1. How can we ensure that the vast streams of real-time biometric data from wearables translate into truly actionable clinical insights - rather than noise - for both patients and care teams?

Tara: Dashboards are essential when using passive monitoring for patients. To be useful to clinicians, the data must feed into a dashboard that alerts them when results fall outside safe parameters.

For individuals, whether patients or not, having access to detailed data—like blood glucose, step count, or heart rate—can be extremely helpful. It allows people to understand how their bodies respond and can be a strong motivator for tracking progress.

Laurence: There is a need for more advanced digital twin approaches in the future which can filter out the noise of messy wellness products which may/ may not have been validated or synced to clinical standards. In the near term, while clearly interesting data points, many clinicians have concerns over the potential medico-legal issues surrounding receiving these data inputs from consumer wellness devices. There is certainly a need for a trusted middleware layer here that is running translation on the variable inputs that may arise (we see this in outpatient/ chronic disease care increasingly, but often with limited scope specific to specialty). Equally, where the measurement and diagnostic tools generating the data can showcase robust clinical evidence equivalent to medical device standards, then there is very clearly a simpler path.

There is also very likely an education and empowerment exercise needed on the clinician side too to assist them in handling the enormous diversity of potential data inputs. (but ideally with tech support primarily handling the job of synthesising more usable outputs).

2. What organizational capabilities and leadership mindsets must healthcare systems build today to embed RPM and wearable technologies into their core operations, rather than treating them as pilot projects?

Breid: I think this requires a fundamental shift in few things: firstly a move away from the mindset that “inpatient bed capacity” always means physical beds in a hospital - technology-enabled hospital-level care at home now offers real alternatives to this traditional thinking. Secondly, we also need to align incentives better as current activity based payment models, or indeed even targeted “technology funds” that are separate to a broader change agenda, continue to support traditional models of care. Just recently, the CEO of the National Institute for Health and Care Excellence in England suggested new technology should be paid for via a similar model to medicines – for me, this is an example of some of the innovative thinking required to support the shift. Lastly, and perhaps most importantly, we need to move away from the traditional paternalistic model of care and enable our patients to be real partners in their own care, acknowledging they can be the real experts in managing their own health, with healthcare professionals acting as their guide and support. All of this needs to be supported by the knowledge that face-to-face care is easily accessible when it is needed.

3. In your work deploying digital care models, how have you tackled the challenge of maintaining patient engagement when the novelty of wearable devices begins to fade?

Tara: With the hospital at home or virtual ward model, that has been extended across the NHS in England and currently also Wales and Scotland, people are typically completing remote monitoring over a short timescale; a maximum of 10 or 14 days, so this doesn’t tend to be an issue.

With long term conditions the monitoring tends to be much less intense so instead of perhaps submitting readings three times a day if on an acute virtual ward, it would be weekly for a stable patient. With the schemes I have been involved in, we haven’t seen a drop in engagement, partly because patients have often been very heavy users of hospitals and have really bought into trying something that keeps them at home longer. 

The companies I work with do provide reminder calls, often automated, in the event of readings being late, so people quickly realise it is better to submit at the set slot. They also message the patient back to say that the clinician has reviewed their readings and this acknowledgement is appreciated with people feeding back that they find it reassuring. 

I am sure as light touch remote monitoring becomes more common place we will see innovators using the clever gamification techniques that products such as Duolingo use to encourage, nudge and reward people for engaging with the programme.

4. Lifelight’s contact-free approach is intriguing - what technical and regulatory hurdles did you have to overcome to validate its clinical accuracy in uncontrolled, real-world settings?

Laurence: While the science of rPPG has been relatively well established over the last decade or so, the methodology had never been successfully adapted into a medical-grade product. Building software that pushes the envelope of clinical practice while robustly retaining patient safety is a challenge; even more so when having to trailblaze a new category entirely of blood pressure measurement. Trial design through to building an effective regulatory process for what would ultimately become a precedent offers fundamental challenges.

5. From both a transformation-consulting and a digital-implementation standpoint, what are the top three change-management strategies that accelerate clinician adoption of RPM workflows?

