The use of remote monitoring technologies – innovations that allow symptoms to be managed and care to be provided at distance, outside of traditional hospital settings – has surged during the past year.
Healthcare providers are increasingly opting for digital ways of working, to protect those at higher risk and enable patients to be supported from home.
Every so often, a game changer comes along. Is the enthusiastic adoption of remote patient monitoring, also known as RMON or RPM, one of those? We decided to find out.
In this feature, we spoke to healthcare teams and suppliers from across the industry and received a number of case studies, which include using symptom trackers, monitoring devices, portals or patient dashboards, and remote consultations. We hear from the South East to the North East and beyond – highlighting their successes and learnings.
Who does remote monitoring benefit?
The potential benefits of remote monitoring are vast, with healthcare professionals and suppliers breaking new ground. But just for starters, these new technologies are currently being used:
- at home for people with long-term conditions
- for those living in care homes
- at home for people with COVID-19.
Dr Shanil Mantri, GP and Clinical Digital Advisor to West of England AHSN, recently said: “With the current challenges of the COVID-19 pandemic, the ability to manage people remotely in care homes has become an essential tool in preventing any potential spread of infection.
“Remote monitoring technologies have the potential to give clinicians – including GPs, community staff and hospital consultants – an up-to-date, more complete picture of a resident’s health status, allowing better management and early detection of acute illness. Use of these technologies can also promote more efficient proactive healthcare by directing health resources to the right individuals.”
Potential for patient empowerment
A common theme that’s cropped up during our research for this feature is that patients also understand the benefits of remote monitoring tools. Therefore, the concept of patient empowerment is an understandable angle being pursued by the NHS.
NHSX, which sets policy and best practice in the fields of tech, digital and data, has provided funding and practical support to regional teams across England. The aim is to speed up the adoption of tech-enabled remote monitoring and digital tools, which will enable new pathways of care to support patients at home. This says Tara Donnelly, Chief Digital Officer at NHSX, can allow them to be “partners in the management of their health condition[s].”
Tara added: “During the pandemic we’ve seen a rapid shift to remote consultations, but digitally supported care pathways go much further than this. These digital tools can be truly transformative in the care of those with long-term conditions. Enabling people to better understand and effectively self-manage their health condition and share this information with their clinical team in a timely way. Supporting the team to provide swift, timely interventions to help keep them well for as long as possible.”
An overview of remote monitoring projects
Here are, in brief, some – but by no means all of – the remote monitoring projects to keep an eye on in England, region by region.
North East and Yorkshire: A scheme which supports patients to monitor their warfarin dose from home and share the results digitally with clinicians, is set to help 1,000 patients over the next six months. Other schemes include using remote monitoring in care homes and for patients with hypertension.
North West: The region is looking to expand its Health Technology (or Telehealth) service. This was introduced to help people with long term conditions monitor their own health, with the support of health professionals.
London: Optimising triage and allocating appointments to those with the greatest need and demonstrating how remotely recorded vital signs help in identifying deteriorating patients.
South East: Expanding support for patients diagnosed with COVID-19 who do not need to be cared for in hospital, through remote monitoring at home in a ‘virtual ward’. The project is set to expand from covering a population of 450,000 to a population of 1.1m by March 2021.
South West: Plans to expand the use of clinical communication tools and increase the take-up of remote monitoring in care homes and in the care of people with learning disabilities.
Case studies – successes, challenges and solutions
We could talk about the potential of remote monitoring all day. It’s a fascinating subject and the opportunities seem almost endless. But what about real-world examples and impact on every day lives? We’ve compiled a few case studies below, provided by healthcare teams across England, to illustrate the types of technologies already being used…
Heart and lung disease patients at Norfolk Community Health and Care Trust
Norfolk Community Health and Care Trust introduced a new remote-monitoring service for patients living with heart and lung disease. The focus of the service is for patients to self-manage their health by providing a monitoring device which displays readings for weight, blood pressure, oxygen saturation and pulse. Patients receive an automated phone call at 11am each day to provide the aforementioned readings.
The service also provides fast access to a heart failure nurse and consultant. And it has reported a reduction in A&E admissions and bed days among a group of ‘high-dependency’ patients.
