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Five Lingering Questions Holding Back Remote Patient Monitoring (RPM) Adoption

Technology adoption often takes longer than expected, and remote patient monitoring (RPM) is no exception. More specifically, I’m referring to multiparameter RPM of patient vital signs. There are currently over 25 companies with multiparameter RPM offerings, including Philips, Honeywell HomMed, Health Hero, ViTel Net, and many others.

I am a big believer in RPM technology — it WILL revolutionize delivery of health care.

However, I’m also a realist. Consider the following questions a collective “voice-of-the-customer” from my six years working in this market space.

The questions are tough ones, and some aren’t obvious. In this post I’m only listing the questions; I’ll offer perspectives on possible answers in a future post.

Here are the five questions:

1) “What’s the incremental value of RPM in addition to a disease management (DM) program?” or,

is RPM + DM > DM alone ?

There are many studies that address the independent value of DM and there are a many studies that address the independent value of RPM. Of course, even this statement is an oversimplification, as there are many varieties and flavors of DM just as there are many varieties and flavors of RPM.

I’ve only seen one study so far that addresses the incremental value of RPM. That study did find that there was additional value to RPM in specific circumstances, but it will take many studies over many years to put this issue to bed — think about how long we’ve been arguing about whether DM has ROI! If you’re aware of other studies, please post to the comments.

2) “What is the OPTIMAL mix of RPM technology and patient self-management approaches?”

The early thinking here was that automating as much as possible around RPM would be a good idea (i.e., MAXIMIZING automation).

For example, requiring a patient with congestive heart failure (CHF) to weigh themselves daily introduces a weak link into the process. The patient must remember to weigh themselves and must comply with the protocol specific to a particular RPM device.

Researchers have been looking at ways to minimize weak links in the RPM process by automating as much as possible. For example — in the case of CHF —researchers are experimenting with weight sensors in beds or toilet seats. This is easier said than done.

As Dr. Kvedar wisely pointed out last week, one of the lessons learned about RPM is that “feedback changes behavior”.

Initially, we thought this approach would lead to more rich and accurate patient information (there are numerous studies showing how humans are notoriously inaccurate at reporting data about themselves). While this has been confirmed, what we didn’t anticipate is how the patient’s participation in gathering this data and their knowledge that health care providers are reviewing is enough to draw them into their care — and dramatically improves adherence. My favorite example of this is the congestive heart failure patient who, in commenting on his required daily weigh-in said, “I can’t cheat on my diet anymore. If I have too much salt today, it will effect my weight tomorrow, and I’ll get a call from my nurse, Rebecca, to make sure I’m OK.”

Thus, MAXIMIZING automation isn’t necessarily the right way to go. A better way to look at this is as OPTIMIZING the right mix of automation and patient involvement. The answer will be different for different patients.

This is good news and bad news. The good news is that the technology is far more powerful than we initially imagined — that the benefits are not just the raw data coming from the RPM device, but that there are powerful and real benefits from from involving the patient in the process. The bad news is that this makes the process more complex than we ever imagined. This will take a while to figure out.

3) “When are RPM prices going to come down like you said?”

By now we’ve all heard the future prophecies about RPM technology — that soon RPM devices will be an extension of your PC, your TV, or your home network. We’ve heard that “someday” you’ll be buying RPM technology at Best Buy or Circuit City. We’ve also heard that prices will approach the prices of consumer technologies, and that we can expect RPM technology to be priced at under $1,000, $500, or even less.

Many potential customers are still waiting to buy until “someday” arrives….or perhaps they’ve bought a few RPM units, but haven’t rolled out the technology to a wide patient base.

When is “someday?” Radio Shack, Best Buy and others have experimented with RPM technology in their retail stores and online shopping sites, but there has been no mass roll out that I’ve seen.

When RPM technology was introduced, prices for individual units tended to be in the $6–8 K price range; at this price point, customers are very concerned about economic and clinical ROI. Prices for many companies have come down to the $1–3K range, but not enough to spark high volume adoption.

4) How will care providers get in the loop?

Under the current system, doctors and other care providers have little incentive to get involved with RPM technology. “I don’t get paid to review RPM data. I don’t have a ‘system’ to respond to patients whose readings are out of the norm. I don’t know whether RPM devices provide valid and reliable data. RPM technologies interrupt my existing office work flow. Come back when you have these things figured out.”

The market sector that has seen the most significant adoption of RPM devices has been home health agencies. Here, the economic and clinical value proposition has been much clearer — “We can’t hire enough nurses. Nurse time is expensive. We know that we can effectively manage patients and eliminate a percentage of nurse visits (typically 30–50%) if we use RPM technologies with out patients.”

5) Who should pay for RPM?

Health plans and other payers? doctors? patients? disease management companies? home health agencies? someone else?

 

These are tough questions.

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6 Comments

  1. Howard Rosen on April 25, 2007 at 8:28 am

    WOW, now I’m depressed! And then again, quite invigorated … thanks Vince. Having become a regular reader of these postings and a somewhat irregular responder, my convictions remain as strong as ever. A key ingredient necessary to this mix is patient engagement. Though not necessarily overlooked, it certainly does not seem to be addressed as often as I think it should. Though engagement doesn’t answer all these very relevant questions in its entirety, it does speak to many aspects.

    My perspective, coming from a consumer marketing background, the more the user can be involved and engaged the more that marketing and related market forces will come to bear to resolve many of these issues. In the cost effective environment that we are in (i.e. seeing cost cuts while facing increasing demands) the way to get interest is to engage the “market”, and one way to do so is by innovation that engages the users. Not by building great ‘rocket ships’ and huge leaps, but by incremental changes, possibly disruptive to existing approaches, but incremental nevertheless.

    Now I feel better!



  2. Charlene Marietti on April 27, 2007 at 10:29 am

    There may be compelling reasons why remote patient monitoring is good, but without funding, all but those most committed, i.e., willing to pursue and pay, will be locked out. However, I’m heartened by recent coverage in The Economist that hails advances despite ‘no business model to deploy, no IT system to manage it and no company to carry out.’ I know, how can I be optimistic with such a dire summation? Simply because this is the stuff of innovative enterpreneurs: Many will try many different pathways trying to find the path to the bucket of gold. A few will make it. I’m counting on the ones who make it (and my sympathies go to those who lose a lot of time, money and hard work.) And maybe I’ll live long enough to benefit from their work!



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  4. George MacGinnis on May 22, 2007 at 8:23 am

    I think your ‘optimal mix’ question should cover much more than ‘RPM vs Self Care’ for two main reasons.

    Firstly, ‘remote patient monitoring’ is very suggestive of measuring devices such as the weight scales you mention but this is not neccessarily the key. A fundamental issue is how do you measure wellness to be more truly preventative rather than reactive. One possible answer, is that the ‘early signs’ may be more perceptive to the indivitdual. Thus, RPM can start with relatively simple questions such as ‘are you feeling well today’, with the more technical readings following as a further diagnostic.

    The second interesting area is the nature – or ‘personality’ – of the RPM service you devise. Drawing on your salt intake impacting on weight example, two services might use the same technology and similar readings, but lead to very different responses. In one, the nurse calls in a ‘parent-child’ manner and seeks to identify why. In the other, the nurse might seek to develop a peer-to-peer coaching relationship, perhaps not calling at the first opportunity but identifying patterns and trends and then discussing them with the patient. While the coaching approach may be more complex, it might actually be less costly to deliver and might just offer the prospect of more tailored intervetions.

    Thus, the ‘right mix’ is not just RPM vs self care, but includes soft vs hard data and coaching vs alarm response styles.



  5. Chan on July 16, 2008 at 11:03 pm

    Very interesting information !
    I am very much interested in finding out what those other 25 companies are who offer RPM services. A suggestion would help out greatly.

    Thanks.



  6. Dobrina Laleva on August 24, 2011 at 6:02 am

    What holds back #RemotePatientMonitoring (#RPM) http://t.co/cCAR252