Remote Monitoring Services Research Articles

Impact of Home Telehealth Expansion on High-Cost Utilization Among Veterans Health Administration Patients with Diabetes.

Home telehealth (HT) services have rapidly expanded in the Veterans Health Administration (VHA), but little is known about the real-world impact of the expansion of these services on utilization. To evaluate the impact of expanding HT diabetes services in VHA on high-cost utilization. This cohort study used cross-temporal propensity score matching to identify patients with diabetes who would receive HT services (treatment group) with program expansion (treatment group) with a comparison group of patients with diabetes who did not receive HT services (control group) between 2010 and 2018. A difference-in-differences design was used to compare pre-post changes in high-cost utilization between propensity-matched groups. Data used was from the VHA's Corporate Data Warehouse. VHA patients with diabetes, n=7214 in the treatment group who received HT services, and n=1,067,138 in the control group who did not receive HT services. Emergency department (ED) visits, all-cause hospitalization, and hospitalizations for ambulatory care sensitive conditions (ACSCs). In the baseline period, patients in our sample had a mean age of 67 years old (SD=11 years), were 97% male, and 78% had a hemoglobin A1c (HbA1c) < 8%. The increase in HT use was associated with a net increase of ED visits per patient (0.215 95% CI [0.152, 0.279]), all-cause hospitalization (0.053 95% CI [0.032, 0.074]), and ACSC hospitalization (0.032 95% CI [0.019, 0.045]). Expanding HT or remote monitoring services may lead to additional needs being identified for patients, including increased access to in-person care, such as ED or hospital services.

Utilization of Remote Patient Monitoring for Neurological Disorders: A Nationwide Analysis of Administrative Claims Data.

Introduction: The use of remote patient monitoring (RPM) services for neurological disorders remains understudied, particularly in the context of newer billing codes introduced before the COVID-19 pandemic. Methods: This retrospective cohort study utilized data from commercial and Medicare employer-sponsored administrative claims between January 1, 2019, to December 31, 2021. The study population included all patients with at least one qualifying RPM-related Current Procedural Terminology (CPT) code for a neurological disorder, separated into first-generation (CPT 99091) codes and second-generation (CPT 99453, 99454, 99457, 99458) code cohorts. We compared patient and encounter characteristics between both cohorts. Results: We identified 27,756 encounters attributable to 11,326 patients who received RPM services for neurological disorders, of whom 5,785 (51.1%) received RPM via second-generation billing codes, 3,941 (34.8%) were female, 6,712 (59.3%) were between 45 and 64 years old, and 10,488 (92.6%) had a primary diagnosis of sleep-wake disorder. The second-generation cohort was significantly more likely to be female (41.5% vs. 27.8%, p < 0.001), be of age 65 or older (15.7% vs. 7.1%, p < 0.001), and reside in urban areas (93.4% vs. 87.6%, p < 0.001) than the first-generation cohort. Patients in the second-generation cohort were more likely to receive RPM in office settings (86.3% vs. 62.5%, p < 0.001), by physicians (77.0% vs. 40.3%, p < 0.001), and less likely for sleep-wake disorders (87.9% vs. 97.5%, p < 0.001) than the first-generation cohort. Patients who received RPM from physicians were most often evaluated by pulmonologists (31.4%). Discussion: In this commercially insured patient population receiving RPM for neurological disorders, we found that sleep-wake disorders and non-neurologists were over-represented.

