Integrating electronic health records, remote patient monitoring, and digital health: a convergence study

Remote Automated Peritoneal Dialysis Management in Colombia

Backgrounde-Health has played a crucial role during the COVID-19 pandemic in primary health care. e-Health is the cost-effective and secure use of Information and Communication Technologies (ICTs) to support health and health-related fields. Various stakeholders worldwide use ICTs, including individuals, non-profit organizations, health practitioners, and governments. As a result of the COVID-19 pandemic, ICT has improved the quality of healthcare, the exchange of information, training of healthcare professionals and patients, and facilitated the relationship between patients and healthcare providers. This study systematically reviews the literature on ICT-based automatic and remote monitoring methods, as well as different ICT techniques used in the care of COVID-19-infected patients.ObjectiveThe purpose of this systematic literature review is to identify the e-Health methods, associated ICTs, method implementation strategies, information collection techniques, advantages, and disadvantages of remote and automatic patient monitoring and care in COVID-19 pandemic.MethodsThe search included primary studies that were published between January 2020 and June 2022 in scientific and electronic databases, such as EBSCOhost, Scopus, ACM, Nature, SpringerLink, IEEE Xplore, MEDLINE, Google Scholar, JMIR, Web of Science, Science Direct, and PubMed. In this review, the findings from the included publications are presented and elaborated according to the identified research questions. Evidence-based systematic reviews and meta-analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Additionally, we improved the review process using the Rayyan tool and the Scale for the Assessment of Narrative Review Articles (SANRA). Among the eligibility criteria were methodological rigor, conceptual clarity, and useful implementation of ICTs in e-Health for remote and automatic monitoring of COVID-19 patients.ResultsOur initial search identified 664 potential studies; 102 were assessed for eligibility in the pre-final stage and 65 articles were used in the final review with the inclusion and exclusion criteria. The review identified the following eHealth methods—Telemedicine, Mobile Health (mHealth), and Telehealth. The associated ICTs are Wearable Body Sensors, Artificial Intelligence (AI) algorithms, Internet-of-Things, or Internet-of-Medical-Things (IoT or IoMT), Biometric Monitoring Technologies (BioMeTs), and Bluetooth-enabled (BLE) home health monitoring devices. Spatial or positional data, personal and individual health, and wellness data, including vital signs, symptoms, biomedical images and signals, and lifestyle data are examples of information that is managed by ICTs. Different AI and IoT methods have opened new possibilities for automatic and remote patient monitoring with associated advantages and weaknesses. Our findings were represented in a structured manner using a semantic knowledge graph (e.g., ontology model).ConclusionsVarious e-Health methods, related remote monitoring technologies, different approaches, information categories, the adoption of ICT tools for an automatic remote patient monitoring (RPM), advantages and limitations of RMTs in the COVID-19 case are discussed in this review. The use of e-Health during the COVID-19 pandemic illustrates the constraints and possibilities of using ICTs. ICTs are not merely an external tool to achieve definite remote and automatic health monitoring goals; instead, they are embedded in contexts. Therefore, the importance of the mutual design process between ICT and society during the global health crisis has been observed from a social informatics perspective. A global health crisis can be observed as an information crisis (e.g., insufficient information, unreliable information, and inaccessible information); however, this review shows the influence of ICTs on COVID-19 patients' health monitoring and related information collection techniques.

e13688 Background: It is well established that digital health (particularly telehealth) utilization increased in response to the COVID-19 pandemic; however, the extent to which digital health is used in oncology care is unknown. Conceptually, telehealth and other digital health solutions may alleviate some of the emotional, financial, and physical burdens associated with receiving oncology care. The objective of this study was to examine trends in the utilization of digital health (telehealth, remote patient monitoring (RPM), and asynchronous messaging (AM)) among cancer patients and the demographics of those patients relative to digital health and oncology patients writ large. Methods: We used the Trilliant Health national all-payer claims database to analyze digital health interactions for both oncology and non-oncology patients from Jan 2020 - Jun 2022. We defined a digital health visit as any visit with a procedure code for telehealth, RPM, or AM. An oncology care visit (digital or in-person) was defined as any visit with a primary diagnosis of cancer. An oncology digital health visit was defined as a visit with one of the digital health procedure codes coupled with a primary diagnosis of cancer. Results: Digital health represented 3.19% of total oncology care volume, a majority of which was telehealth (3.18%). Among all telehealth visits, 0.9% of visits were for oncology-related care. Additionally, a majority (72.8%) of these oncology-related telehealth visits were for E&M encounters related to ongoing cancer care. By payer type, telehealth visits were more common among commercially insured patients (56.1%) compared to commercially insured patients’ share of all oncology care (39.8%). While overall telehealth utilization is disproportionately female (62.2%), women comprised 51.2% of all oncology care volume and 52.5% of all oncology-related telehealth volume. While the 65+ population accounts for just 19.3% of all telehealth volume, they are responsible for 61.1% of telehealth oncology-related volume–more closely resembling that age group’s 73.5% share of total oncology care volume. Oncology care represented 0.2% and 0.5% of total RPM and AM volume, respectively. Conclusions: Oncology digital health visits remain a very small portion of overall digital health utilization and total oncology care. Prior research found that the share of younger patients seeing oncology providers is increasing over time, signaling worsening patient acuity. Given the demand for digital health overall skews younger, it is likely that demand for more virtual cancer care services will increase. While research suggests digital health yields cost savings, more needs to be understood about the quality implications of virtual versus in-person visits. While virtual care increases access to those with time and travel constraints, providers need to ensure equal access to these services for all patients.

