Medical imaging & patient care Science & tech

Under the skin

Advanced patient monitoring is on the rise. No longer a question of wiring the patient into a sensor, many of the newer monitoring systems boast wireless or remote capabilities. This could save time for hospital personnel and ultimately boost the quality of patient care. As we move towards an age of telehealth monitoring solutions, Practical Patient Care explores the implications, and asks what lies behind the remote patient monitoring (RPM) trend.

If it looks like a sticking plaster, feels like a sticking plaster and sticks like a sticking plaster, it probably is a sticking plaster – or so you might assume. Earlier this year, however, researchers flouted that rule with the development of a new adhesive monitoring device for Parkinson’s disease.

At 1mm thick, this prototype gadget resembles nothing so much as a Band Aid. And yet its function is rather more elaborate; through clever use of nanotechnology, it can capture and store medical data before administering an accurate dose of drug. No hospital visits are required, still less the carefully positioned Post It notes reminding you to take your meds.

“This platform overcomes the limitations of conventional wearable devices and has the potential to improve compliance, data quality and the efficacy of current clinical procedures,” wrote the researchers, who are based in the Center for Nanoparticle Research in Seoul, South Korea.

Several thousand miles away, at The University of Kansas Hospital in the US, a team of cardiologists have been trying out a wireless chip for tracking heart conditions. Designed by Minneapolis-based manufacturer Medtronic Inc, the LINQ device was approved by the FDA in February, and is rapidly gaining advocates.

Roughly the same size as a triple-A battery, LINQ is the smallest commercially available implantable device of its kind. Once inserted beneath the patient’s skin, it can monitor the heart for up to three years, and sends a daily update to the cardiologist. As such, it represents the cutting edge of cardiac monitoring.

Patient zero
One of the first patients to receive the device was 56-year-old Carol Spencer, whose heart complaints have thus far eluded diagnosis. Alluding to her characteristic dizzy spells, she told the Kansas City Star “I think this is going to be a big help with the diagnosis. Like anything, [the spells are] not going to happen while you’re there at the hospital and the doctors are watching.”

Taken together, the plaster-like prototype and the battery-sized implant do not sound like harbingers of a new age of medicine, still less like part of an ongoing trend. With their vaguely sci-fi trappings, they read more like experimental outliers than a sign of the times.

And yet devices of this kind are becoming ever more prevalent. In recent years, we have seen a boom in advanced patient monitoring systems, many of which boast wireless or remote capabilities. Spurred on by a perfect storm of market forces, their popularity is expected to climb still further over the next three to five years.

“There has been a surge of interest in implantable electronic devices,” commented Dr. Kamran Zamanian, president and CEO of iData Research, in a press release. “Remote monitoring of these devices by doctors and caregivers could significantly reduce in-office follow-up visits. Devices such as the cardioverter defibrillator that is controlled remotely could be lifesaving.”

Zamanian was remarking on findings that valued the US patient monitoring market at $3.5 billion in 2013. By 2020, this market is expected to surpass $5.1 billion, largely due to the growth of electroencephalograms (EEG), electromyograms (EMG), multiparameter vital sign monitors, cerebral oximeters and pulse oximetry devices. Most crucially, remote patient monitoring (RPM) is on the rise.

Rate of growth
This conclusion is supported by Research & Markets, which recently released a report – ‘Global Remote Patient Monitoring Market 2014–2018’. It forecasts that the market in question will grow at a CAGR of 15.44% in the years leading up to 2018.

As this growth occurs, patients and providers alike stand to reap significant rewards. RPM solutions can cut the risk of hospital readmissions and ramp up access to healthcare. They can save time, cut costs, and enable early detection of deterioration. They can help doctors prepare treatments in advance and play a key role in diagnosis.

We only need think of the possibilities afforded by, say, a tablet device. Doctors can monitor a patient easily from afar, with any issues popping up in real time on the screen. Because RPM programmes can collect and store medical data, the subsequent video conferencing is vastly different from a typical Skype consultation.

While gizmos of this type sound futuristic, telehealth itself isn’t new; the Veteran’s Health Administration (VHA) in the US began exploring the options as early as the late ‘90s. Since rolling out its Care Coordination /Home Telehealth (CCHT) programme between 2003–07, this initiative has been growing year on year.

In 2012 alone, nearly half a million veterans received healthcare remotely, from 150 medical centres and 750 outpatient clinics. The services in question include virtual videoconferencing visits, screening for eye diseases and remote consultations for post traumatic stress disorder (PTSD). Such provisions have enabled around 40,000 people to live independently at home.

Through implementing and evaluating so many new technologies, the VHA has surpassed all expectations as to what RPM can achieve. It has been lauded as a template to follow, most notably informing the development of the 3Million Lives initiative by NHS England. Nothing if not ambitious, this programme aims to roll out telecare solutions to three million people by 2017.

Delve deeper
So what lies behind the upsurge in interest in advanced patient monitoring? Part of it is technological; sensing devices are becoming rapidly more sophisticated, with Bluetooth and smartphone technology streamlining the process of data transmission.

The main drivers, however, are undoubtedly financial. It’s no secret that healthcare systems are under increased pressure to cut costs. Combine this with an aging population and increasing prevalence of chronic diseases, and it is evident that classical models of healthcare provision are no longer fully sustainable.

Particularly in the US, doctors have been given a nakedly economic incentive. Under the Affordable Care Act, they stand to receive a share of the savings when Medicare patients are kept healthy, conversely facing harsh penalties when too many are readmitted to hospital. In this climate, RPM solutions have come to seem especially appealing.

Of course, the shift to advanced monitoring will not be seamless, and many healthcare providers are currently struggling with the transition. A report by Spyglass Consulting Group, ‘Trends in Remote Patient Monitoring 2013’, spoke to Accountable Care Organisations in the US to assess the prevailing attitude. While 55% of the organisations interviewed were deploying RPM technology, not all of them saw advanced monitoring as an unalloyed good.

Over half the respondents questioned the clinical effectiveness of such technologies and their ability to generate a positive return on investment. Nearly three quarters expressed concerns about how RPM technologies might integrate with their existing clinical care processes and information systems, and 58% were unsure how the reams of patient data might translate into actionable insights.

Reading the data
Other studies have earmarked disruption as a central concern. Researchers from Brunel University, UK, asked clinicians for their opinions on telehealth. For many nurses, installing the technology seemed an unnecessary addition to their workload, and they were worried that telehealth might be used to replace vital human interaction.

As one nurse put it: “I think the sort of thing one wonders with is lack of the face-to-face contact. And although you are asking questions… there is always a chance that there could be something that you are only going to see if you are face to face with somebody.”

The Brunel researchers concluded: “Since the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients.”

Time will tell how the associated hurdles may be surmounted. It is worth remembering that many RPM devices are still prohibitively expensive. Once they drop in price, and the appropriate analytic tools have been developed to support them, we may see a far less equivocal reaction.

After all, the rise of RPM is not only unavoidable – it also has the potential to be momentous. As the technologies develop still further, and the market continues to grow, remote monitoring will enable patients to play an active role in their own treatment. They will be able to go about their day with minimal disruption, barely noticing the Band-Aid style monitoring device on their arm. Unwieldy, wire-based sensors, necessitating extended hospital stays, may soon be a thing of the past.

This article appears in the Spring 2014 edition of Practical Patient Care

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