COVID-19 has promoted the adoption of telemedicine and remote patient monitoring across the United States. Currently 36% of American consumers use telemedicine instead of medical consultation.

Although this creates opportunities for health systems to digitally transform their care delivery models, not all health systems have the right resources and organizational support to promote this change.

Among the many challenges, an important factor related to the CIO of these health systems is the lack of willingness in the clinical community to support IT transformation to adopt new care delivery models.

In the field of remote monitoring, despite the obvious benefits of managing large long-term populations through connected devices, clinicians’ lack of confidence in data quality (especially self-monitoring and patient-reported data) is a challenge.

In view of the need to integrate remote patient monitoring, CIOs have to go beyond the sight of EHR and explore independent platforms to enhance their level of care. As CIOs, they must also use available tools and carry out strategic work for corporate transformation.

To ensure that these providers make full use of available resources when making long-term planning, CIOs must consider the following points.

Choose the right equipment for reliable patient data and reimbursement

Nowadays, many health care devices and wearable devices are on the market, but not all CMS have approved these devices for reimbursement. In order to be reimbursed by CMS, the device must be an FDA-listed device.

However, FDA approval ensures that medical devices are used safely and effectively for their intended use. The FDA classifies medical devices into three categories based on the hazards to human life. According to this classification, medical devices must undergo different regulatory procedures, including clinical trials.

The FDA also provides the necessary guidance and supporting documents for operating the equipment, highlighting the precautions and pros and cons to help make informed decisions.

Remote monitoring equipment allows clinicians to monitor the life of patients, such as respiratory rate, heart rate, temperature, heart rate variability and blood oxygen saturation level, so that they can make informed decisions in a timely manner.

Map physician workflows and win their confidence

The implementation of remote patient monitoring procedures in hospitals requires stakeholders and doctors in various fields and virtual care. When defining a roadmap for remote patient monitoring programs, doctors’ opinions can help identify and prioritize professional services.

Factors that can help prioritize each professional service must include remote operation requirements, available budget, ROI, and the combination of use cases for each department under consideration.

Each profession has its own use cases and can be accessed virtually. These use cases must be evaluated first, and then the equipment will be shortlisted by professionals.

For example, compared with other majors, cardiology requires more digital monitoring equipment to monitor blood pressure, weight, heart rhythm and electrocardiogram in real time. At the same time, dermatologists can simply use high-resolution, high-quality cameras.

Adopt FHIR standards to integrate data with doctors’ daily workflow

A typical day in a busy doctor’s life includes seeing scheduled appointments in outpatient and inpatient rounds, as well as emergency visits in between. In order to receive follow-up of patients remotely in routine procedures, doctors need to obtain clinical documents and the patient’s current life status in advance.

For seamless remote follow-up of patients, the device is integrated in the EHR for doctors to view the device readings in the patient’s clinical documents.

Measurements and data from personal health devices must reach the caregiver through a platform synchronized with the device (usually via a mobile application). Today, there are as many formats for sending data to personal health gateways as there are devices on the market.

The lack of standards creates challenges for developers who end up writing code for each individual instance of the device. FHIR resources or data packets define the basic resources required to transmit data from the device to the FHIR server and finally to a receiving system such as EHR in a standard format. When the EHR is received and inserted in a standard format, the data from these devices can help doctors comprehensively diagnose patients.

Remote patient monitoring uses three main FHIR resources:

• patient. Patient resources provide demographic information about patients. The patient identifier in this resource is the key attribute that links the patient to the device. The practitioner can choose not to disclose the patient’s PHI or keep it public.
• equipment. In FHIR, device resources are used to describe static components, such as device identifier, manufacturer, name, model, location, device status, and any other information.
• Observed. This resource is the most important component, it holds the actual data about the important parameters measured. Observation resources include actual results, time stamps, reference ranges and device details of measurement parameters.

The huge differences in physiological readings and data collected from patients’ medical equipment can be summarized into the six main types of observations mentioned below:

• Scalar quantities: such as temperature, weight, stride length, pulse and glucose-anything that can be described in a single numeric field.
• Vector: A measurement that requires multiple values ??to describe, such as BP and acceleration.
• Code: When describing a measurement with a limited set of options in the context of reading, such as reading time, such as before a meal, fasting, or bedtime.
• Event/Status: This type of measurement is used to monitor applications such as the status of the humidifier, whether the patient is in or outside the room in a separate living facility, or the edge signal in a pulse oximeter.
• Waveform: Periodic data is mapped to waveform data, such as ECG traces.
• String: When the measurement result is in text format and only for display, it will capture string data.

COVID-19 has promoted the remote patient monitoring market. The updated physician fee schedule released in December 2020 addresses the changes in nursing management services and remote physiological monitoring services and reflects the ever-changing trends in medical practice.

A physician-friendly reimbursement environment, reliable equipment, integrated workflow, and strategies to encourage remote patient monitoring will help physicians provide remote care easily.

The CIO of the health system must overcome financial constraints and resource shortages by making the situation favorable. First determine organizational priorities, win the trust of stakeholders and doctors, and establish strict governance to drive digital initiatives, while tracking and reporting revenue to drive digital transformation through easy remote patient monitoring in their enterprises.

Dr. Joyoti Goswami is the principal consultant of Damo Consulting.