"Let's fix our terminology before we try to fix our patient care," was the essential message delivered by renowned Remote Patient monitoring leader Dr. Joseph Kvedar in a keynote address to the first Lincoln Healthcare Leadership Home Care Tech conference, earlier this month in National Harbor, Maryland.
Because of the pandemic, he explained, video visits between doctor and patient reached into the popular awareness, where previously they had been familiar primarily to healthcare practitioners, including Home Health and Home Care providers. The word "telehealth" began to be heard everywhere, from politicians to stand-up comedians.
At the same time, however, "Remote Patient Monitoring" is still an in-house concept among healthcare professionals, in this case, mostly Home Health and Home Care providers. Now is the time, Kvedar proclaimed, to separate these terms, and to define and use them properly.
"When you take a close look at the predicted shortfall of clinicians," he continued, "you have to recognize that healthcare does not have the option of continuing one-to-one care. (see figure 1) Acute and post-acute providers must start thinking in terms of one-to-many care, which means relying on Remote Patient Monitoring."
In order to accomplish this unavoidable, seismic shift in the way healthcare is delivered, legal and regulatory changes are required, he said. "Fortunately, there is some movement in both areas. The Omnibus bill, which was signed into law last March, lifts all restrictions on sites in the US where the patient is located. It extends telehealth to OT, PT, Speech Therapy, and Audiology. And it adds audio-only communications (telephone) to the telehealth definition."
Still, these are advancements in one-to-one care, he cautioned. He used his position as President of the American Telemedicine Association to lobby for RPM, and continues to leverage his name and reputation in the effort to convince lawmakers and regulators of the absolute necessity for one-to-many technologies. "It is time to reimagine healthcare," he tells them.
Kvedar described one of the programs he runs out of Boston's Partners Health System. "Connected Cardiac Care" is a program that monitors heart patients with devices in the home. Preliminary data, he said, shows the percentage of participating patients with one or more hospital admissions related to heart failure decreased from 39.8 percent one year prior to enrollment in the program to 13.3 percent one year following disenrollment from the program. All-cause hospitalizations were at 100 percent a year before enrolling in the program and dropped to 58.1 percent a year after disenrollment.
He identified a handful of tech companies enabling one-to-many care in the Digital Therapeutics space, as well as emerging companies with Artificial Intelligence systems. His examples of companies to watch included Pear Therapeutics, with remote care for substance abuse; Alkili Interactive, offering digital medicine for childhood ADHD treatment; and Happify, interactive games to treat stress and depression.
Kvedar is especially excited about the potential of Artificial Intelligence in RPM. He quoted research that found AI's advantage in diagnostics. "Humans working alone prove to be 96 percent accurate. AI alone is only 92 percent accurate. But when human efforts are supplement by AI, accuracy rises to 99.5 percent." He is equally optimistic about the future of AI in remote patient care because the first AI payment code has been approved. #92229 provides reimbursement for "Imaging of retina for detection or monitoring of disease; point-of-care automated analysis and report, unilateral or bilateral."
One example of AI-powered remote diagnostics and therapy was described in the Journal of the American Medical Association.1 The study of "The Deep Learning System" found it "had high sensitivity and specificity for identifying diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes."
He summarized his message with an appeal to Home Health and Home Care providers to join him in reimagining healthcare. "These emerging solutions are each a piece of a large puzzle," he said. "Remote monitoring, chatbots, social robots, computer vision, digital therapeutics, and a willingness to start with virtual contact whenever possible will all work together to create a healthcare environment that can thrive even though there will not be enough clinicians to continue our traditional one-to-one approach."
1 Ting et al, Development and Validation of a Deep Learning System for Diabetic Retinopathy, JAMA. 2017;318(22):2211-2223.
©2022 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org