A Cross-Disciplinary Analysis of the Complexities of Scaling Up eHealth Innovation.

BackgroundThe co-design of health technology enables patient-centeredness and can help reduce barriers to technology use.ObjectiveThe study objectives were to identify what remote patient monitoring (RPM) technology has been co-designed for inpatients and how effective it is, to identify and describe the co-design approaches used to develop RPM technologies and in which contexts they emerge, and to identify and describe barriers and facilitators of the co-design process.MethodsWe conducted a systematic review of co-designed RPM technologies for inpatients or for the immediate postdischarge period and assessed (1) their effectiveness in improving health outcomes, (2) the co-design approaches used, and (3) barriers and facilitators to the co-design process. Eligible records included those involving stakeholders co-designing RPM technology for use in the inpatient setting or during the immediate postdischarge period. Searches were limited to the English language within the last 10 years. We searched MEDLINE, Embase, CINAHL, PsycInfo, and Science Citation Index (Web of Science) in April 2023. We used the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies and qualitative research. Findings are presented narratively.ResultsWe screened 3334 reports, and 17 projects met the eligibility criteria. Interventions were designed for pre- and postsurgical monitoring (n=6), intensive care monitoring (n=2), posttransplant monitoring (n=3), rehabilitation (n=4), acute inpatients (n=1), and postpartum care (n=1). No projects evaluated the efficacy of their co-designed RPM technology. Three pilot studies reported clinical outcomes; their risk of bias was low to moderate. Pilot evaluations (11/17) also focused on nonclinical outcomes such as usability, usefulness, feasibility, and satisfaction. Common co-design approaches included needs assessment or ideation (16/17), prototyping (15/17), and pilot testing (11/17). The most commonly reported challenge to the co-design process was the generalizability of findings, closely followed by time and resource constraints and participant bias. Stakeholders’ perceived value was the most frequently reported enabler of co-design. Other enablers included continued stakeholder engagement and methodological factors (ie, the use of flexible mixed method approaches and prototyping).ConclusionsCo-design methods can help enhance interventions’ relevance, usability, and adoption. While included studies measured usability, satisfaction, and acceptability—critical factors for successful implementation and uptake—we could not determine the clinical effectiveness of co-designed RPM technologies. A stronger commitment to clinical evaluation is needed. Studies’ use of diverse co-design approaches can foster stakeholder inclusivity, but greater standardization in co-design terminology is needed to improve the quality and consistency of co-design research.

Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians' diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking. In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of "early adopter" clinicians and patients. Using a multimethod qualitative approach, we conducted (1) interviews with 13 clinicians across 9 specialties considered as early adopters and supporters of RPM and (2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient representatives, to better understand experiences, preferences, and expectations of pragmatic RPM use for health care delivery. We identified themes relevant to RPM implementation within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventive monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas. This study highlights the unique contexts, perceptions, and challenges regarding the deployment of RPM in clinical practice, including its potential implications for clinical workflows and work experiences. Based on these findings, we offer implementation and design recommendations for health systems interested in deploying RPM-enabled health care.

It is important for healthcare organizations to understand the requirements and challenges of logistics when deploying remote patient monitoring (RPM) technologies in patient homes. Although most organizations prepare thoroughly for the clinical and work flow aspect of RPM solutions, they neglect to consider the logistical resources necessary to successfully manage a broad deployment. The term "logistics" in this context refers to the processes and infrastructure required to enable the use of RPM technologies in the patient's home. This article has been generated from the findings and observations of several studies where logistical objectives were included in the protocol in addition to the conventional metrics of clinical outcome, satisfaction, and economic measures. These studies implemented several high-speed Internet connectivity models with the use of wired broadband, 3G wireless, or a combination. The organizations that utilized 3G to provide Internet connectivity experienced significantly fewer logistical issues and patient frustration. It was also observed that regardless of the model, each of the clinical partners in these studies were not adequately prepared to manage Internet connectivity. Because of this, all experienced some level of difficulty installing and supporting RPM devices in the home.

