Incorporating a Human Element Into RPM Services

Over the past two years, remote patient monitoring (RPM) programs have increased, with health systems using the care modality for various clinical activities, including tracking chronic disease patient outcomes.

Both providers and patients are in favor of integrating RPM into clinical care. A survey by the American Medical Association shows that 20 percent of physicians used RPM in 2020, twice the number that used the care modality in 2018.

Similarly, a 2021 survey polling 300 Americans showed that nearly half favor incorporating RPM into medical care.

Advancements in technology, enabling real-time monitoring of patients, alerts, and data analysis, are critical to the success of any RPM program. But, in the race to create state-of-the-art remote care services, providers must ensure that they have included a human element, according to Sumir Sahgal, MD, founder and chief medical officer of Essen Health Care, a New York City-based multispecialty medical group.

"The aspect of [adding the] human element to the technology — that's what is going to really help us change the way healthcare is delivered," Sahgal said in a phone interview.

Essen Health Care's RPM program

Essen Health Care is using RPM to track various patient care metrics, including blood pressure, weight, and blood sugar.

Though providing patients with the devices needed to track these metrics isn't hard, staying on the same page as patients regarding how often to monitor and share their readings posed a challenge, Sahgal explained.

"The problem we faced was when we started giving [out] those blood pressure machines…the patient would check their blood pressure, but in most cases forgot to bring the readings to us," he said. "[But] with the Bluetooth technology, when the patient checks their blood pressure, it automatically gets registered in a platform, and we are able to see it."

Essen's technology partner is Verustat, which offers Bluetooth-connected devices, like blood pressure monitors and pulse oximeters, that enable clinicians to view patient-generated data in real-time. Further, Verustat gives patients access to care coordinators. These coordinators communicate with patients, providing technical assistance and ensuring they follow their care plans.

For example, if the patient has an abnormally high or low blood pressure reading, a care coordinator will call and ask the patient to check their blood pressure again to ensure accuracy.

"And if it is high or low, then [the care coordinator] will get in touch with our physician," Sahgal said. "And then we would be able to do a virtual call with our patient."

So far, Essen has monitored more than 1,000 patients using this technology.

Keeping the human element top-of-mind

For Essen Health Care, the care coordinator team has been a critical factor in the deployment of RPM services.

"It's human engagement," Sahgal said. "You don't have robotic intervention or calls. [The] care management team actually is able to call and talk to the patient."

This engagement is critical as patients tend to become complacent with technology. Care coordinators can help ensure that patients are engaged in their care plans, reminding them to take their readings or even their medications.

"Typically, patients are on multiple medications, especially the elderly," Sahgal said. "So, medication adherence becomes a very big issue where they have to be reminded that they are taking the medication. We have occasional messages that can be sent out."

Further, because patients are more engaged in their care, they are empowered.

"Prior to [RPM], patients with high blood pressure would have to wait until they come back to the office after a few weeks, or months, or whenever the appointment is, to follow up," Sahgal said.

"But now they can check their blood pressure and engage with not only the care management team but also with our physicians and specialists because now they have a resource available in case the blood pressure is high," he added.

The support from a human care coordination team also drives engagement among patients with other debilitating chronic conditions.

For example, an elderly and blind patient of Sahgal's appeared to be having trouble keeping her blood pressure in check.

"Her blood pressure would always be high when she came to the office," he said. "And she would have dizziness. I wouldn't know if her dizziness was from high blood pressure or low blood pressure."

After providing the patient with the Verustat technology, Sahgal and his team were able to get her blood pressure in control within weeks. They found that while the patient couldn't read her blood pressure metrics, she could call the care coordinators and ask them what her blood pressure was.

"She actually got to know her own blood pressure because she knew somebody was watching it," he said. "So that was amazing."

Not only can having a human element in a technology-driven program help boost engagement, but it can also provide the necessary support to patients.

No matter how simple manufacturers attempt to make technology set-up, there will be some amount of hesitation and anxiety from patients, Sahgal said. This is especially true of the elderly, a key RPM demographic.

Care coordinators can help walk patients through the initial set up of their devices and are also available to troubleshoot any technical issues as they arise, Sahgal explained.

Next steps

Essen Health Care has several plans to expand its RPM services, including integrating the care modality into its cardiology division.

"A lot of times as people get older, their cardiac needs become more," Sahgal said. "So, we [will be] able to monitor those high-risk patients and make our cardiologists available to them."

The organization is also a part of the Centers for Medicare and Medicaid Services' Global and Professional Direct Contracting Model. Through this model, Essen is taking on the full clinical and financial risk of caring for 1,000 high-needs patients in New York.

"So, we are creating this almost hospital-at-home system using remote patient monitoring so that patients don't have to go to the emergency room and to the hospital," Sahgal said.

The benefits of RPM are vast, but as programs proliferate and care increasingly moves out of the hospital, providers must not forget that human connection is an inextricable part of care delivery.