Remote Patient Monitoring for Early Detection of Cytokine Release Syndrome in Myeloma Patients: A Comparative Study between Standard Care and Remote Monitoring

BackgroundDigital health technologies, such as telehealth, remote patient monitoring, and smartphone apps, have the potential to reduce access disparities faced by rural patients with cardiovascular disease, but little is known about rural health care providers’ perspectives on adopting digital health in their practice.ObjectiveThis study used diffusion of innovations theory as a guiding framework to interpret interview findings on rural and rural-serving health care providers’ perspectives on the use of digital health to deliver rural cardiovascular care.MethodsWe conducted semistructured interviews with rural and rural-serving health care providers, including primary care advanced practice providers and physicians, as well as referring cardiologists from 6 primary care clinics in Alaska, Idaho, and Washington. We performed a directed content analysis of interview data informed by diffusion of innovations theory and identified emergent subthemes related to each of the 5 factors that influence adoption: relative advantage, compatibility, complexity, trialability, and observability.ResultsSeventeen health care providers participated in this study. Participants described cycles of adopting and discontinuing the use of digital health in their practice. Participants identified advantages of digital health including reduced patient travel, the ability to leverage nonphysician health care workers, and the availability of objective patient data from remote patient monitoring. Compatibilities included increased patient adherence and follow-up and the ability to involve specialists in patient care. The trialability of digital health was described through experiences with remote patient monitoring and scaled-up use of telehealth during the COVID-19 pandemic, and participants observed the benefits of digital health in other disciplines and as patients. We also identified several disadvantages, incompatibilities, and complexities that may hinder the adoption of digital health technologies in rural practice, most of which were highlighted at the clinic and patient levels. These disadvantages, incompatibilities, and complexities included substandard equipment, inability to perform a physical examination, connectivity issues caused by poor internet and cell phone service, concerns about patient age and technical abilities, concerns about proper fit and distribution of remote patient monitoring equipment, and questions about billing and data management for digital health technologies.ConclusionsRural health care providers recognize the many advantages of using digital health in caring for patients with cardiovascular disease but find that digital health is often complex and incompatible with their needs and the needs of their patients. There may be a disconnect between the potential of digital health and how it works in practice, as evidenced by the cycles of adoption and discontinuance of digital health technologies described by rural health care providers. Future rural digital health interventions in cardiovascular care should take into consideration specific complexities and incompatibilities in the rural context.

The Adoption and Implementation of Digital Health Care in the Post–COVID-19 Era

Cardiovascular disease (CVD) encompasses various heart conditions, such as arrhythmias, congenital heart diseases, and strokes. This review focuses on the remote monitoring of CVD patients by discussing the already available devices, the architecture of the CVD remote monitoring system, the challenges, and future perspectives. CVDs have become a major cause of morbidity and mortality globally, responsible for about 30% of all diseases. Risk factors for CVD include demographic characteristics, smoking, genetic factors, and lifestyle habits, such as obesity and physical inactivity. CVDs are no longer limited to developed countries, with 80% of CVDrelated mortality occurring in developing nations. Remote Patient Monitoring (RPM) technology allows healthcare providers to monitor patients using wearable and non-wearable devices, enabling efficient evaluation and consultation for better patient care. In the case of CVDs, timely intervention hinges on regular symptom monitoring and response to treatment, with Remote Patient Monitoring (RPM) emerging as a key approach. This method allows automatic recording of patient data through various devices, including invasive ones, such as pacemakers and implantable cardioverter defibrillators. Non-invasive devices aid in long-term self-management by monitoring and transmitting data to prevent emergencies and enhance prognosis. Patients with serious CVDs may have cardiac implantable electronic devices that provide continuous physiological information, which can be analyzed using machine learning algorithms to identify risks. RPM devices can reduce hospitalizations and costs by enabling preventive interventions and medication management, ultimately enhancing healthcare systems' ability to provide remote care for CVD patients. Despite the numerous applications of the digital health system, challenges hinder its implementation in developing countries. The main challenge lies in the absence of ICT infrastructure in rural areas, which hinders the effectiveness of healthcare systems, along with the difficulty in obtaining electronic devices and ensuring an uninterrupted power supply, both of which hamper the deployment of ICT services and the adoption of digital health systems by healthcare professionals and consumers. Overall, addressing these challenges requires human resource training, universal standards for RPM advancement, and a change in stakeholders' perceptions towards digital health technologies in underdeveloped nations.