Background— Current guidelines recommend using remote patient monitoring (RPM) for implantable cardioverter-defibrillators, but the patterns of adoption of this technology have not been described. Successful use of RPM depends on (1) the enrollment of the patient into an RPM system and (2) subsequent activation of RPM by the enrolled patient. We examined RPM enrollment and activation rates and the patient, physician, and institutional determinants of RPM use. Methods and Results— Information about the use of RPM-capable devices was obtained from the Boston Scientific Corporation ALTITUDE program and linked to the National Cardiovascular Data Registry ICD Registry. Patients were first categorized as RPM-enrolled and RPM-not enrolled, and the RPM-enrolled patients were further categorized into RPM-active and RPM-inactive groups based on whether they transmitted RPM data. Variables associated with RPM enrollment and activation were identified with the use of multivariable logistic regression. Among 39 158 patients with newly implanted RPM-capable devices, 62% (n=24 113) were RPM-enrolled. Of those enrolled, 76% (n=18 289, or 47% of the entire cohort) activated their device. RPM enrollment was highly variable among institutions. The hospital-specific median odds ratio for RPM enrollment was 3.43, signifying that physician or institutional factors are associated with RPM enrollment. In contrast, the hospital-specific median odds ratio for RPM activation was 1.69. Age, race, health insurance, geographic location, and health-related factors were similarly associated with both RPM enrollment and activation. Conclusions— RPM technology is used in less than half of eligible patients. Lack of enrollment into RPM systems is the major cause of underutilization, and this primarily relates to the local practice environment.

1582 Background: While the benefits and acceptability of remote patient monitoring (RPM) during cancer care are well documented, barriers to implementation and use of these digital technologies remain. Feasibility may be particularly restricted in rural settings. The Association of Community Cancer Centers (ACCC) surveyed U.S. cancer programs, patients with cancer and caregivers in various geographic settings to illuminate the current practice landscape and perceptions regarding the use of digital technologies to monitor patients for adverse events and collect patient reported outcomes (PROs). Methods: ACCC convened an expert advisory committee and patient advocacy partners to guide development of two surveys, one for cancer program staff and the other for patients/caregivers. Surveys were distributed between December 2022 and January 2023 and included 25 closed and open-ended questions. Exploratory analysis was performed and responses were compared between rural, suburban, and urban settings for both groups, with comparisons made by two tailed Fisher’s exact test. Results: There were 128 cancer program staff and 162 patient/caregiver responses. Of staff respondents (52% physicians, 20% other clinicians, 21% administrators/managers), 58% work in urban, 30% suburban, and 13% rural settings. Of the patient/caregiver respondents (56% patients, 44% caregivers), 28% live in urban, 51% suburban, and 21% rural areas. 56% of rural, 24% of urban, and 26% of suburban respondents indicated that their cancer programs have not implemented and are not considering implementing RPM. Of rural program staff, 44% indicated they have no experience/familiarity with RPM, compared to 7% for urban and 13% for suburban staff (p<.001, p=.03, respectively). Fewer rural programs, as compared to urban, use secure text messaging (6% vs. 42%; p=.008) or automated phone surveys (6% vs. 34%; p=.03). More rural patients/caregivers compared to their urban/suburban counterparts indicated concerns about privacy (47% vs 27%; p=.02), concerns about the need to pay (44% vs. 19%; p=.004), and lack of strong cell service (5% vs 21%; p=.007) as barriers to RPM technology use. Conclusions: RPM is gaining momentum in academic and community cancer program settings; however, significant gaps exist in RPM experience and implementation for rural cancer programs. In addition to well-documented disparities in access to internet and cellular service for rural patients, perceptions about privacy and cost pose additional barriers. Secure text messaging and automated surveys are often used as example solutions to bridge digital literacy and access gaps, yet cancer programs in rural areas are less likely to use these technologies. Tailored patient/provider education, funding/reimbursement strategies, and advocacy for policies expanding technology infrastructure may be needed for cancer programs to equitably provide RPM technologies.

