Remote patient monitoring can help enhance chronic care management in many ways, including allowing clinicians to track their patients daily and adjust treatment plans in real time.

May 27, 2022 – Amid the rapid expansion of virtual care, remote patient monitoring (RPM) has emerged as a reliable tool for treating both acute and chronic conditions.

RPM involves leveraging connected digital tools to record personal health data in one location that a provider reviews at a different location, either in real time or later, according to the Department of Health and Human Services’ Health Resources and Services Administration.

RPM programs employ different devices, like weight scales, pulse oximeters, blood glucose meters, blood pressure monitors, and heart monitors. These enable providers to keep track of patient health metrics between clinic visits and adjust treatment plans as needed, making RPM a beneficial tool for long-term chronic disease management. Further, hospital-at-home programs have proved to be a viable alternative to in-hospital stays for patients with chronic diseases.

Here are some of the chronic conditions that could benefit from RPM services:

DIABETES

There is strong evidence showing that RPM can improve diabetes care, and as a result, providers are increasingly incorporating the care modality into their diabetes services.

A study published in 2019 showed that patients with more frequent and regular participation in remote monitoring had lower hemoglobin A1c levels — which measures average blood sugar — at the end of the program.

Even during the COVID-19 pandemic, RPM helped providers manage type 2 diabetes patients. A study conducted at St. Joseph’s/Candler health system in Savannah, Georgia, showed that an RPM platform managed by a pharmacist helped reduce A1c levels by 2.2 percent over a six-month period in 2020.

In addition to type 2 diabetes patients, RPM tools can be used to improve care for young children with type 1 diabetes. Stanford Children’s Health in Palo Alto, California, conducted a study that showed 53 percent of children provided with continuous glucose monitors reached the standard of care goal of having an A1c below 7 percent.

“There has been debate in the medical community about when is too early to start diabetes technology,” Priya Prahalad, MD, Stanford Children’s Health pediatric endocrinologist and member of the Maternal and Child Health Research Institute at Stanford Medicine, previously told mHealthIntelligence. “And I think what we are able to show is that starting diabetes technology early does not have any adverse effects on patients and families. It does not decrease their quality of life.”

Among providers, RPM strategies are increasingly being applied to diabetes care. In April, UBMD Pediatrics, a medical group in New York State, announced a collaboration with Cecelia Health to enhance care for children with type 1 diabetes by providing RPM.

Last year, the University of Mississippi Medical Center partnered with a federally qualified health center to increase access to diabetes care through RPM.

HYPERTENSION

Several studies have found that RPM can help maintain and decrease hypertension or high blood pressure (BP).

One published in 2018 showed that 81 percent of hypertension patients who enrolled in a home-based BP monitoring program achieved their BP goal in about seven weeks. Another study showed an RPM program that combined home BP monitoring with virtual nursing support helped maintain and even reduce BP during the pandemic.

Not only that but home-based BP measurements were found to be more reliable and accurate than those taken in clinics or kiosks.

Based on this clinical evidence, several providers have incorporated RPM into their hypertension treatment programs.

Last year, Northwestern Medicine piloted OMRON Healthcare’s VitalSight RPM service for its high-risk hypertensive patients. The service provides patients with the necessary devices to measure and share BP readings with their care team.  

And it’s not just the major health systems — smaller facilities with fewer resources are also turning to RPM to manage hypertension. In January, North Carolina-based federally qualified health center Robeson Health Care Corporation announced a partnership with HealthSnap that would enable it to offer RPM to more than 2,500 patients living with hypertension.

CANCER

Research showing that RPM can be used to enhance cancer treatments was available long before the pandemic.

In a study published in 2016, some patients receiving routine outpatient chemotherapy at Memorial Sloan Kettering Cancer Center were asked to report 12 common symptoms via tablet devices. Health-related quality of life improved for patients who reported their symptoms via the tablet than those who received usual care, which did not include remote self-reporting of symptoms. Further, patients receiving the intervention were less frequently admitted to the emergency room or hospitalized.

More recently, researchers at Huntsman Cancer Institute at the University of Utah found that the patients who participated in its adult oncology hospital-at-home program were 58 percent less likely to be admitted for an unplanned hospital stay than those not in the program.

Amid the recent disruptions in cancer care, RPM has helped ensure continued care access for cancer patients in their own homes, including those who contracted COVID-19.

A study published last September showed most COVID-19-positive cancer patients enrolled in an RPM program agreed that the program was worthwhile, enabled better management of their COVID-19 symptoms, and made them feel more connected to their care team.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems.

Studies show that RPM can be used to improve care for COPD patients, including one where researchers concluded that “remote monitoring of COPD patients holds promise for detection of exacerbation events.”

Another study published in 2021 revealed that RPM could help make COPD diagnoses and treatment more efficient.

In addition, research indicates that patients are ready to use a telemonitoring system for at-home pulmonary rehabilitation. The study published in 2018 shows that 98 percent of the participants agreed the system was easy to use and said they would be willing to use it throughout the pulmonary rehabilitation period.

As the initial COVID-19 surges slowed, providers and payers began adding COPD care to their home monitoring programs.

In 2021, West Tennessee Health modified its RPM platform to monitor patients with congestive heart failure and COPD, and Deaconess Health made a similar move.

Humana also launched a home healthcare service last year that included RPM. The payer announced plans to develop care pathways for members with various chronic conditions, including COPD.

As RPM becomes further integrated into care delivery, the physical boundaries of the healthcare system will shift, opening up possibilities for more comprehensive chronic care management.

The post 4 Chronic Care Use Cases for Remote Patient Monitoring appeared first on Dr. Miltie.

The most powerful drivers for digital home hospital adoption are advances in telehealth, remote monitoring and emerging digital technologies that facilitate high quality, cost-effective care beyond hospital walls.

