Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings (e.g.in the home),which may increase access to care and decrease healthcare delivery costs.

Incorporating RPM in chronic disease management can significantly improve an individual’s quality of life.It allows patients to maintain independence,prevent complications,and minimize personal costs.RPM facilitates these goals by delivering care right to the home.In addition,patients and their family members feel comfort knowing that they are being monitored and will be supported if a problem arises.This is particularly important when patients are managing complex self-care processes such as home hemodialysis.Key features of RPM,like remote monitoring and trend analysis of physiological parameters,enable early detection of deterioration;thereby,reducing number of emergency department visits,hospitalizations,and duration of hospital stays.The need for wireless mobility in healthcare facilitates the adoption of RPM both in community and institutional settings.The time saved as a result of RPM implementation increases efficiency,and allows healthcare providers to allocate more time to remotely educate and communicate with patients.



Applications
Physiological data such as blood pressure and subjective patient data are collected by sensors on peripheral devices.Examples of peripheral devices are: blood pressure cuff,pulse oximeter,and glucometer.The data are transmitted to healthcare providers or third parties via wireless telecommunication devices.The data are evaluated for potential problems by a healthcare professional or via a clinical decision support algorithm,and patient,caregivers,and health providers are immediately alerted if a problem is detected.As a result,timely intervention ensures positive patient outcomes.The newer applications also provide education,test and medication reminder alerts,and a means of communication between the patient and the provider.The following section illustrates examples of RPM applications,but RPM is not limited to those disease states.

Dementia and falls
For patients with dementia that are at risk for falls,RPM technology promotes safety and prevents harm through continuous surveillance.RPM sensors can be affixed to the individual or their assistive mobility devices such as canes and walkers.The sensors monitor an individual’s location,gait,linear acceleration and angular velocity,and utilize a mathematical algorithm to predict the likelihood for falls,detect movement changes,and alert caregivers if the individual has fallen.Furthermore,tracking capabilities via Wi-Fi,global positioning system (GPS) or radio frequency enables caregivers to locate wandering elders.

Diabetes
Diabetes management requires control of multiple parameters: blood pressure,weight,and blood glucose.The real-time delivery of blood glucose and blood pressure readings enables immediate alerts for patient and healthcare providers to intervene when needed.There is evidence to show that daily diabetes management involving RPM is just as effective as usual clinic visit every 3 months.

Congestive heart failure
A systematic review of the literature on home monitoring for heart failure patients indicates that RPM improves quality of life,improves patient-provider relationships,shortens duration of stay in hospitals,decreases mortality rate,and reduces costs to the healthcare system.

Infertility
A recent study of a remote patient monitoring solution for infertility demonstrated that for appropriately screened patients who had been seeking In-Vitro Fertilization (IVF) treatment,a six-month remote monitoring program had the same pregnancy rate as a cycle of IVF.[9] The remote patient monitoring product and service used had a cost-per-patient of $800,compared to the average cost of a cycle of IVF of $15,000,suggesting a 95% reduction in the cost of care for the same outcome.

Early adopter: Veterans Health Administration
The Veterans Health Administration (VHA),United States’largest integrated healthcare system,is highly involved in the implementation and evaluation of RPM technologies.It has expanded use of RPM beyond common chronic disease applications,to post-traumatic stress disorder,cancer and palliative care.VHA’s findings indicate improvements in a wide range of metrics,including decrease in emergency department visits,hospitalizations,and nursing home admissions.Findings from the VHA Care Coordination/Home Telehealth program show that RPM deployment resulted in significant savings to the organization.

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