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Continuous, Connected Care

Remote patient monitoring is critical in terms of care and forging patient and referral partner relationships. Where does it stand and where is it heading?

connected technologies for patient careHow human beings manage their relationships is changing right before our very eyes. So is how we manage our healthcare, and those changes are creating new opportunities for improved care and business relationships.

Twenty years ago, you kept in touch with friends and family through actual, realtime contact — you talked on the phone; you met for coffee; you traveled to visit one another. Now, thanks to mobile data communications and social media, you keep in touch with a broad, far reaching range of friends. You might see what your roommate from college had for lunch. You might see a baby pictures posted by a previous co-worker from an old job. You might watch and interact a Facebook Live video stream from a friend who moved to the other side of he world. You make and maintain connections with people you might not necessarily see all that much in real life.

And while that landscape might seem strange or jarring to some, today’s permanently connected world is having a positive impact in the healthcare world, thanks to remote patient monitoring. Now healthcare professionals can track patients with chronic conditions to see how they are progressing with their treatment, ensure therapy compliance, and help manage their care for better outcomes.

And it’s all thanks to ubiquitous data communications. Wireless connectivity has replaced the public telephone network and LANs as the de-facto standard for communications technology for most types of connected home medical devices. In terms of scale, wireless will account for 19.2 million connections in 2020.

How Big a Trend?

Better yet, it’s creating an ample market opportunity for HME providers. How big of an opportunity? The number of remotely monitored patients grew by 51 percent to 4.9 million during 2015, according to “mHealth and Home Monitoring,” a study from market researchers at Berg Insight that was released several months ago. (“mHealth” being Berg’s word for mobile health technology.) Looking ahead, the number of remotely monitored patients will grow at a compound annual growth rate (CAGR) of 48.9 percent to reach 36.1 million by 2020, according to the study.

The study tracked patients enrolled in mobile healthcare programs in which connected medical devices were used as part of their treatment and care. The study did not include connected medical devices used for personal health tracking, such as Fitbits and similar gadgets.

Revenues for remote patient monitoring reached roughly $6.8 billion in 2015. That revenue includes revenues from medical monitoring devices, mobile health connectivity solutions, care delivery platforms and mobile healthcare programs. Berg reported it expects remote patient monitoring revenues to grow at a CAGR of 32.1 percent between 2015 and 2020, to eventually reach $27.4 billion.

And where the home medical equipment market is concerned, connected medical devices, such as sleep therapy equipment, accounted for a whopping 71 percent of total remote patient monitoring revenues in 2015, according to Berg. That said, revenues for mobile health connectivity solutions, care delivery platforms and mobile healthcare programs are growing at a faster rate and will account for 46.3 percent of total revenues in 2020, up from just 29 percent in 2015.

The fact that HME is at the center of that growth is critical. For years, implantable cardiac rhythm management (CRM) has traditionally been the largest segment of the remote monitoring market, led by companies such as Medtronic, Biotronik and St Jude Medical. Now, Berg’s report says that the sleep therapy segment of remote patient monitoring has been growing at the fastest rate of all, with the number of remotely monitored sleep therapy patients grew by 170 percent during 2015. Now the report has pegged sleep to outpace CRM by about the time you are reading this.

And sleep isn’t alone. Other fast-growing remote patient monitoring categories that will take off over the next five years include blood glucose monitoring, air flow monitoring and connected pharmaceuticals, according to the study. But for now, let’s look at where the current sleep patient monitoring market stands, where it is headed, and whether or not that can give us clues about where remote patient monitoring is headed for HME as a whole.

Current State of Remote Monitoring

Currently, sleep is the foundation — or, better yet, launch pad — for remote patient monitoring in the post-acute care space. In this setting, patients go home with a PAP therapy device that lets them, the HME provider and the referring physician or clinician track their care. They can see how they are performing against various performance metrics on a daily basis; trend that data; and work to correct events that are happening during their sleep and improve overall compliance.