8469 Endocrinologists Underutilize Virtual Care Services Resulting in Suboptimal Clinical and Financial Outcomes

Abstract Disclosure: D. Terry: Employee; Self; Valendo Health. Less than 150,000 Medicare patients with diabetes (PWD) receive billable telehealth and remote monitoring services, even though over 12 million PWDs are eligible for these services. This is a missed quality opportunity, as studies show that PWDs who receive these services experience reductions in A1C levels and improvements in TIR. It is also a missed financial opportunity for Endocrinologists, who are among the lowest paid specialists in the US. The economics of Endocrinology are important, because inadequate compensation is leading to access constraints when the diabetes population is growing, and care complexity is increasing. We analyzed billed virtual health claims for every Medicare PWD in 2022. The types of services we examined included: Chronic Care Management (CCM &amp; PCM), Continuous Glucose Monitoring (CGM &amp; RPM), Medical Nutrition Therapy (MNT), and Diabetes Self-Management Training (DSMT). When we looked by Endocrinologist by virtual care service type, we found the following levels of service delivery for Endocrinologists at the median levels of utilization:4.8% of eligible PWDs received remote Continuous Glucose Monitoring support.4.2% received virtual Chronic Care Management services.6.2% received virtual Diabetes Self-Management Support.&amp;lt;1% received Medical Nutrition Therapy This is clearly a missed clinical quality opportunity as a study published in JAMA in October 2023, Comprehensive Telehealth Model to Support Diabetes Self-Management, reported the following improvements for PWDs who received virtual care for 6 months:Mean change in A1C levels: Type 1: -0.6%; Type 2: -1.0%Mean TIR Improvement: Type 1: 16%; Type 2: 18% It is also a missed financial opportunity for Endocrinology practices. Each patient with diabetes is potentially eligible for $100 or more of virtual care services per month. We’ve looked at every Endocrinology practice in the US and many are missing out on over a million dollars of annual revenue opportunity. This is important as Endocrinology organizations everywhere, independent and hospital based, are struggling to retain the doctors &amp; staff necessary to provide adequate access to care - leading to months of wait time to see an Endocrinologist. The prevalence of diabetes is growing significantly, while Endocrinologist capacity is shrinking. Value added and billable virtual care services create new opportunities for Endocrinologist to generate the revenue necessary to increase clinical capacity and improve access by creating diverse clinical teams led by Endocrinologists and supported by Diabetes Educators, Dietitians, and others with expertise in diabetes who can care for many more PWDs. Creating virtual care capabilities is also an early step in moving Endocrinology into Value-Based Care arrangements that reward providers for improving care and reducing costs rather than for generating more visits. Presentation: 6/1/2024

Remote asthma monitoring: How and why?

Background: The coronavirus disease 2019 pandemic contributed to substantial advancement in digital technologies in health care. Health-care professionals involved in respiratory care can now tailor their therapy for their patients with asthma, who still account for &gt;1 million emergency department visits annually, with remote monitoring services. Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) are both ways to help patients with chronic asthma and other patients who need respiratory monitoring in pulmonary and in allergy and immunology clinics. RPM and RTM allow clinicians to gain further understanding as to what is going on in the patient’s home on a regular basis. Objectives: To ensure that the populations to monitor are correctly identified, privacy and security measures are in place, staffing resources are sufficient, and billing practices are understood before initiating RPM and RTM. Methods: A review of the current literature (2019‐2023) for RPM and RTM from PubMed, National Center of Biotechnical Information, American College of Allergy, Asthma and Immunology and the U.S. Centers for Disease Control and Prevention as well as practical experiences are outlined to provide an easy-to-follow guide for implementation in practice. Results: RPM and RTM services help identify and address gaps in care for patients such as patients with uncontrolled asthma and to assist with populations of need such as the underserved, the elderly, and rural populations. Conclusion: As artificial intelligence and other technologies continue to grow in the healthcare space, remote monitoring services are expected to transform health-care delivery to new heights yet to be seen.

Abstract P405: Integrating Self-Measured Blood Pressure Device Data Into Electronic Health Records – Barriers And Solutions