By GARY MANNING

May 4, 2022 at 4:19 PM

In 2005, a study in the Annals of Internal Medicine demonstrated that digital home hospital, or hospital-at-home, solutions delivered better clinical outcomes, shorter average length of stay, higher patient and family satisfaction, fewer complications and significant cost savings, compared to traditional inpatient care. Since then, other research has shown similar findings including 70% reduced readmission rate, 40% lower cost and improved patient mobility for patients managed at home.

Despite these measurable benefits, adoption of hospital-at-home models is limited. However, several factors have recently converged to hospital at home implementation.

Pioneered by Johns Hopkins in 1995, the innovative hospital-at-home model provides hospital-level care in a patient’s home as an appropriate and, in some cases, better substitute for acute hospital care.

Current digital home hospital care models typically require eligible patients to be identified in the emergency department or an ambulatory care site. Once patients are admitted or accepted into the program, clinicians visit daily and all necessary care infrastructure—from infusion services to medication delivery devices to remote monitoring—is set up in the home.

Why now?

The Deloitte Center for Health Solutions identified several key reasons why hospitals are seeking to transform their business models, including the desire to reduce costs, maximize technology, better engage consumers, boost clinician satisfaction and compete with healthcare disruptors from Walmart to Amazon.

The digital home hospital concept offers potential for addressing all these challenges, especially given healthcare systems, physicians and patients alike embraced virtual care and digital technologies with newfound enthusiasm during the pandemic. Managing patient care virtually allowed patients fearful of Covid-19 exposure to be treated at home when possible. Simultaneously, hospitals stretched beyond capacity by waves of Covid-19 patients—and juggling limited resources—were able to hold more hospital beds available for more acutely ill patients.

In addition to the pandemic’s broadening acceptance for telehealth, it removed a major hurdle to digital home hospital adoption by spurring CMS and other payers to begin covering care provided outside of hospitals, including in patients’ homes.

McKinsey & Company estimates that up to $265 billion worth of care services for certain Medicare beneficiaries could shift from medical facilities to homes by 2025—without a reduction in quality or access. This critical change in reimbursement policies enables healthcare providers to cost-effectively expand care access to more patients while eliminating the need for substantial investment in building or acquiring more inpatient facilities.

Consumer expectations for improved care experiences are also accelerating interest in hospital-at-home models. Although hospitals are the gold standard of care for acute illness in the U.S., they can be expensive and uncomfortable, especially for older patients who frequently suffer delirium, contract hospital-associated infections or decline in function.

The digital technology edge

The most powerful drivers for digital home hospital adoption, however, are advances in telehealth, remote monitoring and emerging digital technologies that facilitate high quality, cost-effective care beyond hospital walls.

First, continuous remote patient monitoring (cRPM) sensors are improving in quality and data capture while also becoming smaller, easier to wear and more economical. Second, the pervasive use of smartphones and mobile apps allows clinicians and patients to stay in contact and share vital health information. Third, volumes of data can be stored in the cloud and accessed in near-real-time. These solutions are designed not only to emulate the care that patients receive in a hospital, but to enhance it. And last, FDA-cleared artificial intelligence (AI) algorithms can be used to analyze multivariable patient data and support the delivery of personalized insights that can transform care. In fact, the Deloitte Center for Health Solutions identified AI and machine learning as significant transformers of healthcare in the next 10 years.

Patient-centric care 

The digital home hospital model provides an outstanding opportunity for hospitals to offer patient-centric care, which encourages active collaboration and shared decision-making between patients, families and clinicians to design and manage customized and comprehensive care plans.

For example, many in-patients receive periodic visits in their room from clinicians to spot check their vitals, whereas digital home hospital patients can be conveniently monitored, continuously, and often passively. This way, clinicians can closely track key health indicators, receive alerts to early signs of potential deterioration and check in with patients through a mobile app, text or video call. This allows the right care to be provided to the right patient at the right time—focusing on both the patient’s physical comfort and emotional well-being.

In the digital home hospital model, patients—especially those with a chronic condition such as heart failure or COPD—feel more confident and comfortable that they are being constantly monitored, as do their family members and others who play a role in decisions and communication about their care. Clinicians now have access to patient-reported outcomes and hard data to make informed care decisions, such as whether to continue monitoring and treating patients at home or admit them to the hospital. The ubiquitous use of EMRs across health systems also helps ensure that digital home hospital care delivery can be entered into patient records to keep all care providers updated on a timely basis.

The digital home hospital environment also can support improved medication adherence, crucial to patient outcomes. For example, adding a layer of cRPM on top of multiple daily clinician visits, as part of the digital home hospital model overall, provides an opportunity to monitor patients for changes in vital signs that might indicate side effects or non-compliance.

Hospital at home in action

Let’s consider a hypothetical scenario to illustrate the benefits of the digital home hospital model. A 70-year-old woman with NYHA Class II Heart Failure and atrial fibrillation (afib) visits the ED with palpitations, anxiety and shortness of breath.

The ED physician determines she is having poor rate control of her afib and changes her medication dosage. After a consult with the hospitalist, she is admitted to a hospital-at-home program (instead of an inpatient bed) and receives training on the cRPM solution, which includes a chest patch and mobile smartphone app.

The app links her to a clear explanation of her new medication regimen and information about her condition to share with family members. Her home health nursing team sends messages to remind her to respond to daily check-in surveys.

When the patient overexerts herself a couple of days later, the app immediately asks her to answer a few questions and shares the results with her care team. A nurse reaches out to further assess her status, advising rest and re-educating on when to take her medication—avoiding an unnecessary ED visit. Moving forward, the home health team continues to monitor her activity, vital signs and progress as she engages in her rehab exercises on her app.

A positive outlook 

All signs point to the hospital business model of the future looking radically different than today’s version. Digital home hospital solutions are going to be pivotal in their ability to improve the patient experience. With the right technology, clinicians can deliver hospital-level care to more patients in the right place—which for many, is in the comfort and familiarity of their own home.

