Remote patient monitoring solutions for healthcare providers

Ensuring connectivity between various parts of the healthcare system is a rising trend. Bring the patient closer to the doctor, the symptom closer to the diagnosis, the diagnosis closer to the clinical decision, and, therefore, provide precise and efficient care faster.

Remote patient monitoring (RPM) is vital for achieving this connectivity. In this article, we take a look at how cutting-edge technological solutions can make the healthcare system more cohesive. But first, let’s check how the coronavirus pandemic has irreversibly affected the RPM domain. 

The COVID-19 pandemic has put an enormous amount of pressure on medical facilities worldwide. Considered the largest health crisis of the 21st century, COVID-19 has greatly increased the number of people who require both immediate medical help and continual health monitoring. A lot of hospitals were not prepared for the strain and failed to provide services that were expected of them.

Due to this crisis, remote patient monitoring technologies have come to the fore of the medical industry. Creating distance between the patient and the doctor is extremely effective during the pandemic because it provides both safety and the possibility for medical professionals to monitor and help more people. Health monitoring software and devices provide information crucial for treatment, such as:

• Physiological data, including heart rate, temperature, and blood oxygen level
• Data gathered by patients, including self-reported activity, general physical and mental state, and well-being
• Long-term monitoring data that can be hard to gather during a patient’s visits to the hospital or clinic, such as general level of activity, number of daily steps, general tendencies, and changes in physiological data

The sporadic and sudden nature of COVID complications that can lead to severe (and sometimes fatal) consequences also requires some kind of medical alert button built into a remote health monitoring system. In circumstances when the number of medical specialists is limited as is the number of hospital beds for providing direct monitoring, the ability for a patient to send a distress signal and receive emergency aid is vital.

Considering all this, it’s no wonder that the remote patient monitoring device industry is booming. According to Transparency Market Research by PRNewswire, the annual growth rate of this market will amount to 12.5 percent in the next decade.

The majority of leading US hospitals and medical facilities have already implemented remote patient monitoring technologies into their workflow, mostly SaaS-based and cloud-based solutions. Here are some prominent cases:

• University of Pittsburgh Medical Center (UPMC)

The main RPM focus for UPMC is chronic heart disease. UPMC has created a system that allows patients to have greater control over disease management by providing them with a kit containing all necessary devices for physiological measurements and parameter monitoring. Healthcare provision is still monitored by appointed medical professionals who can intervene, but the fact that patients are given certain control over managing their diseases has greatly increased overall patient compliance. 

• Munson Healthcare

The Munson Healthcare system in Traverse City, Michigan, consists of nine hospitals and is a state leader in implementing remote patient monitoring technologies. 

The focus of Munson is changing the principles of the hospital–patient relationship towards modern digital standards. They have provided tablets to patients so patients can answer a series of daily questions. The answers are sent to an appointed nurse who uses them to map current patient states and make decisions about the necessity of in-person visits. 

• Emory Healthcare

Emory Healthcare tries to take remote patient monitoring a bit further than others by providing special wearable patches to their patients that allow for continuous ECG readings and, therefore, continuous heart rate monitoring for three-day stretches. 

The main focus here is studying and treating coronary heart diseases. ECG data provides a valuable source of information that can potentially be used for early detection of medical crises and even scientific data on connections between heart rate properties and blood flow disturbances.

Despite the growing global acceptance of remote patient monitoring technologies, some health providers are still reluctant to implement them. This is mostly because of the hardships associated with implementation — namely, problems with authorization and unclear benefits of RPM. Let’s talk about how to ensure RPM implementation. 

RPM systems are mostly considered a kind of IoT network. However, remote patient monitoring is wider than IoT and includes some cases with direct human-to-device interaction.

Here are some key components of an RPM system:

Let’s talk about RPM system components in detail.

Medical devices

All medical tools and devices provided by the modern medical industry deal directly with the subject of human health and well-being; therefore, they require careful scrutiny and thorough control. The US Food and Drug Administration (FDA) provides authorization for medical devices and decides whether they can be used as a source of data sufficient for clinical decision-making.