Introduction: Despite clinical evidence supporting the use of self-measured blood pressure monitoring (SMBP)in improving blood pressure control, the infrastructure to enable data transfer from device to electronic health record (EHR) is complicated by policy, interoperability, and operational challenges. The National Hypertension Control Initiative (NHCI) engaged 350 HRSA-funded federally qualified health centers (FQHCs) to improve blood pressure control leveraging SMBP devices and integrating SMBP data into EHRs. Hypothesis/Aims: FQHCs could integrate SMBP device data into their EHR with financial support and training and technical assistance (T/TA). Methods: T/TA was provided through a curriculum to support technology infrastructure self-assessment, explore effective integration options, and implement solutions. Additionally, FQHCs were offered 1:1 consultations and EHR-specific guidance documents. Results: More than half (52%) of responding FQHCs reported moving through all stages of planning, preparing, piloting, scaling, and evaluating their SMBP program during the 3-year grant, while 30% reached the scaling stage. Ultimately, 27% reported full data integration and 51% reported partial integration of SMBP device data into their EHR, while 4-12% reported no to minimal integration, respectively. Based on the five most used EHRs, numerous integrations were identified with five validated SMBP devices. Successful integration strategies included upgrading to the latest EHR version, choosing SMBP devices with verified EHR integration, utilizing EHRs with patient portal apps, and engaging with remote patient monitoring (RPM) services for pre-established integrations. Third-party integration engines emerged as complex and expensive solutions. Challenges included costly or time-consuming EHR upgrades, SMBP device purchases without prior SMBP integration assessment, limitations posed by non-cloud based EHRs or EHRs without patient portals, ability to sustain RPM subscription costs, and limited information technology expertise. Conclusion: SMBP device data can be integrated into EHRs, but the complexity, costs, and sustainability vary significantly. Several viable integration strategies with common EHRs and validated SMBP devices were verified. As the technology landscape evolves rapidly, the underlying need for education, strategic technology planning, and vendor collaboration remains.

Patient Characteristics Associated With Disparities in Engagement With and Experience of COVID-19 Remote Home Monitoring Services: A Mixed-Methods Evaluation.

The adoption of remote healthcare methods has been accelerated by the COVID-19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID-19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups. This was a mixed-methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis. Survey responses were received from 292 staff and 1069 patients and carers. Twenty-three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring. Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care. The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript.

Cloud-Based Remote Real-Time Monitoring and Control System for Spring Fatigue Testing Machine

In recent years, the utilization of cloud technology has witnessed a surge, particularly in the domains of industrial automation and intelligent scenarios. However, the prevailing spring fatigue testing machine is still in the traditional single-machine working mode. In this mode, there are many problems such as low automation of testing equipment, poor experimental site environment, and the need for experimenters to be on duty for a long time. In order to solve the above problems, this paper builds a cloud-based remote monitoring and control system based on the high-temperature constant-force spring fatigue testing machine. The system is based on Browser/Server architecture, and clients can access it anytime and anywhere using a browser in a public network environment. The server is hosted on a public cloud platform and includes website service, data storage service, WebSocket real-time communication service, and remote video monitoring service. Clients can remotely monitor and control the testing machine in real time through the cloud. After experimental verification, the real-time monitoring and control messages delay is 11 ms, and the video monitoring delay is 291 ms, which can meet the actual needs of remote spring fatigue testing. This remote monitoring and control system improves the automation of the spring fatigue testing machine and improves the working environment of the experimenters. In addition, it can be applied to other reliability testing machines in the laboratory, and can further help build a workshop-level remote monitoring and control platform.

Identifying the Internet of Things (IoT) implementation benefits for sustainable construction project

ABSTRACT Understanding the implementation of the Internet of Things (IoT) in sustainable construction projects. Implementing the IoT in sustainable construction schemes can offer many benefits, including resource management, remote control and monitoring, improving safety, optimizing building performance and data-driven decision-making. This research presents a unique effort to enhance our comprehension of IoT implementation in such projects. We analyzed 55 studies using a systematic approach to literature selection and filtration, using theoretical models for Internet of Things (IoT) implementation to study the sustainability of construction industries. The results revealed that monitoring constituted 9 (16.4%), machine/equipment control 2 (3.6%), safety in construction 5 (9.1%), water management 4 (7.3%), 4IR 2 (3.6%), BIM 5 (9.1%), green IoT 5 (9.1%), prefabricated design 2 (3.6%), IoT adoption level 6 (10.9%), and other aspects accounted for 15 (27.3%). The primary areas of IoT application in the construction industry include BIM, remote application monitoring, construction management, repair and equipment services, construction implements, and tracking equipment. Notably, there is a lack of research awareness regarding the potential integration of IoT and BIM by construction companies. Despite numerous studies on IoT adoption, limited literature addresses the challenges and awareness of how IoT tools impact implementation in the building industry. Our review proposes a framework for implementing sustainable construction projects to address this gap. However, further investigation is required to analyze potential security threats associated with IoT in a smart city setting, explore promising countermeasures, and delve into open research issues.