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Remote patient monitoring (RPM) provides clear benefits for clinicians, health systems and patients. Patients can stay at home, and go about their daily routines, while their conditions are monitored, reassured in the knowledge that action can be taken if needed. Meanwhile, health providers can plan resources knowing which ongoing patient conditions can be managed remotely, requiring fewer in-person appointments.

The rising trend of RPM

The COVID-19 pandemic highlighted the important role RPM can play in effective healthcare. A recent government health and social care policy paper cited the need to, “maintain the pace of adoption seen through the pandemic, when … consultations moved online, clinicians and other staff worked from home, people were monitored remotely, including in care homes, and information flowed more effectively between care settings.”

At a time of social distancing, monitoring patients remotely helped minimise gatherings in waiting rooms and reduced strain on a stretched health system. However, even before the pandemic two clear factors drove demand for RPM. The first, a changing population demographic with a higher percentage of older patients with more complex health needs, and the second, ongoing and continued pressures on a health sector faced with resource constraints.

Through RPM, health and social care providers can track a range of conditions including chronic obstructive pulmonary disease, diabetes and sleep apnoea. Care workers and doctors can collect the data they need to make informed decisions, all without patients having to leave their homes.

Devices, including wearables, capture regular patient readings. These can include measures of lung capacity and blood pressure, for example.

The opportunities for RPM extend to social care too. Assisting the elderly and vulnerable so they can live independent lives while being monitored for their wellbeing helps improve quality of life. Being able to monitor patients taking their medication helps make this possible. Pill dispensers set to open at relevant times are a simple but valuable way of facilitating this.

The technology making RPM possible

RPM technologies must be quick and easy to setup and use. Transmitting data from patients’ devices back to healthcare organisations cannot depend too heavily on patient-side infrastructure, such as Wi-Fi or fixed lines. These may not be available and, even if they are, they may require a level of patient knowledge to set up that would complicate RPM deployment.

Data transfer must also be reliable, and security is exceptionally important. After all, patient data is among the most sensitive information there is.

Solutions providers need insight into their deployed devices and the ability to effectively manage their active connections. Many providers will have thousands of devices out there and will want a simple, effective way of monitoring and controlling these.

All of which means the right connectivity choice is central to effective RPM and healthcare organisations, and their solutions providers, should weigh up their options carefully.

Making the right cellular choice

Cellular connectivity for RPM gives control over implementations. For patients, it is the simplest way to get up and running as it makes no demands on their own broadband, mobile connections or technical know-how as RPM devices can be used straight out of the box

It provides flexibility too, as RPM solution providers can choose connectivity type, network and tariff according to each deployment. Network bandwidth, for example, will depend on application type and the levels of data being transferred.

Typically, 4G will support higher bandwidth applications requiring fast, secure and resilient connectivity. Low power wide area networks (LPWANs) are ideal for devices with low data throughput and low power use, for example battery-operated devices. Meanwhile, for solutions that require two-way device communication, fixed private IP addressing allows secure connectivity via virtual private networks (VPNs).

As cellular connectivity evolves, it offers enhanced functionality that makes it the ideal choice for RPM. One recent innovation is the eSIM, a clever new take on the traditional mobile SIM that can be provisioned ‘over-the-air’ to adapt or change the profile or applications held on the SIM. A provider may wish to do that to change network to, for example, access a different tariff or improve coverage. For multi-national deployments, eSIMs are particularly convenient as they make it possible to use the same SIM in all devices, and simply provision for each local network, with adherence to local regulations governing security and data privacy.

Working with a partner

Healthcare and solutions providers implementing RPM don’t want to spend time thinking about which network or cellular technology provides the best solution. They need reliable partnering so they can concentrate on patients, and not technicalities.

As RPM data is so sensitive, they will also want to trust in a managed service provider accredited for ISO 27001 to provide the reassurance that processes, and data transfer, are secure.

An IoT connectivity platform provider takes away the inconvenience RPM providers would otherwise have of ‘stitching’ coverage together across multiple mobile network operators, and the complexity of managing SIMs across those networks.

A ‘network of networks’ approach simplifies cellular connectivity for RPM. It can also offer full visibility to solutions providers, across their SIM estates, with control and the capability to scale up or down as required.

Healthcare and technology intersect where innovation and increasing knowledge creates exciting possibilities for the future. RPM is a growth area of healthcare with the potential to expand to support more patient groups and conditions. Digital healthcare creates a growing need for secure, reliable and always-on connectivity, with cellular connectivity supporting healthcare providers and patients through RPM. 

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Program Will Support Connected Care Services Across Country, Focus on Low-Income and Veteran Patients

  —

WASHINGTON, March 16, 2022—Today, the Federal Communications Commission announced its fourth and final set of approved Connected Care Pilot Program projects.  These 16 projects were approved for a total of $29,752,601 in funding.  With the newly selected projects, the Connected Care Pilot Program is set to fund 107 projects serving patients in 40 states plus Washington, D.C. 

Today’s action also sets a uniform deadline for all participants to file their initial funding request by September 16, 2022.

Telehealth has assumed an increasingly critical role in health care delivery, enabling patients to access health care services without needing to visit a health care provider’s medical office. Among other benefits, connected care services, delivered via a broadband internet access connection directly to the patient’s home or mobile location, also can help contain and treat health conditions during public health emergencies, such as the ongoing COVID-19 pandemic. The Pilot Program will make available funds from the Universal Service Fund over a three-year period for selected pilot projects to help defray the costs of providing certain telehealth services for eligible health care providers, with a particular emphasis on providing connected care services to low-income and veteran patients. 

The additional projects selected today will address a number of critical health conditions such as high-risk pregnancy/maternal health, mental health conditions, opioid dependency, COVID-19, and chronic conditions.  Funding these projects will help bring connected care services to rural and other underserved areas nationwide and will also help the Commission learn more about how Universal Service Fund support can enable providers to use connected care to help improve health outcomes.

