chris: Exactly. Some care team members may be able to login to a dashboard or app tied to the device to see reported data for the last 30 days, much like you can with your Nest thermostat or Dyson air purifier. And it’s possible the wearable trackers or at-home monitoring devices will one day be able to automatically trigger an intervention if someone is struggling to manage their health or having an acute medical crisis at home. But we’re not quite there yet, at least not on a mass scale. In the meantime, the patient or an at-home caretaker can proactively track device readings and then work closely with doctors and nurses to decipher what they mean in the context of the patient. This is still so beneficial when you consider the alternative. Information is power, and RPM tools are providing far more information about our personal health than we had even a few years ago.
Your Edge Blog Team: It seems like the possibilities of RPM technology are very promising, then, right?
Chris: We still need to iron out accessibility-related concerns specific to at-home patient monitoring practices. The healthcare community must work cooperatively with governments, non-profits and even private sector partners to ensure patients have the proper at-home technology and medical device hardware. They must also ensure patients have stable internet connections so data can be transmitted and they can tap into virtual care as needed. And as information sharing starts to happen automatically, we must be sure patient privacy, security and safety are not compromised. There are a lot of benefits to at-home patient monitoring, though. So, healthcare leaders need to sit down with the various stakeholders to have worthwhile conversations about where this goes long term.
That being said, we are already seeing RPM become part of the new standard of care in hospital settings. That’s where investments are increasing the most right now and the impact of these technologies is looking to be the greatest long term.
Rikki: Chris is right. Much like telehealth, remote patient monitoring has the potential to increase the quality of care for hospital patients, especially given the disparity between the number of patients needing care and the number of doctors and nurses available to provide it. Remote patient monitoring can help healthcare facilities overcome staff shortages, the spread of infectious diseases, and quality of care being impacted by distance between clinicians and patients.
The mobility, visibility and connectivity that comes with the integration of remote patient monitoring solutions help optimize the performance of healthcare workers – regardless of the inflow of patients scattered across a single hospital facility. And acute care nurses and doctors can feel better supported during their hectic schedules knowing they can check in on all their patients from anywhere at any time.
Your Edge Blog Team: COVID-19 has presumably strengthened the case for remote patient monitoring, then?
Rikki: No doubt. But even before the pandemic, healthcare leaders understood that the more inpatient care teams can enlist the help of offsite providers, the more likely they are to provide the right type of intervention at the right time. The nursing workforce has been understaffed for several years, and clinicians can only be in so many places at once. It is impossible for one person to keep an eye on every patient at once. Of course, this issue has been compounded by the influx of COVID-19 patients over the past 18 months. Even if there are enough beds to handle surges, there isn’t enough staff – at least not on site. So, teams of healthcare change agents have been coming up with new ways to expand their workforces. Many are setting up remote monitoring centers where doctors, nurses, EMTs and others who aren’t comfortable or able to be in a hospital setting all day can sit at a desk and watch over patients from a distance. Nemour’s Children’s Hospital is a great example of how remote patient monitoring is taking patient care to a whole new level.
Others are just trying to make it easier for offsite physicians to consult on patient cases remotely, often via telehealth systems, by providing them with real-time information dispatched by a host of smart Internet of Things (IoT) devices connected in patient rooms.
Of course, every possible precaution must be taken to minimize physical staff interactions with infectious patients, especially in hospitals where there are many immunocompromised and vulnerable patients. This is true whether patients have COVID-19 or other highly transmissible and dangerous diseases. In fact, minimizing staff exposures to contagious patients and slowing the spread to others has been one of hospitals’ long-standing challenges. Now, remote patient monitoring technologies, when combined with telehealth solutions, can allow staff to administer some forms of care and/or guidance to patients without physically entering the patient’s space.
Your Edge Blog Team: Are they just hooking up vital monitoring devices in patient rooms and transmitting real-time information to the nurses’ station? Or does it go beyond that?