A Cost Evaluation of COVID-19 Remote Home Monitoring Services in England.

Remote home monitoring services emerged as critical components of health care delivery from NHS England during the COVID-19 pandemic, aiming to provide timely interventions and reduce health care system burden. Two types of service were offered: referral by community health services to home-based care to ensure the right people were admitted to the hospital at the right time (called COVID Oximetry@home, CO@h); and referral by hospital to support patients' transition from hospital to home (called COVID-19 Virtual Ward, CVW). The information collected for the oxygen levels and other symptoms was provided via digital means (technology-enabled) or over the phone (analogue-only submission mode). This study aimed to evaluate the costs of implementing remote home monitoring for COVID-19 patients across 26 sites in England during wave 2 of the pandemic. Understanding the operational and financial implications of these services from the NHS perspective is essential for effective resource allocation and service planning. We used a bottom-up costing approach at the intervention level to describe the costs of setting up and running the services. Twenty-six implementation sites reported the numbers of patients and staff involved in the service and other resources used. Descriptive statistics and multivariable regression analysis were used to assess cost variations and quantify the relationship between the number of users and costs while adjusting for other service characteristics. The mean cost per patient monitored was lower in the CO@h service compared with the CVW service (£527 vs £599). The mean cost per patient was lower for implementation sites using technology-enabled and analogue data submission modes compared with implementation sites using analogue-only modes for both CO@h (£515 vs £561) and CVW (£584 vs £612) services. The number of patients enrolled in the services and the service type significantly affected the mean cost per patient. Our analysis provides a framework for evaluating the costs of similar services in the future and shows that the implementation of these services benefit from the employment of tech-enabled data submission modes.

Health in a Virtual Environment (HIVE): A Novel Continuous Remote Monitoring Service for Inpatient Management.

The aim of this study was to describe the implementation of a novel 50-bed continuous remote monitoring service for high-risk acute inpatients treated in non-critical wards, known as Health in a Virtual Environment (HIVE). We report the initial results, presenting the number and type of patients connected to the service, and assess key outcomes from this cohort. This was a prospective, observational study of characteristics and outcomes of patients connected to the HIVE continuous monitoring service at a major tertiary hospital and a smaller public hospital in Western Australia between January 2021 and June 2023. In the first two and a half years following implementation, 7541 patients were connected to HIVE for a total of 331,118 h. Overall, these patients had a median length of stay of 5 days (IQR 2, 10), 11.0% (n = 833) had an intensive care unit admission, 22.4% (n = 1691) had an all-cause emergency readmission within 28 days from hospital discharge, and 2.2% (n = 167) died in hospital. Conclusions: Our initial results show promise, demonstrating that this innovative approach to inpatient care can be successfully implemented to monitor high-risk patients in medical and surgical wards. Future studies will investigate the effectiveness of the program by comparing patients receiving HIVE supported care to comparable patients receiving routine care.

