With the development of the “smart home” concept, the Internet of Things (IoT) and better mHealth technology, remote patient monitoring (RPM) has the potential to bring care management and coordination into the home and make health and wellness an integral part of life. The potential use cases for RPM in mHealth care management include chronic care management, post-discharge care, senior care, workmen’s compensation cases, and behavioral health and substance abuse cases.

Most of these programs focus on the collection of patient health data from home (by self or automatically) through devices and mobile health platforms that connect to the primary care provider. This enables the provider to continuously keep track of a patient’s health parameters (such as blood glucose, activity) the environment, even social determinants, and develop a care plan matching the patient’s life. A provider can also provide mHealthcare management recommendations and other resources to the patient, based on RPM data.

More or less, practices both big and small can benefit from mHealth care management with RPM, to reduce unnecessary in-person visits, cut traffic in the waiting room, improve patient engagement, and make sure patients don’t have to visit the hospital or doctor’s office unnecessarily.

The American Medical Association (AMA) has grown more supportive of the technology alongside healthcare organizations alongside healthcare organizations such as the Healthcare Information and Management Systems Society (HIMSS).

RPM program designers require to focus on patient selection (patients with health issues that can be improved through home monitoring and who are open to home monitoring), program duration, data collection, devices to be used, and care coordination management. The programs start slowly with patient acceptance and engagement taking time. So, RPM programs need to be proactive and meet goals rather than reacting to events.

Healthcare providers are wary of using commercial technology like fitness bands, smartwatches and connected home devices for clinical care as they lack the vigorous design, testing and retesting undergone by clinical tools. However, top brands such as Fitbit, Apple, Samsung, and Garmin are used by many health providers such as the Los Angeles-based Cedars Sinai and Boston’s Partners Healthcare.

The ultimate goal for any RPM program and mHealth care management is to create a self-sufficient mindset in the patient that they can live a healthier life by paying more attention to exercise, diet, and other daily habits – with guidance from one’s care provider. Leveraging objective data and the cloud in the arena are companies like Ideal Life.

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Healthcare leaders give their feedback to the Senate Committee members on how to improve the care management of chronic high-risk patients. The feedback being constant by all and focusing on three key areas the healthcare industry must deploy in order to have comprehensive success: EMR interoperability, improvements in patient engagement and the use of telehealth technologies and services.

By Jennifer Bresnick on June 18, 2015

The healthcare system must focus its efforts on improving health data interoperability, boosting patient engagement, and overhauling the nation’s telehealth policies if providers are to succeed with chronic disease management and better population health, say the leaders of the College of Healthcare Information Management Executives (CHIME) in a letter to Congress.

“A high degree of data fluidity” across the care continuum will provide the foundation for a number of different important activities related to chronic disease management, including care coordination, home monitoring, and the integration of patient-generated health data into the comprehensive electronic health record.

After a May 15th hearing discussing methods for improving care for Medicare patients, the Senate Committee on Finance formed a bi-partisan working group to address the growing need for more robust and cost-effective population health management for patients with chronic conditions such as diabetes, heart failure, hypertension, asthma, and COPD.

The Committee also asked for suggestions on how the healthcare industry can strengthen its chronic disease management and preventative care strategies to meet the rapidly growing needs of this large patient cohort.

“Stakeholder input is critical for the committee to work toward its goal of producing bipartisan legislation that can be introduced and marked up later this year. To aid the Finance Committee in bipartisan chronic care reform policy development, we request all interested public and private sector stakeholders submit their best ideas on ways to improve outcomes for Medicare patients with chronic conditions,” wrote Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) in a letter to the healthcare industry.

CHIME’s response to the call for feedback highlights three major areas where the industry must focus its efforts if it is to make strides with chronic disease management: health data interoperability, patient engagement, and a heavier reliance on telehealth and remote monitoring throughout the care process.

At the core of these efforts is the creation and maintenance of a longitudinal patient health record that will aid care coordination across multiple settings, write Russell Branzell, CHCIO, LCHIME, President and CEO of CHIME and Charles E. Christian, CHCIO, LCHIME, FCHIME, FHIMSS, Chair of the CHIME Board of Trustees and Vice President of Technology and Engagement at the Indiana Health Information Exchange.

“The concept of a longitudinal healthcare record should reflect the patient’s experience across episodes of care, payers, geographic locations and stages of life,” Branzell and Christian said. “It should consist of provider-, payer- and patient-generated data, and be accessible to all members of an individual’s care team, including the patient, in a single location, an invaluable resource in care coordination.”

“Foundational to coordinated care is the need to accurately match patients with their healthcare data across providers, systems and states,” the letter continues.  The industry must embrace the idea of a widely-heldpatient identification process, such as a national patient identifier, to ensure that matching and synthesis of data across different healthcare systems is conducted in a secure, accurate, and meaningful way.

“A longitudinal healthcare record, supported by widely adopted standards, also should improve a patient’s ability to manage consent privileges and diminish privacy concerns related to the digitization of personal health information (PHI),” the authors add.

As well as considering the use of a national patient identification system, the healthcare industry must retool its approach to telehealth, starting by addressing the convoluted patchwork of state and regional regulations that make it difficult for providers to deliver remote care.

“Hospitals and health systems are embracing the use of telehealth technologies because they offer benefits including the ability to perform high-tech monitoring without requiring patients to leave their homes, which can be less expensive and more convenient for patients,” CHIME says.

“Yet whether public and private payers cover telehealth services and adequately reimburse hospitals and other health care providers for providing those services, is a complex and evolving issue and, as a result, a possible barrier to standardizing the provision of these valuable services.”

CHIME asks Congressional leaders to take an active part in revising regulations that restrict the delivery of telehealth services according to geographical boundaries.  While parity laws that require private payers to cover remote care services are reaching a growing number of communities, licensing concerns and sluggish Medicare payment approvalare restricting the way providers can extend chronic disease management services to rural populations, homebound patients, and those who find it difficult to travel to a care location on a regular basis.

Telehealth can also be an important strategy for improving patient engagement, Branzell and Christian continue.  “One of the most common limitations of physical presence healthcare is time,” the letter says. “Providers’ time limitations have been well documented, while patients’ time pressures can lead to forgotten questions and concerns.”

The use of asynchronous telehealth communications, which allow patients and providers to communicate at their leisure, might help to make the care experience more satisfactory and comprehensive for patients who feel flustered by the clinical environment.  This may lead to more meaningful contact with the healthcare system for those patients with ongoing chronic care needs, CHIME predicts.

Remote monitoring can provide another strong link between patients and their providers, the letter continues, and may become increasingly vital to the care process as healthcare’s Internet of Things becomes a daily realityfor more and more patients.

“The adoption of remote monitoring technologies has increased, especially as the market for fitness trackers and wearable devices continues to thrive,” say Christian and Branzell. “Providers are increasingly prescribing remote monitoring in the care plans of both patients with acute and chronic conditions. Thus, the need to address the technical complexities is even more important.”

Congress should develop and promote policies that encourage the high level of health data interoperability and adoption of data standards that are necessary to provide a foundation for the big data analytics that will make remote monitoring worthwhile for chronic disease management, CHIME concludes.  The Committee should also seek ways to continue integrating meaningful use and other current initiatives into the ongoing process of regulating and fostering population health management across the evolving continuum of care.

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