All patient-side RPM devices gather data and send it further — to the mobile device, such as a tablet or phone, and to a mobile application for patients. Several wireless technologies can be used to transmit data from an RPM medical device to a mobile application, but Bluetooth Low Energy is the most commonly used.

Although only data from authorized medical devices can be used for clinical decisions, medical specialists can also find data from common wearables (such as fitness trackers and smartwatches) useful. The healthcare community is still discussing this matter, but the overall opinion towards common wearable devices is becoming increasingly positive. 

Another way health data can be gathered is manually by the patient.

Patient

Bringing the possibilities of remote patient monitoring beyond the limits of IoT devices, patient-managed RPM applications present another actively growing market segment. 

IoT is great, but devices cannot measure everything, at least for now. No sensor can detect a patient’s overall mood and how it changes over time, or detect a patient’s subjective level of depression. Still, these factors are really important in creating a broad picture of illness, especially when it comes to long-term diseases such as cancer.

Such information can be obtained via a questionnaire or a feedback form filled out manually by the patient. After the data is filled in, it is then processed by a mobile application and sent to the cloud, where it can be analyzed by medical professionals.

Here are some of the parameters that patient-managed remote control applications can gather:

• Overall mood and feeling of wellness
• Sleep quality
• Whether a patient feels well-informed about the illness and possible treatment
• Level of accomplishment in daily activity
• Feelings of nausea
• Weight loss or gain
• Social activity

This list can be long and must be specific for each particular illness.

Analog data undergoes digital transformation and is sent to the next component: the patient-side mobile application.

Mobile application

An intermediary between a patient/medical device and the recipient of collected data, mobile applications must comply with a lot of regulations to both satisfy legal requirements and simultaneously be user-friendly to maximize patient feedback. We will get to the topic of applications in-depth later when talking about Yalantis projects. For now, let’s proceed to the next component.

Cloud data storage

There are two possible ways for cloud storage to receive data: from a mobile application or, in rare cases, directly from the IoT device if it has sufficient connectivity protocols. The information then gets transmitted to hospital devices.

Hospital devices and software

This is another part of the RPM flow where an application is needed, often being integrated with a general EHR system. On the hospital side, the application should consist of several main centers, each with its own function:

• The center of analysis provides medical personnel with complete and processed patient data along with visualization tools and business intelligence. It is the main part of the application that allows doctors to make informed clinical decisions. 
• The assistance center is a tool that automatically compares data received from the patient to the limits set by the doctor. If the limits are surpassed, this information is transmitted to the notifications center.
• The notifications center part of the application is designed to generate warning messages once the assistance center discovers that limits have been surpassed. If they are, a notification is immediately sent to the medical specialist responsible for monitoring.
• The report center gathers all information generated by measurements and their processing, arranges them into reports, and sends them to the person responsible.

After data has been received and processed on the hospital side, the next step is for hospital staff to react. The responsible healthcare professional either makes a clinical decision on changes in the treatment process or, if the information was obtained by unauthorized devices such as fitness trackers, gives general recommendations to the patient.

RPM systems are generally very useful, but they excel in telehealth solutions. A large portion of healthcare institutions have already implemented telehealth solutions into their workflow, and they can be improved by adding RPM functionality. 

The Maastricht University Medical Centre in the Netherlands faced certain challenges several years ago. They needed to: 

• modernize and optimize their catheterization laboratories
• upgrade the workflow of their cardiology department to improve patient outcomes
• enhance operational performance and also contain and manage costs

By implementing a complex IoT service management system that included a remote patient monitoring module, the medical center achieved the following results:

• A 90 percent reduction in patient admission times
• A 37 percent reduction in canceled procedures through better planning and scheduling
• $2.5 million in savings in one year
• A 33 percent reduction in the length of stay for cardiac resynchronization therapy patients
• A 43 percent reduction in staff overtime

At Yalantis, we have experience implementing such complex solutions. 

