Remote patient monitoring (RPM) uses a variety of digital technologies to collect real-time personal health information and electronically communicate the data to a healthcare provider for assessment, and possible intervention. RPM is a form of telemedicine, also called telehealth or digital health. Historically, telemedicine used to consist of a health consultation by a phone or video call only. However, the tools and technologies available for telemedicine in one form or another have vastly improved over the last several years, culminating in 2020-21. Indeed, the current COVID-19 pandemic forced many traditional healthcare delivery models to abruptly shift to telehealth. While this disruption in healthcare delivery was in response to a global crisis, it was also an opportunity for RPM telehealth systems to be implemented on a massive scale. In the future, it is likely that RPM will be seamlessly integrated into healthcare in an appropriate, efficient, cost-effective, and sustainable manner for patient care.
Ideally, RPM will capture complex physiological measurements for health management. One could argue that a basic form of RPM has already been introduced into the general population as fitness and activity trackers, smart watches, wearable devices, and smart phone health apps. Although these devices are not marketed to be used by a physician for medical management, they can help users check activity and achieve health goals. Today, there are multiple smart watches, wearables, and apps that can assist with physical activity, exercise, diet, mindfulness, sleep, stress, fertility, and mental health, among other health goals. It is estimated that more than 19% of Americans use some sort of wearable fitness tracker.
Prior to the COVID-19 pandemic, RPM was adopted on a small, fragmented scale. There were many barriers to ubiquitous use of RPM, some of which persist even after the paradigm shift to telemedicine being commonplace. RPM technology must be backed by clinical trials and peer reviewed publications for validation. Historically, RPM systems were rigid and did not have the ability to communicate with other devices and software. Until recently, these devices have been cost-prohibitive. Fortunately, modern RPM hardware can be built with a level of Artificial Intelligence (AI) or “smart technology” so it can respond to the multitude of physiological measurements and parameters and offer actionable data to the patient and/or healthcare provider. The expansion of high-speed Internet access also allows for the data to be transmitted from RPM devices to a healthcare provider or system efficiently.
RPM is available for people with asthma. The goals for these electronic monitoring devices are medication compliance, sleep monitoring, and the identification of asthma triggers (with possible prevention of an asthma attack). RPM equipment is paired with a smartphone app that has GPS capabilities which may warn the user of adverse weather that could exacerbate asthma symptoms. The Digihaler is an FDA approved device with electronic sensors that record data important for evaluating proper inhaler use by the patient. A pilot study demonstrated the Digihaler was able to predict asthma exacerbations. There is a similar device from Propeller Health that attaches to a rescue inhaler and is designed to manage chronic obstructive pulmonary disease (COPD) and asthma. Studies have shown that the Propeller Health device was able to reduce the use of a rescue inhaler by 39%. Propeller Health also has a provider portal for healthcare professionals. While these devices are helpful for patients with asthma and COPD, there is a need for RPM that will target the larger population.
MouthLab recently received FDA 510(k) clearance and was designed after the concept of a Tricorder – the health assessment equipment seen in the Star Trek science fiction television shows and movies. The MouthLab is an RPM device that uses biomarkers from the patient’s breath and saliva to provide actionable health information for the patient. Research has shown that biomarkers from saliva (salivaomics) and breath (breathomics) are valid mechanisms for rapid health assessment and point of care testing. The Mouthlab is a handheld device with a mouthpiece and is simple to use by a wide range of individuals from children to adults. The user inhales and exhales into the device, and the data is available in less than a minute for 10 health measurements including: blood pressure; electrocardiogram information; heart rate and variability; oxygen saturation; pulse; respiration rate and pattern; spirometry (lung function); and temperature. The manufacturer envisions that MouthLab can be in every household for daily use. It is compared to a “check engine” light for health assessment. If there are health measurement changes that warrant an evaluation by a healthcare professional, the patient may see a doctor or check into the emergency room based on the data from the MouthLab. An early study published by the manufacturer in 2015 demonstrated that many of the health parameters measured were comparable to traditional instrumentation for accuracy, and the device could be easily used by patients with no prior training. The MouthLab consolidates many different patient monitoring devices that can be found in a healthcare facility into a small handheld device that may be used at home.
RPM research, technology, and capabilities have increased rapidly within the last several years. The COVID-19 pandemic was the opportunity to employ remote digital health tools for telemedicine on a massive scale in 2020. Prior to the pandemic, the increased use of wearable fitness and activity trackers served as a brief introduction to the concept of RPM for point of care and health assessment to the general population. The confluence of better technology, high speed Internet, and the increased need for remote telemedicine due to the global pandemic has set the stage for the wide-scale execution of RPM. There are remote devices available for patient monitoring for specific conditions like asthma, and the MouthLab has demonstrated that RPM technology may be used for the general population for point of care and health management.
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