One such patient, aged 83, stated that the service, “provides great peace of mind”.
Care home residents in South Tyneside and Sunderland
Prior to the pandemic, South Tyneside and Sunderland were already adopting digital technology to improve the monitoring of care home residents to identify early signs of deterioration and communicate observations across organisations.
The Trust states that ‘the local deployment of remote monitoring technology has been integrated within clinical practice. In particular, it has been aligned with tools such as the National Early Warning Signs score to detect and respond to clinical deterioration and “Is my resident unwell?”, a checklist which helps care home staff to pass on concerns to other healthcare professionals.’
RPM technology has allowed care home staff to measure vital signs, take photos, and record assessments which can then be shared between clinicians.
The Trust focused on avoiding face-to-face contact with residents as much as possible during the pandemic with RPM being crucial in this. A three-week period at the start of the pandemic saw training being rolled out for staff in a dozen care homes on the use of RPM equipment.
The changes to South Tyneside and Sunderland’s approach to the care of residents through the use of RPM will stay in place post-pandemic and has shown ‘the potential to help avoid non-elective admissions, lower A&E attendance, and improve patient outcomes and satisfaction.’ The Trust has also stated that the pandemic has ‘prompted the exploration of additional features with the existing technology’ such as the sharing of images and virtual contact.
INR digital monitoring in Darlington and Durham
The remote testing of the INR (international normalised ratio) service was set up at Durham and Darlington NHS Foundation Trust in 2014 and has supported over 2,500 patients taking warfarin and other anticoagulants.
The digital solutions enable INR levels to be remotely monitored. This involves reducing the requirement to attend a GP practice or hospital in person for face-to-face appointments; decreasing the risk of infections but also providing patients with the assurances that their health care professionals are monitoring their health and providing the correct treatment.
Take-aways from the testing included:
- In an audit of 77 patients by Durham and Darlington, 100% of those on the home INR self-testing service said they’d recommend the service to others.
- Patients who monitor their own blood levels in this way have better levels of control and spend much longer in the therapeutic range, significantly reducing their chance of a stroke.
- 70% of patients in the service experienced sustainable clinically significant improvements in their INR management.
COVID Oximetry in the South East
NHS England and NHS Improvement has supplied pulse oximeters to local clinical commissioning groups (CCGs) free of charge, where there is an urgent local need such as increased infection rate of COVID-19.
During the first peak of COVID-19, it was common for patients to present extremely late with silent hypoxia. The new service aims to detect earlier a dangerous drop in oxygen levels and help to provide a faster intervention.
Hampshire Hospitals, with a population of around 600,000 people, wanted to embed a remote monitoring service that would empower patients to recognise COVID-19 symptoms and when to call for help. It implemented remote oximetry in community care based upon the ‘virtual ward’ concept where patients are:
- triaged and have either a face-to-face or virtual assessment
- classified based on oxygen levels, NEWS2 scores, symptoms and age/comorbidities as Red (high risk), Amber (medium risk) and Green (low risk).
Patients with different levels in severity of symptoms were considered for different levels of care and, if accepted to the ‘virtual ward’, used pulse oximetry monitoring three times a day to enable the clinical team to track their vital signs.
Matt Inada-Kim, Consultant Acute Physician at Hampshire Hospital, said: “We are learning more and more about COVID-19 from our patients as time goes on. It is vital that we turn this learning into pathway redesign across all care settings to optimise outcomes.”
Challenges included ensuring people’s voices were ‘heard’ when discussing treatment, supporting patients with language barriers and arranging a staffed single phone point of access for patients who deteriorated.
Results collected by Hampshire Hospitals and the Isle of White support the emerging evidence base that shows oxygen saturation can be a predictor of mortality and deterioration. They also found:
- Reduction of suspected COVID-19 Emergency Department (ED) mortality rates
- >35% reduction ED attendances
- >20% reduction hospital admission from care homes
- Reduction ED attendances from assessment centres.