• Boston Medical Center, Boston, MA.  Boston Medical Center seeks $446,250 in Connected Care support to provide video visits or consults, remote treatment, and remote patient monitoring to low-income patients who are suffering from chronic/long-term conditions and mental health conditions.  Boston Medical Center would serve approximately 1,500 patients, 85% of whom would be low-income.  Boston Medical Center was selected because of its potential impact on this low-income patient population.
   
• Boston’s Community Medical Group, Inc., Boston, MA.  Boston’s Community Medical Group, Inc., seeks $918,000 in Connected Care support to deploy a HIPAA-compliant telehealth platform to serve its 22,000 low-income patients across Massachusetts with primary care and wrap-around services.  Patients to be served are eligible for both Medicare and state Medicaid-supported services, with many having a physical or behavioral disability, a severe mental illness, or substance-use disorder.  Boston’s Community Medical Group’s proposal was chosen because of its potential impact on rural and medically underserved areas and its focus on high-need, low-income populations.  
  
  
• Children’s Hospital of Denver, Aurora, CO.  Children’s Hospital of Denver would use $824,096 in Connected Care support to provide remote patient monitoring and treatment services to low-income patients under 21 years of age suffering from medically complex conditions.  Children’s Hospital would serve an estimated 200 patients in Wyoming and Colorado, 100% of whom are low-income.  Children’s Hospital of Denver was selected because of its potential impact on low-income children with medically complex conditions in Colorado and surrounding rural areas.
  
  
• Christiana Care Health Services, Newark, DE.  Christiana Care Health Services’ Pilot project would use $3,253,627 in Connected Care support to provide prenatal remote patient monitoring and telehealth visits to primarily low-income patients.  Christiana Care Health Services’ Pilot project would serve an estimated 5,000 patients in Delaware, 80% of whom would be low-income.  Christiana Care Health Services was selected because of its focus on maternal health for low-income patients. 
  
  
• Community Guidance Center – Indiana Location C19, Indiana, PA.  Community Guidance Center would use $154,530 in Connected Care support to provide teletherapy services to low-income and veteran patients in western Pennsylvania.  This Pilot project will focus on providing mental health, substance abuse, and intellectual disability treatment services to 150 patients.  Community Guidance Center’s Pilot project was selected because of its focus on expanding access to mental health services to low-income patients residing in rural areas.
  
  
• Community Health Center, Inc. (CHCI), Middletown, CT.  Community Health Center, Inc., is a consortium with 30 different sites across Connecticut.  CHCI seeks $1,093,398 in Connected Care support to provide remote patient monitoring and video consults to low-income and veteran patients with complex, chronic conditions such as hypertension, mental health disorders, obesity, opioid dependency, and HIV, often compounded by adverse social determinants of health such as homelessness.  CHCI would treat an estimated 15,000 patients, more than 80% of whom would be low-income and approximately 5% of whom would be veterans.  Community Health Center, Inc. was selected because of its potential impact on low-income and veteran patients across multiple communities.
   
• Council of Athabascan Tribal Governments (Yukon Flats Health Center), Fort Yukon, AK.  Through its Pilot project, Council of Athabascan Tribal Governments (Yukon Flats Health Center) seeks $1,124,486 in Connected Care support to provide patient-based, internet-connected remote monitoring, other monitoring, video visits, imaging diagnostics, remote treatment, and other services for veterans and low-income patients with chronic conditions, high-risk pregnancy/maternal health, infectious diseases like COVID-19, mental health conditions, and opioid dependency.  This Pilot project would reach an estimated 5,588 patients, 95% of whom would be low-income and 5% of whom would be veterans.  This project was chosen because of  its potential impact on low-income and veteran patients in a rural region in Alaska.
  
  
• Golden Valley Health Centers, Merced, CA.  Golden Valley Health Centers’ Pilot project would use $725,195 in Connected Care support to provide patient-based internet-connected remote monitoring, other monitoring, video visits or consults, and imaging diagnostics primarily to low-income patients suffering from chronic or long-term conditions, mental health conditions, and opioid dependency.  Golden Valley Health Centers’ Pilot project would provide connected care services to 70,000 patients in California, nearly all of them low-income.  Golden Valley Health Centers was selected because it would serve a large number of low-income patients.
  
  
• Greater Baden Medical Services, Inc., Brandywine, MD.  Greater Baden Medical Services, Inc., seeks $406,249 in Connected Care support to provide patient-based, internet-connected, remote monitoring, video visits, and remote treatment for veterans and low-income patients whose needs include chronic or long-term conditions, high-risk pregnancy/maternal health, infectious diseases like COVID-19, mental health conditions, and opioid dependency.  Greater Baden Medical Services’ Pilot project would reach an estimated 5,400 patients across Maryland, 35% of whom would be low-income and 20% of whom may be veterans.  Greater Baden Medical Services was selected because of its potential impact on the low-income and veteran populations that it serves. 
  
  
• MUSC Medical Center, Charleston, SC.  MUSC Medical Center’s Pilot project seeks $246,347 in Connected Care support to provide remote patient monitoring and video visits to treat patients for maternal health, chronic conditions, mental health issues, opioid dependency, and infectious diseases.  MUSC Medical Center’s pilot project would reach an estimated 3,500 patients, 25% of whom would be low-income patients.  MUSC Medical Center was selected because of its focus on expanding connected care services, with a specific focus on maternal health and chronic conditions. 
  
  
• New England Telehealth Consortium, Inc., a consortium with a site in North Conway, NH, and 10 sites in Maine.  New England Telehealth Consortium seeks $2,560,098 in Connected Care funding to connect patients directly into its existing consortium network for purposes of receiving connected care services.  The Pilot project would serve 1,872 patients, 20% of whom would be low-income patients and 11% of whom would be veterans.  New England Telehealth Consortium was selected because of its potential impact on these patient groups and its commitment to address maternal health, chronic and long-term conditions, infectious diseases, mental health conditions, and opioid dependency. 
  