Minimizing patient falls and fall-related injuries within organizational constraints is a high priority for nurse leaders. The Centers for Medicare & Medicaid Services do not reimburse hospitals for fall-related expenditures. In-person sitters are used to prevent falls but are resource intensive and costly. Remote patient monitoring (RPM) may offer alternatives to in-person sitters to reduce fall-related harm. The efficacy of RPM to reduce patient falls and fall-related injuries was explored. Electronic health record data were extracted from a 13-hospital integrated health care system. Incidence rate ratios were used to analyze the impact of RPM technology on falls and fall-related injuries. When used in conjunction with standard fall precautions, RPM reduced falls 33.7% and fall-related injuries 47.4%. Fall-related expenditures decreased $304 400 with a combined estimated savings systemwide of $2 089 600 annually. RPM technology minimized falls and associated harm and improved patient safety, positively impacting hospital expenditures.

Remote Patient Monitoring (RPM) is a rapidly growing healthcare technology that enables healthcare providers to remotely monitor and manage patients' health outside of traditional healthcare settings. This paper explores the value of RPM, including its potential to improve patient outcomes and reduce healthcare costs, and provides an overview of the RPM market, including market size, growth trends, and business models. The paper also discusses the challenges and opportunities facing the RPM industry, including regulatory and reimbursement issues, privacy and security concerns, and the need for robust evidence of the effectiveness of RPM technologies. The potential for effective RPM has been accelerated as a result of new technologies. We also examine these technologies and their impact to RPM. The paper concludes by highlighting the key drivers of RPM adoption and the future outlook for the RPM market, including the impact of COVID-19 and the growth of digital health more broadly. By providing a comprehensive overview of the RPM market and its business model, this paper will be of interest to healthcare providers, investors, policymakers, and other stakeholders interested in the growth and development of the RPM industry.

Remote Monitoring of Patients With Heart Failure: A White Paper From the Heart Failure Society of America Scientific Statements Committee

.Significance: The COVID-19 pandemic is changing the landscape of healthcare delivery in many countries, with a new shift toward remote patient monitoring (RPM).Aim: The goal of this perspective is to highlight the existing and future role of wearable and RPM optical technologies in an increasingly at-home healthcare and research environment.Approach: First, the specific changes occurring during the COVID-19 pandemic in healthcare delivery, regulations, and technological innovations related to RPM technologies are reviewed. Then, a review of the current state and potential future impact of optical physiological monitoring in portable and wearable formats is outlined.Results: New efforts from academia, industry, and regulatory agencies are advancing and encouraging at-home, portable, and wearable physiological monitors as a growing part of healthcare delivery. It is hoped that these shifts will assist with disease diagnosis, treatment, management, recovery, and rehabilitation with minimal in-person contact. Some of these trends are likely to persist for years to come. Optical technologies already account for a large portion of RPM platforms, with a good potential for future growth.Conclusions: The biomedical optics community has a potentially large role to play in developing, testing, and commercializing new wearable and RPM technologies to meet the changing healthcare and research landscape in the COVID-19 era and beyond.

BackgroundCommunity health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic.ObjectiveThe aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic.MethodsThis retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC’s implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record–extracted health outcomes data and semistructured interviews with the CHC’s staff and patients participating in the RPM program.ResultsThe CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology.ConclusionsWhile RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance.

Increasingly, healthcare delivery organizations (HDOs) are relying on telehealth and remote patient monitoring (RPM) capabilities to treat patients at home. RPM is convenient and cost-effective, and its adoption rate has increased. However, without adequate privacy and cybersecurity measures, unauthorized individuals may expose sensitive data or disrupt patient monitoring services. RPM solutions engage multiple actors as participants in patients' clinical care. These actors include HDOs, telehealth platform providers, and the patients themselves. Each participant uses, manages, and maintains different technology components within an interconnected ecosystem, and each is responsible for safeguarding their piece against unique threats and risks associated with RPM technologies. This practice guide assumes that the HDO engages with a telehealth platform provider that is a separate entity from the HDO and patient. The telehealth platform provider manages a distinct infrastructure, applications, and set of services. The telehealth platform provider coordinates with the HDO to provision, configure, and deploy the RPM components to the patient home and assures secure communication between the patient and clinician. The NCCoE analyzed risk factors regarding an RPM ecosystem by using risk assessment based on the NIST Risk Management Framework. The NCCoE also leveraged the NIST Cybersecurity Framework, NIST Privacy Framework, and other relevant standards to identify measures to safeguard the ecosystem. In collaboration with healthcare, technology, and telehealth partners, the NCCoE built an RPM ecosystem in a laboratory environment to explore methods to improve the cybersecurity of an RPM. Technology solutions alone may not be sufficient to maintain privacy and security controls on external environments. This practice guide notes the application of people, process, and technology as necessary to implement a holistic risk mitigation strategy. This practice guide's capabilities include helping organizations assure the confidentiality, integrity, and availability of an RPM solution, enhancing patient privacy, and limiting HDO risk when implementing an RPM solution.