Sleep providers are seeing that they can help patients manage their care, provider referral partners with actionable data on patient compliance and progress, and create real business value for themselves in the process. One of the key reasons for the success this sector has enjoyed with remote monitoring is because it is hassle-free for the people who really matter, the patients.

“Regarding patient care, the best thing about remote compliance monitoring is that it is easy for the patient,” says Angela Giudice director of clinical sales and education for sleep and oxygen therapy equipment maker 3B Medical Inc. “They’re able to take their machine home, set it up how their provider tells them to, and that’s it. As long as they’re using their machine they have no worries.”

“And it also gives them peace of mind to know that they’re being monitored, rather than being sent into the wild with this machine they no nothing about,” she adds.

And on the provider and referral partner side of that scenario, they stay on top of that patient’s care.

“With today’s reporting systems, you can pretty much see everything the patient is doing,” Giudice says. “If they’re having certain types of events; if they’re having leaks; you can even determine if a mask isn’t right for a patient. It’s an amazing tool for those that choose to use it. Whether it’s home health or doctors or clinicians, they have the ability to log in and see what their patient is doing for literally half their life.

And the numbers bear that out. In October of last year, sleep equipment ResMed presented results from world’s largest study on sleep apnea and digital connected care, and that study showed that remote monitoring and clinical management tools improved patients’ adherence to treatment by 87 percent and 70 percent, respectively.

“Online self-monitoring tools, like ResMed’s myAir, engage patients and significantly improve their compliance and adherence to treatment,” says Amy Cook, director of Healthcare Informatics for ResMed. “ … Remote monitoring reinforces the efforts of clinicians and helps patients keep themselves informed and motivated, factors long considered to play a role in effective treatment of sleep apnea and other medical conditions. Remote monitoring is equally beneficial to home medical equipment providers and clinicians.”

And beyond clinical benefits, the provider knows that they are going to get reimbursed for those patients because those patients are complying with their therapy and are ahead of the curve. “And if a patient falls off that curve, and is not meeting compliance, they can be the coach in between, because it’s in their best interest to get paid for the machine they’ve provided,” Giudice adds. “It makes it easy for [providers] to be the go-between, sitting between the physician and the patient.”

Plus, the sleep equipment provider is regularly demonstrating its value and relevance to their partners.

“Demonstrating to referral sources the benefits your practice can provide, including a focus on clinical outcomes and patient satisfaction, are key in maintaining good referral relationships,” Cook says. “At ResMed, we have focused on making management of sleep patients as easy as possible through both data management systems and connected devices that carry the weight of this sometimes complex aspect of our system. In providing these solutions, we hope to help HMEs demonstrate the value of the partnership between a partner and a sleep practice.”

So it’s no surprise that remote monitoring has become ubiquitous for patients, providers and partners.

“Very few patients leave the provider or the lab without some kind of remote monitoring in place,” Giudice notes. “The only patients that I know that don’t have any kind of monitoring are usually self-pay, cash-pay patients, where the monitoring doesn’t matter, or patients on their second or third CPAP where the monitoring doesn’t matter so much. Whereas almost every insurance payer has gone to compliance monitoring; I don’t even know of a payer that doesn’t do it.”

Active Patient Participation

The next major, evolutionary step in remote monitoring for sleep therapy — and perhaps for remote monitoring as a whole — is getting patients involved. Right now, the process is fairly passive: patients help ensure the data is collected; the physician or clinician reviews the data; that healthcare professional then determines what if any tweaks to therapy or equipment need to happen; and the provider and patient react accordingly.

Now the patient needs to get more involved. Adopting that mindset should be easy. Living in a Fitbit world, we already use wearable health devices and smartphone apps to see how we are performing in terms of diet and fitness. We are actively engaged with our personal health and try to use technology to manage it. Patients need to have that same relationship with their sleep therapy devices and treatment.

