Common remote patient monitoring tools

April 09, 2024 - Remote patient monitoring (RPM) is a valuable healthcare delivery mechanism. RPM allows healthcare providers to continuously track patient health metrics over time, giving them a comprehensive view of the patient’s condition and how they may react to treatment plans.

Amid the digital healthcare boom spurred by the COVID-19 pandemic, RPM claim volume rose 1,294 percent, data from Definitive Healthcare revealed. Chronic conditions like hypertension and diabetes accounted for the highest shares of RPM claims between January 2019 and November 2022.

As clinical evidence backing RPM use, especially in chronic disease management, grows, healthcare providers are investing in the tools and implementing programs supported by RPM. A survey conducted last year by Sage Growth Partners shows that 46 percent of healthcare executives expect to increase their RPM budget in 2024, and another 46 percent expect to maintain their current budget.

RPM is facilitated by numerous devices that collect patient data and transmit it to care teams, usually via Bluetooth. Here, mHealthIntelligence details commonly used RPM tools:

BLOOD PRESSURE MONITORS

A blood pressure monitor measures the pressure on the walls of the circulatory system's large blood vessels as the heart pumps blood through the body. Measuring blood pressure can enable early detection of hypertension, which could damage the brain, heart, and kidneys and lead to heart attacks and heart failure, according to the Centers for Disease Control and Prevention (CDC).

Manual and digital blood pressure monitors can be used at home. Manual blood pressure monitors include a cuff that wraps around the patient’s arm, a rubber squeeze bulb, and a gauge. A stethoscope is also required to hear the blood pulsing through the artery. The gauge's circular dial shows the blood pressure as the cuff inflates and deflates, adding and then removing pressure on the patient’s arm.

However, digital blood pressure monitors are recommended for at-home care as manual monitors can be misused, resulting in inaccurate readings. Digital monitors also utilize a cuff that inflates and deflates automatically or through a rubber squeeze ball. After the cuff is inflated, a digital screen will show the patient’s systolic and diastolic blood pressure readings. Once the reading is shown, the cuff slowly deflates on its own.

ECG MONITORS

An electrocardiogram (ECG) is a diagnostic tool used to perform cardiovascular assessments. These assessments can help clinicians detect cardiovascular diseases, such as heart failure, stroke, and arrhythmia, or abnormal heart rhythm.

ECG devices record electrical signals generated by the heart’s activity. The ECG architecture typically encompasses four layers. The bottom acquisition layer uses sensing devices, including mobile sensors and Internet of Things (IoT) sensors, that gather data and pass it on to the next layer, the pre-processing and processing layer. This layer performs various tasks like ECG noise and artifact filtering and ECG wave delineation and transformation. Following this, the data moves to the modeling and analytics layer, where machine learning, deep learning, and statistical analyses are performed to assess and collect ECG data patterns. Finally, the insights gleaned from the analysis move to the visualization layer, where application and device interfaces display the insights for the user.

Technology advancements have led to the development of ECG devices that conduct real-time monitoring and can be used at home. These devices range from wearable systems to wireless devices to ambulatory heart monitors.

GLUCOMETERS

A glucometer measures blood glucose, or blood sugar, which is the main sugar found in blood from the breakdown of food in the body. Measuring blood glucose is essential for people with diabetes whose bodies cannot produce insulin, a hormone that helps turn glucose into energy. Diabetes patients must keep their blood glucose levels within an appropriate range. If it is too low, patients may experience weakness, confusion, and a fast heart rate. If it is too high, patients can experience diabetic ketoacidosis, which could cause a coma or death.

A glucometer measures blood sugar using a small amount of blood, typically gathered from the patient’s fingertip. A lancet is used to prick the fingertip, drawing blood. This sample is then transferred to a test strip that is inserted into the glucometer.

Within RPM programs, continuous glucose monitors (CGMs) have become popular. A CGM has three parts: a tiny sensor that can be inserted under the patient’s skin, a transmitter, and a software program.

