TytoCare

Delivered April 14th, 2019. Contributors: Sarah D. and

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Benefits of Remote Patient Monitoring Devices

Advantages of remote patient management include the ability to send data to healthcare professionals in real-time, increased affordability, increased accessibility, increased patient engagement, and a larger physician pool. 
SENDING DATA IN REAL TIMERemote patient management permits data to be sent to physicians and other healthcare professionals in real-time. The patient can use a mobile device to perform routine tests without having to physically visit a hospital. This is extremely important for those with chronic illness that would typically have to visit a physical healthcare center regularly.  Incorporating remote patient management, using real-time analytics, can improve a patient's quality of life by helping them to maintain independence, minimize spending and prevent complications. 

Remote patient monitoring and trend analysis of physiological parameters can inform patients if they have a critical deterioration in health, so that they can seek emergency care immediately. 
MORE AFFORDABLE/ fewer DOCTOR VISITSRemote patient management allows for significant savings.  It allows patients to receive prescriptions and find out test results remotely, decreasing frequency of visits. By reducing the number of visits for more routine reasons, hospitals are becoming less crowded. This helps hospitals to admit patients quickly who actually need emergency care.  Remote patient management can also help to prevent the spread of infectious diseases.  For example, a person with influenza can be treated from home and will be less likely to spread the virus to others.  In a recent study by Oxford University Institute of Biomedical Engineering, physician appointments dropped by 25%, when they used a mobile app that was developed by the institute.  The American Hospital Association reported that telemedicine has helped to cut costs by 11% and has increased ROI for investors over three times.
Easier access to careA recent Cisco survey reported that 74% of patients stated that they would rather have easy access to healthcare over in-person visits with providers. Remote patient management allows patients who are homebound, have heavy work schedules, and those living in remote areas to access health care. This is especially true for patients that are disabled and may normally need assitance getting to and from appointments.  Doctors can see patients online; therefore, patients do not have to wait for an appointment date and can be seen faster.  
INCREASED PATIENT ENGAGEMENT AND QUALITY OF CAREA recent study indicated that remote patient care has lowered patient scores for stress, anxiety, and depression. Patients who use remote monitoring devices had an average of 38% fewer hospital admissions than those who did not partake in telemedicine. Telemedicine introduces patients to primary care and preventive measures and allows them to interact with healthcare professions in ways they were not able to before.  
PATIENTS HAVE A LARGER pool OF PHYSICIANS TO CHOOSE FROMPatients have a larger selection of doctors to chose from.  They can choose specialist referral services, primary care, consumer medical and health information, remote patient monitoring, and medical educational services outside their geographic scope. This helps patients to develop stronger relationships with physicians and be more selective when choosing a provider. In the United States there are only 43 specialists available for every 100,000 patients living in rural areas. By using remote patient monitoring, patients have access to a greater pool of specialists to choose from.

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Remote Patient Monitoring Devices - Decision Makers

Key decision makers for Tytocare on the B2C side include patients with chronic illnesses, Generation X to include parents and care givers of elderly, Millennials, Baby Boomers, and the elderly. We also compared and contrasted the high usage audience for remote patient monitoring services with the total usage audience for remote patient monitoring. 
KEY DECISION MAKERSPATIENTS WITH CHRONIC CONDITIONSPatients with chronic conditions find remote patient monitoring to be extremely effective because they typically need to visit physicians more frequently. Patients can monitor health conditions from home and physicians can detect changes to a patients condition in real-time, and refill prescriptions.  Remote monitoring devices can conduct trend analysis of physiological parameters using such measurements.  This enables them to inform patients if they have a critical deterioration in health, so that they can seek emergency care immediately. 

According to a recent study from vEngagement, patients with chronic conditions who used remote patient monitoring devices experienced, a 50% reduction in re-admission, and a 50% reduction in emergency room visits.  98% reported to be satisfied with their device.
Generation X (PARENTS AND CARE CAREGIVERS OF ELDERLY PATIENTS) Generation X is typically in charge of healthcare decisions for both their elderly parents and their own children.  They also must manage their own personal health care. Remote patient devices can alleviate the stress of managing three generations of healthcare. It is cost effective, convenient, and time-saving.  Generation X are typically aware of the surrounding technology. They are hyper-connected and although they "still place value to include improved logistics, better patent care, increased patient engagement, and increased access to healthcare professionals. 
MILLENIALS  Millennials are a driving force and key decision maker in remote patient monitoring. This age group is generally focused on preventive care and general wellness. They tend to have healthier diets, get regular exercise, and lower rates of alcohol consumption.  They are also more likely to share data, which allow medical researchers to develop effective preventive strategies.

