Operational Implementation of Remote Patient Monitoring Within a Large Ambulatory Health System: Multimethod Qualitative Case Study (Preprint)

Abstract

BACKGROUND Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians’ diagnostic and treatment decisions. However, to date scaled RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on health information technology infrastructure design and workflows is lacking. OBJECTIVE In this study, we evaluate the early implementation of a large-scale RPM initiative within the ambulatory network of an academic medical center in New York City, focusing on human-computer interaction (HCI) impacts and challenges. METHODS Utilizing a multi-method qualitative approach, we conducted 1) interviews with 13 clinicians across 9 specialties considered “early adopters” and supporters of RPM, and 2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient-representatives. RESULTS We identified themes related to HCI considerations for RPM within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventing monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care, and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas. CONCLUSIONS This study highlights the unique contexts and human-computer interaction concerns regarding the implementation of RPM in clinical practice and its potential implications for clinical workflows and work experiences. Based on these findings, we offer design recommendations for health systems interested in deploying RPM-enabled healthcare. CLINICALTRIAL N/a