BackgroundDue to the Covid-19 pandemic, remote monitoring of patients outside hospitals rapidly increased. Previous studies show that healthcare professionals’ competence in digitalization needs to be improved. Little is known about how Covid-19 has affected the use of remote monitoring of cancer patients. The purpose of the study was therefore to explore healthcare personnels’ experiences with remote monitoring of cancer patients during the Covid-19 pandemic. MethodsThe study had an explorative and descriptive design using semi-structured individual interviews for data collection. Data was analyzed by content analysis.ResultsA total of ten healthcare personnel working in the cancer department and out-patient cancer clinic in the hospital participated; four physicians and six registered nurses. Two categories and four subcategories were identified: 1) «Maintaining personalized healthcare services» comprising the subcategories a) «Adjusting services to patients’ health condition» and b) «Ensuring continuity»; and 2) «A supplement, but not a replacement» comprising the subcategories a) «Impact on interpersonal relations» and b) «The importance of clinical assessment».ConclusionsThis study indicates that remote monitoring through telephone was preferred by both healthcare personnel and patients. The nurses and physicians experienced a more frequent contact with their patients, but emphasized the importance of physical meetings for building relationship, and for thorough clinical examination. Our findings indicate a need to facilitate a work environment where healthcare personnel can be fast learners in using digital tools to provide best possible healthcare quality. Moreover, it is imperative to develop a workplace suitable for the use of digital technology for remote monitoring, and to provide digital tools that is easy to use for both healthcare personnel and patients.

A conceptual IoT-based early-warning architecture for remote monitoring of COVID-19 patients in wards and at home

Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices

Digitally delivered health care, such as telehealth, mobile apps and remote monitoring via apps or devices, can result in improved outcomes for chronic conditions. However, Australia is struggling to maximise the potential of digital health for chronic conditions, due in part to funding arrangements that lack incentives for providers and end users. The aim of this article is to examine the current landscape of digital health funding for chronic conditions and considers potential funding arrangements for the future. Current funding arrangements for digital health in Australia lack sufficient incentives for both providers and end users, limiting the reach and effectiveness of digital health for managing chronic conditions. Alternative funding approaches, such as value-based models, are used internationally which include funding avenues for mobile apps and remote patient monitoring via apps or devices as well as for those operating digital health services. The development of sustainable value-based funding mechanisms that support stakeholder involvement and national adoption are recommended. For Australia to fully leverage the benefits of digital health in managing chronic conditions, funding reforms are one critical area to assist with the implementation of patient-centred and outcome-driven funding models. Effective and sustainable funding structures are essential to ensure long-term benefits of digital health for chronic disease management. Further research will be essential to identify effective funding avenues for digital health services, including mobile apps and remote patient monitoring.

Artificial intelligence-powered remote monitoring of patients with chronic obstructive pulmonary disease.

IntroductionEarly recognition of fluid congestion is a key management strategy in heart failure (HF). The role of non-invasive remote monitoring (RM) in patients with heart failure with reduced ejection (HFrEF)...

ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts

Background Digital health programs have the potential to enhance secondary prevention strategies for coronary artery disease (CAD) by enabling remote patient monitoring (RPM) and improving long-term disease management. Patient engagement and retention within these programs play a crucial role in maximising their effectiveness. This randomized controlled trial (RCT) evaluated the effectiveness of a 6-month digital health program alongside standard care (SoC) for patients with CAD receiving care at a university hospital. Here we present key exploratory outcomes for the intervention group, specifically for digital engagement metrics. Purpose To assess digital engagement, program retention, satisfaction, and compliance with RPM surveys and changes in self-reported symptom severity in the intervention group. Methods A single-center, parallel-group RCT was conducted with 200 patients with CAD post-percutaneous coronary intervention (PCI), randomized to receive a digital health program + SoC (n=98) or SoC alone. The digital health program included remote patient monitoring, disease-specific education, motivational messages and content promoting healthier lifestyle. Symptom severity was assessed using the RPM questionnaire, which included core questions on breathlessness, chest pain, medication adherence, and side effects. Responses were categorized into high, medium, or low severity based on a predefined scoring system developed by experts to guide clinical follow-up. Results A total of 97 participants engaged with the digital health program after the first week, 79.6% males, average age 63.9 years. Over the 6-month intervention, 86% (83/97) completed the program, and 71% (69/97) remained active for the full duration. The median active days per week was 5.75 (IQR 3.67–6.92). After 24 weeks, 84% (81/97) of users were still retained. The weekly RPM completion rate was 94% during the intervention phase. In a complete case analysis (n=75) of the RPM questionnaire, the symptom severity improved over time, with the proportion of users reporting low-severity symptoms increasing from 57% in Week 1 to 83% in Week 24 (McNemar’s test: p < 0.001). Users reported motivation and perceived benefits from the program. Overall, 68% of users felt the app motivated them to improve their lifestyle habits, and 76% found it helpful for understanding lifestyle improvements. Additionally, 83% of users indicated they were likely to recommend the app. Conclusion Users of the digital health program demonstrated high engagement, strong retention, and robust compliance with remote monitoring. The program was perceived as valuable, helping users better understand healthy habits, increasing motivation, and leading to a strong likelihood of recommendation. The high compliance with RPM surveys and reduction in symptom severity highlight the potential of digital interventions to enhance CAD management and secondary prevention.