Dr Ravinder Sachdev, Deputy Chief Medical Information Officer, Tan Tock Seng Hospital, discusses how remote monitoring devices can be successfully managed and improved.
With the accelerated adoption of telehealth due to COVID-19, remote patient monitoring (RPM) is also capturing the limelight. RPM is a subcategory of home-based telehealth allowing patients to use mobile devices to monitor physiological data such as vital signs, weight, blood pressure, glucose levels, and heart rate and send it for diagnosis to clinicians.
Tan Tock Seng Hospital (TTSH) in Singapore has used a number of RPM devices over the past decade, including RFID-based automated patient temperature tracking for inpatients, vital signs monitoring devices for blood pressure, pulse, oxygen saturation, blood sugar, and weight, and Bluetooth stethoscopes for remote auscultation.
These RPM technologies are definitely advantageous for both patients and healthcare providers, acknowledges Dr Ravinder Sachdev, Deputy Chief Medical Information Officer at TTSH. Yet, they come with a number of challenges that need to be overcome before being successfully integrated into the industry.
Regulations and data security
Always, the very first consideration with online diagnosis and monitoring are regulations. In Singapore, RPM devices are regulated the same way as the standard medical peripherals. Thus, they need to be approved by the Health Sciences Authority (HSA).
Also, regulations mandate that data ought to be encrypted and transmitted in such a way that all data stay in Singapore. Hence, if the RPM device uses a public cloud server like Amazon Web Services or Microsoft Azure, the server must also be located locally.
Ensuring data security doesn’t come cheap. It is expensive to use premium, local cloud servers and high levels of encryption, as well as to integrate with backend medical record systems. Still, ensuring confidentiality, data security, and healthcare interoperability must be a top priority in the adoption of RPM devices, and telehealth in general. Dr Sachdev suggests that these “can be built-up incrementally as long as a clear implementation plan is in place”.
With every novel technology comes a challenge on user acceptance, and RPM devices are no exception. Dr Sachdev reveals that both patients and clinicians may not find it easy to accept these new devices, especially if the methodology of data measurement and monitoring are unfamiliar.
Older patients, in particular, have struggled to come to terms with using the new RPM technologies. They could feel uncomfortable monitoring their own health without a doctor or a nurse by their side. More often than not, the older generation faces usability issues even when the hospital attempts to find ways to better engage them, like using touch-screen devices for easier use. However, as the adoption of smart devices increases within this population, RPM technologies are likely to gain traction.
Additionally, doctors may sometimes also be reluctant to embrace these innovations in healthcare. Dr Sachdev shares one instance when he tried to introduce a remote auscultation project. Many clinicians questioned whether the data transmission from the stethoscope was accurate enough for them to make a diagnosis, when, in fact, making a diagnosis was highly dependent on the physician’s skills and not on the device, which was simply a tool just like a standard stethoscope.
Dr Sachdev recognises that this aversion can be attributed to the fact that older devices, which have been through the rigorous process of validation and testing, are recognised as the ‘Gold Standards’ of clinical measurement and monitoring, while newer technologies may be perceived as “less” reliable. To address this, validation studies have been performed on a number of devices to generate local data that demonstrate reliability and accuracy of these novel technologies, but convincing clinicians takes time.
Connectivity and availability
Connectivity can also be a significant issue, as a lack of reliable internet access could limit data transmission. This could be bidirectional, meaning clinicians not being able to receive parameters from patients or doctors not being able to share more information with patients. This limitation, however, has improved over the years, given the increasing adoption of smart devices and infrastructure improvements.
On another note, the availability of RPM devices on certain markets could be a challenge. To illustrate, the Singaporean market is small as compared to the US, Europe, and even India, therefore, it usually takes a while for these devices to reach the island-state and receive approval from HSA.
Additionally, the cost associated with adopting these devices can limit their deployment amongst healthcare organisations as well as patients. In TTSH, various models have been explored, including encouraging patients to purchase their own devices or loaning devices on a subscription model. Dr Sachdev believes that as TTSH is constantly looking at ways to improve access to care, the increasing use of RPM devices will play a big role in this endeavour.
Since Singapore is a multi-racial state and people speak a variety of languages, the language configuration of these RPM devices can influence their rollout. TTSH has used devices that communicate in English and Mandarin, but patients who aren’t fluent in either of these two languages may feel left out. According to Dr Sachdev, the team has previously worked to include Malay and Tamil into some of the platforms but it has been a slow process. He believes that integrating other languages like Burmese, Tagalog, and Chinese dialects, could also increase patient and caregiver interest and acceptance.
Remote patient monitoring and diagnostic devices could very well be the next big thing in healthcare. In the next few years, as telehealth becomes the new norm, the industry could see more improved technologies that can help facilitate home- and community-based care. For now, though, there is much to learn and change about doctors’ and patients’ perceptions, devices’ attributes, cyber protection, and regulatory environments encompassing RPM.