Millennials can be considered a high usage audience. Findings support that they use remote patient care much more than other audiences, as can be viewed below:

Use of mobile devices to manage health: Millennials 46% Average 36% 
Accessing EHRs: Millennials: 38% Average: 27% 
Social media as a healthcare tool: Millennials: 35% Average:23% 
Smart scales Millennials: 27% Average 15% 
Online communications: Millennials: 25% Average: 14% 
Remote consultations: Millennials: 16% Average: 12% 
Remote monitoring: Millennials: 14% Average: 9% 
 Baby Boomers/ ELDERLY Baby Boomers are the largest age-based population group in the United States.  The oldest members are approaching their 70s, which carries the risk of inherent health conditions.  Research has found that Baby Boomers are less healthy than preceding generations due to higher rates of obesity, less physical activity and  higher incidence of chronic diseases. These conditions all increase the demand for healthcare services. This will put a "tremendous strain on the system without a substantial increase in the adoption of remote patient monitoring." Remote patient management can reduce this strain and allow Baby Boomers to manage chronic conditions and receive health care services from the comfort of their homes. According to the AARP, 86% adults over the age of 65 wish to remain in their homes as they grow older, which sets up the ideal usage situation for remote monitoring devices.
HIGH USAGE AUDIENCE AND OTHER DEMOGRAPHICS FAIR Health recently released a white paper analyzing the usage audience for remote patient monitoring services.  Although the study took place from 2011-2016, current publications from 2018 are still using this data. As such, we believe this is the most recent data available. The report proclaimed that remote patient care increased substaintially, with a 960% increase in rural areas, a 629% increase in urban areas, and a 643% increase nationally. However, urban usages has surpassed rural usage with an increase of 20% between 2015 and 2016, as compared to rural usage which only increased just over 5%. The states with the highest remote patient care claims include "Massachusetts, California,  Texas, South Dakota and Minnesota." 

According to FAIR Health, "remote patient care was most associated with individuals between 31 and 60 years old, who accounted for 56% of distribution claim lines with telehealth usage in 2016. The peak age groups for telehealth were 41 to 50 and 51 to 60, each at 19 %." The report proclaimed that mental health reason accounted for 31% of remote healthcare, followed by respiratory infections at 15%.

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Tytocare - Barriers

Some barriers to using Tytocare as opposed to a minute-clinic or traditional doctor's visit include additional training and equipment, reduced care continuity, fewer-in person consultations, insurance and reimbursement rates, and accessibility. 
BARRIERSTraining and equipment purchaseIn order to build a successful RPM program, training is crucial.  Purchasing the proper equipment and restructuring IT staff responsibilities within the physicican's offices costs time and resources. After data is collected, it needs to be rerouted from the RMP device to electronic medical record systems.

The American Medical Association stated concerns over the fact that the "majority of medical students are not being taught how to use technologies such as telemedicine or electronic health records during medical school and residency."  The AMA suggested that medical students be trained in three telehealth-focused areas which include patient safety, patient education and virtual imaging.
Reduced Care ContinuityRPM services typically connect a patient to a random healthcare provider. This can cause care continuity to suffer.  The patient's primary physician may not have access to all visits and end up with an incomplete patient history. Reduced continuity of care can decrease care quality.

The number of connected devices is increasing and with this comes challenges to transferring data from the RPMs to the medical record systems. This causes physicians to have to use third party-applications in addition to their electronic medical records (EMR) to gain full medical records of a patient. 
Fewer In-Person ConsultationsMany physicians are skeptical about RMP.  Among the concerns are poor broadband connections which can lead to “possible patient mismanagement.”  According to NEJM Catalyst Insights Council survey, "RPM appears to be the least effective patient engagement initiative." Some doctors also feel that "a virtual appointment may not seem enough to diagnose or treat a patient." RPM may be extremely effective to diagnose minor conditions, but it may be harder to diagnose and treat more serious ones.
Insurance and Reimbursement RulesAlthough there have recently been advancements regarding RPM, healthcare laws and insurance policies may struggle to keep up-to-date with this fast-growing industry.  Telemedicine regulations are different from state-to-state.  They can be sometimes difficult to decipher. Recently, more legislation has been passed in favor of covering RPMs at the state level. 
ACCESSIBILITYRPM is not available to everyone due to limited broadband accessibility and smartphone/table/computer ownership. It is less available in rural areas or small healthcare institutions. The elderly population may have trouble operating a smart device.  The Tytocare solution carries a price tag of $999 for the TytoPro kit and $299 for the TytoHome version.  This does not include the monthly fee.  This may not be affordable to those whose insurance does not cover the device or monthly fees. 
RELIABLILITYMany patients and physicians question the reliability of RPM devices since they have error margins up to 25 percent.  Some RPM devices are not WiFi, forcing patients to submit data manually.  This is less accurate and increases the chances of errors. Manually tracking and sending data is less reliable and accurate than automatic data transfers through a connected device.  A recent study from JAMA Dermatology showed that smart apps for melanoma detection had a 30 percent failure rate. 
Regional DifferencesThe only significant difference noted in terms of geographical location was a potential limitation seen rural areas and areas with populations of lower-economical statuses. RPMs require strong broadband connections, which are not always available in rural areas. Cost factors may also place limitations on those living in lower-economical areas, thus they may not be able to afford devices and the proper internet connections.  

Western and southeastern states typically have lower connectivity rates, lower averages speeds, and lower broadband coverage.  Montana, Mississippi, Arkansas, and Wyoming score the lowest, when it comes to broadband coverage.  Northeastern states scored the highest, with New Jersey, Connecticut, Rhode Island, and New York having the best coverage.  A complete list of coverage can be viewed, at here. 