Digital Home Care Progress
Technology in healthcare took a major leap during the Covid-19 global pandemic, particularly tech that enabled care to be delivered at home. This article explores some of the benefits, opportunities and challenges of scaling this new model of care, for health systems and for citizens.
Technology used in Digital Home Care
Remote Patient Monitoring (RPM) or home monitoring, is a healthcare delivery method that uses technology to monitor patients outside of traditional clinical settings, such as in their own homes, or a care home. It involves the use of digital devices to collect medical and health-related data from patients and electronically transmit this information to healthcare providers for assessment, recommendations, and treatment. It has been around for many years, with different levels of uptake across the world, and the main focus to date has been on the management of long term health conditions, also known as chronic disease.
Remote Patient Monitoring
Typically RPM includes three main components; data collection and transmission and real-time monitoring. In terms of data collection, RPM uses devices like blood pressure monitors, glucose metres, pulse oximeters, digital thermometers, heart rate monitors, and wearable activity trackers. These devices collect patient health data in real-time. Data transmission refers to the collected data being sent to healthcare providers through secure, cloud-based platforms or mobile applications, allowing for continuous tracking and monitoring. This results in real-time monitoring and alerts: Healthcare providers can monitor patients’ vital signs and health status in real time. If the data indicates that the patient’s condition is deteriorating, healthcare professionals can intervene quickly, often preventing complications or hospitalisation.
Examples of Remote Patient Monitoring Devices:
● Blood pressure cuff - for monitoring hypertension.
● Glucometers - for tracking blood glucose levels in patients with diabetes.
● Home or Wearable ECG monitor: for heart rate and rhythm monitoring.
● Smartwatches - with health features like heart rate monitoring, sleep tracking, and activity level tracking.
● Pulse oximeters - for measuring oxygen saturation in patients with respiratory conditions.
Benefits of Remote Patient Monitoring:
The benefits of this model are many, including substantially greater freedom for the patient. The main benefits are improved access to care, enhanced patient engagement, reduced hospital admissions, cost and time savings and some evidence of enhanced outcomes.
In terms of access improvements, RPM provides continuous access to healthcare for patients, which can be particularly valuable for those living in rural, remote or underserved areas.
Patients are able to take a more active role in their healthcare when they see real-time data about their health status. RPM encourages patient engagement by giving individuals insight into their own health data, and the real time nature means that they have access to what makes a difference to their readings. Patients can therefore make better-informed decisions about their health and feel more involved in their care.
By catching potential problems early, enabling earlier intervention, RPM reduces the need for hospital admissions and Emergency Department visits. This lowers healthcare costs by reducing the need for frequent in-person visits and saving time for both patients and providers. By detecting problems early, RPM can reduce emergency room visits and hospital admissions.
In terms of health outcomes, RPM appears to be particularly beneficial for managing chronic diseases such as diabetes, hypertension, heart disease, and COPD. It allows for continuous monitoring and early detection of potential health issues, enabling them to resolved and the patient to stay at home, well for longer. As the challenges are identical to those for Virtual Wards they are considered below.
In summary, Remote Patient Monitoring is a transformative tool in modern healthcare that enhances patient care, especially for managing chronic conditions, while improving efficiency and reducing costs. However, it does require thoughtful implementation, to achieve the desired impact, and to reach scale.
Virtual Wards
Virtual Wards, also known as Hospital-at-Home, use RPM as the central technology, and build on the benefits achieved by using them for patients with acute healthcare needs.
Virtual wards are an innovative healthcare model designed to provide hospital-level care to patients in their homes. This approach leverages technology, remote monitoring, and coordinated care teams to manage patients with acute or chronic conditions who would traditionally require hospitalisation. Virtual wards aim to deliver the same quality and level of care found in a hospital setting while allowing patients to remain in the comfort of their homes, improving patient experience, reducing hospital admissions, and alleviating pressure on healthcare systems.
During the Covid-19 Pandemic, many countries introduced a Virtual Ward model for Covid patients, typically using a simple, low-cost pulse oximeter, and an app on the patient’s own phone. In several areas, the potential of this model to transform other healthcare pathways has been seized, with a number of countries introducing schemes across their health systems.
Key Features of Virtual Wards:
Hospital-Grade Care at Home: Patients receive care that mirrors the hospital experience, including regular cheque-ins from healthcare professionals, medication management, diagnostics, and interventions, all coordinated remotely. Their results are reviewed regularly by the clinical team and interventions arranged as necessary. These could be video or phone calls, requests to repeat a measurement, advice or escalation.
Remote Monitoring: As with RPM, virtual wards use devices such as pulse oximeters, heart rate monitors, and blood pressure monitors to track patients’ vital signs. This data is shared with healthcare teams in real-time, enabling timely interventions when needed.
Multidisciplinary Team Approach: Virtual wards often involve a team of healthcare professionals, including doctors, nurses, and allied health staff (such as physiotherapists, and pharmacists). This team works collaboratively to manage patient care remotely and, if necessary, in-person.
Patient-Centred Care: Virtual wards offer personalised care tailored to each patient’s condition and needs, focusing on recovery in a familiar environment. This can help improve patient outcomes and satisfaction by reducing stress and promoting a quicker recovery process. There is less risk of infection at home, or other aspects of deconditioning that can occur in hospital. Additionally, being able to sleep well and eat the food that appeals as well as being able to access one’s social network, contributes to the recovery process.
