Lucy Mackillop, chief medical officer, Sensyne Health, discusses the key challenges in implementing remote patient monitoring technologies, and their role in helping to continue to look after the most vulnerable.
The pandemic has led to huge spikes in digital technology adoption as doctors and patients have complied with social distancing guidelines. In fact, according to the Royal College of General Practitioners, 71% of routine consultations were remote in the four weeks leading up to April 12th, compared to 25% in the same period last year. This is a tremendous shift.
COVID-19 has sharpened the mind. We all understood the need for social distancing and minimising footfall to our GP surgeries and hospitals as lockdown came into effect in March, in order to manage infection rates effectively and ensure healthcare systems were not overwhelmed. Having the technological capability to offer remote consultations, where appropriate, is beneficial for general practice, the wider NHS and patients alike. However, although adopting a remote monitoring system to complement usual care may improve user satisfaction and potentially have some benefits on outcome, it doesn’t necessarily reduce demand on the healthcare system – in fact, often, quite the reverse.
As we move into phase three of controlling the virus and start easing lockdown measures across the country, we need to learn how to continue to support our healthcare system moving forward to manage an ever-increasing demand.
There is a real imperative for remote patient monitoring (RPM) and management to support patients and help healthcare systems become more efficient. RPM has allowed us to take more control of our own health whilst reducing footfall to our healthcare facilities, allowing resources to be focused on where it is needed most. As demand for healthcare continues to grow, RPM can, when implemented intelligently, play a key role in assisting healthcare staff manage increasing demand without over-stretching already strained clinic and staff resources.
Key challenges of RPM adoption
While we’re well aware of the benefits of RPM, the implementation of these technologies does not come without its challenges.
Firstly, a thorough understanding of how a remote patient monitoring system is anticipated to support, for example, earlier interventions or improve operational efficiency, are essential to any implementation. And indeed, the anticipated benefits need to be clearly identified and measured before and after implementation.
Secondly, prior to the pandemic, Deloitte’s ‘Shaping the future of UK healthcare: Closing the digital gap’ report found that many digital health innovations failed as clinicians were reluctant to engage with them. Key reasons included the amount of change required to familiar processes, the time taken to implement, and a lack of education and training. Therefore, it is imperative that a proper change management process is followed. This is preferable, and likely to be much more impactful, than the lazy alternative of adding the technology to existing care-pathways.
Third, but of equal importance, is ease-of-use. New technologies must be simple and intuitive for both clinicians and patients if they are to bridge, rather than reinforce, the digital divide.
Finally, digital health technology providers need to understand the regulatory and technical environment the technology will inhabit. It is very likely that the technology may be deployed in hardware that is not high spec; therefore, what is developed in a high-tech company might not work seamlessly in an NHS hospital with older, less powerful infrastructure.
The role of RPM in easing lockdown
As strict lockdown measures were introduced in March 2020, the government, Public Health England and the NHS, encouraged those with milder COVID-19 symptoms to use applications to help self-manage their health and help manage the strain on local healthcare services. This allowed clinicians to focus more time on the patients that need emergency care. The result was a tremendous rise in deployment and use of digital health technologies in just days and weeks instead of months and years.
RPM also has the power to improve access to healthcare services for vulnerable groups advised to shield during the COVID pandemic. For example, Sensyne’s GDm-Health digital therapeutic app helps pregnant women and their care teams proactively monitor and manage diabetes remotely. The risks to mother and child associated with this condition are significant if not treated, and include an increased rate of caesarean section, pre-eclampsia and premature birth. Clinicians use the system to remotely monitor blood glucose levels, and prioritise care to women needing it most. Mums-to-be upload their blood glucose readings from home, and communicate with their care teams through the app. The need for face-to-face appointments is reduced, administrative time is saved, and quality of care is improved. GDm-Health is an exemplar of how RPM can enhance the existing care pathway, improve operational efficiency and help deliver better outcomes for patients.
Despite lockdown measures easing, the threat from COVID-19 is far from over and it’s important that we continue to look after vulnerable patient groups. RPM can help us achieve this, by giving providers the option to deliver care to patients in their homes, reducing the risk of infection spread and freeing up capacity for those who need it the most. It may even allow some patients to be discharged earlier because follow-up care can be delivered remotely. If a patient's condition deteriorates, RPM software can alert clinicians in real-time, enabling them to take the appropriate course of action quicker than might otherwise be the case.
Equipping scientists with data for drug discovery
The fundamental role of RPM is to improve the quality of data and information flow to deliver timely, effective and safe care. Data from RPM applications can be uploaded to Electronic Patient Records (EPR), which can be used to provide a complete medical history and real-time information resource. Furthermore, this data can be anonymised, aggregated and used to analyse patterns within a disease and inform clinical research aimed at drug discovery and disease prevention. Gaining insights from anonymised patient data may, for example, allow for faster vaccine development and new treatments, not just for COVID-19, but also for other diseases.
As we continue to fight coronavirus, we must recognise the great potential of technology to help us. It is important that RPM solutions are implemented swiftly but with a clear pathway to deliver operational efficiency and improved clinical care in a tightly controlled ethical, information governance and regulatory framework. The hope is that by doing so, healthcare providers can manage future peaks, continue to improve health outcomes, free up time for clinicians to treat more patients and drive scientific research into disease prevention and treatment.
COVID-19 may have provided the motivation for both patients and clinicians to embrace new technologies - something that was difficult to achieve before – and this change is likely to be a common feature of routine clinical practice going forward. Demand on our healthcare systems will continue to rise, yet this demand can be better managed with technology that is aimed at earlier detection and intervention, preventing more costly treatments and providing the catalyst for transformative change in medical practice, helping to move from reactive to preventative models of care.