AI-based heart monitoring: the FIFPRO player pilot study

Abstract Background The implementation of remote global heart screening and monitoring services in professional players is essential as it allows: (1) efficient and rapid identification of cardiac abnormalities ensuring their safety and health; (2) standardizing the quality of medical heart checkups in low-resource regions to promote health equity; (3) prioritizing diversity in data collection to aid in the research and prevention of sudden cardiac death in sports. Purpose To demonstrate the feasibility of a global standardized heart screening program for professional footballers by leveraging an artificial intelligence platform to efficiently identify cardiac patterns from Holter’s records. In this study, we presented the most prevalent cardiac patterns, the patterns that prompted further assessment by the cardiologist, and an example of a typical research question exploring the effect of age on the prevalence of cardiac patterns. Methods The pilot study included 100 players from 9 different countries: Australia, Botswana, Bulgaria, Ghana, Greece, Indonesia, Panama, Spain and the UK. Holter data (Bittium Faros 180) were acquired in real-life monitoring from 24h to 48h including training sessions. Electrocardiograms were analyzed through an AI platform with a deep learning-based methodology to detect over 20 cardiac patterns. Medical team reviewed labels of detected cardiac patterns to validate and further train the AI algorithm. Thereafter cardiologists reviewed the cardiac patterns to determine whether further cardiac assessment was required. Results 145 sessions were recorded, with 100 players having one session and 45 players having two sessions. The mean age was 27.5 years (minimum 15, maximum 41), with 31 female players. The median duration of the Holter session was 25.1 hours. Table 1 presents the most frequently detected cardiac patterns: low density premature atrial complex, mild sinus bradycardia and low density premature ventricular complex in over 50% of the players. 18 players were identified with abnormalities requiring further study. 14 presented altered cardiac patterns (6 with negative T-waves, 5 with intraventricular conduction delay, 2 with QRS low voltage and 1 with P wave enlargement) and 3 presented premature ventricular complexes during exercise or high density. 1 was excluded because of inadequate clinical information. Regarding the effect of age, players with mild sinus bradycardia, premature ventricular complex, pause (2-3 seconds) or 2-degree atrioventricular block were found to be significantly older than players without those patterns (Figure 1). Conclusion This is the first global AI-based platform to obtain standardized heart screening program in professional athletes remotely. This study has been validated using diverse data from groups on 5 continents. This approach is beneficial to promote health equity in screening and monitoring of possible cardiomyopathies and channelopathies in order to prevent sudden cardiac death.Table 1Figure 1

Acceptability of a New Remote Monitoring Service for Patients with COVID-19 Infection using Wearable BioStickers™: A Mixed Methods Study

Acceptability of a New Remote Monitoring Service for Patients with COVID-19 Infection using Wearable BioStickers™: A Mixed Methods Study

Research and Innovation of a Community Intelligent Pension Service System: Taking Longhua District, Shenzhen, China, as an Example

With the aging of China's population, as a new model combining information technology and high-quality elderly care services, the topic of smart elderly care continues to warm up and has immediately attracted widespread attention. With the innovation of Internet technology, elderly people and families are in demand of the smart pension industry, and national policies have issued a series of policies and plans to encourage the development of smart pensions, allowing the innovation and design of China's smart elderly service system to fully expand. However, the research shows that from the perspective of the macro development of China's smart pension industry, the overall operation system is not mature, the talent gap is more accurate, there are fewer services, and it is still in the market development stage. This paper focuses on the Shenzhen Longhua District, which is a local part of the community wisdom endowment service industry chain investigation. The analysis of the current pension service system development is not mature enough, and it does not completely combine Internet technology and wisdom endowment. Additionally, because the economic strength and cultural level limit of wisdom endowment service acceptance are not high, the policy support for community wisdom endowment is not large enough. On this basis, this paper draws on the excellent successful experience at home and abroad. From the perspective of three aspects and put forward opinions for innovation, first, the innovation of community smart elderly care service technology, which combines Internet information technology and elderly care services organically, improves the quality of life and the happiness index of elderly people. Second, the innovation of community smart elderly care services, including the full use of medical institutions to provide 24-hour rehabilitation monitoring, remote monitoring services, and personalized and differentiated services, are tailored for elderly people. Third, the national policy innovation of community elderly care services, through policy guidance and support, promotes the healthy development of community elderly care services to provide better quality and convenient pension services for elderly people. The author believes that in the future, community elderly care services will be more professional and standardized, and a set of digital systems and service standards with scientific standards and rules will be established to ensure the quality of service and personalized demand.

