Fueled by an aging and growing population, the challenge of managing chronic disease and post-operative patients to prevent hospital re-admissions and emergency department visits has been near the forefront of policy discussions for many years. With years of experience from Canadian and international pilots, programs and research, Remote Patient Monitoring (RPM) is increasingly becoming an important part of the solution.
RPM has been touted as a game-changing model of health care delivery for many years. Recent evidence suggests that RPM is not only evolving in Canada, but that it has the potential to deliver high-quality care at the right cost while improving patient-reported outcomes.
RPM is the delivery of healthcare to patients outside of conventional care settings (e.g., a patient’s home, instead of a hospital bed), made possible by connecting the patient and a health care provider through technology. It involves the electronic transmission of patient data (e.g., symptoms, vital signs, outcomes) from a remote home location to the provider, as well as the supporting services and processes required to conduct data review, interpretation and potential alteration to the patient’s course of care.
A study by Ernst & Young (EY), entitled Connecting Patients with Providers: A Pan-Canadian Study on Remote Patient Monitoring, revealed strong evidence of RPM supporting reductions in emergency department visits, hospital admissions and bed days, as well as strong patient satisfaction and quality of life improvements.
As one family caregiver in BC’s Island Health Telehomecare Pilot said: “Since getting the home monitor machine, I have been able to pick-up on signs of pneumonia and heart failure in my dad. I have been able to prevent it from getting worse. I have also learned how to monitor his results each day, and have been able to treat him more or less as needed.”
What can jurisdictions and health systems do to increase the chance of success for these programs? From various Canadian case studies, a number of key success factors for moving past the pilot stages and growing RPM into a mainstream care delivery mechanism have been identified:
• engagement of and collaboration with clinicians;
• integration into established clinician pathways and processes;
• selection and recruitment of suitable patients (some patients are too ill to participate, while others may not benefit from intervention); and
• the ongoing measurement of impacts attributed to RPM.
All of these aspects are needed to ensure value and optimize these programs over time.
So, how viable are these programs in a Canadian context? Despite significant variability in the scale and focus of programs currently implemented across the country, the evidence suggests that long-term sustainability is a realistic goal for programs large and small.
These factors have been incorporated into a new investment program initiated by Canada Health Infoway to assist in the establishment and growth of RPM across Canada.
The program is split into two investment streams: start-up and deploy.
Start-up investments are aimed at planning for jurisdictional and/or large regional or disease-specific programs; deploy investments are designed to focus on enhancing and expanding program offerings to grow the adoption and use within patient populations where there is evidence of benefit (e.g., Congestive Heart Failure, Chronic Obstructive Pulmonary Disorder).
Through a multi-faceted approach, the RPM portfolio targets patients and consumers who have serious health problems and are likely to be frequent users of the health system, and for whom RPM has the potential to significantly improve outcomes (e.g., through earlier discharge from hospital or reduced admission rates).
RPM investment activities will further be supported through undertakings such as conducting program-level benefits evaluations, as well as creating change management resources to support clinician engagement and patient enrolment.
While there have been some mixed outcomes reported in international studies, Canadian evidence suggests that for a targeted segment of the population, RPM does indeed present a cost-effective, innovative solution that transforms the healthcare delivery model by bringing care into the home setting and significantly improving patient-reported outcomes such as satisfaction and quality of life.
Bobby Gheorghiu is Benefits Realization Leader, Canada Health Infoway; and Fraser Ratchford is Group Program Director, Consumer Health and Innovation, Canada Health Infoway. For more information on remote patient monitoring, visit www.infoway.ca