Chris: There are two fundamental things that hospitals must do to set up and benefit from remote patient monitoring. First, doctors, nurses and even some non-clinical support staff such as pharmacists, lab technicians, porters and facilities managers should be equipped with mobile devices that enable them to stay in touch with one another. This enables them to coordinate patient care actions in real time while on the move. However, these should be healthcare purpose-designed clinical devices that can be disinfected and connect to healthcare information systems and telehealth systems.
Many hospitals that have supported “bring your own device” (BYOD) policies in the past are now changing course. Both hospital administrators and clinicians are concerned about the spread of infectious diseases right now, as they made clear in Zebra’s recent Hospital Vision Study, and workers’ personal devices may not be able to be sanitized to healthcare standards. Plus, they may struggle to safely connect with some of the IoT smart medical devices that are required in order for remote patient monitoring applications to be successful.
Plus, BYOD policies can put undue burden on IT, as they must make sure every device is properly configured and locked down. In clinical environments, mobile devices are being used to access private patient data in electronic health records (EHR). And, if used for telehealth consults with doctors across campus or even across the country, sensitive patient matters will be discussed. Hospital administrators and IT must ensure those mobile devices don’t become points of vulnerability for cybercriminals. Issuing staff hospital-owned devices purpose built for healthcare applications, synced with the right information systems, and loaded with the right features for each user’s role and unique workflows is the best way to do that.
Once staff have the right mobility solutions in hand, then patient rooms can be equipped with IoT devices that allow doctors and nurses outside the room to see what’s happening inside at all times. This might include a blood pressure machine, IV pump and oximeter as well as video monitors that allow someone to visually assess the patient from afar.
From there, you can decide whether you want to take it a step further and employ artificial intelligence (AI) to help monitoring and interventions or simply employ more clinicians in a central monitoring center like Nemours Children’s Health System did.
Your Edge Blog Team: What are the key benefits of hiring nurses, physicians and paramedics to work in a command center?
Chris: The quality of patient care can be improved tremendously because clinicians are watching patients in real time. They can call in the right people to consult on cases, which brings about faster and more accurate clinical resolution. The technology also allows specialists to be leveraged more effectively, as they can see patients without having to actually be on site. A cross-functional group of experts can leverage their collective knowledge and real-time data to solve problems. It’s teamwork at its finest. Plus, it’s much cost-friendlier than “feet on the street” specialist approaches and gives patients access to the best specialists for them.
As a side benefit, it also opens doors for new job opportunities and responsibilities for healthcare professionals who are high risk, nearing retirement, recovering from injury or experiencing burnout. Remote patient monitoring assignments could enable these clinicians to take on virtual preceptor or virtual mentorship roles for a given amount of time. This broadens the scope of healthcare provider involvement and engagement in a multitude of circumstances. For example, they could provide support for EMTs in the field as well as hospital ICU or bedside nursing teams.
Rikki: Command center staff can also manage the flow of patients and clinicians in a way not possible if they were on the ground. They’re kind of like air traffic controllers, but better, as they help hospital staff see how best to care for hundreds or thousands of critical patients in settings only designed to support a few dozen.
Your Edge Blog Team: Would you say that’s the top benefit of remote patient monitoring, in general?
Rikki: I think the biggest advantage of remote patient monitoring is that care teams can see and do more from a distance. This is especially true when you also combine RPM toolsets with telehealth. There are fewer missed alarms, we can better screen those alarms to see if they warrant immediate action, and we don’t have to wait for the assigned nurse or doctor to get to the bedside to help the patient. We can intervene more quickly than if we didn’t have the additional oversight or support resources. Those sitting in the central monitoring center or perhaps even a clinic across campus can take action as soon as they’re alerted to an issue. That may entail dispatching an EMT to check on the patient while the nurse is occupied or notifying the on-call doctor that the patient’s status is changing and requesting a new medication order or lab test. The physician may not need to come in to do those things on every occasion. In fact, being able to consult from a distance makes doctors and specialists more accessible to more patients as Chris previously said.