Coordination with Primary and Secondary Care: Virtual wards act as an extension of the traditional healthcare system. They are typically integrated with hospitals and primary care services to ensure continuity of care, allowing seamless transitions if a patient’s condition worsens and they need to be readmitted to a physical hospital. The most common model is to be run out of an acute hospital or a community service provider, but there are also examples of the service being provided by primary care.
Blended services: while some patients will be suitable for fully remote care, for example a patient in their 40s with an acute respiratory infection, others will receive Virtual Ward support combined with care delivered in the home. This could include for example an 85 year old with frailty.
Patient Groups
Virtual wards are used to care for a variety of patient groups:
● Post-Hospital Discharge Patients: Patients who can be discharged from a hospital earlier than would otherwise be the case, who require ongoing care but do not need to stay in the hospital to receive it.
● Acute Care Patients: People with short-term health issues that require close monitoring, such as infections or exacerbations of chronic conditions, but who are stable enough to stay at home.
● End-of-Life Care Patients: Providing palliative care at home for terminally ill patients, ensuring comfort and dignity in their final stages of life.
● Chronic Disease Patients: Those with long-term conditions like heart failure, COPD, or diabetes, where regular monitoring and intervention can prevent hospital readmissions.
Benefits of Virtual Wards:
Virtual Wards have many of the benefits outlined for RPM but there are a number of additional factors, particularly as the model reaches greater scale.
Digital Care at Home is typically very popular with patients and their carers. Patients often feel more comfortable and less stressed when receiving care in their home environment, which can speed up recovery and improve mental well-being. It is less disruptive for carers, who can also experience a loss of control when their loved one is admitted to hospital. Patient satisfaction scores are consistently very high with this model of care.
Virtual wards allow healthcare providers to optimise their resources, balancing hospital demand by managing a significant portion of care remotely. This provides valuable flexibility for healthcare providers.
New opportunities for Clinical Staff. Every year, thousands of nurses leave healthcare roles globally to take on other positions that are non-clinical, but provide them with greater flexibility. These roles, monitoring patients through Virtual Wards, which are less physically demanding than hands-on nursing, provide opportunities to retain staff, enabling them to continue to contribute clinically, while providing them with improved flexibility.
Greater Continuity of Care: Integrated care ensures that patients can seamlessly move between hospital and home care, with all their health information being continuously available to the multidisciplinary team managing their care.
Improved Outcomes: Evidence from a range of studies, indicates that patients on virtual wards may have lower readmission rates, shorter recovery times, and higher satisfaction compared to traditional inpatient care.
Technologies
The technology used in Virtual Wards is based on RPM at the core, but often has additional components:
● Video Conferencing Tools - Healthcare providers will often use secure video calls to consult with patients and assess their condition in real-time.
● Mobile Apps - Patients can use apps to log symptoms, track medication schedules, and communicate with their care team.
● Home test kits - lateral flows, blood and urine testing enabling point of care testing in the home.
● Cloud-Based Platforms - These facilitate the secure transfer of patient data between the home and the hospital, ensuring that clinicians have up-to-date information to guide care.
Challenges with Digital Home Care models
Challenges include effectively building clinical confidence in a new care model, getting patient selection right, reimbursement, individual’s technology access, patient compliance and data security and privacy. To expand on each of these in turn; building clinical confidence is key. This is a very different model of care than the one most clinicians have been trained in and practised. It is therefore very important that clinicians are supported through the change and redesign of services to build confidence that it will work successfully.
Not all patients will be suitable for this model, particularly those with highly unstable conditions that require regular in-person care.
There needs to be a means of healthcare providers being paid for this activity. Some countries do not have a method for reimbursement of these services and it varies by region and payor. While RPM services are increasingly being reimbursed by insurance providers and health care systems, this is not the case in every region.
Not all patients have access to the technology required for RPM, such as smartphones, internet, or the devices themselves. Some providers of RPM systems will provide all the technology required, others are based on apps and use of the person’s own phones and tablets.
Successful RPM depends on patients consistently using their monitoring devices and following through with instructions. A small number of providers of RPM systems provide a compliance support function and achieve very consistent performance as a result.
As health data is transmitted electronically, there is a risk of data breaches. Strong cybersecurity measures are required to protect sensitive patient information, but this is no different than the security required for all healthcare data.
In summary, Digital Home Care - that is both Virtual Wards and RPM - represent a transformative shift in healthcare delivery, allowing patients to receive hospital-level care in their homes through the integration of technology and a multidisciplinary team approach. This model can improve patient outcomes, reduce healthcare costs, and alleviate hospital pressures, though challenges like technology access, data security, and patient suitability must be carefully managed.
As the public appetite for tech solutions in health care has increased, at the same time the cost of the tech has reduced, making this perhaps an idaea whose time has come. All health care systems are finding recruiting their clinical workforce challenging and these models provide a means for clinicians to safely supervise many more patients. With the advent of LLMs and AI we may well see the number increase further.
The shift we are starting to see, away from a dependance on healthcare delivered in hospitals to significantly more provided at home, should mean that there is a bright future for these models globally.