Since 2015, we’ve cooperated with Healthfully, a Californian company that offers multi-platform healthcare solutions for hospitals and hospital stakeholders. Our development team was responsible for creating an elaborate healthcare system, including patient engagement platform, and facing multiple challenges in the process such as:

• Ensuring secure data sharing between modules. We had to work with poorly documented legacy systems while maintaining system integrity. Our development team faced several challenges, such as ensuring PII and PHI data exchange between the app and third-party EHR system, implementing an HL7 message processing layer, and switching from hardware-driven IPsec with IKEv1 to the more secure IKEv2.
• Ensuring HIPAA and ONC compliance and product security. Since the Healthfully system was developed for large healthcare providers, compliance with HIPAA and ONC requirements was an absolute necessity. Considering the ever-increasing aggression of hackers on the internet, the final product also had to be particularly secure. To achieve that, we limited the scope of data visibility for sensitive PII/PHI data and implemented secure sharing of HL7 messages, session expiration, activity logging, etc.
• Developing a telehealth module in response to the COVID-19 outbreak. After the necessity of remote doctor appointments became apparent due to the risks associated with the pandemic, our client requested to add e-visits functionality to their solution. The time limits for this task were stiff, and therefore we decided to initially create an MVP instead of a fully developed solution. We also chose TokBox as a third-party video solution due to the ease and speed of its implementation.

The final product is being constantly supported and expanded by our development team, but it has already satisfied our client’s initial demands along with those that appeared during our cooperation. The results of our cooperation allowed our client to:

• partner with social health organizations 
• expand their network of healthcare provider partners by negotiating several key contracts
• participate in discussions with charity foundations on initiatives associated with remote online doctor visits, such as helping psychologically traumatized people get back to normal life

We also have another fresh case study about a telehealth solution upgrade and improvement with an emphasis on remote patient monitoring and implementation of IoT technologies. Following the client’s wish to increase the effectiveness of patient treatment for clinicians, we successfully:

• Designed mechanisms for storing data from wearable devices using data compression, a system of discarding data that is no longer valuable, and regular automated overviews of stored data with weekly summaries
• Developed ways of optimizing the data flow from wearable devices with schedule-based data control mechanisms
• Implemented security measures to ensure the security of sensitive information in compliance with HL7 protocol requirements

In light of this, implementing or upgrading an RPM system seems quite an obvious step forward for any large healthcare provider. How should one approach it, though?

We believe that the key to successful RPM implementation lies in your approach to patient-side and hospital-side software application development.

Custom software development for an RPM system can be divided into two main parts: building the patient-side application and building the hospital-side application. 

Patient-side application

First of all, a patient’s interactions with the RPM solution have to be as clear as possible: the effectiveness of data gathering depends on it, as does the overall quality of treatment by extension. It is also important to consider that the application’s UI/UX must be accessible for various user groups, including elderly people and people with motion and/or vision limitations. 

Besides, an application intended for a patient’s mobile device has to meet a certain set of criteria:

• Support the correct protocol for interaction with IoT medical devices gathering vital patient data. Most likely, these devices would use the Bluetooth Low Energy (BLE) protocol, but they may also use LoRa or other standards. 
• Maintain a high level of security for protected health information and comply with HIPAA regulations
• Be able to integrate into a system of interconnected medical software products by establishing a connection with the hospital-side system through a secure API that supports HL7 FHIR standards
• Caching mechanisms to prevent connectivity issues in case of network failures

In addition to meeting these criteria, you could implement a great number of upgrades and improvements according to your particular requirements.

For example, we had a case where a client required us to refine their existing telehealth solution and we needed to enhance the functionality of both patient-side and hospital-side applications. The client’s focus was on integrating IoT elements into their telehealth solution and increasing the effectiveness of overall patient treatment. Here are the improvements we introduced into the patient-side application:

• Improvements aimed at the patient experience. The user interface was lacking in terms of user-friendliness. We created a new UI, making it easy for patients to navigate, send information, follow guidelines from medical professionals, track overall treatment progress, and give feedback. We also made sure that the UI was clear and understandable for all age groups and patients in any physical condition. 
• Live visit mode with vitals tracking. We added a feature that allows the application to automatically detect when an online doctor visit is live and switch to a mode that allows the doctor and patient to seamlessly interact with each other and share real-time medical data.
• Comprehensive patient dashboard. A patient’s understanding of the treatment flow and their state is crucial for overall treatment success. Therefore, we implemented an overview with all data accumulated over a certain period presented in a clear and easy-to-read form. 
• Doctor-controlled schedules. Another effective tool for maintaining the treatment flow is a scheduling system. It’s a great way for doctors to assign times when patients should do any kind of routine activity: take medication, check vital signs, or perform physical exercises. The system sends automated notifications to patients.