Tara: A big question but I would say that 1) where clinicians have been given the time and space to really think about their service and how the tech could enable home based pathways, it really does work. 2) It helps build clinical confidence if they have an opportunity to see how others in their specialty have tried and got good results. 3) Finally, the patient feedback really helps keeps teams motivated.

Breid: For me this is all about adding value rather than burden. Clinicians want to deliver high quality care, that’s why they do what they do! To support this I think we need to (1) co-design technology-enabled delivery models with the people who will utilise them, that is clinicians and patients, as it has to work for both as this is all about partnerships. (2) Ensure the technology is easy to use, and is interoperable, so it enables them to work efficiently rather than adds burden, which is what we sometimes see through poorly designed systems and (3) Align the implementation of any of these systems to the existing change management/improvement methodologies within their organisation, to encourage a “test and iterate” approach supported by data to understand what does and doesn’t work.

6. As AI becomes more entrenched in remote monitoring platforms, where do you see the sweet spot between algorithm-driven triage and the clinician’s final judgment?

Laurence: AI has the potential to reintroduce empathy at scale to the medical profession by releasing time for clinicians to focus on the human elements of care at the core of the profession. Automations can support in the generation of more scalable personalisations to meet emergent demographic healthcare crises, and enable patients to access reliable personalised insights that can be onwardly confirmed by clinicians. AI has the potential to reverse the recent trend of healthcare innovations’ negative correlation to GDP growth in the 21st Century thus far, supporting with the construction of more proactive and preventative models of healthcare.

7.  What design principles have you found most effective in making RPM solutions inclusive for elderly or digitally-underserved populations?

Tara: Starting with digitally-underserved populations the best way is to provide the technology needed and pay for the data as well. One of the programmes I most enjoyed working on last year had the highest take up from the most deprived deciles - 40% of patients were from the three lowest deciles - with the largest cohort 19% from the most deprived cohort.

There is a persistent myth that older people don’t want to use technology and we haven’t found that to be the case in the tech enabled hospital at home rollout. Most patients - around 75% of those on virtual wards - are over 65. There is also strong appetite from older people for home rather than hospital based care. In a large Health Foundation study older people were more enthusiastic than their younger counterparts in response to the question would you rather use technology than be admitted to hospital. 78% people of all ages agreed with this statement, among the over 65s it was 85%.

However, there are things that tech companies can do - keep design and interfaces simple and add no unnecessary bells and whistles. If people have sight or dexterity issues - and this can apply at any age - it may be that Bluetooth devices or passive monitoring may suit better as the results load up automatically. Some of the feedback received on high quality products that have done proper user testing is along the lines of - I am a technophobe but I was pleasantly surprised. If you can use a mobile phone you can use this.

8. Data privacy and security are non-negotiable. How should solution-builders and regulatory bodies collaborate to create frameworks that both protect patient data and foster rapid innovation?

Laurence: Privacy preserving features in health technology are of course a non-negotiable. It pays to invest upfront and pay forward the commitment to this as early as possible. We have seen how quickly markets and requirements can shift as new technologies become more established (e.g. AI scribing requirements). Nonetheless, shooting for the highest standards in medical device/ data protection regulation offers more of a hedge for new tech where there could be uncertainties. We have found dialogue with regulators to be essential and fundamentally supportive in terms of unearthing required proof points. This needs to continue with as much transparency as possible to enable innovators to plan well ahead given the significant time and expense of attaining full compliance.

Breid: That is a very timely question and I agree it’s absolutely non-negotiable. We’ve just had some new legislation passed on this in the UK (June 19th) through the Data Use and Access bill and people are now working through what this means for healthcare. For me, I think it’s all about transparency at every stage of the process. We have examples of where we have got this wrong in the past - so meaningful discussions to include citizens/patients, not just with solution-builders and regulatory bodies, are essential. I agree collaboration is key and for the UK, this new legislation now provides this opportunity to work together to ensure compliance from all parties. There is a real tension between rapid innovation and the time it takes to satisfy the data protection requirements, so we also need to consider whether there are better approaches which do not compromise privacy and security.

9. How do you measure long-term ROI - both clinical and economic - when scaling RPM deployments across diverse patient cohorts?

