Emerging research estimates suggest that approximately 30 million people in the United States will be using remote patient monitoring (RPM) devices by the year 2024, which would represent over a 28 percent increase from the 23 million Americans who utilized RPM devices in 2020.1 A recent survey, independently commissioned by a market research firm, found that four out of five adults are in favor of RPM.2
Adam Isaac, DPM, FACFAS, is not surprised by the projections and the increasing comfort level with RPM applications, noting symmetry with the continued rise and convenience of mobile apps.
“More than ever, patients have come to expect a certain degree of technology to be applied to their medical care, and that certainly includes RPM,” maintains Dr. Isaac, the Director of Research for Foot and Ankle Specialists of the Mid-Atlantic. “From the perspective of patients, if they can unlock the front door, turn on the air conditioning, respond to a delivery person, etc. all from a smartphone, then why shouldn’t their medical care be more ‘mobile’ and adaptive to their particular needs?”
According to the survey from MSI International, respondents noted that benefits of RPM included greater convenience, more control over personal health, improved accuracy, and peace of mind.2 Dr. Isaac also recalls a high level of enthusiasm for RPM from patients during a recent multicenter study, which assessed the use of a smart mat for remote foot temperature monitoring in patients with recently healed diabetic foot ulcers (DFUs).3
“So many of these folks, who suffered from peripheral neuropathy and a history of prior ulcer or amputation, were engaged, excited and educated about the technology, and were eager to find ways to prevent further complications,” notes Dr. Isaac, who was the primary investigator for the study. “By standing on the smart mat for a very short period of time every day, the patients found comfort in knowing that someone was looking out for them, and would intervene if a problem developed, even if the patients themselves could not detect an impending complication.”
The heightened enthusiasm for RPM doesn’t appear to have an age limit. While the MSI International survey skewed a bit younger with a median age of 40 among the 300 respondents, Dr. Isaac says the average age of patients in the aforementioned study was 60.5. 2,3 While resistance to technological adaptation may have been a traditional concern with integrating technology into care paradigms of a generally older cohort of patients with diabetic foot disease, Ryan Crews, PhD, says “older” patients with diabetic foot disease in 2021 are different from those of 20 or 30 years ago.
“Within the context of research studies, I have found participants to be highly receptive to the use of technology for both interventions and outcome assessments,” notes Dr. Crews, an Associate Professor at the Rosalind Franklin University of Medicine and Science.
While Dr. Crews acknowledges that the recent surge of interest in RPM likely occurred out of necessity due to the COVID-19 pandemic, he believes use of the technology will continue to grow and provide preventative benefits for high-risk patients with diabetes.
“I do believe the upward trajectory will continue in a post-COVID pandemic world,” maintains Dr. Crews. “I’m particularly excited by the potential for remote patient monitoring to be used for diabetic foot ulceration prevention by monitoring for pre-ulcerative warning signs (such as pre-ulcerative hotspots on the feet) and helping patients improve their adherence with preventative measures, such as the use of prescribed offloading diabetic footwear. This is exceptionally good news in light of the traditional skewing of resources toward treating active DFUs as opposed to preventing them in the first place.”
For high-risk patients without DFUs, Bijan Najafi, PhD, MSc, says RPM shows great promise in identifying areas of impending injury/tissue loss, the presence or absence of infection, and in other areas of cardiometabolic care. He also points out that RPM, through the use of temperature sensing devices, meets the Centers for Medicare and Medicaid Services (CMS) guidelines for a physiologic measure, and has “robust data as an early warning system for DFU in high-risk patients.”4.5
“Remote temperature monitoring has already proven to be effective at reducing health-care resource utilization and decreasing complications such as ulcer recurrence and amputation,” concurs Dr. Isaac.3 “The challenge is translating the data and successful outcomes for prospective patients, payors and health systems.”
In terms of other challenges with RPM, there needs to be ongoing education of patients and caregivers on the effective use of RPM to facilitate broader implementation, according to Dr. Najafi, a Professor and Director of Clinical Research in the Division of Vascular Surgery and Endovascular Therapy within the Department of Surgery at the Baylor College of Medicine.
Dr. Crews says a potential hurdle to overcome with RPM is defining who should have access to remote monitoring data and for what purposes. In addition to potential cybersecurity issues with streaming data, Dr. Najafi points out that high-speed Internet may be elusive for many patients.
“Thus, RPM systems should have an embedded cellular connection. Otherwise, the applications would be limited,” notes Dr. Najafi.
That said, Dr. Najafi believes RPM could be impactful in supporting remote care delivery, empowering patients to be more engaged in the health-care ecosystem and triaging high-risk patients for timely intervention and personalized scheduling of visits in clinics or hospitals.6,7 Noting an array of RPM innovations in recent years, ranging from smart socks to smart insoles and a smart mat to smart offloading and smart thermography imaging systems, Dr. Najafi says these modalities may go a long way to preventing limb-threatening complications.
“These technologies can enable monitoring of risk factors and have potential to scale up and transform the future of diabetic foot syndrome management,” notes Dr. Najafi, the Director of the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP).
References
1. Dolan S. The technology, devices, and benefits of remote patient monitoring in the healthcare industry. Available at: https://www.businessinsider.com/remote-patient-monitoring-industry-explained . Published March 10, 2021. Accessed July 23, 2021.
2. MSI International. Americans’ perceptions of remote monitoring in health. Available at: https://www.msimsi.com/msi-remote-monitoring-study-pr/ . Published June 8, 2021. Accessed July 21, 2021.
3. Isaac AL, Swartz TD, Miller ML, et al. Lower resource utilization for patients with healed diabetic foot ulcers during participation in a prevention program with foot temperature monitoring. BMJ Open Diabetes Res Care. 2020;8(1): e001440. doi: 10.1136/bmjdrc-2020-001440.
4. Centers for Medicare and Medicaid Services (CMS). Final policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for calendar year 2021. Available at: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1. Published December 1, 2020. Accessed July 26, 2021.
5. Lavery LA, Petersen BJ, Linders DR, Bloom JD, Rothenberg GM, Armstrong DG. Unilateral remote temperature monitoring to predict future ulceration for the diabetic foot in remission. BMJ Open Diabetes Res Care. 2019; Aug 6;7(1):e000696. doi: 10.1136/bmjdrc-2019-000696. eCollection 2019.
6. Najafi B, Mishra R. Harnessing digital health technologies to remotely manage diabetic foot syndrome: a narrative review. Medicina (Kaunas). 2021;57(4):377.
7. Najafi B. Post the pandemic: how will COVID-19 transform diabetic foot disease management? J Diabetes Sci Technol. 2020;14(4):764-766.