Feedback was that patients particularly liked being able to speak to the same person each time, enabling relationships to be built. While learnings included the need to form a specific team to lead with strong clinical leadership, develop a standardised template for data entry and capture, not to ignore COVID-19 negative patients, to be prepared to give strong nursing support and also to ascertain patients’ day zero.
Supporting vulnerable residents in the South West
In the South West region, there are plans for entire health and care system to make best use of available technologies to support vulnerable residents during the winter months. This includes residents in care homes, those who live with frailty, and people with learning disabilities.
Some of the main strands are:
- Improving remote monitoring of residents – helping care homes to communicate and share information about patients more easily with other care providers, such as GPs, hospitals and pharmacists.
- ‘Virtual ward’ approaches with care homes, using video consultation, pulse oximetry, blood pressure, temperature and RESTORE2 technologies and tools.
Also in the South West, in Dorset 4,000 Pulse Oximeter devices have been made available for patients, who are asked to monitor themselves through a finger reading three times a day. The readings are sent by SMS or directly over the phone with the Dorset Healthcare team.
These are services run out of primary, community or hospital settings, where people with COVID-19 are given a device to measure their blood oxygen levels (a pulse oximeter) teamed with an app on their smartphone. This enables them to track their symptoms and share their results with the clinical team.
The first sites using these models found patients ‘hugely appreciated’ seeing their results had been reviewed. They also reportedly found it reassuring that if they wanted to contact a clinician, they could do so easily via a video or phone call within the app. Clinicians found the dashboards helpful in giving them ongoing information about progress and rapid information on any deterioration, so they could focus on those patients that most needed their input.
Simon Longman, Dorset Integrated Care System and Dorset CCG, said: “Remote monitoring can help reduce admissions to local emergency departments, means patients can be discharged faster, and people’s medicine needs are reduced, but also immediately accessible where required. These are great outcomes for patients as they don’t need to be in hospital and can stay in their own homes, which we know is better for recovery. It also means fewer GP appointments are needed, freeing up valuable doctor time for other patients and means fewer trips for often vulnerable patients who live with frailty.”
Plans to provide improved remote and digital support for people with learning disabilities, aims to reduce health inequalities, will include helping people manage their long-term conditions and track potential COVID-19 symptoms and using tools to increase the uptake of annual health checks.
Care home residents in Coventry get first 5G remote diagnosis and monitoring trial
Vulnerable care home residents in Coventry have become the first in the UK to receive contact-free treatment from GPs using 5G technology.
The healthcare trial was developed in partnership with West Midlands 5G (WM5G) and Tekihealth – a small telemedicine company – and has enabled GPs to provide treatment during the pandemic without the need to visit care homes, through the 5G connected diagnostics tool.
Teki-Hub provides high resolution photography, video, thermometer readings and otoscope readings (a medical device used to look into the ear) as well as, portable ECG and spirometry. This makes it possible for patients to receive a full examination as their GP receives the patient’s clinical information in real-time from the device operated by staff at the five local care homes.
Mayor of the West Midlands, Andy Street, said of the trial: “Giving staff and GPs the technology necessary to safeguard patients while being able to perform thorough examinations is an important first step to deliver on our commitment to improving healthcare across the region.”
What else is out there?
The scope of services, companies and suppliers working in remote monitoring is huge and can seem overwhelming at times. With this in mind, we’ve also compiled a – far from exhaustive – list of interesting projects and innovations below. If you’re interested in finding out a bit more about what’s out there, it’s a good place to start…
Internet of Things dementia study is ‘UK first’
An Internet of Things (IoT) study, led by Surrey and Borders Partnership NHS Foundation Trust partnering with the University of Surrey, the Alzheimer’s Society, and Howz, analysed the effectiveness of Technology Health Management (TIHM) for dementia.
The IoT allows technology in the home to be interconnected whilst simultaneously being connected to the internet. The study is part of the NHS England Test Beds programme, which brings NHS organisations and industry together to test combinations of digital technologies. It is the first of its kind in the UK.
TIHM utilises the connectivity between devices installed in the home, such as monitors and sensors, as well as GPS trackers that monitor an individual’s movements outside of the home, to alert a Clinical Monitoring Team when a patient with dementia requires assistance. Data analytical techniques are used through machine learning algorithms to detect when a patient may be in distress.