Approaching Mental Health Through a Preventive Data Analysis Platform

The rising prevalence of chronic diseases and the aging population globally are diminishing the overall quality of life, especially for those with demanding daily routines. As medical advancements extend lifespans, the proportion of individuals over 60 is set to double by 2050, necessitating societal shifts toward health-responsible citizenship. Despite longer lifespans, evidence suggests that older age often accompanies mental health challenges such as anxiety, depression, and substance misuse. Social isolation and loneliness further compound these issues, affecting both physical and mental well-being. Digital wellness empowers individuals to take charge of their health, promoting proactive care and literacy to foster health-conscious citizenship. This paper explores the intersection of mental health, aging populations, preventive wellness initiatives, and health literacy, emphasizing their significance within the Health 5.0 framework, especially for older adults. Traditionally, health regulators offer static workflows for adopting standard procedures in health and well-being, reflecting a reactive approach. However, the evolving landscape of wearable and mobile devices connecting to healthcare IT systems through secure online networks necessitates a shift. Technology now facilitates remote patient monitoring and telemedicine service subscriptions and empowers individuals to manage their health proactively. The BE4YOU project, conducted in Portugal, serves as a case study, facilitating individual maintenance of health and well-being through intelligent and dynamic workflows, which are defined based on analytical models considering each person’s risk profile. By facilitating data sharing, promoting healthy lifestyles, and enabling early detection of mental health issues, the project leverages technology to support personalized monitoring and enhance overall health outcomes. Through technology-driven empowerment, individuals and healthcare professionals are better equipped to assess risks and ensure ongoing wellness monitoring, underscoring the role of technology in fostering personal health and supporting healthcare effectiveness.

Assessment of a community pharmacist remote monitoring service in patients using continuous glucose monitors

BackgroundDiabetes is the eighth leading cause of death and has a substantial impact on the U.S. health care system. Recent changes to major insurance formularies allow for increased access to continuous glucose monitors (CGMs). Community pharmacists routinely assist and educate patients about diabetes care, including usage of CGM. ObjectivesThe purpose of this study was to evaluate the clinical impact of a community pharmacist remote CGM monitoring service on patients’ glycemic metrics. Patient completion of comprehensive diabetes standards of care and pharmacist interventions and recommendations were assessed as secondary objectives. MethodsThis study was a prospective, feasibility study conducted at two pharmacies within 1 regional division of a large community pharmacy chain between November 2022 and June 2023. A pharmacist conducted patient enrollment visits and remotely monitored CGM glycemic metrics via cloud-based platforms per the study protocol. CGM glycemic metrics were evaluated for each patient 3 months pre- and post-study enrollment, including time above range (TAR), time in range (TIR), time below range, glucose management indicator, average glucose, CGM utilization rate, and glucose variability. Metrics were evaluated for statistical significance using the Wilcoxon signed-rank test and descriptive statistics. ResultsPharmacists enrolled 36 patients in this study with 20 patients completing the full 3-month study period per protocol. There was a statistically significant improvement in three of eight glycemic metrics (very high TAR, TIR, and average glucose). Specifically, TIR had the largest improvement from 61.8% pre-enrollment to 69.9% (P < 0.006) postenrollment. All other pertinent glycemic metrics displayed improvements but were not statistically significant. ConclusionThe results demonstrate clinically and statistically significant improvements in several glycemic metrics for patients who participated in the community pharmacist-led remote CGM monitoring service, which may result in improved diabetes control and fewer long-term diabetes-related health complications.

Evaluation of Telehealth Services that are Clinically Appropriate for Reimbursement in the US Medicaid Population: Mixed Methods Study.

When the US Department of Health and Human Services instituted a State of Public Health Emergency (PHE) during the COVID-19 pandemic, many telehealth flexibilities were fast-tracked to allow state Medicaid agencies to reimburse new specialty services, sites of care, and mediums such as FaceTime to communicate with patients.. This resulted in expanded access to care for financially vulnerable Medicaid patients, as evidenced by an uptick in telehealth use. Research has mostly focused on telehealth reimbursement for limited use cases such as rural primary care, without broader consideration for how telehealth can be appropriately mainstreamed and maintained. This study sought to (1) evaluate the continuation of flexible telehealth reimbursement broadly, beyond the COVID-19 pandemic; (2) analyze the clinical effectiveness of the new telehealth services; and (3) offer code-by-code reimbursement guidance to state Medicaid leaders. We surveyed 10 state Medicaid medical directors (MMDs) who are responsible for the scientific and clinical appropriateness of Medicaid policies in their respective states. Participants were asked to complete an internet-based survey with a list of medical billing codes, grouped by service type, and asked if they believed they should be reimbursed by Medicaid on a permanent basis. Additional questions covered more detailed recommendations, such as reimbursing video with audio versus audio-only, guardrails for certain specialty services, and motivations behind responses. The MMDs felt that the majority of services should be reimbursed via some modality of telehealth after the PHE, with the most support for video combined with audio compared to audio-only. There were exceptions on both ends of the spectrum, where services such as pulmonary diagnostics were not recommended to be reimbursed in any form and services such as psychotherapy for mental health had the most support for audio-only. The vast majority of MMDs were supportive of reimbursement for remote monitoring services, but some preferred to have some reimbursement guardrails. We found that 90% (n=9) of MMDs were supportive of reimbursement for telehealth interprofessional services, while half (n=5) of the respondents felt that there should be continued guardrails for reimbursement. Motivations for continuing reimbursement flexibility were largely attributed to improving access to care, improving outcomes, and improving equity among the Medicaid patient population. There is a strong clinical endorsement to continue the telehealth flexibility enabled by the PHE, primarily for video combined with audio telehealth, with caution against audio-only telehealth in situations where hands-on intervention is necessary for diagnosis or treatment. There is also support for reimbursing remote monitoring services and telehealth interprofessional services, albeit with guardrails. These results are primarily from a perspective of improving access, outcomes, and equity; other state-specific factors such as fiscal impact and technical implementation may need to be taken into account when considering reimbursement decisions on telehealth.

