Remote Monitoring – The Future Is Now

Remote monitoring has evolved significantly since its inception. Not too long ago, remote monitoring represented a convenient alternative to frequent visits to the arrhythmia clinic. Statistics show that a rise in the number of geriatrics and rising cases of chronic obstructive pulmonary disease (COPD) are straining the healthcare systems. Furthermore, the high incidence of diabetes, cardiac arrhythmia, ischemic diseases, hypertension, sleep apnea, and hyperlipidemia are also adding to the insurmountable medical expenses that cannot be afforded by many.

As the numbers of geriatrics are expected to reach 265 million by 2020, deployment of remote patient monitoring systems will help to deliver value-for-money services. This will also allow the elderly patients to remain independent, thereby reducing the economic burden on themselves, primary caregivers, and the hospitals.

However, the biggest drawback of advanced remote patient monitoring systems is the possibility of technical glitches that can render the systems useless. Furthermore, methods of tracking consultations with patients for remunerating the medical practitioners also remain a debatable issue. Despite the positives and the negatives in the overall market, analysts predict that the advanced remote patient monitoring systems will make an indelible mark by saving and transforming lives.

Technology Trends
While the utilization and innovation of remote monitoring may not be completely predictable, there are several areas where change is most likely to occur. These potential changes include greater incorporation of remote monitoring data in practice management and research, consolidation and integration of software and information technology platforms, and increasing patient participation and access to remote monitoring data and practices.

Early clinical studies of remote monitoring helped establish that remote monitoring reduces time to clinical decision making. Additionally, remote monitoring has been shown to reduce inappropriate shocks and improve survival. Prior studies have also shown that remote monitoring is associated with significant reductions in healthcare utilization and hospitalization. Given the existing consensus recommendations for remote monitoring and the emerging outcomes data, it is increasingly likely that health systems will pay more attention to remote monitoring. In order to maximize benefits from remote monitoring, health systems will need to place continued investment in the infrastructure and clinical staff needed to facilitate efficient and high-quality remote monitoring care. However, these commitments should lead to improvements in clinical efficiency, outcomes, and cost savings. Finally, it is not out of the realm of possibility that remote monitoring will become a reportable performance measure in the near term to intermediate future.

While remote monitoring utilization will continue to grow in clinical practice, it will become an essential research tool. For example, remote monitoring systems and databases offer the potential for improved collection of outcomes in pragmatic clinical trials. One could easily envision a clinical trial of device programming or other intervention with online consent, minimal clinical visits, and remote data collection via the electronic medical record and CIED monitoring data.

Despite the increasing use of remote monitoring in clinical practice and its emphasis in long-term patient management, there are some aspects of remote monitoring that have not improved. Among these are the need for clinicians and practices to access, review, and manage several remote monitoring programs and databases. Furthermore, these multiple, vendor-specific databases do not exchange data or interface with current electronic medical record systems. There is a clear unmet need for information technology and software programs that can import data from diverse remote monitoring systems and provide clinicians with centralized arrhythmia and device monitoring evaluation and management. There are already several efforts underway to try and develop such software programs in order to further streamline remote monitoring management.

While the future will bring greater incorporation of remote monitoring data in practice management and research, the patient’s relationship with remote monitoring systems will also evolve. There is increasing demand for improved patient access to their own device data and a desire to empower patients to take a more active role monitoring their health status and participating in their arrhythmia care. While there are challenges to improving patient access, there are several emerging technologies that may make it more feasible. In 2015, the first Bluetooth-based remote monitoring platforms were approved by the FDA and are now available for use in clinical practice in pacing systems. For example, the MyCareLink smart monitor allows pacemaker patients to transmit data in real time to their healthcare provider, using a handheld device reader and a smartphone application. Future iterations of Bluetooth-enabled pacemakers will communicate directly with the remote monitoring system without the need for a handheld wand.

There are also emerging data that suggest remote monitoring can be harnessed to help patients actively manage their own medical care. At present, patients with atrial fibrillation and risk factors for stroke take their oral anticoagulants on a chronic basis. However, the recent React.Com pilot study tested the feasibility of an implantable cardiac monitor-guided intermittent anticoagulant strategy – so-called pill-in-the-pocket anticoagulation. The patients with nonpermanent AF and a CHADS2 score of 1–2 were randomized to daily non-vitamin K oral antagonist anticoagulation (NOAC) versus remote monitoring-guided intermittent NOAC therapy. In the interventional arm, patients with more than one hour of AF on their implanted monitors were switched to active NOAC therapy, but could also discontinue NOAC therapy after 30 consecutive days without AF. In 59 subjects, the React.Com investigators demonstrated that implantable cardiac monitor-guided intermittent NOAC therapy resulted in a 94 percent reduction in the total time on NOAC therapy. The React.Com pilot study is just one example of how remote monitoring technology can be used to guide remote patient management. There are many more, including the use of handheld electrocardiogram recordings to guide corrected QT assessment for class III antiarrhythmic drug monitoring.

The Future
The future of remote monitoring is now. Clinical practices and healthcare systems should invest in remote monitoring infrastructure and utilization to promote improved efficiency and outcomes as well as reduce hospitalization. Remote monitoring platforms will eventually be integrated and increasingly used to guide research. Finally, remote monitoring will also serve as a mechanism to engage patients in their care, including remote management.