Telemedicine and Remote Patient Monitoring Rely on Wireless

The Coronavirus pandemic spurred exponential growth in telemedicine. At Penn Medicine (the clinical and research arm of the University of Pennsylvania) in Philadelphia, for example, 9,000 health care providers were equipped to meet with patients by video or phone in March 2020. The organization began averaging 5,000 telemedicine visits per day. Meanwhile, Houston Methodist in the Texas Medical Center saw its average telemedicine visits grow from 44 per day before the pandemic to between 2,400 and 2,500 in mid-2020.

Technology to enhance telemedicine is emerging rapidly. TytoCare Ltd. (www.tytocare.com) offers the Tyto Device with an exam camera and thermometer, which also comes with an otoscope adapter for examining ears, a stethoscope adapter for heart and lung sounds and a tongue depressor for the throat, all of which interface with the TytoApp. Another company, binah.ai LTD (www.binah.ai), offers vital signs monitoring using a smartphone camera.

This shift to telemedicine from certain office visits will be permanent to some extent, as long as insurers continue to pay for it. One big question is what price insurers should pay. Should they pay the same rate for a brief telemedicine call as they would for office visits, or reduced rates? Consumers find telemedicine much more convenient than traveling to doctors’ offices and sitting through waiting room delays. Doctors often find that they can see more patients per hour. Of course, many types of procedures, tests and exams will still require in-person contact, but a very large portion of medical visits can be conducted simply and quickly via teleconferencing.

The healthcare products business of electronics giant Royal Philips Electronics offers an ICU (intensive care unit) remote monitoring system called eICU. Originally developed by Visicu, Inc., a Baltimore, Maryland medical information technology company that is now part of Phillips, eICU is a combination of software, video and audio feeds and real-time patient vital statistics that hooks patients in ICUs in multiple hospitals to central monitoring facilities manned by ICU specialists. A specialist at the central location mans a standing desk outfitted with a cutting-edge graphical dashboard called orb that displays patient data, including real-time video and audio for up to 150 ICU beds at a time. The system ranks patients according to their conditions and flags gravely ill patients in red so that their progress can be more easily monitored. Indications such as changes in blood pressure alert the specialist who then contacts the nurse or physician on duty to treat the patient accordingly. eICU is in use in hundreds of hospitals around the world.

Hospitals that have eICU have experienced significant cost savings since the system cuts the average ICU stay from 4.4 days to 3.6 by lowering the instances of complications such as pneumonia and infections (these conditions generally occur when patients are not closely monitored by ICU specialists). The Leapfrog Group estimates that 54,000 patients per year could be saved if every U.S. ICU were monitored by specialists.

Other remote monitoring systems are allowing patients to be monitored at home or at out-of-the-way care facilities. For example, American Telecare, Inc.’s CareTone Telephonic Stethoscope checks for heart, lung and bowel sounds using a small stethoscope, a phone line and two-way video stations. Cardiocom LLC’s Telescale is a telemonitoring device integrated with an electronic scale. The patient steps onto the scale and answers questions using a touch pad about his or her symptoms. The answers and the patient’s weight are communicated via two-way messaging to the consulting physician, who is alerted if there is any deterioration in the patient’s health. The system also sends alerts back to the patient for follow-up visits or care plan adjustments. Other remote monitoring systems track cardiac patients’ vital signs and links them via video chat to a nurse when necessary.

Many of the world’s leading technology companies see immense potential in remote home monitoring of elderly and chronically ill patients. One example is the “Health Buddy” from Bosch, which can utilize home monitors for weight, glucose, blood pressure and blood oxygen. Philips, Honeywell and Intel are also developing products. Intel’s design includes two-way video between the patient at home and caregivers.

Another slant on telemonitoring is the growing practice of patients connecting with physicians via laptop webcams, video-enabled tablets or smartphones. Rather than an expensive doctor visit, some patients are opting for virtual consultations at much lower costs than office or hospital visits. Insurers including WellPoint, Aetna and United Health are offering virtual visit options in several U.S. states that do not require a face-to-face meeting before a doctor can prescribe medication. A large number of companies have launched telehealth services, with many of them aimed at saving costs for employee health plans. LiveHealth, for example, is a videoconference platform offered by Anthem Blue Cross. HCA Healthcare, through a partnership with Teladoc, offers its clients remote consultations.

A major player in the wearable sensor arena is Apple’s smartwatch (the Apple Watch) which is essentially a wearable computer that is part watch, part iPhone, part iPod and much more. With regard to health care, users can download apps to the watch that track readings from external monitors such as those used to measure glucose. DexCom, Inc. offers just such an app to go with its glucose monitor that displays blood sugar data in a simple, easy to read graph. There are now apps and sensors that track other medical data, including electrocardiograms (EKGs), blood oxygen levels and respiratory rates. For example, AliveCor offers KardiaMobile, an FDA-approved clinical grade personal EKG monitor. Apple is cooperating with institutions such as UCLA in studies that might eventually enable its watch to greatly expand health monitoring into such areas as cognitive decline and mental health problems—possibly by identifying biomarkers (such as facial expressions or typing metrics) that can be tracked.

Between June 2018 and June 2019, 2,300 patients who were in recovery from cardiac events enrolled in a remote, eight-week rehab program from Kaiser Permanente. The patients wore smart watches to monitor exercise and medication. More than 87% of the patients successfully completed the eight-week program. Hospital readmission rates were fewer than 2% of the participants, an excellent outcome for the program.

Mobile health apps are extremely popular with consumers and are adding features and capabilities on a continual basis. Examples include MyFitnessPal, which was acquired by Under Armour, and Runkeeper. Apple released the HealthKit, ResearchKit and CareKit (in addition to its Health tracking and fitness app) that enable physicians search for health apps according to their medical specialty and leverage health resources. Stanford University found that 11,000 people signed up for a cardiovascular study using ResearchKit less than 24 hours after its release. The latest Apple Watch technology offers (or will soon offer) data relating to the wearer’s temperature, heart rate, ECG, irregular heart rhythm, sleep, handwashing duration time and menstrual cycles. By 2024, Apple Watch may also offer a blood pressure measurement tool.

In the Finnish city of Oulu, a telemonitoring system called Self Care has users who login to their computers to make appointments, refill prescriptions and exchange messages with doctors. People who test blood pressure or blood sugar levels at home can enter the results online for doctors to view. Lab results are posted within hours. Self Care costs the city $390,000 each year, but has saved millions in reducing expensive, face-to-face doctor’s visits.

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