Background: Digital health tools to bridge gaps in managing infectious pandemics was a proposition grounded until recently more in the hypothetical than in reality. The last two years have exposed the extraordinary global need for robust digital solutions. Objective: The objective of this study was to determine the ability of remote patient monitoring (RPM) during the COVID-19 pandemic to improve clinical outcomes and assure continuity of care in patients with asthma. Methods and Findings: Design: The intervention combined health coaching telephone calls and remote telemonitoring. Participants: 102 patients with asthma were enrolled in a telemonitoring protocol at the beginning of the COVID-19 pandemic in the United States. Setting: A private, university affiliated, outpatient clinical adult and pediatric allergy/immunology and pulmonary practice. Intervention: Patients were enrolled with the primary rationale of maintaining continuity of care in the face of uncertain clinical care options. Enrollment and data collection proceeded in a fashion to allow detailed retrospective analysis. Telemonitoring included a pulse oximeter linked to a smart phone using the software platform Plan-it Med (PIM)®. A healthcare professional monitored data daily, and patients were contacted by providers due to vital sign abnormalities and treatment plan alterations. Patients were encouraged to remain on the platform daily during the first three months of the pandemic. After respiratory and or clinical stability was achieved and clinic visit opportunities were resumed, patients were encouraged to maintain engagement with the platform but were not expected to use the platform daily. Main Outcome measures: Asthma Control Test (ACT) scores were recorded before and after 6 months. Paired Wilcoxon signed-rank tests (dependent groups, before vs. after) and Wilcoxon rank-sum (Mann-Whitney) tests were performed for unpaired results (independent groups, RPM vs. Control). Results: 19 of 102 patients had physiological abnormalities detected (18.6%). Eight of these 19 patients had actionable changes in prescription regimens based on RPM findings (42.1%). In patients utilizing RPM, there was a reported decrease in shortness of breath episodes and a decreased need for rescue inhalers/nebulizer medications (P=0.005). Daily engagement in the first three months of the protocol was 61%. In a subset analysis, 48 study participants (47.1%) chose to continue to actively use the program for at least 14 months. 54 RPM patients were 99.1% compliant with RPM after 110 patient months. Of the patients that chose to discontinue the RPM program the reasons included: (1) symptom alleviation (41.7%); (2) out-of-pocket costs to patients (38.9%), and (3) difficulty using the RPM program (16.7%). Conclusions: A novel RPM technology positively impacted continuity of care, asthma outcomes, quality of life, and self-care.