Tara: With tech enabled hospital at home a range of studies have found outcomes to be at least as good as hospital based care. In the UK, the financials of it tend to find that this model of care is around half to one third of the cost of care in a hospital bed, depending on how much care is delivered in person in the home.

Where RM is offered to those with severe and progressive long term conditions where the usual trajectory is many hospital admissions, the ROI can be even more marked.

It is also interesting to see, from countries that started this journey some time ago, such as France that begin providing RM for Heart Failure at some sites back in 2007 that they now have evidence that survival rates are better in the RM group; perhaps the ultimate outcome measure.

10. Which emerging sensor technologies or modalities are you most excited about for the next wave of wearable-based diagnostics?

Laurence: To a degree we haven’t even unlocked the entire potential of the devices we already carry with us, which forms a part of the health equity mission I subscribe to. That being said I’m excited to see what electrochemical/ electrophysiological sensors might do when combined with other diagnostic modalities to potentially support in the identification of new clinical phenotypes through more ambient monitoring paired to classical episodic measures.

11. In your transformation projects, what key performance indicators (KPIs) have best demonstrated the shift from reactive to proactive, value-based care enabled by RPM?

Breid: This is an interesting question and something researchers and evaluators are working on. There is emerging evidence of the impact of this shift on reduced activity in comparison with traditional models of care – such as inpatient bed days used, reduction in Ambulance use, reduced Emergency Department attendances. What is of course more interesting, is whether we see better longer term outcomes from patients who use RPM in the management of their long term conditions, and avoidance of complications. Diabetes care is a great example here, and there is already lots of evidence of the impact.  In the early stages of this work, one programme that inspired me was a study of 1,000 patients on long term warfarin who were enabled to remotely monitor their bloods rather than attend traditional phlebotomy clinics. Medication adjustment was also managed virtually. This cohort of patients’ blood results were much better maintained within the therapeutic levels required than for those patients using the traditional model of care. Given the impact that failing to control INR levels has on longer term health complications, this really demonstrates the longer term benefits to healthcare so I expect we will see more of this in time. It also demonstrates how we value the time of our patients - a finger prick blood test at home is much less time consuming than a trip to a phlebotomy service taking say two hours, which will also have wider economic benefits because people don’t have to take time out of work.

12. Looking ahead to the next decade, what one bold prediction would you make about how wearable-driven RPM will redefine patient pathways - and what should stakeholders be doing now to prepare?

Tara: I think in the next decade, our hospitals, primary and community care services will change significantly. Crises will be far rarer as we have monitoring information on those at most risk, enabling us to intervene before the major deterioration takes hold. We will be far less dependent on hospitals. There will be an array of cheap, at home tests in the average first aid box. People with long term conditions will be provided with a companion app on diagnosis and those with severe disease be given remote monitoring support, including coaching. AI will be helping clinician time go further as well as supporting lifestyle shifts that keep people active, well and connected to their communities.

Laurence: RPM-related tools are already making the transition into the consumer space, but this will also evolve/ shape the front-end of healthcare into a more proactive and preventative domain. A person’s phone suddenly becomes a mobile command centre for any care they require, with a focus on the optimisation of attaining a health state versus today’s outmoded medical disease avoidance models. Significant reductions in the cost, improved accessibility of these tools and wider regulatory engagement/ more advanced clinical data packages for the technologies will mean they become much more established in home settings.

Stakeholders need to be thinking about how to get on the front foot and work with underrepresented populations earlier with a view to mitigating local disease burden (and govts/ payors need to interrogate how their own reimbursement models shift to meet the groundswell).

Breid: I agree with Tara and Laurence but would add one thing, I think we will have shifted mindset from a traditional paternalistic model of care to one where there are more genuine partnerships between clinicians and their patients, sharing responsibility in a more meaningful way for a health orientated approach rather than an illness orientated approach.

On behalf of AsianHHM Magazine, I extend my sincere thanks to Tara Donnelly, Laurence Pearce, and Breid O'Brien for sharing their expertise and insights with us. Your perspectives have been truly valuable in understanding how remote patient monitoring and wearable technologies can drive meaningful, scalable change in healthcare delivery across Asia and beyond.

Thank you!

--Issue 69--