Advice for Physicians Navigating from an In-Person to a Virtual Practice Part 3: Remote Monitoring
The COVID-19 Pandemic has dramatically accelerated the use of telehealth and telemedicine. Changes in regulations to reimburse telemedicine visits the same as in-person visits, to allow telemedicine visits across state lines, and to allow physicians to prescribe medications via telemedicine visits have encouraged physicians to consider a partial or complete transition from an in-person to a virtual type of practice. In Parts 1 and 2 of this series, we examined the various types of telemedicine platforms available, how to conduct a virtual patient encounter, how to obtain informed consent and medical record keeping as well as reimbursement issues, and how to ensure patient privacy and confidentiality. In this article, we shall consider the role of remote monitoring devices as a component of any full-service telemedicine practice.
Two general types of monitoring devices are available. One example is those that patients themselves can use, such as blood pressure cuffs, pulse oximeters, thermometers, and blood sugar meters for intermittent monitoring.
The other types are remote monitoring devices that patients wear and that continually monitor patient parameters and send the data to the physician. A 2017 article provided an extensive review of wearable sensors for remote health monitoring.
For wearable remote monitoring devices to provide long-term usefulness, they need to satisfy specific ergonomic and medical requirements. For example, the system needs to be comfortable; the components should be flexible, small in dimensions, and must be chemically inert and nontoxic, and hypo-allergenic to the human body. Importantly, remote monitoring devices must be inexpensive and user-friendly to ensure their widespread acceptance by patients.
TYPES OF REMOTE MONITORING DEVICES
Wearable sensor-based health monitoring systems include different types of flexible sensors that can be integrated into textile fiber, clothes, and elastic bands or directly attached to the human body. The sensors are capable of measuring physiological signs such as electrocardiogram, electromyogram, heart rate, body temperature, electrodermal activity, arterial oxygen saturation, blood pressure and respiration rate. Also, micro-electro-mechanical systems based miniature motion sensors such as accelerometers, gyroscopes, and magnetic field sensors are widely used for measuring activity related signals such as gait, distance walked or run and sleep patterns. Real-time monitoring of an individual’s motion activities could be useful in fall detection, gait pattern and posture analysis, or sleep assessment.
When considering devices for either intermittent or continuous monitoring, let us not forget the smartphone. A 2019 article is an extensive review of the smartphone as a remote patient monitoring device. The report estimated that by 2021 there would be 3.8 billion smartphones in use worldwide. Smartphones can monitor cardiovascular parameters such as heart rate and heart rate variability, eye health, respiratory and lung health, skin health, daily activity and falls, sleep, ear health, cognitive function, and mental health.
Caution, however, has been recommended when using smartphone Apps for telehealth because many of them were designed and built without input from medical professionals and are not FDA approved, although there are FDA approved smartphone apps for patient monitoring.
Regardless of how they are obtained, the measured and possibly processed physiological data are, eventually, transmitted to the remote healthcare facility or physician over the internet. Therefore, it is also necessary to use a secured communication channel to safeguard the privacy of sensitive personal medical data. Robust encryption techniques, as well as appropriate authorization and authentication algorithms, should be implemented for enhanced data security.
WHAT SYSTEM TO CHOOSE?
In an earlier article, we discussed the difference between commonly used platforms such as Zoom or Facetime for telemedicine versus commercial platforms. One of the advantages of commercial platforms is that such platforms have their own telehealth remote monitoring systems.
THE ILLUMINATE HEALTH REMOTE MONITORING SYSTEM
An excellent telehealth monitoring system is the Illuminate Health System. Their system employs an otoscopic attachment to any smartphone and an additional sensor 1”x 1.5”x1.65 inches. These devices can monitor ear health, single-lead EKG, pulse oxygen level, and body temperature. The system also can act like a stethoscope to listen to heart, lung, and stomach sounds. They also include all of the necessary precautions for safe transmission, recording, and storage of the data obtained.
THE ILLUMINATE HEALTH REMOTE MONITORING SYSTEM
Remote patient monitoring with devices used intermittently or with wearable devices for continuous monitoring is an exciting new arena of healthcare via telemedicine. A 2017 extensive meta-analysis of published studies, however, concluded that “despite its potential, the rapid development of technological capabilities in the healthcare field has outpaced the capacity to implement many novel remote patient monitoring interventions into real-world practice. Hence, scant evidence demonstrating improved health outcomes with noninvasive patient monitoring devices is available, and even fewer studies have demonstrated any cost-benefit.”
In spite of the cautious recommendations, it seems that remote monitoring of physiological parameters will become a mainstay of telehealth and telemedicine in the future.
Ronald Young, M.D.