Remote patient monitoring: the future of health technology

The future is now: the technologies of today were the stuff of sci-fi novels a few years ago. Artificial limbs controlled with a thought, genetically modified pigs bred for organ transplantation into humans, and self-driving cars, all these amazing advances, and many others, are part of our world (although perhaps not yet everyday items).

To many Americans, owning a cell phone, a necessity to most, is not an option. But cell phones have been an early predictor of personal technology, an area of great interest in the technology sector. Medicine became interested when personal sensors were developed allowing a remotely located individual to monitor some aspect of health in another.

Remote patient monitoring (RPM) is the term developed for this direction in electronic devices, coming under the auspices of home telehealth. The concept allows for the use of mobile medical devices to gather specific information about some particular patient, which is then sent to the appropriate healthcare provider. Depending on what is being monitored, these can look at numerous factors affecting health.

Some of the more common components of overall health include heart rate, blood pressure, weight changes, breathing, sleep, and others. These devices are quickly becoming a vital part of chronic disease management and for numerous conditions. The benefits of a physician being able to monitor minute to minute changes in blood sugar for a diabetic, or respirations in someone with lung disease, are significant for many population groups.

The use of these smart technologies only looks to expand in the coming decade. Bluetooth-enabled scales and blood pressure monitors for those with cardiovascular conditions, these and other devices are working their way into the homes and onto the bodies of many Americans who benefit from this 24-7 monitoring of their vitals or some other component of health.

Some of these measures are predictable and obvious, like blood sugar. Certainly, with diabetes mellitus being epidemic, checking on blood sugar levels would be helpful in promoting health and well-being. But the uses of RPM are expanding as our capabilities in the field of personal electronics expand and advance.

As with any new opportunity, we are learning as we go, what is applicable to these developing options for remote evaluation of health. One of particular interest to those dealing with diabetes and diabetic foot ulcers is a temperature sensing mat. These non-healing defects in the “container” that is our skin are the cause of about half of all hospitalizations for diabetes. A review of the dollars required to treat these wounds makes it blatantly obvious why any technology serving to lower these expenditures is going to be of interest.

The morbidity and mortality associated with diabetic foot ulcers is staggering. Eighty percent of major diabetic lower extremity amputations (foot, ankle, leg) were preceded by a foot ulcer. But since the first sign of skin breakdown is typically a slight increase in temperature, detecting this change early can lead to preventative measures. Stopping the process leading to infection and amputation is a grand goal, with a skin ulcer being the seminal event leading down this difficult road.

A rectangular, rubbery mat. upon which the individual momentarily stands, allows the sensors in the mat to detect skin temperature on the bottom of the foot at multiple points. The increased temps preceding the formation of an ulcer can be detected a week or more prior to skin breakdown. When the system is working appropriately, both parties are notified in a timely fashion, and interventions instituted.

We now have sensors, worn on the ankle, which can be used in a home-based exercise program, allowing the physician to monitor the patient’s participation in and performance of the prescribed activities. Also in use is a device for those susceptible to falls. This is a huge problem in our aging society, with multiple diseases increasing one’s risks for gait instability. Statistics reveal most of these injuries occur in the home so its not as though some innocent bystander will alert emergency services. RPM can monitor your positioning and the occurrence of a fall and notify the appropriate parties in a timely fashion.

Being able to see your progress, accurately visualize the calories burned, or maybe just seeing healthy sleep patterns, people find motivation in being able to evaluate the changes made and exercise performed. Certainly convenience is an obvious benefit to RPM. These devices are able to transmit data directly to a healthcare provider, reducing the need for trips to your primary care office for check-ups and routine monitoring.

Naturally, there are concerns. Perhaps the most significant is regarding the data. Health information is incredibly personal and there can be serious financial and social ramifications to inappropriate access to it. Some worry we will become over-reliant on RPM, neglecting needed medical care only because we have our monitor on. It is of benefit to listen to your body and not ignore the signals it can provide.

As with every technology, there can be accuracy issues. Is the data received by the sensor and transmitted to the provider correct? Many things may lead to an answer of ‘No!’ Cost is an additional concern since these monitoring devices can be expensive. But for some conditions, it is a covered service by Medicare. For other diseases and certain types of monitors, it is not (yet), usually putting these out of reach of most individuals.

Not discussed specifically are the implantable monitors, with research in this direction looking to explode in the approaching decade. For a decade people have gotten credit card chips implanted in their hand, providing for the ultimate in shopping convenience, a simple “wave of the hand.” How long before that live-giving phone is inside your hand. The field of biotechnology, electronics implanted on a “permanent” basis, is no longer the stuff of the imagination: truly we have entered into the realm of science fiction.

Issues are plentiful at this early stage in development, questions of trust, certainly of reimbursement, and their equitable distribution. But have no doubt, the capabilities of health monitoring devices will continue to advance, offering exciting prospects for health care. “Will we become more machine than man?” is a pertinent question, one for which we have no answer at this primitive level of complexity. Only that the current and future benefits of remote patient monitoring guarantees it an important place in American health care.

Dr. Conway McLean, DABFAS, FAPWHc, has offices in L’Anse and Marquette. He is a physician who specializes in treating lower leg, ankle and foot problems.


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