  
• Northern Nevada HOPES, Reno, NV.  Northern Nevada HOPES’ Pilot project seeks $331,884 in Connected Care support to provide remote patient monitoring services and virtual visits to low-income patients suffering from HIV/AIDS, diabetes, opioid dependency, heart disease, and hypertension.  Northern Nevada HOPES’ Pilot project would serve an estimated 180 patients, nearly all of whom would be low-income.  Northern Nevada HOPES was selected because of its focus on providing broadband to patients residing in transitional housing intended to relieve homelessness. 
  
  
• Palmetto State Providers Network, a consortium with 34 sites in South Carolina.  Palmetto State Providers Network’s Pilot project would use $7,192,893 in Connected Care support to provide remote monitoring and video consults to primarily low-income patients suffering from chronic conditions and infectious diseases.  Palmetto State Providers Network’s Pilot project would serve an estimated 18,000 patients at six locations, of whom 80% are low-income.  Palmetto State Providers Network was selected because of its provision of broadband to a large number of low-income patients.
  
  
• Tower Health – Reading Hospital, West Reading, PA.  Tower Health – Reading Hospital’s Pilot project seeks $396,457 in Connected Care support to provide patient broadband and connected care services for low-income residents of transitional housing.  Tower Health – Reading Hospital’s Pilot project would serve an estimated 169 patients, nearly all whom would be low-income and 15% of whom would be veterans.  Tower Health’s project was selected because of its provision of broadband to low-income and veteran patients and potential impact on these populations.
  
  
• University Hospital, Newark, NJ.  University Hospital seeks $627,300 for telehealth platforms, including an integrated telehealth platform, to facilitate virtual visits and remote patient monitoring to treat patients with chronic and long-term conditions, as well as COVID-19.  University Hospital would serve 80,000 patients in Newark, approximately 29.7% of whom are low-income or veteran patients.  University Hospital was selected because it has significant telehealth experience and is the only state-owned acute healthcare facility in Newark New Jersey’s Central Ward, with a service area that includes medically underserved areas. 
  
  
• Willis-Knighton Health System, Shreveport, LA.  Willis-Knighton Health System seeks $9,451,791 in Pilot Program funding for patient broadband and to expand remote patient monitoring and video visits and consults to treat patients for chronic conditions (including diabetes, hypertension and chronic obstructive pulmonary disease), high-risk pregnancy/maternal health, mental health conditions, opioid dependency and infectious diseases.  Willis Knighton Health System’s Pilot project would serve an estimated 12,554 patients, approximately 57% of whom would be low-income or veterans, in Arkansas, Louisiana, and Texas, including rural and medically underserved areas.  Willis Knighton Health System’s Pilot project was selected because of its focus on expanding access to connected care services and addressing broadband connectivity barriers for low-income and veteran patients, including in rural and underserved areas.

To learn more about the FCC’s Connected Care Pilot Program, visit https://www.fcc.gov/wireline-competition/telecommunications-access-policy-division/connected-care-pilot-program.

Action by the Commission March 16, 2022 by Public Notice (FCC 22-23).  Chairwoman Rosenworcel, Commissioners Carr, Starks, and Simington approving.  Chairwoman Rosenworcel, Commissioners Carr and Starks issuing separate statements.

WC Docket No. 18-213

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ASX ANNOUNCEMENT
23 December 2021

Respiri enters its first 5 year Remote Patient Monitoring (RPM) Distribution/Marketing Agreement in the United States with Dr. Miltie, LLC
Highlights:
• Five-year, Non-Exclusive Distribution and Marketing Agreement signed with Dr. Miltie in the key US
market
• Dr. Miltie is a premier provider of RPM services based in Florida
• First key distribution and marketing agreement signed in the US market
• Initial US$150,000 order, with minimum forecast sales of US$1 million over the life of the agreement by Dr. Miltie
• Physicians will be able to claim RPM CPT reimbursement for wheezo® and Respiri will share these monthly recurring revenues in addition to the devices sales
• Further third party agreements anticipated as Respiri builds out US RPM strategy for wheezo®

Respiri Limited (ASX:RSH)(“Respiri” or the “Company”), an eHealth SaaS Company supporting respiratory health management is excited to announce its first non-exclusive distribution/marketing partnership with Remote Patient Monitoring (RPM) and chronic care provider Dr. Miltie LLC, effective immediately. Under the terms of the Agreement, Dr. Miltie has placed a significant initial order for wheezo® devices and services, totalling USD$150,000 in December 2021 for delivery in January 2022 and is contracted to . Either party can terminate with 30 days’ notice if there has been a material breach of the Agreement. This Agreement is material, as the Company currently has no US sales for wheezo®. Dr. Miltie has forecast a minimum of US$1 million in wheezo® device sales over the five years of the Agreement (forecast only) with a contracted minimum quarterly commitment of 1,000
wheezo® units.

In addition to these initial device sales, Respiri and Dr. Miltie will share the Product as a Service (PaaS) monthly fees that will be charged to physicians and other Healthcare Professionals claiming RPM and other CPT reimbursement codes.