Hospital-side application

The hospital-side application has its own set of requirements to comply with, including:

• HIPAA requirements. Just like with the patient-side application, HIPAA compliance must be maintained at all times.
• Healthcare interoperability standards. The application must be able to successfully become part of a complex device and software system, which most of the time means adopting HL7 FHIR and US Core Data for Interoperability (USCDI) standards.

Getting back to the Yalantis IoT integration case we described above, we also made some major improvements to the existing hospital-side application. Here are some of the most important enhancements:

• Notification system. The system constantly receives data from vital sign sensors and sends out notifications as soon as changes reach a pre-established threshold indicating a serious deterioration in the patient’s state. Medical professionals monitoring the system can then react accordingly, administering urgent measures.
• Synchronization of online sessions with tracking process. The second half of the synchronization system is built into the hospital-side application. The doctor can review measurements taken during the online visit and analyze them without interrupting the visit. 
• Enhanced monitoring and control of vitals data. We made the visual representation of information gathered from vital sign sensors more user-friendly and easier to handle. A plethora of visual tools are now available to the user, such as graphs and tables, so that even large amounts of information can be processed by the doctor. 
• Routine creation tool. Now doctors can create customized routines for patients, setting times for medication intake, physical exercises, vital sign checks, and online visits. Notifications are sent to patients, ensuring their awareness and improving the treatment flow.

Setting up your IoT remote patient monitoring system is a great way to ensure a constant increase in healthcare service quality, but it’s not the limit. Yalantis specialists can assist you in building another kind of RPM: a Patient-Reported Online Measures (PROM) system.

Some medically significant metrics cannot be measured via IoT devices alone. Especially in the case of chronic and long-term diseases such as cancer or diabetes, many things crucial for the treatment process can only be measured or assessed by patients themselves.

Therefore, patient-reported outcome measures, or PROMs, keep gaining importance in the field of medical data assessment. Of course, the subjective experience of the patient cannot (for the most part) be a reason for a clinical decision. However, it can be used for creating a general picture of treatment progress and as a basis for recommendations aimed at improving a patient’s quality of life. PROM-based applications can also include access to online patient portals, creating self-help groups, and providing a sense of unity.

Here are some important points on the importance of PROM applications:

• Patient reported information helps medical professionals establish the most effective treatment practices by presenting large amounts of data on the pain levels, physical function, and mental state of patients, simultaneously aiding in making clinical decisions. 
• PROM questionnaires can use both generally accepted standards — such as SF-36, VAS, or EQ-5D — and implement more specific sequences developed for a particular ailment.
• PROM questionnaires should be created with user-friendliness and compactness in mind; an abundance of information can lead to patients getting bored and annoyed and can therefore reduce patient compliance.
• PROM systems are also useful for creating predictive models. Establishing patterns in patients’ states and treatment flows makes it easier for doctors to make clinical decisions and leads to more cost-effective services. 

Our specialists believe that the trend toward PROM systems and applications will continue to grow, especially as more and more healthcare providers switch to value-based services.

The COVID-19 pandemic has changed the rules in the healthcare industry forever. No matter how long it takes to overcome the coronavirus, the changes are here to stay. 

People will rely more and more on remote healthcare IT, be wary of face-to-face interactions, and expect the industry to be ready for the next global pandemic. The best way for healthcare providers to demonstrate such readiness is to employ reliable remote healthcare technologies now. 

RPM systems, however, are more than an alternative to on-site healthcare. They intertwine with it and expand its limits. They can allow patients to register a lot more data on their health and general state of body and mind, leading to an increase in the effectiveness of in-person visits to the doctor.

RPM systems are gathering data in much larger volumes than traditional medical methods, and they are also teaching patients to be more attentive towards their health.

Yalantis has specialists with immense expertise in remote patient monitoring and telehealth in general. If you want a reliable partner or an expert consultation on such matters, contact us. We would be happy to help.