“Being able to plug in the CPAP or the Fitbit and know how many hours I used or how many hours I slept and knowing what’s going on during every part of my sleep or my day and what I’m doing to control my health is really important to a lot people,” Giudice says. “It’s amazing to see when people realize how much control they actually have over their health and how much they can influence their lives and make them better.”

“Instead of a passive experience — a device sends data to a provider, who can then make decisions — remote monitoring can be something that brings a patient into their therapy and care options,” Cook explains. “The future is in engaging patients to be involved with managing their condition, and data suggests that putting the data and right, actionable information in front of patients does make a difference.

“One such engagement platform is our patient app myAir, which utilizes behavioral management techniques and PAP usage data to provide users with a daily ‘myAir score,’ personalized tips for greater comfort and sleep, and badges for therapy milestones,” she continues, again referencing her company’s global study.

That research showed that more than 87 percent of CPAP users were compliant on therapy when using ResMed’s myAir and monitored by their provider with AirView (patient therapy management solution), compared to 70 percent compliance for those who were monitored by their provider with AirView alone. Proof that patient involvement pays off.

What will help foster increased patient involvement is the fact that there are various stakeholders in not only the patient’s care, but the patient’s life who want to see that patient stay on top of his or her sleep therapy.

“Especially in the places that are mandating remote monitoring, such as transportation and aviation,” 3B Medical’s Giudice notes. “They’re mandating that their drivers and their flyers are doing sleep studies, so [monitoring] is a very important piece of their medical history and a lot of people are taking it more seriously as a result.”

More Remote Monitoring Opportunities

Perhaps most important to note is that sleep isn’t the only remote patient monitoring opportunity. In fact, there are various sectors of post acute care that are starting to see remote patient monitoring take root and expand, and those represent key opportunities for HME providers to get involved.

For starters, diabetes care is a big opportunity. Already we are seeing glucometers that use wireless technology to update patient performance metrics. One example is the Dario smart glucometer from Dario Health. The Dario plugs directly to a smartphone’s headphone socket so that users can view and share their results through the Dario WebPortal to record, track, analyze, manage, and share their data with physicians and clinicians via a cloud-based platform. Another example is the GLUCODARD Shine from Arkray USA Inc. The Shine collects user compliance data, which can be downloaded into a data management system for easy tracking and charting. This helps patients and health professionals monitor and manage performance.

Already the equipment and data sharing portals are there when it comes to remote monitoring of diabetes patients, and it’s likely that landscape will only expand with more products. Plus, the data is there to back it up, according to Cook.

“There is precedence of remote monitoring with diabetic patient apps/monitors that allow a patient to check their own insulin levels and parents to monitor their child’s insulin levels, and the fields were some of the first studied at Mass General Hospital in 2009 with promising results for reducing glucose levels through engagement and patient-focused apps,” she notes.

And perhaps one of the most revolutionary opportunities for increased remote patient monitoring in the HME industry is the respiratory care sector. One manufacturer that has really pursued this has been oxygen concentrator O2 Concepts. Back in 2014, the company added what it called Dynamic Network Analysis (DNA) as an option for its Oxlife Independence portable oxygen concentrator. The original value proposition was to leverage telemetry via GPS and cellular data provided by Verizon to help providers keep track of their expensive equipment out in the field.

This would help solve the problem of delicate and costly POCs winding up getting provisioned to patients that, contrary to the ambulation goals of portable, long-term oxygen therapy, simply decide to stay at home for whatever reason. This could help the provider identify this point of inefficiency and work with the physician to outfit that user with something more within his or her needs. It also meant that providers could remotely check on POCs to ensure they were performing properly without having to deploy a tech in a truck.

“Patient monitoring is usually evaluated based on clinical outcomes, but there are also very important cost impacts to monitoring your patients,” says O2 Concepts CEO Rob Kent. “When a patient starts using too many tanks, you put them on non-delivery equipment right? But what happens when patients on non-delivery equipment stop ambulating? How do you know?