Remote monitoring of patients with rheumatoid arthritis in a low disease activity state: a mixed methods evaluation across six hospitals in London, UK.

This study evaluated the scale-up of a remote monitoring service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes. A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks. The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n = 202) showed high levels of patient engagement with the service. The patient survey (n = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritization of staff needs was emphasized. Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling remote monitoring interventions for patients with rheumatoid arthritis in routine care settings.

Adoption of Emerging Web-Technologies by Medical Doctors in Enugu Metropolis, Enugu State

Emerging web-technologies play pivotal role in advancing remote patient monitoring and telemedicine services in various ways that are currently transforming healthcare delivery. Adoption of these technologies by medical doctors in their medical practice is generally considered as important for improved healthcare delivery. This study examined adoption of emerging web-technologies by medical doctors in Enugu metropolis, Enugu State. Two research questions guided the study. The study adopted a descriptive cross sectional design. The population of the study was selected 10 health facilities is Enugu metropolis. The sample of the study comprised 150 medical doctors drawn from the public and private health facilities in Enugu metropolis. The instrument for data collection was a questionnaire. The data collected from questionnaires was analysed using frequencies, percentages, and chi-square test. Findings of the study revealed that majority of the medical doctors, 63.33% utilize patient remote monitoring devices to facilitate health care services. Also, majority of the medical doctors, 51.33% utilize telemedicine to facilitate health care services. Results showed that gender and practice-locations of medical doctors had significant association to the level to which they utilize patient remote monitoring devices to facilitate healthcare services. The study recommended that health policy makers should develop and implement ongoing training programmes for medical professionals to enhance their proficiency in using remote patient monitoring devices and telemedicine. This will ensure that healthcare providers stay updated on the latest features and functionalities of these web-technologies for maximal benefits. Government should recognize and address issues related to internet connectivity and infrastructure, particularly in remote or underserved areas. Improving broadband access and reliability will ensure seamless telemedicine interactions and also broaden its reach to a wider population.

