Remote Patient Monitoring: Not Just a Set of Vital Signs

Background: As a result of the CCOVID pandemic, telehealth has taken its place as a mainstream avenue of care. Traditional telehealth has included video visits and remote patient monitoring of vital signs (RPM). Remote vital sign monitoring has improved outcomes for CHF and COPD patients. However, as telehealth utilization increases, opportunities for expanding RPM beyond vital signs have become evident. This increase in monitoring options allows telehealth teams to improve the care they provide to their patients and families.
Intervention: As the TRU telehealth service expanded, it became clear that patients and families would benefit from additional support. As a result, expanded RPM opportunities were developed in two main categories: care coordination and psychosocial support. These interventions deploy a “pathway” designed specifically for the patient being served. These pathways include interactive questions and information sent out via the telehealth system. Pathways are delivered at intervals determined by the patient’s treatment team. As patients respond to their inquiries, telehealth nurses can provide care proactively.
The care coordination RPM is designed to promote better coordination between all patient care team members. The philosophy of this pathway is to move away from reactive care to a paradigm of proactive care delivery. Care coordination pathways are monitored for minor changes that indicate the need for early interventions. The telehealth team then uses interventions like virtual care conferences to bring patients, families, and providers together to adjust care.
The psychosocial RPM uses a wide variety of pathways to support telehealth patients. Based on patient responses, the telehealth nurses can order needed medical supplies, coordinate medication refills, or prompt a social worker visit. One of the most successful components of the psychosocial RPM has been helping to reduce the anxiety of patients and their families. Telehealth patients report that having the ability to respond to these pathways helps them feel supported and that a telehealth nurse is always available.
Outcomes: Traditional RPM of vital signs will always have a place in a robust telehealth program. However, expanded RPM allows telehealth teams to increase the support provided to patients and families. In many instances, patients who would not traditionally receive telehealth services benefit from the expanded RPM approach. Early outcomes for this approach show a decrease in rehospitalizations of telehealth patients. In addition, the program has improved medication compliance by assisting with timely prescription refills and daily medication reminders.
Discussion: Expanding RPM is a complex endeavor. However, the interventions by the TRU telehealth team have opened many new opportunities to support patients and families.