Dr. Miltie is a well-respected and known provider of complete turnkey RPM and associated services to physicians and relevant healthcare delivery organisations for over 11 years and is domiciled in Florida, US. Dr. Miltie’s US footprint is broad and includes the Departments of Health and their County affiliates, payor Health Maintenance Organisations (HMOs), hospitals, Universities, Medical Centres, along with other RPM corporations and institutions. RPM is the use of digital technologies deployed in the collection and analysis of patient physiologic data that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition. RPM systems improve patient health and device compliance, which leads to a reduction in hospital admissions and reduced healthcare costs. In parallel, RPM generates new revenue streams for healthcare providers while improving patient care and associated medical information outside the clinic for evaluation and management purposes. In the US, the physician and relevant healthcare physicians are reimbursed directly for providing medical devices to
patients allowing them to provide Remote Patient Monitoring services, which are reimbursed by HMOs and Medicare. Organisations like Dr. Miltie have built relationships with physicians and relevant medical and reimbursement institutions to deliver devices and services that enable the physician to provide said RPM service enabling them to claim the reimbursement. Respiri has developed a US commercialisation strategy around forging strategic partnerships with such RPM service providers with these existing relationships. The US market is large and fragmented and there is no single company providing national coverage, hence Respiri’s strategy is to execute further agreements to gain broader coverage in the market. Respiri is delighted to have executed an agreement with Dr. Miltie, as a premier and first partner of the Company.

The overall RPM market is expected to show annual growth exceeding 30% to 2026 to US$85 billion, driven by the increase in the occurrence of chronic diseases (including asthma), demand for wireless and portable systems, the presence of sophisticated reimbursement structures, and a move to more cost effective medical expenditure.1

CEO and Managing Director of Respiri, Mr Marjan Mikel said “We are particularly excited about our partnership with Dr. Miltie, a trusted RPM partner to many healthcare delivery organisations and physicians across the United States. Marc and his team very quickly understood what patient benefits wheezo® could provide and imparted invaluable local knowhow to help us better tune our US launch strategy and leverage the existing RPM CPT reimbursement codes available to Respiri. This agreement demonstrates that we are executing on our US strategy.”

President and CEO of Dr. Miltie, Mr Marc Poulshock said “We have a long pedigree in providing our customers across the United States with chronic care and remote patient monitoring turnkey solutions and we could see the health benefits that wheezo® could provide patients with asthma where very little, in the form of RPM solutions are available today. Part of our wheezo® due diligence was to discuss the device with physicians, HMOs and local Department of Health authorities and the responses were very positive. This was again reflected in the high level of inquiry that our initial marketing campaign waves generated from very large HMOs to county health departments and we are very confident with our 5 year forecasts for wheezo® sales. There is definitely a need for wheezo® in the US and we are pleased to have partnered with Respiri in this large and growing market.”

The Company is in active discussions with a number of additional RPM/chronic care providers, which should be finalised progressively during 2022.

For further information, investors and media please contact:

Mr Marjan Mikel
CEO & Managing Director
Respiri Limited
P: +61 408 462 873

E: marjan@respiri.co

Mr Nicholas Smedley

Executive Chairman

Respiri Limited

P: +61 447 074 160
E: nicholas@respiri.co

This ASX announcement dated 23 December 2021 has been authorised for release by the Board of Directors of Respiri Limited.

About Respiri Limited

Respiri is an e-Health SaaS company supporting respiratory health management. Its world-first technology detects wheeze, a typical symptom of asthma, COPD and respiratory disease to provide an objective measure of airway limitation. wheezo®, Respiri’s innovative technology, comprises an eHealth app combined with a simple, easy-to-use, handheld device. wheezo® is the first smart device to help improve asthma management by monitoring wheeze and documenting symptoms, signs, triggers, weather conditions and medication use. The asthma management platform also facilitates the sharing of data with caregivers, physicians, and other health care professionals.

1 https://www.businesswire.com/news/home/20210720005704/en/85-Bn-Remote-Patient-Monitoring-Market—Global-Forecasts-from-2021-to-2026—
ResearchAndMarkets.com

Respiri’s mission is to help improve quality of life for hundreds of millions of children and adults around the world and dramatically reduce hospital admissions and the economic burden of asthma. Respiri Limited’s operations are based in Melbourne, Australia.

For additional information about Respiri and its products, please visit www.respiri.co

About wheezo®
Developed in Australia, with the support of respiratory specialists and other healthcare professionals, the innovative wheezo® device analyses breath sounds for wheeze, and the eHealth App assists patients with managing their asthma by tracking symptoms, triggers, medication use and geo-specific weather conditions. The platform has been designed to extend asthma management beyond the clinic and make it easy to share information with doctors and make appropriate adjustments to asthma action plans. Better active management may lead to better outcomes and improved quality of life for the asthma patient.

For further information about wheezo®, follow the online link https://wheezo.com

wheezo® is a registered trademark of Respiri Limited.

About Dr. Miltie

Dr. Miltie, LLC, founded in 2010 and based in Delray Beach, FL, United States, is a premier provider of Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Telemedicine, Chronic Care Management (CCM), Virtual Exam, Video Visit, and related Telehealth solutions. Dr. Miltie’s Remote Health Monitoring System, Powered by a TouchAway™, provides a complete solution to remotely collect, store, and report timely and accurate health information anywhere. The company connect patients with their families and care providers through an easy-to-use, affordable, remote health monitoring kit. For more information about Dr. Miltie, please visit our website: https://drmiltie.com.

Forward Looking Statements

Certain statements made in this announcement are forward-looking statements. These forward looking statements are not historical facts but rather are based on Respiri current expectations, estimates and projections about the industry in which Respiri operates, and its beliefs and assumptions. Words such as “anticipates,” “expects,” “intends,” “plans,” “believes,” “seeks,” “estimates,” “guidance” and similar expressions are intended to identify forward looking statements and should be considered an at-risk statement. Such statements are subject to certain risks and uncertainties, particularly those risks or uncertainties inherent in the process of developing technology and in the endeavour of building a business around such products and services. These statements are not guarantees of future performance and are subject to known and unknown risks, uncertainties and other factors, some of which are beyond the control of Respiri, are difficult to predict and could cause actual results to differ materially from those expressed or forecasted in the forward looking statements. Respiri cautions shareholders and prospective shareholders not to place undue reliance on these forward looking statements, which reflect the view of Respiri only as of the date of this release. The forward looking statements made in this announcement relate only to events as of the date on which the statements are made. Respiri will not undertake any obligation to release publicly any revisions or updates to these forward looking statements to reflect events, circumstances or unanticipated events occurring after the date of this announcement except as required by law or by any appropriate regulatory authority.

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The e-health company’s shares closed in the green today on news of a new partnership

Published December 23, 4:39pm AEDT

The Respiri Ltd (ASX: RSH) share price leapt 14% to 6.5 cents in early trading this morning. This came following the announcement of a distribution and marketing deal with a United States healthcare company.

At the closing bell, Respiri shares had wiggled back down to 5.9 cents apiece, a 3.5% increase from yesterday’s closing price.

Respiri’s telehealth deal

At its core, Respiri is focused on bringing simple respiratory solutions to those living with asthma.

Its primary product, wheezo, assists in the tracking and management of asthmatic symptoms. It also has the ability to share relevant information with doctors and caregivers.

The deal driving the Respiri share price today combines the efforts of US-based remote patient monitoring (RPM) provider Dr. Miltie, LLC with Respiri.

The partnership entails an initial request from Dr. Miltie for USD$150,000 (A$208,000) worth of wheezo devices and services to be delivered as early as next month.

Up until now, wheezo products had not been sold in the US.

Respiri also predicts the RPM market will grow by more than 30% by 2026, up to US$85 billion, due to the increase in asthma and chronic diseases.

Therefore, Dr. Miltie has predicted US$1 million in wheezo sales over the next five years and has agreed to obtain a minimum of 1,000 units every quarter.

This marks the first deal of its kind signed for Respiri.

Respiri CEO pleased with the partnership

Commenting on the news fuelling the Respiri share price today, CEO and managing director Marjan Mikel said:

We are particularly excited about our partnership with Dr. Miltie, a trusted RPM partner to many healthcare delivery organisations and physicians across the United States.

Marc [Poulshock, president and CEO of Dr. Miltie] and his team very quickly understood what patient benefits wheezo could provide and imparted invaluable local knowhow to help us better tune our US launch strategy and leverage the existing RPM CPT reimbursement codes available to Respiri.

Poulshock said there was “definitely a need for wheezo in the US” and the company was pleased to have entered the partnership.

Respiri share price snapshot

The Respiri share price has seen a year in red, declining by around 55%.

The company has a market capitalisation of $41.2 million based on its current share price and over 720 million shares issued.

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Markets Reporter

jessica.defreitas@themarketherald.com.au

23 December 2021 14:54 (AEDT)

Respiri (RSH) has entered a non-exclusive distribution and marketing partnership with remote patient monitoring (RPM) and chronic care provider, Dr. Miltie.

Under the deal, the US-based healthcare company will place an order for Respiri’s wheezo devices and services.

Importantly for Respiri, this marks its first key distribution and marketing deal in the US market.

The wheezo device analyses breath sounds and the eHealth app helps patients with managing their asthma by tracking symptoms, triggers, medicine use and weather conditions.

wheezo is available in pharmacies across Australia and received the tick of approval from the US Food and Drug Administration earlier this year.

Respiri has been focused on commercialising its product in the US market and forming partnerships with Remote Patient Monitoring (RPM) service providers and was pleased to be signing the agreement.

Respiri and Dr. Miltie will share the Product as a Service (PaaS) monthly fees that will be charged to physicians and other Healthcare Professionals claiming RPM and other Current Procedural Terminology (CPT) reimbursement codes.

Respiri CEO and Managing Director Marjan Mikel is excited about the partnership, praising Dr. Miltie CEO Marc Poulshock and his team.

“Marc and his team very quickly understood what patient benefits wheezo could provide and imparted invaluable local knowhow to help us better tune our US launch strategy and leverage the existing RPM CPT reimbursement codes available to Respiri. This agreement demonstrates that we are executing on our US strategy.”

The initial order is valued at US$150,000 (A$208,087) however Dr. Miltie has forecast at least US$1 million (A$1.4 million) in wheezo device sales over the five year term of the agreement. The deal has a contracted minimum quarterly commitments of 1000 wheezo units.

In addition to the initial device sales, Respiri and Dr. Miltie will share the product-as-a-service monthly fees that will be charged to physicians and other health professionals who claim RPM and other CPT reimbursement codes.

The devices are expected to be delivered in January.

Company shares were up 3.51 per cent and trading at 5.9 cents at 2:11 pm AEDT.

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The study aimed to identify the usefulness of telemonitoring to detect and manage acute exacerbation of COPD (AECOPD).

Telemonitoring can reduce emergency department (ED) visits and exacerbation-related readmissions, as well as acute exacerbation-related hospital days in chronic obstructive pulmonary disease (COPD), according to a recent analysis out of China.

The results also showed improvements in mortality and the St. George’s Respiratory Questionnaire (SGRQ) score.

Acute exacerbation of COPD (AECOPD), where there is an acute worsening of respiratory symptoms affecting health status and lung function, account for the bulk of health care costs related to COPD (about 70%). In AECOPD, patients, many of whom are older, often have difficulty recognizing early signs that the disease is getting worse based on symptoms and cannot respond quickly to manage their health, indicating an urgent need to develop effective options to help patients recognize the early onset of AECOPD.

The authors said they conducted the review and meta-analysis in order to compare the evidence on the effectiveness of telemonitoring in patients with a history of past AECOPD, compared with patients without the intervention.

The authors searched PubMed, Embase, and the Cochrane Library for randomized controlled trials published from 1990 to May 2020. Primary endpoints included ED visits and exacerbation-related readmissions and results were analyzed with multiple regression analysis.

Out of 505 studies, 17 were selected for the final analysis (N = 3001); each included telemonitoring and a control group.

The telemonitoring may have included various forms of telemedicine: telehealthcare, telerehabilitation, teleconsultation, telecare, telehealth, mobile tool, apps, or a call center. The studies also had to include a telemonitoring device to monitor significant parameters or symptoms.

The control group had usual care without the use of any telemonitoring.

Telemonitoring was found to reduce:

• ED visits (mean difference [MD] −0.70; 95% CI, −1.36 to −0.03)
• Exacerbation-related readmissions (risk ratio, 0.74; 95% CI, 0.60–0.92) Exacerbation-related hospital days (MD, −0.60, 95% CI, −1.06 to −0.13)
• Mortality (OR, 0.71; 95% CI, 0.54–0.93)

SGRQ scores also showed improvement (MD, −3.72; 95% CI, −7.18 to −0.26)

However, telemonitoring did not make a statistically significant difference in all-cause readmissions, the rate of exacerbation-related readmissions, all-cause hospital days, time to first hospital readmission, anxiety and depression, and exercise capacity.

A subgroup analysis by observation period showed that longer periods of telemonitoring (12 months or more) was more effective in reducing readmissions.

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September 28, 2021 – All those with Chronic Obstructive Pulmonary Disease (COPD) now can have access to the RESPIPLUS™ Living Well with COPD self-care resources through the Aetonix aTouchAway® digital platform.

More than 2 million Canadians aged 35 and older are living with COPD, a debilitating condition that impacts every element of life for its sufferers. COPD is the second most common reason for hospital admissions (after giving birth) and has the highest re-admission rate of any chronic disease in Canada.

The partnership between RESPIPLUS and Aetonix that has officially launched today makes available a process of care combining leading educational resources for people with COPD and a digital platform that can dramatically improve patient outcomes. This is done through virtual communications, remote patient management, and better management of clinical workflows. Patients using this new digital platform will benefit from the highest standard of care regardless of where they are in their journey, starting with a special follow-up post-hospital discharge, followed by in-depth evaluation protocols and proper education and support responding to their needs and priorities.

“Physicians and health care systems require an effective and more efficient platform to provide the best care to this (COPD) population. Aetonix will help us do this” said Dr Jean Bourbeau, a world renown respirologist at the McGill University Health Centre and the founder of RESPIPLUS.

Using the aTouchAway® platform in conjunction with RESPIPLUS Living Well with COPD resources, patients will be able to partner with their care team to obtain optimal care digitally. A 2020 survey by Canada Health Infoway showed 84% of Canadians want to use technology to better manage their health and 90% want technology that gives them more control over their health.

“aTouchAway® is the right solution to deliver the Living Well with COPD program seamlessly and successfully to significantly improve patient outcomes,” says Michel Paquet, CEO and Founder of Aetonix.

The ability to monitor COPD symptoms remotely through a platform such as aTouchAway® can significantly improve both patient satisfaction and outcomes. An analysis of remote patient monitoring studies for chronic conditions including COPD published earlier this year showed this approach can help reduce the need for in-hospital acute care.

Dr. Bourbeau and the team at RESPIPLUS, the non-profit providers of the Living Well with COPD educational resources, have worked successfully over the last 20 years to improve patient care and promote patient self-management. This has been demonstrated with more than 40 research publications showing improvements in patient self-management, reduced hospital admissions and costs.

“This initiative could not have been launched at a more key and pertinent time for our COPD population, who have been underserved in this country for many years”, explains Maria Sedeno, Executive Director at RESPIPLUS.

About Aetonix:
Aetonix is changing lives daily with its virtual care platform, aTouchAway®, which provides telehealth, care pathways and remote patient monitoring to optimize connected health. Its face-to-face communication platform is revolutionizing the way families, healthcare professionals and patients receive care. Over 250 hospitals and tens of thousands of patients use Aetonix globally. For more information on the Living Well with COPD care pathway, please visit: aetonix.com/copd-care-pathway-lwwcopd/

About RESPIPLUS:
The Living Well with COPD self-management program by RESPIPLUS™ was created to help patients affected by the disease learn skills to adopt healthy lifestyle behaviours. The program offers a series of learning modules with interactive tools and videos that explore topics, such as managing stress and anxiety, preventing symptoms and saving energy and being healthy with COPD. Medical experts, in collaboration with patients, created this comprehensive program. For more information, please visit: livingwellwithcopd.com

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• Respiri (RSH) has received United States Food and Drug Administration (FDA) clearance for its wheezing aid, Wheezo
• Wheezo monitors wheezing to manage and improve asthma
• With the green tick from the FDA, the company can now market and sell the technology in the United States
• On the market this afternoon, Respiri is in the grey and trading at 17 cents per share

Respiri (RSH) has received United States Food and Drug Administration (FDA) clearance for Wheezo.

Wheezo monitors wheezing to help manage and improve asthma. The technology can also share data with caregivers, physicians and other health care professionals.

With the green tick from the FDA, the company can now market and sell its technology in the United States.

Asthma is a significant problem in the U.S., with around 8 per cent of the population and 7.5 per cent of children living with the disease.

Respiri is aiming to launch Wheezo in the U.S. market in the third quarter of 2022.

CEO Marjan Mikel says FDA approval is a major milestone as Respiri continues to expand its footprint for Wheezo.

“The FDA is one of the most stringent regulatory bodies in the world and this clearance further validates the efficacy and utility of our wheezo device and algorithm. To our knowledge the first time the FDA has cleared a device/mobile application for the detection, recording and changes of wheeze rates,” he said.

“This represents a step-change in technology for patients with respiratory wheeze seeking an effective, replicable and rapid device measurement and associated App that monitors this important measurement of lung function,” he added.

Notably, the product has been granted over-the-counter approval, which means Wheezo can be provided to patients with or without a prescription.

“Further, although we remain heavily focused on asthma, we are pleased that the approval was indication agnostic where wheezo can be used in any respiratory condition where wheeze is a symptom,” Marjan said.

On the market this afternoon, Respiri is in the grey and trading at 17 cents per share at 1:31 pm AEDT.

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