e13806 Background: Immune checkpoint inhibitor therapy-related (ICI) pneumonitis poses a significant challenge for patients with cancer. It is associated with increased clinical morbidity and mortality, often resulting in prolonged hospital stays and delays and/or discontinuation of cancer-directed treatment. Early detection and prompt treatment of ICI pneumonitis is critical to improve patient outcomes. Therefore, our institution implemented a remote patient monitoring (RPM) program leveraging in-home, electronic health record-integrated technology and virtual centralized nursing to monitor vital signs and patient symptoms in “high-risk” patients treated with immunotherapy. Methods: Patients receiving immunotherapy deemed to be “high-risk” for ICI pneumonitis seen at Mayo Clinic Rochester, Minnesota were offered enrollment in the RPM program beginning in June 2023. High-risk patients included those with pre-existing lung disease (chronic obstructive pulmonary disease, interstitial lung disease); those with a history of resolved ICI pneumonitis being rechallenged with immunotherapy; and those with grade 1 ICI pneumonitis continuing immunotherapy. Eligible patients who agreed to participate in the program were provided a kit consisting of RPM technology and electronic symptom questionnaires. The kit included an armband for continuous vital sign monitoring, a blood pressure monitor, a scale to measure weight, and a pre-connected cellular-enabled tablet for questionnaire answering. RPM data utilized real-time electronic health system integration and predetermined parameters to alert RPM nurses. Pre-specified escalation care pathways were then used to respond and escalate care, as necessary. The primary outcome of this pilot study was to assess the feasibility of implementing an RPM program in this patient population with a secondary outcome to determine the ability to detect ICI pneumonitis before significant clinical symptoms. Results: Sixteen patients were enrolled of whom 5 declined participation (2 due to inconvenience and 3 for unclear reasons) resulting in 11 patients who underwent monitoring. Five patients graduated monitoring without detection of ICI pneumonitis within a 4-month timeframe. Six patients are currently undergoing RPM. 372 alerts occurred of which 8 (2%) were escalated to physician review. These alerts included elevated heart rate in 4, shortness of breath in 3, and elevated blood pressure in 1. One patient was triaged to an emergency department and diagnosed with grade 2 ICI pneumonitis. Conclusions: We show that RPM in patients who are at high-risk for developing ICI pneumonitis can be effectively integrated into a care model and monitor pneumonitis related symptoms. Further studies are needed to prove whether RPM is beneficial in this population including other ICI toxicities.

Remote Patient Monitoring (RPM) has evolved into an influential modality within the field of dermatology, aiding in both treatment compliance engagement and early detection of skin cancer. RPM technologies have emerged as a critical modality in these efforts, including artificial intelligence (AI) and machine learning (ML), and smartphone applications for skin monitoring, screening, and treatment of melanoma. This chapter explores the importance of RPM in treatment compliance and engagement and how effectively aligned patient engagement strategies contribute to adherence monitoring with a compliant clinical treatment regimen. Teledermoscopy is among the most important fields of RPM, and it allows the diagnosis and monitoring of skin lesions remotely through a smartphone with an accuracy equivalent to that of conventional visits. This highlights the significance of early detection of skin cancer, portraying how RPM can help in making timely interventions that lead to better patient outcomes. The most prominent benefits of RPM for skin cancer patients are increased communication between patients and providers, more access to specialized dermatological care, and overall improved satisfaction with the treatment process. The chapter identifies challenges and limitations as well, including technology obstacles, difficulties in data integration, patient privacy issues, and the necessity for enhancing patients' digital health literacy. The chapter concludes by contemplating the future of RPM for skin cancer monitoring, including new imaging technology trends, potential expansion into preventive dermatology, and policy/regulatory challenges that must be addressed to facilitate broader adoption of RPM. This chapter identifies these elements to guide an understanding of how RPM can assist treatment adherence and early detection of skin cancer.

Chronic diseases such as diabetes, hypertension, heart disease, and chronic obstructive pulmonary disease (COPD) are prevalent worldwide, demanding innovative solutions for efficient management. Managing chronic diseases typically requires continuous monitoring, medication adjustments, and frequent visits to healthcare providers. Traditional in-person care, however, can be burdensome for both patients and healthcare systems. Telemedicine and remote patient monitoring (RPM) have revolutionized healthcare by offering patients the ability to receive continuous, personalized care outside of traditional clinical settings. Artificial Intelligence (AI) has emerged as a key technology, enhancing telemedicine and RPM in chronic disease management. The integration of AI into these technologies holds promise for enhancing disease management by offering real-time analytics, predictive capabilities, and personalized interventions. This systematic review seeks to provide an in-depth examination of the role of AI in telemedicine and RPM for chronic disease management, exploring its potential, challenges, and implications for future healthcare delivery. This paper presents a systematic review of the role of AI in telemedicine and RPM for chronic disease management, providing insights into its benefits, challenges, and future trends.