In fact, many now say they wouldn’t be able to do their jobs effectively without this type of tech in place. It’s enabling them to connect to other clinicians during hectic shifts and see the real-time status of all their patients in the palm of their hands. It’s also allowing them to become more proactive than reactive. Nurses can get alerts when a patient needs another dose of medicine, for example, which helps to reduce mistakes or oversights as they’re bouncing from room to room.
Chris: Clinicians should also be able to spend more time with each patient upon the adoption of this technology, which is the most valuable aspect of care. As Rikki noted, we’ve already started to see the flexibility of clinicians to work from anywhere at any time. Burnout was becoming ubiquitous among healthcare workers even before the COVID-19 pandemic. In fact, chaos in the work environment is the number one cause of burnout among clinicians, followed by a lack of effective teamwork and being inundated with bureaucratic tasks. Integrating remote monitoring and telehealth tools into existing workflows has shown to reduce burnout in acute care environments by reducing the cognitive burden and enabling clinicians to care for all patients collaboratively versus working in a silo.
Your Edge Blog Team: Chris, you mentioned AI earlier. How exactly does that play into remote patient monitoring?
Chris: One of the surgeons on Zebra’s healthcare customer advisory board was telling us how the capstone project for her MBA program in 2018 was focused on AI in healthcare and, specifically, the ways in which it could be used for remote patient monitoring. At the time, there was doubt about the viability of such a solution as it was designed with the assumption that a primary physician is standing at a computer at all times waiting for data to come in, which just doesn't happen. Even in command centers, there isn’t a one-to-one patient to provider ratio, and there isn’t just one data feed for each patient. So, recent innovation and engineering efforts in this space have been really focused on creating a solution that takes the massive amount of data being generated by edge systems, such as mobile devices and remote monitors, and puts it into a format that’s actually accessible and useful to a clinician from both an IT and workflow perspective. Such a technology platform is only beneficial if it allows for real-time alerting and action, and AI can help bridge those digital divides a bit by more prescriptively assigning that action to the best person in real time.
Rikki: Yes, she gave a great example of how, within her own institution and emergency room, they are now setting up alerting systems for sepsis and other things that employ aspects of AI. Although, it was interesting to hear her describe this particular application as being more like “big data crunching” than remote patient monitoring. The AI system essentially collects and analyzes data before sending it to teams that are remotely monitoring patient status on a screen outside the room. But that speaks to Chris’ point in that it can’t just be another data feed. It has to provide actionable intelligence to the person on the receiving end. If they have to stop and figure out what to do with the incoming information, that doesn’t really help them become more efficient or make better decisions.
Your Edge Blog Team: Would you say AI is the key to unlocking more benefits from today’s remote patient monitoring tools? Is that what’s needed for this to be widely adopted as part of the standard, everyday inpatient and outpatient care models?
Chris: AI will certainly have to mature a bit more and become more pervasive before we’ll see remote patient monitoring available and utilized at full scale for outpatient use cases as mentioned before and, perhaps to a certain extent, in hospitals as well. The key is to achieve an effective, operationalized program that allows AI to surveil an at-home or in-patient’s condition accurately and determine if and when physician intervention is needed. Simply put, the physician may not need to be involved in each phase of patient care or even be the one to take care of every patient’s needs. That’s why remote patient care is a great tool with the potential to reinvent typical care administration. It can provide more accessible, practical and beneficial wellness solutions for professionals and patients alike.
Rikki: Remote patient monitoring still has a long road ahead, but we have to start somewhere. And the benefits this technology can bring to acute care settings are going to become a pivotal aspect of caregiving well into the future.
For now, though, remote patient monitoring gives flexibility to the caregiving process, and that holds a lot of weight given the gravity of the pandemic and the level of exhaustion and defeat healthcare providers are feeling right now. Time and space hold no bounds with remote monitoring and telehealth technologies. Patients can have unconditional access to nurses, doctors or specialists, even if they can’t physically be in the room. More patients can be treated at once. Expert advice can be harnessed from wherever. And greater trust can be established between patients and healthcare providers knowing that the care will be safe and timely.
The results of Zebra’s latest Healthcare Vision Study are now available here: