Becoming Better Listeners to Improve Remote Patient Monitoring

By Matt Phillion

Roughly 6.7 million Americans over the age of 20 currently are living with heart failure, and this number is projected to grow to 8.5 million by 2030. Meanwhile, the lifetime risk of developing heart failure has increased to 24%. While treatment options for heart failure continue to advance, it is still a major cause of morbidity and mortality.

And looking beyond the human cost of heart failure, the financial impact can’t be ignored—it’s one of most expensive conditions to manage, with high healthcare costs due to frequent hospitalizations and complex treatment plans.

Where can providers look for new solutions to help patients with congestive heart failure, and is the growth of remote patient monitoring (RPM) the answer?

“Heart conditions are one of the scariest patients can encounter,” says Oren Nissim, CEO of Brook Health. “The first and foremost, and very human reaction is: ‘What’s going to happen to me?’”

The statistics are out there for patients to see for themselves: the chance of dying in that first year after experiencing congestive heart failure climbs by 50%, and this puts an incredible amount of stress on the patients, Nissim says.

“They need agency. They want to feel safe, supported, and know what happens next,” says Nissim.

A big part of that is knowing when things can take a turn for the worse. When you’re in the hospital, Nissim notes, you’re surrounded by medical professionals and all the things you need to be treated for your condition.

“But when something happens, it’s not going to happen while you’re in the hospital. It’s going to be after you go home,” says Nissim. “And patients want to go home! But now comes the question of what happens when you get there.”

Fear and anxiety can lead patients back to the hospital often, and quickly, he explains.

“Going back home with a complex condition like congestive heart failure can sometimes be scary, and if something happens your immediate and very human reaction is to run right back to the hospital,” says Nissim. “Primary care is more available than ever but if you’re experiencing something of such an acute nature, you’re not going to wait for anything—you’re going to drive right back to get care.”

Nissim notes that many—studies say as high as 70% to 80%—readmissions are found to be unnecessary, but they happen because patients are worried and they lack agency.

“The system is not designed to provide continuous support with tight oversight of what happens at home. And so we have to find a way to bridge the gap between the very urgent need to answer a concern and track what’s happening in the home and then be able to deliver this information.” Nissim says. “And the system itself shouldn’t be blamed, either. The system doesn’t have the capacity to hold everyone’s hand at all times. So we need something else in the middle.”

The technology is not the issue

With the modernization and miniaturization of so much technology, Nissim explains that many of the technical barriers in the way of remote patient monitoring have been solved.

“All of the equipment necessary to monitor you accurately at home exists—there is no technology barrier. It’s about who and what system then monitors and listens to the information as it’s coming from the home in real time,” says Nissim.

Patients and providers are more and more comfortable with devices for monitoring as well. We see patients using devices to track their blood glucose levels, blood pressure cuffs are getting smaller and smaller, and many people wear a watch that will tell you if you’re experiencing atrial fibrillation.

Granted, at some point you’re going to want to talk to a human being sooner rather than later when you’re concerned, but day to day monitoring has come so far, Nissim says. The real challenge isn’t technology, or comfort with technology, but rather with data.

“We need to be able to analyze those numbers and come up with a better level of understanding quickly, and AI can help with that,” says Nissim. “I think the key question is how much of this analysis, number crunching, and diagnosis is through a machine and at what point do we introduce the human?”

If you’re trying to be able to provide 24/7 care—that handholding for patients in need discussed earlier—it’s a balancing act for leveraging technology to make the human’s job more efficient.

“The capacity of a single individual to track multiple people at home simultaneously is limited, and this is where AI can help,” says Nissim.

This begs the question: how can we best leverage technology to get the most out of that human time, for better patient-to-provider performance and experience and to better validate that patient’s time?

This requires sensitivity and care, Nissim says. With the introduction of this type of technology, there is always a fear that it will attempt to take jobs away from providers.

“The reality is, it’s the grunt work that is taken away. Providers need to be able to practice at the top of their license,” he says. “Reading charts is not the best use of their time, and now we’re getting to a point where machines will do the work analyzing numbers and provide the insight back to the provider to make medical decisions.”

It’s a two-way street in terms of benefit, Nissim points out. “We need to offer care 24/7 for patients, but no provider can be on call 24/7,” he says. “How do we give patients agency at home while also being responsible for medical decisions for their care? One way is to use software and AI to track and analyze information so that care can focus on insights and recommendations.”

The technology is an extension or augmentation for the provider, Nissim says.

Drowning in data

There’s an incredible need to help separate signal from noise when it comes to the data RPM technology is collecting, Nissim says.

“There’s a huge amount of noise,” he says. “For you as the physician to do a good job, you must analyze all of the noise just to figure out the signal, and no human can really do this. People talk a lot about machine learning but the reality is, algorithms are pretty simple: the physician can tell you exactly what they’re looking for, exactly what they want to hear. The physician wants to be able to put the technology in place, listen to the noise, and carve out the signal.”

The technology development in this space is contrary to the technology adoption, however, Nissim says.

“From a technology perspective, we’re very far ahead. But from actual adoption, we’re at maybe 5% to 10%,” he says.

Barriers sometimes involve whether people are comfortable with the technology or with change, but compliance and reimbursement also looms heavily. CMS has made moves toward ensuring remote care in the home is paid for, and the pathway to better adoption is being built, Nissim says.

Compliance is not so much a roadblock but rather a proceed with caution sign:

“There isn’t a significant barrier, but always we must be careful with patient data and information, understanding the risks,” says Nissim.

“It’s been said the adoption cycle in healthcare is 15 to 20 years to fully adopt new technology, but I think the pandemic helped shorten that,” says Nissim. “And we’re very used to going home right now with technology that impacts our day-to-day lives, whether it’s shopping, streaming entertainment, social media, ordering an Uber. All of those things have shifted our perspective. And in healthcare, every patient with a chronic condition goes home with some technology stack for tracking, monitoring, and understanding their condition.”

One issue this technology faces, though, is literal barriers between healthcare technologies themselves.

“The barriers are high and not friendly,” he says. “The reality is, for the consumer to move through these barriers, there’s a huge navigation issue. You get lost. We have a lot of work there. We all move between providers, and our data moves around, and suddenly they all have pieces of a patient’s story but nobody has it all combined. We need to remove some of that friction. Everybody stands to gain if it’s friendly, if you drop the walled garden.”

Improving remote patient monitoring offers a chance for better outcomes, but also a massive reduction in cost of unnecessary readmissions—and removes a lot of stress for patients when they’re outside the four walls of the hospital.

“Someone with a glucose monitor is manufacturing thousands of points of glucose data a day. Companies are investing a huge amount of time listening to those signals,” says Nissim. “If we’re going to understand humans better, we’ve got to become better listeners.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.