Hybrid Home Care Pilot Project

1.The ‘Hybrid Home Care’ pilot project offers remote monitoring through video calls to eighty home care clients. The aim is to create an achievable and feasible ecosystem that integrates remote monitoring and home care services. The latter includes all types of non-medical support at home (e.g. cooking, personal hygiene) that help clients to live independently at home for as long as possible. The project is organised by three home care organizations (Familiehulp, Zorgband Leie &amp; Schelde and i-mens) and Remote Carecenter Z-plus. It was funded by the Flemish Department of Welfare and the three participating organizations.&#x0D; 2.Eighty home-care clients have received a tablet or television with an internet connection. Each client is contacted at least once a week through video call by one our caregiver. In addition to these weekly scheduled calls, the client can contact us 24/7 for a video conversation with a Z-plus operator. The device also allows clients to keep in touch with their family. However, participating clients often lacked digital skills. Therefore, we opted for a 'warm installation'. Our partner Zorg &amp; Meer visited each client at home to install and demonstrate the hardware and software. Additional support is available.&#x0D; 3.Our partner Artevelde University of Applied Sciences is researching the added value of Hybrid Home Care. Interim results are very encouraging and strengthen our believe that this hybrid form of care can be of tremendous value in many different ways.&#x0D; The newly acquired digital skills open many doors for them and amongst other things reduces loneliness by providing them with a new way to be connected to relatives. Relatives worry less about their loved one. Participating clients say they feel heard and generally feel better supported.&#x0D; The fact that our caregivers can see the client (as opposed to a telephone call) allows them to better assess the client's situation. This ensures that any needs will be picked up on sooner and any necessary preventive care measures can be implemented in time. &#x0D; Not only the clients benefit from hybrid care. Our (video)team is very enthusiastic about the project as it allows them to combine their job as home-based care provider with less physically demanding desk work. They indicate that they enjoy really listening to the client, rather than engaging in superficial conversation while doing other tasks in the client’s home. Hybrid Home Care also allows caregivers to work from home. &#x0D; 4.Hybrid Home Care proves to be an opportunity to improve the quality of life for our clients, their loved ones and our employees. Our clients feel more connected to their caregivers and their family. Our employees can combine physically demanding work with working from home, improving their work-life balance. &#x0D; 5. Hybrid Care requires a reconsideration of how public care fundings are allocated. For that reason we are in consultation with the government throughout the project. While this pilot project has promising first results, we have yet to learn how clients will evaluate this remote care when it is no longer free.&#x0D;

AI remote ECG monitoring improves arrhythmia detection

Abstract Background Ambulatory ECG monitoring is needed to investigate intermittent heart rhythm symptoms. Traditional monitoring approaches are resource intensive, requiring multiple patient hospital visits and time-consuming analysis, using fixed capacity monitoring equipment. Low diagnostic yield means tests are often repeated. Purpose We carried out a large pilot to compare ambulatory cardiac monitoring with an AI-led remote ECG monitoring service (Zio XT) with Holter monitoring. Patients were fitted with single-use Zio monitoring patches, which they wore for 14 days of continuous monitoring and then returned it by Freepost for outsourced analysis and reporting. Methods Over the course of 12 months, 3505 patients were involved in evaluation of Zio. Of these, we reviewed the detailed rhythm data of 200 consecutive patients, and compared this with a retrospective cohort of 200 consecutive standard Holter monitored patients, fitted prior to the evaluation period. All patients had been referred to cardiology for investigation of heart rhythm symptoms. Results The total Zio group had a mean age of 63.8 years. The 400 participants used in the analysis groups matched this (Table) and there was no significant difference in the age ranges between the two groups. Holter duration was for: 24-hr (45%), 48-hr (8%), 72-hr (20%), 5-day (2%), 7-day (26%). Significant arrhythmias (defined as SVT ≥ 30s, VT ≥ 8bts, AV Block Mob 2⁰ or 3⁰, Pause ≥ 3s, Paroxysmal AF) were detected in 49 (25.8%) Zio patients compared with 18 (9.0%) Holter patients (P&amp;lt;0.00001). Total number of arrhythmia findings was greater in Zio compared with Holter; P&amp;lt;0.05 (Table). The arrhythmia findings in Zio were comparable with those in the pilot’s total cohort. In Holter, 41% of significant arrhythmias were detected in patients monitored for 24 hrs, comparable with Zio where 46% of arrhythmias were detected within the first 24 hours of wear-time. In Zio, 15% of significant arrhythmias were detected post 7 days of the wear-time. Conclusions Arrhythmia detection with Zio was significantly greater compared with Holter; detecting significant arrhythmias in nearly 3 times as many patients. Longer detection enabled greater arrhythmia detection, with 3 in every 20 patients having episodes occurring after 7 days. Even when adjusting for wear time, arrhythmia detection within 7 days was superior in the Zio group. Over half (59%) of arrhythmias were detected in patients monitored for 48 hours or longer, suggesting that for an efficient service longer monitoring is needed, particularly when symptoms are intermittent. For Holter monitoring this has considerable resource utilisation implications, relating to staff (cardiac physiologist) time and capital equipment (Holter monitoring stock). Also, greater detection of arrhythmia across the wear time suggests a higher sensitivity than Holter for detecting cardiac arrhythmias.