The Next Frontier of Remote Patient Monitoring: Hospital at Home

Abstract

Remote patient monitoring (RPM) has shown promise in aiding safe and efficient remote care for chronic conditions; however, its use remains more limited within the hospital at home (HaH) model of care despite a significant opportunity to increase patient eligibility, improve safety, and decrease costs. HaH could achieve these goals by further adopting the 3 primary modalities of RPM (ie, vital sign, continuous single-lead electrocardiogram, and fall monitoring). With only 2 in-person vital sign checks required per day, HaH patient eligibility is currently often limited to lower-acuity cases. The use of vital sign RPM within HaH could better match the standard clinical practice of vital sign checks every 4-8 hours and enable safe care for appropriate moderate-acuity medical and surgical floor-level patients not traditionally enrolled in HaH. Robust, efficient collection of more frequent vital signs via RPM could expand patient eligibility for HaH and create a digital health safety net that enables high quality care. Similarly, our experience at Massachusetts General Hospital has demonstrated that appropriate use of continuous single-lead electrocardiogram RPM can also expand HaH enrollment, particularly for patients with acute decompensated heart failure. Through increasing enrollment of patients in HaH, RPM stands to enable more patients to reap the potential safety benefits of home hospitalization, including decreased rates of delirium and hospital-acquired infections, and better avoid aspects of posthospital syndrome. Furthermore, instituting fall detection RPM allows care teams to further HaH patient safety during their episode of acute care and develop enhanced mitigation strategies to avoid falls post home hospitalization. RPM also has the potential to assist HaH in achieving greater economies of scale and decreasing direct variable costs. By expanding HaH eligibility, RPM could enable HaH programs, which have traditionally operated under capacity, to care for a larger census and decrease allocated fixed costs per hospitalization. Additionally, RPM for HaH could further optimize hybrid in-home and remote nurse or physician evaluations, decreasing costs on a per-episode basis by up to an estimated 3.5%. Overall, RPM holds great promise to increase patient eligibility and patient safety while decreasing costs. However, it is in its infancy in achieving its potential to advance the HaH model of care; further research and experience that inform operational and technical as well as policy considerations are needed.

Large-scale real-life implementation of technology-enabled care to maximize hospitals' medical surge preparedness during future infectious disease outbreaks and winter seasons: a viewpoint

“…Economic analysis is currently not reported for most models and does not go beyond the simple reporting of resources used and the amount spent per patient monitored ( 30 ). A recent publication stated that RPM could further optimize hybrid in-home and remote nurse or physician evaluations, reducing costs by up to an estimated 3.5% overall ( 75 ).…”

Six-Lead Electrocardiography Enables Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting: A Prospective Validation Study

“…Increasing the safety belt for HAH patients is a worldwide challenge and demand. Future tasks for the HAH world include maintaining patients in their home environment without jeopardizing their health [29][30][31][32], bearing in mind that novel infrastructures and technologies, such as the IoT (internet of things), must be evaluated and adopted [33,34] for this purpose. Nevertheless, current HAH practices do not include reliable, validated means for patients' deterioration detection and prediction [35].…”

6-Lead Electrocardiography is a Viable Option for Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting. A Prospective Validation Study

“…Increasing the safety belt for HAH patients is a worldwide challenge and demand. Future tasks for the HAH world would include maintaining patients in their home environment without jeopardizing their health [30][31][32][33] bearing in mind that novel infrastructures and technologies, such as IoT (Internet of Things) must be evaluated and adopted [34,35] for this purpose. Nevertheless, current HAH practices still do not include reliable, validated means for patients' deterioration detection and prediction [36].…”