The sensors can be disposable, stuck to the skin with a sticky patch and changed out routinely, or implanted inside the body. The sensor estimates blood glucose levels in the fluid between cells rather than in the blood. The transmitter sends the information collected by the sensor to a software program on a smartphone, an insulin pump, or a separate device.

PULSE OXIMETERS

A pulse oximeter is an electronic device that measures oxygen saturation in red blood cells. This measurement is important to ensure enough oxygen is circulating in the blood for organs to function, which can help clinicians identify conditions impacting lung function, such as chronic obstructive pulmonary disease (COPD), lung cancer, and COVID-19.

The device is clipped to a part of the patient’s body, usually the fingertip. It uses a special type of light that passes through the skin into the blood. The device includes a sensor that measures the amount of light passing through and uses it to calculate the oxygen saturation level in the blood. A screen on the oximeter then displays the heart rate and oxygen saturation level.

Due to the COVID-19 pandemic, at-home pulse oximeter use grew. However, researchers have uncovered racial disparities in pulse oximetry readings. A study published in 2022 revealed that these devices provided inaccurate readings for racial minorities. Researchers assessed pulse oximetry readings for 3,069 patients and found that Asian, Black, and Hispanic patients had higher readings and received less supplemental oxygen.

THERMOMETERS

A thermometer measures the temperature of a body. The average normal body temperature is 98.6 degrees Fahrenheit (37 degrees Celsius). High or low body temperature indicates the presence of an illness. When the body temperature falls below 90 degrees Fahrenheit or rises above 106 degrees Fahrenheit, it could result in irreparable damage to organ structure and function.

Various types of thermometers employ different approaches to measure body temperature. For example, liquid thermometers, once the most common type, use liquids that expand in the presence of heat and contract when cooled, while electronic contact thermometers work with a thermistor, an instrument that changes its resistance to an electric current based on temperature.

Thermometers can be used orally, where the instrument is placed in the patient’s mouth below their tongue, or rectally, where the probe is placed in the patient’s rectum. The latter is usually used for children or patients who will not or cannot cooperate.

Within the RPM arena, patients can take their temperatures at home and send the data to their care teams via cellular technology or cloud-based solutions.

BODY WEIGHT SCALES

A body weight scale calculates a person’s weight, which is a measure of total body components. Being overweight or underweight is a health risk, with the former increasing the risk of hypertension, diabetes, and other chronic conditions and the latter increasing the risk of nutrition deficiencies.

The run-of-the-mill body weight scale is a small rectangular platform that a person stands on. According to a New York Times | Wirecutter article, scales measure a person’s weight “mechanically, with springs, or electronically, with circuits that bend under weight, altering the current coursing through them.” The platform displays the weight via a dial or digital screen.

In RPM, smart scales are often employed. These cellular-connected devices integrate a classic weight scale with a foot-to-foot impedance meter that can estimate body composition. The data is transmitted remotely via cellular connection to care teams.

WEARABLE DEVICES

Wearable devices are worn on the body and track several activities and parameters, including pulse monitoring, physical activity levels, and nutrition.

Smartwatches and fitness trackers are popular consumer-facing wearables that can track heart rate, step count, and other metrics. Data from these can be incorporated into RPM models to provide clinicians with a comprehensive view of the patient’s vital signs and lifestyle.

Patch monitors are another type of wearable enabling remote monitoring. In 2021, University of California San Diego researchers developed an epidermal patch that could continuously monitor cardiac output and metabolic levels of glucose, caffeine, or alcohol. Additionally, chest-strapped devices use sensors to detect respiratory rate, ECG, heart rate, and temperature.

A survey that polled 2,005 US consumers in the first quarter of 2022 revealed that wearable users are satisfied with their devices, with 70 percent saying the tools helped improve their fitness and health. In addition, about 55 percent of wearable device owners said they share their data with their healthcare providers.