“Our DNA technology can also tell you POCs are not being used for ambulation,” he continues. “We observed a great example recently where a provider redeployed 20 devices instead of placing another order. We showed them how to use our platform to find patients not ambulating on their equipment. By doing this they’ve reduced their average need for non-delivery equipment by 25 percent.”

That’s a pretty solid business case on its own, but then O2 Concepts and providers using the Oxlife Independence with DNA started taking a second look at a the data and realized there was a bigger case to be made.

“Designed as a ‘fleet management’ platform to track POC location, performance and usage, the usage feature is proving most impactful,” Kent explains. “With our Oxlife Independence being deployed as a 24/7 solution (no stationary), our DNA platform can give you a 24-hour snapshot of a patient’s oxygen use.

“Since launching the platform, the base functionality has not changed much,” he continues. “However we continue to evolve automated reporting and alerts based on market feedback. In terms of patient monitoring, people are most interested in patients’ total usage and ambulatory usage. We are making the platform smarter by allowing the entry of expected usage for each device. This allows our system to alert you only of particular risk points where patients aren’t using oxygen as you would expect.”

And from there, we can see the foundation being laid for physicians, RTs and other clinicians involved in the patient’s care to start using that data to engage in targeted outreach and help improve compliance.

“Our DNA platform is also configurable to work with multiple tiers of users,” Kent explains. “For example we are about to kick of a study with a provider and major hospital chain. Our Oxlife Independence, dual-mode TPOC will be deployed on higher-risk patients as they are discharged.

“Our DNA platform will monitor the devices for usage against expectations,” he continues. “When devices aren’t being used as expected, a group of telehealth nurses will get an email the next day showing expected usage compared to actual. They can then reach out to the patient to assess why they weren’t using oxygen as expected and mitigate a potential readmit risk.”

And anyone working with hospitals knows that reducing readmissions is a top priority, given that their reimbursement often depends on it. If a provider can help a hospital or physician accomplish that goal, it will definitely establish its indispensable value to those referral partners.

“In this environment, finding automated ways to eliminate risk-points is a very compelling story,” Kent says. “In this business case, the oxygen solution and telehealth nurses are already in place. We are just using ‘DNA technology’ to work smarter.”

And it doesn’t stop with diabetes or oxygen. Even wound care is starting to see remote patient monitoring, which makes sense given that wound care really does benefit from constant follow-up. The more a wound care physician or nurse can inspect how a wound is healing, the more he or she can adjust compression, medication, dressings, etc. Bearing that in mind, the SWAN-iCare project taking place in Europe ( is developing smart negative pressure wound care devices that perform a number of tasks:

Collect data and monitor several wound parameters via non-invasive integrated micro-sensors.

Help physicians and other caregivers provide innovative personalized therapy in combination with the NPWT.

Help healthcare providers remotely track the patient’s condition and progress, as well as receive alerts to development that require direct actions.

The net takeaway should be that remote monitoring is coming to post acute care in any way that it can, because everyone in the care continuum wants it.

“We feel confident that the model of connected device and patient engagement could extend to meet the needs of providers working with chronic conditions,” says ResMed’s Cook. “Our experience in sleep has shown us that connected technologies play a huge role in the areas that are the most important – value-based care, meeting regulatory standards, providing workflow efficiencies and ensuring the best, quality outcomes.

“Embracing connected technologies in managing these conditions is extremely important for doing business in today’s complex regulatory environment, and end-to-end healthcare informatics solutions will only continue to improve as the industry moves toward increased connectivity,” she continues.

“What is most exciting about monitoring technology is the ability to impact costs so dramatically, and bring an incredibly exciting story to your referral sources on patient care,” Kent adds.

Ultimately, what remote patient monitoring represents is an enticing and rewarding blend of technology to help patients while providing a solid business case for HME providers’ continued — and expanded — role in the post-acute care market. Now is the time and opportunity for providers to starting forging the kinds of meaningful, patient-provider-referral connections across a variety of care sectors that will ensure their longterm success.

This article originally appeared in the January 2017 issue of HME Business.

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