In healthcare, particularly regarding new technologies, we habitually chase after the latest, greatest shiny object. And we very often accept these innovations as being beneficial even before the data is confirmed, sometimes even failing to terminate usage when it’s not shown to be of benefit. And Remote patient Monitoring (RPM) risks falling into that scenario.
Hypothetically, the idea of continuous monitoring makes sense. If the clinician can “observe” what is happening, they have a greater chance of positively intervening. Unfortunately, this mentality fails to account for the numerous possible downsides of continuous monitoring including cost, intervening when it isn’t necessary, and the sheer panic it may cause for the user who is not trained to understand or is constantly worried about the information and what it might show.
Though there has been rapid growth in this space, understanding where its usage is occurring, and questioning its benefit are critical to understanding the potential value. A recent study by Tang et al. in Health Affairs found that using RPM is driven by a small number of primary care clinicians. Furthermore, they did not observe substantial targeting in people with a more significant disease burden or worse disease control.
These findings highlight a few incredibly troublesome situations. For instance, are clinicians using the tool indiscriminately, and if so, why? Is it because they believe it makes a difference, or do they merely gravitate to newer tools? And are there external influences that can lead to biases? Moreover, is this a comment on the use, or lack of use, of evidence-based medicine in the same clinician cohort?
The downside to such usage is the need for appropriate data, or the data we will collect will be inconsequential and lead us down a path where we might miss the benefit. Additionally, without understanding the value generated, payers will not accept the need for payment. Hence, the issue is not the technology itself or the possibilities of clinical improvement it might bring but the nature of how we implement new technology. In our pharmaceutical and interventional device usage, our thinking is more mature. Meaning medications and devices are studied to determine whether they provide more benefit than harm. So we should be evaluating technologies with the same scientific rigor. Unfortunately, we tend to discount the damage such interventions might cause as RPM is a passive approach. We have yet to determine if this model of thinking is correct. As the modalities that are being used in the monitoring are already well accepted, RPM is just a means to get the same information continuously.
As with any new situation, let us analyze its usage and implementation diligently. Without such an approach, we risk causing harm by overestimating the value of the technology or underestimating the potential positive impact. Let us utilize a scientific method as we have done with other treatments and interventional modalities.