The programme aims to identify health problems early, in order for patients with dementia to receive prompt treatment in their homes, thus reducing pressure on carers.
Sensors within the home monitored movement and environmental data such as temperature and light, and monitors recorded vital signs such as blood pressure, body temperature, pulse, oxygen saturation, weight and hydration.
Data streamed by these devices was integrated and analysed using data analytics and machine learning in a back-end system developed and designed by technical experts at the University of Surrey.
The early findings from the study are that ‘participants with the technology placed in their homes experienced a statistically significant reduction in neuropsychiatric symptoms associated with dementia, such as depression, agitation, anxiety and irritability.’
Digital Care Home service
More than one hundred care homes are using the Digital Care Home service to refer patients’ details to clinical teams using a secure portal, such as a website or app. Using the SBAR (situation, background, assessment and recommendation) Tool, staff are able to provide clinical observations such as blood pressure, oxygen saturation and temperature, whilst also providing details of their concerns. The system calculates the National Early Warning Score 2 (NEWS2) based on the information provided.
This information can be pulled through to the patient’s electronic record on widely used systems such as EMIS and SystmOne, making it available to all appropriate clinical staff.
A number of services can be added to the Digital Care Home Solution, including videoconferencing, undernutrition, wound management.
Digital blood pressure monitoring (hypertension)
The home monitoring hypertension service enables patients to record and relay readings to a clinician remotely, without the need for regular appointments. If readings fall outside of NICE guidelines, an alert is automatically generated which notifies the clinician for the need to follow up with the patient. Patients can choose to use SMS text messaging, an automated telephone call, an online portal or an app to submit their readings, meaning the service is widely accessible to suit patients of all technical abilities.
The hypertension service calculates the seven-day average blood pressure reading, negating the need to do this manually. All information can then be pulled directly through to the patient’s medical record, reducing staff time and duplication of work.
Catherine McShane, Project Manager, County Darlington and Durham Foundation Trust, says: “The hypertension service was built jointly with GP’s to support the management of patients diagnosed with hypertension. It will help patients to manage their hypertension, improve the self-recording of blood pressures and reduce the duplication of work of manually entering BP’s into clinical records and having to calculate the seven-day average.”
The service can help with earlier identification of significant changes in blood pressure, resulting in quicker treatment and better outcomes, as well as improving the efficiency of producing documentation, preventing duplication of work and reducing “white coat syndrome”, where patients exhibit a blood pressure level above the normal range, in a clinical setting.
Huma symptom logging
With Huma, patients use their phones to log symptoms like heart rate, blood pressure, gait analysis and BMI assessment through photos, temperature, questionnaires etc. Clinicians will, in turn, see a dashboard and spot changes to see who needs to be prioritised.
The company is building up a library of ways that can use simple measurements, such as putting your phone on your chest to measure breathing rate, to track people’s health.
Examples of Huma remote monitoring initiatives include:
- Virtual COVID-19 wards for 10 NHS sites
- Similar work for patients awaiting cardiac surgery, and knee and hip replacements to help deal with the waiting lists and ensure that people aren’t being overlooked if they start deteriorating fast.
- Projects for people managing long-term conditions, such as diabetes, so that they can keep being monitored with minimal impact on their lives, reducing the need to have regular hospital visits and allowing clinicians to spot issues earlier.
- A test with Stanford [university] and Bayer to run clinical trials virtually.
Freebis mobile platform
Feebris enables non-medics to conduct health check-ups and clinical teams to conduct remote reviews in care homes. The platform includes a mobile application, which guides the user through capturing soft signs, measurements with medical sensors as well as measurements with more specialist respiratory sensors such as a digital stethoscope.
The platform also includes a doctor portal which GPs access to find a risk-stratified list of their patients and a standardised clinical picture of each patient, saving them time in acquiring the information and improving the specificity of clinical decision-making.
Within a few months of deployment, the project saw care homes transition from no formal process for gathering of health information to conducting virtual weekly ward rounds, supported by clinical measurements.
To find out more about how the NHS plans to use remote modelling, visit nhsx.nhs.uk for more stories.