Providing Physicians A More Complete Picture of the Chronically Ill Patient Through Virtual Remote Patient Monitoring

In a fifteen-minute office visit, it is almost impossible for a doctor to get a complete and accurate picture of the chronically ill patient’s health.  Patients themselves often fail to communicate all relevant information to their physician.

Thus, that snapshot in time in the office or emergency room is incomplete.  Physicians agree that the more information they have the more effectively they can manage care.  When the picture is complete, they can help the patient achieve a higher quality of life and reduce health care costs.

Virtual or remote patient monitoring delivers more than a snapshot in time.  It's the home extension of the physician’s office and can provide:
•Reporting to medical staff of daily health indicators.
•Insights into home routines that affect a person’s health.
•A learning tool for the patient to take more responsibility for their own health care.

As an introduction to how virtual or remote patient monitoring works and the benefits it can provide, this article answers two important questions:

1. What and how do the patients think and feel?
2. What has been the experience of the physicians who have put it into place?

“I’m not sure why I bother going to the doctor. There’s nothing wrong with me. All she has to do is write a refill for my medication.”
Jolene is an eighty-five-year-old grandmother who lives alone and has always been proud, feisty and independent, especially when it comes to her health. But her daughter is concerned about her growing list of health complaints, which she conveniently “forgets” to tell her doctor about.
“Did you tell her about your nausea, and how you’ve felt tired during the last few weeks?”
“No, I was fine while in the doctor’s office, so I let it go.”

Joe is a retired commercial construction worker.  He led a pretty active lifestyle until he started having shortness of breath and often felt a tightness in his chest that made it hard for him to breathe.  During one especially frightening episode and a trip to the emergency room, a chest x-ray and subsequent spirometry revealed COPD as the underlying cause.
As time progressed Joe experienced more frequent COPD exacerbations, and Joe’s doctor has brought up using oxygen therapy, but…
“I don’t want to be tied to a tank,” Joe laments, so he limits his forthcoming of information with the doctor to the bare minimum, making it hard for his physician to really know what is going on.

For all sorts of reasons physicians often feel left out of the loop.  During those fifteen- or twenty-minute interactions in the office, patients may forget, exaggerate or even fail to tell the truth about their health, what is going on at home and how they really feel.  Spot-check readings in the office can only reveal a momentary veneer of information.  On top of this, distance, scheduling and the inconvenience factor often lead to less than optimal frequencies in patient visits, during which time the monitoring of symptoms becomes sporadic at best.

It’s hard to see the big picture of a person’s health or a patient’s reaction to treatment when physicians only get a snapshot in time during an office visit.

Medical professionals are rightly frustrated with their inability to see the patient’s whole health picture.  They know that Jolene’s and Joe’s stories are all too common.  They also know that insufficient information and an infrequent monitoring of disease conditions will most likely lead to quicker disease progression, more rapidly occurring symptomatic episodes and more frequent hospitalizations.

In today’s world where we’re told to magically produce the triple-play of:
•Reduced costs, unnecessary admissions and re-admissions,
•Improved patient outcomes and their ongoing quality of life,
•Increased health care accessibility,
…this infrequent snapshot in time puts the medical community between a rock and a hard place.

While goals listed above are desirable, they are not always possible when the patient is remote, somewhat less than truthful about their condition or when physician visits can’t happen on an optimal basis.  And of course, once a patient shows up either at the office or emergency department with progressed symptoms, doctors then have to play catch-up.  They also know that with each passing episode the prognosis is less favorable.

From his couch, Phil talks to his doctor’s physician assistant. Phil’s blood pressure was exceptionally high during his last reading, taken only moments before at the kitchen table and electronically sent with an alert to the doctor’s office.
While going over the events leading up to the BP reading with the PA, advice and possible interventions if the BP remains high, Phil said, “This is amazing.”
“What’s that?” asked the medical team member.
“I just took my blood pressure. You’re twenty-two miles away and you knew what it was before I could walk to the couch.”

What Phil just experienced was the next generation in health care and patient monitoring, and it is proving to be more than the thin snapshot in time physicians often get when the patient comes into the office.  Virtual remote patient care monitoring provides real-time readings from devices appropriate to the patients’ conditions from anywhere in the world at any time.  The easy-to-use devices then deliver those readings electronically to the patients’ electronic health records (EHR) so physicians have multiple biometric data points and a more complete recording of what is going on with a patient.  Customizable parameters alert the medical staff when a reading is outside norms so they can quickly react via a phone call, video chat or message.  The GTS VirtualHealth system makes monitoring more convenient, consistent and frequent.

“Close communication between patients and caregivers [sic] fosters a strong relationship that can lead to improved patient compliance to the prescribed lifestyle modifications.  Improving continuity of care can lead to better compliance and, in turn, a reduction in readmissions.”
Mary Lynne Withrow, Director of WVU Healthcare’s Cardiovascular Service
  • Three quarters of patients say they are comfortable with the idea of communicating with doctors using technology instead of seeing them face-to-face.
Cisco Study
  • 67% of patients, combined, respond that using telemedicine “somewhat” or “significantly increases” their satisfaction with their medical care. Only 10% cite “somewhat decreased satisfaction”.
Mayo Clinic, mHealth News, Software Advice, et al

What Do Physicians Think?

Of those with telehealth experience,

  • 76% of health care professionals believe that those with chronic diseases will benefit the most from remote, mobile applications.
  • 72% believe that this trend will encourage patients to take greater responsibility in their health.
  • 50% believe it will increase the efficiency of patient treatment.

Survey:  Patient Opportunities High

Over seven million patients are now “hooked up” with remote monitoring.  This advancement is expected to continue to grow at a compound annual rate of 47.9 percent to reach 50.2 million by 2021.  (Berg Insights)  In an age where we are experiencing, as a nation, all time levels of heart diseases, diabetes, obesity and cancers, yet decreased provider resources and budgets, remote patient monitoring not only offers a way to provide scalable and cost-effective care but, additionally, more than a snapshot in time when it comes to seeing the patient’s total health picture.

Favorable outcomes for the chronically ill rely on more than just snapshots in time while patients present themselves to their physician’s office or emergency department.  It’s comparatively advantageous to get the whole picture of a person’s biometric data:

        • How well does the patient follow the prescribed regimen on a daily basis?
        • What tell-tale events triggered the last episode that might have been avoided had they been known?
        • How can we improve patient responsibility while opening up better doctor/patient communication?

Virtual remote patient monitoring systems can answer these and many more questions by providing more than a snapshot in time.